Medical Expenses - Optional (applicable to Global 1 Plan only)

If accidental injury or emergency illness occurs during the Period of Coverage, the Plan will pay, subject to a $300 Deductible, reasonable and customary charges for Covered Medical Expenses resulting from such occurrence, up to the Medical Expense Maximum selected, $25,000 or $100,000. Only those expenses specifically described below which are incurred within the Maximum Coverage Period (13 weeks from the onset of an injury or emergency illness) and which are not Excluded (see Exclusions section) are considered Covered Medical Expenses. Initial treatment of an injury or emergency illness must occur within 72 hours of the accident or onset of emergency illness, defined as a condition requiring immediate care and/or hospitalization.

1. Charges made by a hospital for room and board, floor nursing and other services, exclusive of charges for professional services and with the exception of personal services of a non-medical nature; provided, however, that expenses do not exceed the hospital's average charge for a semiprivate room and board accommodation, or intensive care when medically necessary;
   
   
2. Charges made for physician's diagnosis, treatment and surgery;
   
   
3. Charges made for the cost and administration of anesthetics;
   
   
4. Charges for medication, X-ray services, laboratory tests and services, the use of radium and radioactive isotopes, oxygen, blood transfusions, and medical treatment;
   
   
5. Charges for physiotherapy, if recommended by a physician, for the treatment of a specific disablement and administered by a licensed physiotherapist;
   
   
6. Dressings, drugs and medicines that can only be obtained upon the written prescription of a physician or surgeon.
   
   

The charges listed above shall in no event include any amount of such charges which are in excess of reasonable and customary charges.

Exclusions

For Medical Expenses, this insurance does not cover:

1. Pre-existing Conditions, defined as any injury or any illness for which a licensed physician was consulted, or for which medical treatment or medication was prescribed within 12 months prior to the Insured Person's Effective Date of insurance under the Plan, except for conditions that remained controlled by prescribed medication as long as the prescribed drugs and medicine (maintenance prescriptions) did not change during the 12 months prior to the Effective Date of insurance. The costs of the maintenance prescriptions, which were required or continued during the Period of Coverage, are not a Covered Medical Expense;
   
   
2. Services, supplies or treatment, including any period of hospital confinement, which are not recommended, approved and certified as necessary and reasonable by a physician, or expenses which are non-medical in nature;
   
   
3. Expenses incurred as a result of or in connection with a) declared or undeclared war or any act thereof; b) injury sustained while participating in professional sports, sponsored scholastic or amateur athletics, which are defined as organized sports activities associated with a team, league or similar group; c) intentionally self-inflicted injury, suicide while sane or attempted suicide while insane; d) scuba diving, mountain climbing, sky diving, professional or amateur racing, piloting an aircraft; or e) commission of a felony;
   
   
4. Expenses for a) pregnancy, childbirth or miscarriage; b) routine physicals; c) cosmetic or plastic surgery, except as the result of an accident; d) elective surgery; e) any mental and nervous disorders or rest cures; f) dental care, except as the result of injury to natural teeth caused by accident; g) eye refractions or eye examinations for the purpose of prescribing corrective lenses for eye glasses or for the fitting thereof, unless caused by accidental bodily injury incurred while insured; h) alcoholism or drug addiction or use of any drug or narcotic agent; or i) treatment by a family member;
   
   
5. Treatment paid for or furnished under any other individual or group policy or other service or medical pre-payment plan arranged through an employer to the extent so furnished or paid or under any mandatory government program or facility set up for treatment without cost to any individual.
   
   

Previous

Table of Contents

Next