Medical Expenses

If an injury or illness occurs during the Term of Insurance, only those expenses specifically described below, and which are incurred within the Maximum Coverage Period (26 weeks from the date of such injury or onset of such illness), and which are not excluded (see Exclusions section) are considered Covered Medical Expenses. Initial treatment of an injury must occur within 60 days of the accident. Illness must first manifest itself during the Term of Insurance.

1. Charges made by a hospital for room and board, floor nursing and other services, exclusive of charges for professional service 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 semiprivate room and board accommodation, or intensive care when medically necessary;
   
   
2. Charges made for diagnosis, treatment and surgery by a physician;
   
   
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 a 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 illness, injury or any medical condition for which symptoms manifested, or for which a licensed physician was consulted, or for which treatment or medication was prescribed, within 36 months prior to the Insured Person's Effective Date of insurance;
   
   
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) motorcycle driving, 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;
   
   
6. Loss or expense caused by, contributed to, or resulting from any loss that occurs while traveling or enrolling solely for the purpose of obtaining medical treatment, while on a waiting list for a specific treatment, or while traveling against the advice of a physician.
   
   

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