Hospital Indemnity Exclusions
Benefits for a pre-existing condition (defined as a sickness or injury or symptoms of a sickness or injury, whether diagnosed or not) for which you received medical treatment, care or services, including diagnostic measures, took prescribed drugs or medicine, or had been prescribed drugs or medicine to be taken during the 12 months just prior to your effective date) will not be paid if the date of the covered loss occurs during the first 12 months after your effective date.
Unum will not pay benefits for a claim that is caused by, contributed to by, or occurs as a result of:
- participating in war or act of war, whether declared or undeclared;
- committing acts of terrorism;
- treatment for alcoholism or drug addiction, unless the insured is addicted to a narcotic taken on the advice of a physician;
- treatment for dental care or dental procedures, unless treatment is the result of a covered accident;
- elective procedures and/or cosmetic surgery or reconstructive surgery, unless it is a result of trauma, infection or other diseases;
- participating or attempting to participate in a felony or being engaged in an illegal occupation;
- any pregnancy of a dependent child, including services rendered to her child after birth;
- committing or trying to commit suicide or injuring oneself intentionally, whether sane or not;
- hospital confinement caused by, contributed to by, or resulting from mental illness. However, dementia as a result of stroke, trauma, viral infection, Alzheimer’s disease or other conditions not listed which are not usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment are covered under this policy;
- any hospital confinement of a newborn following the birth unless the newborn is sick or injured.
If you choose to cancel your coverage under the policy, your coverage ends at 12:00 midnight on the first of the month following the date you provide notification to your employer. Otherwise, your coverage under the policy ends on the earliest of the:
- date this policy is cancelled;
- date you are no longer in an eligible group;
- date your eligible group is no longer covered;
- date of your death;
- last day of the period for which you made any required contributions; or
- last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness. Unum will provide coverage for a payable claim which occurs while you are covered under this policy.