Exclusions and Limitations

http://www.cedarville.edu/Offices/University-Medical-Services/Insurance/Undergraduate/Exclusions-Limitations.aspx


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Exclusions and Limitations

The Policy does not cover loss nor provide benefits for any of the following, except as otherwise provided by the benefits of the Policy and as shown in the Schedule of Benefits.

  1. Preventive medicines, serums, or vaccines of any kind; routine physical or other examinations where there are no objective indications of impairment of normal health
  2. Medical services rendered by provider employed for or contracted with the School (including Physician visits at UMS), including team physicians or trainers, except as provided in the Schedule of Benefits
  3. Dental treatment including orthodontic braces and orthodontic appliances, except as specified for accidental Injury to the Insured Person's teeth
  4. Services or supplies in connection with eye examination, eyeglasses or contact lenses or hearing aids, except those resulting from a covered accidental Injury
  5. Expenses covered under any Workers' Compensation, occupational benefits plan, mandatory automobile no-fault plan, public assistance program, or government plan, except Medicaid
  6. Loss incurred as the result of riding as a passenger or otherwise (including skydiving) in a vehicle or device for aerial navigation, except as a fare-paying passenger in an aircraft operated by a scheduled airline maintaining regular published schedules on a regularly established route anywhere in the world
  7. Loss resulting from war or any act of war, whether declared or not, or loss sustained while in the armed forces of any country or international authority, unless indicated otherwise on the Insurance Information Schedule
  8. Act of terrorism
  9. Intentionally self-inflicted Injury, attempted suicide, or suicide, while sane or insane
  10. Treatment, services, supplies, or facilities in a Hospital owned or operated by the Veterans Administration or a national government or any of its agencies, except when a charge is made which the Insured Person is required to pay
  11. Expenses incurred after: a) The date insurance terminates as to the Insured Person; b) The Aggregate Lifetime Maximum Benefit for each Covered Injury or Sickness has been attained; and c) The end of the Benefit Period specified in the Benefit Schedule
  12. Elective surgery or treatment
  13. Expenses incurred for plastic or cosmetic surgery, unless they result directly from a Covered Injury that necessitates medical treatment within 24 hours of the Accident or results from reconstructive surgery. For the purposes of this provision: Reconstructive surgery means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to either improve function or to create a normal appearance, to the extent possible; Cosmetic surgery means surgery that is performed to alter or reshape normal structures of the body in order to improve the patient's appearance.
  14. An Insured's a) committing or attempting to commit a felony, b) being engaged in an illegal occupation, or c) participation in a riot
  15. Treatment of nervous or mental disorders or treatment of alcoholism or substance abuse except as provided for in the schedule of benefits
  16. Loss resulting from playing, practicing, traveling to or from or participation in or conditioning for Club Boxing and Club Rugby
  17. Expenses incurred as the result of an accident involving a motor vehicle, to the extent that benefits are payable under any Automobile Medical Expense Insurance.

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