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Limitations

Pre-existing Conditions:

If an existing condition is fully and accurately disclosed on the application, and the condition is not excluded or restricted by a rider, your preexisting condition will be covered up to a lifetime maximum of $50,000 ($5,000 limit per year) after you have been continuously insured for 24 months.

Preexisting conditions are any Injury or Illness which meets the following criteria: 1) A condition that would have caused a person to seek medical advice, diagnosis, care or treatment prior to the Effective Date of coverage under this Certificate; 2) A condition for which manifestation, medical advice, diagnosis, care or treatment (including medication) was recommended or received prior to the Effective Date of coverage under this Certificate; 3) Expenses for Pregnancy within twelve (12) months of the Effective Date of coverage under this Certificate.

Charges for treatment of the following illnesses or surgeries, which manifest themselves or are recommended, or symptoms occur during the first 180 days of coverage hereunder beginning on the initial effective date: any condition of the breast, any condition of the prostate, disorders of the reproductive system, gall stones or kidney stones, any acne diagnosis or acne related condition, or any surgery that is not emergency in nature, as emergency is defined hereunder. Note: coverage for such illnesses or surgeries may be further limited under the pre-existing condition exclusion and definition contained herein, or other exclusions contained herein;

 
Exclusions

The following conditions, treatments, supplies, services, and/or expenses are not covered:
(This is a Summary of the Exclusions contained in the Certificate of Coverage.)

  1. Preexisting conditions as defined above.
  2. Claims not presented to Company within ninety (90) days following incident.
  3. Treatment not medically necessary, treatment which exceeds reasonable and customary charges, treatment provided at no cost to the Insured Person, or treatment performed by a relative or anyone who lives with the Insured Person.
  4. Experimental treatment.
  5. Suicide or any attempted suicide.
  6. War or warlike operations.
  7. Injury in organized, professional, amateur, or interscholastic athletics.
  8. Routine physicals or procedures.
  9. Treatment of Temporomandibular joint.
  10. Vocational, Speech, Recreational or Music Therapy.
  11. Cosmetic surgery except as a result of a covered accident.
  12. Dental or eye treatment unless otherwise covered.
  13. Injuries as a result of disablement due to liquor or drugs.
  14. Telephone consultations.
  15. Treatment or services relating to custodial, rehabilitative, or nursing home care.
  16. Congenital conditions.
  17. Non-medical expenses.
  18. Self-inflicted injury or illness.
  19. Expenses in connection with the commission or attempt of a criminal offense.
  20. Injury while taking part in mountaineering, hang gliding, parachuting, bungee jumping, racing, scuba diving (unless PADI or NAUI certified).
  21. Treatment of venereal or sexually transmitted disease.
  22. Treatment due to HIV or AIDS.
  23. Drug treatment relating to infertility.
This brochure is only a brief description of RESIDE Prime. A complete description of the Master Policy Provisions and Benefits is contained in the Certificate of Insurance, which will be mailed to you once your application and premium have been received and approved by SRI.

Exclusions Regarding the AD&D benefit are listed in the Certificate of Insurance.


 
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