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LifeShield National Insurance Co.

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Benefits and Exclusions

Benefit Description 100A100200200+3005007501,000
Hospital Confinement BenefitPer Day$100$100$200$200$300$500$750$1,000
Max Day1030303030303030
Primary Care Doctors Office Visit BenefitPer Day$50$50$50$50$50$50$50$75
Max Day33555555
Specialty Care Doctors’ Office Visit BenefitPer Day-$50$50$50$50$50$50$75
Max Day-3555555
Emergency Room BenefitPer Day-$50$50$50$50$50$75$100
Max Day-1121111
Basic Pathology & Radiology BenefitPer Day--$50$50-$50$50$75
Max Day--13-223
Advance Studies BenefitPer Day--$50$50-$50$50$75
Max Day--13-223
Surgery BenefitPer Day---50%50%70%80%100%
Max Day---33333
Anesthesia BenefitPer Day---20%20%20%20%20%
Max Day---33333
Mental Health Inpatient BenefitPer Day----$150$250$375$500
Max Day----60606060
Mental Health Outpatient BenefitPer Day----$50$50$50$50
Max Day----20202020
Supplemental Accident Inpatient Admission BenefitPer Day----$500$500$500$500
Max Day----1123
Supplemental Accident Emergency Room BenefitPer Day----$250$250$250$250
Max Day----1111
Hospital Intensive Care Unit BenefitPer Day--------
Max Day--------
Additional Hospital Admission BenefitPer Admission--------
Max Day--------
Accidental Death Benefit Critical IllnessMax Benefit-$10,000$10,000$10,000$10,000$10,000$10,000$10,000
-n/an/a$1,000$1,000$1,000$1,000$1,000

There is no coverage for a pre-existing condition for a continuous period of 12 months following the effective date of a Covered Person’s coverage under the Policy.

Benefits are based on an annual period per insured from effective date. There is a 30 day waiting period immediately following the Coverage Effective Date; does not apply to an injury.

Policy Limitations & Exclusions

We will not provide a Benefit for any of the items listed in this section regardless of Medical Necessity or recommendation of a health care provider.

  • Treatment, services and supplies, unless for the Medically Necessary care and treatment of medically diagnosed congenital defects and birth abnormalities, which are not related to a specific diagnosis, acute symptoms or course of treatment; medical care or surgery which is not Medically Necessary; and any maintenance type therapy not reasonably expected to improve the patient’s condition;
  • Pre-employment or pre-marital examinations; or routine physical examinations;
  • Treatment, services and supplies for an Injury caused by an accident that arises out of or in the course of employment or for which the Covered Person is entitled to benefits under any Worker’s Compensation Law, Occupational Disease Law or similar legislation;
  • Non-prescription drugs, vitamins, minerals and nutritional supplements;
  • Experimental substances and/or drugs not approved by the Food and Drug Administration, or for investigative drugs or substances labeled “Caution – Limited by Federal Law to investigational use”;
  • Treatment, services and supplies for Experimental or Investigational procedures, drugs or treatment methods;
  • Treatment, services and supplies for any Experimental or Investigational organ transplant procedure;
  • Treatment, services and supplies for which the Covered Person is not legally required to pay;
  • Telephone consultations, failure to keep scheduled appointments, completion of claim forms, or providing medical information necessary to determine coverage;
  • Treatment, services and supplies provided by a Close Relative (i.e. spouse, child or parent);
  • Enrollment in including, but not limited to, a health, athletic or similar club or weight loss, non-smoking, exercise or similar programs;
  • Recreational or educational therapy, or non-medical self-care or self-help training, nutritional counseling, marriage, family or goal oriented counseling;
  • Treatment, services and supplies provided outside the scope of the license for the institution or practitioner rendering services;
  • (Education, training, custodial care or bed and board while confined to an institution which is primarily a school or other institution for training, a place of rest or a place for the aged, a personal residence;
  • Cosmetic Surgery;
  • Eye examinations, eyeglasses, or contact lenses to correct refractive errors and related services including surgery performed to eliminate the need for eyeglasses, for refractive errors such as radial keratotomy or keratoplasty and hearing exams, hearing aids, or the fitting of hearing aids;
  • Illness or Injury that results from war or an act of war, riot or in the commission or attempted commission of an assault or felony. This includes an act of international armed conflict. It also includes a conflict in which the armed force of any international authority is involved;
  • To the extent that payment under the Policy is prohibited by any law of the jurisdiction in which the Covered Person resides;
  • Treatment, services or supplies received prior to the Covered Person’s Effective
  • Date, or after their termination date of coverage under the Policy;
  • Inpatient Hospital admission occurring on a Friday or Saturday in conjunction with a surgical procedure scheduled to be performed during the following week. A Sunday admission will be eligible only for the procedure scheduled to be performed early Monday morning. (This limitation will not apply to necessary medical admissions requiring immediate attention or toEmergency surgical admissions);
  • Pregnancy and related services;
  • Custodial Care;
  • Dental services;
  • Voluntary sterilization or reversal thereof;
  • Transsexual surgery and related surgery;
  • Routine foot care;
  • Amniocentesis, ultrasound or any other procedures requested solely for sex determination of the fetus, unless Medically Necessary to determine the existence of a sex linked genetic disorder;
  • Infertility and impregnation procedures, such as but not limited to, artificial insemination, in-vitro fertilization, embryo and fetal implantation and G.I.F.T. (gamete intrafallopian transfer);
  • Intentional self-inflicted Illness or Injury while sane; except that this exclusion will not apply to any self inflicted Illness or Injury that is the result of a medical condition ;
  • An Illness or Injury incurred:
    1. during the commission or attempted commission of a crime or felony or while engaged in an illegal act; or
    2. while imprisoned;
  • Physical therapy, Speech therapy and Occupational therapy;
  • Mental and Nervous Disorders;
  • Substance Use Disorders;
  • Venipuncture;
  • Prescription drugs;
  • Hospice Care;
  • Home Health Care;
  • Treatment, services, supplies for obesity, extreme obesity, morbid obesity or weight reduction, including, but not limited to, wiring of the teeth and all forms of surgery including, but not limited to, bariatric surgery, intestinal bypass surgery and complications resulting from any such surgery; and
  • Treatment, services and supplies for an Illness prior to the expiration of the Waiting Period