In addition to other limitations on benefits and
exclusions, benefits are not paid under any plan for a sickness or bodily injury resulting from:
- any act of war, declared or undeclared, or service in the military forces of any country, including non-military units supporting such forces;
- participation in a riot, felony, or other illegal act or being under the influence of alcohol, drugs or toxic substances unless administered by a physician;
- suicide or attempted suicide, or self-inflicted bodily injury while sane or insane;
No benefits are paid that are provided:
- free of charge in lieu of this insurance;
- by a government-operated hospital unless the insured person is required to pay;
- for treatment received outside the United States except for an emergency while traveling for up to a maximum of 90 consecutive days.
Additionally, no benefits are paid for:
- sickness or bodily injury that arises out of, or as a result of, any work if the insured person is required to be covered under Worker's Compensation or similar
legislation.
Other Exclusions include:
- normal pregnancy and delivery;
- routine physical examinations and "well baby" care of a dependent child unless CeltiCare Plus option is chosen. "Well-baby" care is defined as
charges not related to a sickness or bodily injury;
- treatment or surgical procedure relating to fertility, including diagnosis or treatment of infertility;
- birth control (except where state mandated);
- tubal ligations and vasectomies while hospital confined are not covered. The reversal of a tubal ligation or vasectomy is not covered at any time;
- treatment for weight loss (unless covered by Healthy Lifestyle Program), and exogenous obesity;
- gender reassignment (sex change or reassignment);
- eye refractions, fitting of glasses or hearing aids, glasses, contact lenses, radial keratotomy, or hearing aids;
- treatment or medication that is experimental or investigational;
- custodial care;
- treatment of drug addiction or chemical dependency;
- myringotomy or dilation and curettage and surgical treatment of tonsils, adenoids or hernia within first 6 months of coverage unless due to emergency.
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