The plan provides flexible underwriting methods to extend coverage to you. Your application may be underwritten by Standard Underwriting or the Flexible Underwriting Rider.
Standard Issuance - There are two levels of underwriting when all medical conditions have been disclosed and they have not been specifically excluded or restricted by a rider (subject to the foregoing limits and the other terms of the plan*).
The Silver, Gold and Gold Plus plan options provide a $50,000 lifetime benefit for eligible pre-existing conditions that existed at or prior to the effective date, subject to a maximum of $5,000 per period of coverage after coverage has been in effect for 24 continuous months. This benefit is payable whether or not you have received consultation or treatment for the condition(s) during the 24-month period of continuous coverage.
The following illnesses which exist, manifest themselves, are treated or have treatment recommended prior to or during the first 180 days of coverage from the initial effective date are considered pre-existing conditions and are subject to the waiting period and other limitations of coverage described above: acne, asthma, allergies, tonsillectomy, back conditions, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the reproductive system, hysterectomy, hernia, gall bladder or gall stones and kidney stones, any condition of the breast, and any condition of the prostate.
On the Platinum plan option, conditions that are fully disclosed on the application and have not been excluded or restricted by a rider will be covered the same as any illness. Conditions, including any complications therefrom, that are not fully disclosed on the application will not be covered.
Flexible Underwriting Rider - Where you may have otherwise been declined for coverage, the Flexible Underwriting Rider allows us to extend coverage to you. After 24 months of continuous coverage, a disclosed pre-existing condition which has not been specifically excluded by a rider will be covered as any other pre-existing condition so long as in that 24 month period no treatment has been received for that condition. If treatment has been sought or should have been sought, then the 24 month period starts over from the treatment date.
Other Exclusions & Limitations*
- Adult routine physical examinations are excluded under the Silver plan option, and for the first 12 months for the Gold, Gold Plus and Platinum plan options
- Out-patient mental and nervous is excluded for the first 12 months on all plan options
- In-patient mental and nervous is excluded under the Silver plan option and for the first 12 months for the Gold, Gold Plus and Platinum plan options
- Maternity, newborn and congenital care (unless the maternity rider or Platinum plan option is purchased - see Benefits page by clicking link above) Note: maternity expenses including prenatal, delivery, postnatal, newborn and congenital disorders are excluded when the pregnancy is a result of fertility treatment
- Organ transplants not specifically listed
- Devices to correct sight or hearing are excluded under the Silver, Gold and Gold Plus plan options
- Treatment or supplies not medically necessary
- Treatment not ordered or received by a physician
- Treatment by a relative or family member
- Treatment as a result of war, riot, or terrorism
- Treatment resulting from illegal activities
- Organized amateur or professional sports
- Services and treatment eligible for payment by any government or other insurance
- Investigational, experimental or research procedures
- Routine foot care
- Elective cosmetic or plastic surgery
- Drug and alcohol abuse treatment
- Speech therapy
- Custodial care
- Weight modification
- Treatment of impotency
- Contraceptive medication or treatment
- Persons HIV+ at effective date
This invitation to inquire allows eligible applicants an opportunity to inquire further about the insurance offered and is limited to a brief description of any loss for which benefits may be payable. Benefits are offered as described in the insurance contract. Benefits are subject to all deductibles, coinsurance, provisions, terms, conditions, limitations, and exclusions in the insurance contract. The contract does contain a pre-existing condition exclusion and does not cover losses or expenses related to a pre-existing condition.