Plan Benefit Highlights Hospital Admission Benefit: We will not pay this benefit for (j) experimental treatment, drugs, or surgery, except in connection outpatient treatment, emergency room treatment, or a stay of with an approved cancer clinical trial; less than 18 hours in an observation unit. Successive hospital (k) performance of military, naval, or air force service of any admissions will be considered as one admission if they are due country; to the same or related accident or sickness and separated by less (l) dental or routine vision services, unless: than 90 days. (1) resulting from an Accident occurring while the Covered Hospital Confinement Benefit: We will not pay this benefit for Person’s coverage is in force and if performed within 12 months of outpatient treatment or a hospital stay of less than 18 hours. the date of such Accident; or Hospital shall not include an institution used by you as a place (2) due to congenital disease or anomaly of a covered newborn for rehabilitation; a place for rest or for the aged; a nursing child; or convalescent home; a long-term nursing unit or geriatric (m) immunizations, sports and routine annual physicals; ward; or an extended care facility for the care of convalescent, (n) services, treatment or loss rendered in any Physician’s office, rehabilitative, or ambulatory patients. Veterans Administration or Federal Hospital or any other Hospital, except if there is a legal obligation to pay; Rehabilitation Facility Confinement Benefit: Confinement to the (o) artificial insemination, in vitro fertilization, test tube facility must be physician authorized for at least 18 continuous fertilization, sterilization, tubal ligation, or vasectomy, and reversal hours and begin immediately following a hospital confinement. thereof; Successive rehabilitation facility stays will be considered as one (p) loss that takes place outside of North America; confinement if they are due to the same or related accident or (q) participation in any sport for pay or profit; sickness and separated by less than 30 days. (r) alcoholism or drug use, unless such drugs were taken on the Outpatient Accident Treatment Benefit: Pays a benefit when any advice of a Physician and taken as prescribed; covered person incurs an expense and receives treatment by a (s) mental or emotional disorders without demonstrable organic physician in an emergency room, physician’s office or urgent care disease; facility due to a covered accident. Accident means an event which (t) air or ground ambulance; results in bodily injury that is independent of disease or bodily (u) Pre-Existing Conditions, unless the Covered Person has satisfied infirmity or any other cause. the Pre-Existing Condition Exclusion period of 12 months. Accident Surgical Procedure Benefit: Pays a benefit when Pre-Existing Condition: means a disease, Sickness, Accident, any covered person incurs an expense and requires a surgical or physical condition for which you: had treatment; incurred procedure due to a covered accident. The procedure must be expense; took medication; or received a diagnosis or advice from performed by a Physician in a hospital, ambulatory surgical center, a physician, during the 12 month period immediately before your urgent care facility, or physician’s office. We will pay for only one effective date of coverage. The term pre-existing condition will accident surgical procedure performed on the same day even if also include conditions which are related to such disease, Sickness, caused by more than one accident. We will not pay this benefit for Accident, or physical condition. colonoscopy or flexible sigmoidoscopy. Pregnancy Limitation: Exclusions: We will not pay benefits resulting from or caused by: For the Pregnancy Limitation Period, 10 months, the Company will (a) suicide or any attempt, while sane or insane; not pay benefits due to any Covered Person giving birth as a result (b) any intentionally self-inflicted injury or Sickness; of a normal pregnancy, including cesarean section. Complications (c) voluntary abortion except, with respect to You or Your covered of Pregnancy will be covered to the same extent as any other Dependent Spouse; covered benefit. Complications of Pregnancy includes but is not (1) where You or Your Dependent Spouse’s life would be limited to, conditions requiring Confinement (when pregnancy is endangered if the fetus were carried to term; or not terminated), whose diagnoses are distinct from pregnancy but (2) where medical complications have arisen from abortion; are adversely affected by pregnancy or are caused by pregnancy, (d) pregnancy of a Dependent child; such as acute nephritis, nephrosis, cardiac decompensation, (e) participation in a riot, civil commotion, civil disobedience, or missed abortion and similar medical and surgical conditions of unlawful assembly. This does not include a loss which occurs while comparable severity, ectopic pregnancy which is terminated, acting in a lawful manner within the scope of authority; spontaneous termination of pregnancy which occurs during (f) commission of a felony; a period of gestation in which a viable birth is not possible, (g) participation in a contest of speed in power driven vehicles, puerperal infection, eclampsia and toxemia. parachuting, or hang gliding; Complications of Pregnancy shall not include false labor, (h) air travel, except: occasional spotting, Physician prescribed rest during the period (1) as a fare-paying passenger on a commercial airline on a of pregnancy, morning sickness, hyperemesis gravidarum, regularly scheduled route; or preeclampsia and similar conditions associated with the (2) as a passenger for transportation only and not as a pilot or management of a difficult pregnancy not constituting a crew member; classifiable or distinct Complication of Pregnancy. (i) elective procedures or cosmetic surgery, including complications of elective procedures or cosmetic surgery; This product may contain limitations, exclusions and waiting periods. This product is inappropriate for people who are eligible for Medicaid coverage. 1AHRQ Healthcare Cost and Utilization Project, National Inpatient Sample as of February 5, 2019. 2American Hospital Association: Fast Facts on U.S. Hospitals, January 2020. 3AHRQ 4 Healthcare Cost and Utilization Project, National Inpatient Sample as of February 5, 2019. MD Save: Procedures A to Z; accessed 10/3/2018 from 5 MDsave.com. Healthcare Bluebook: Emergency Room Visit – Moderate Problem; Accessed from www.healthcarebluebook.com on April 6 3, 2020. Figures from Oklahoma City, OK. https://www.healthcarebluebook.com/ui/proceduredetails/239. CostHelper: How Much Does a 7 Broken Arm Cost?; accessed 10/3/2018 from health.costhelper.com. CostHelper: How Much Does a Broken Arm Cost? Total out of pocket costs assumes a 20% coinsurance amount.