Pre-existing health conditions are not covered the first year. PRE-EXISTING CONDITION means a condition for which medical: advice; diagnosis; care; or treatment was recommended by or received from a Physician during the six-month period immediately prior to your Effective Date of coverage. The Pre-existing Condition Limitation will apply to new Covered Dependents or an increase in benefits on the effective date of the change in coverage, but will not apply to coverage already in force.
The Certificate will not pay a benefit for Hospital Confinements caused by, resulting from or contributed to by:
- Injuries resulting from active military service; any active participation in a riot; armed conflict, or insurrection;
- declared or undeclared war or any act of war;
- the use or taking of any narcotic, barbiturate, or any other drug by the Insured unless administered in a therapeutic dosage as prescribed by a Physician;
- an Injury that occurs while the Insured has a blood alcohol level of .08 (by weight or volume) or higher;
- treatment of a Mental Disease or Disorder, alcoholism or drug addiction;
- pregnancy or childbirth (Complications of Pregnancy are covered on the same basis as Sickness);
- any Confinement rendered in a Hospital which does not comply with the Hospital definition (e.g., nursing facility, convalescent facility, or rehabilitation facility, are not covered);
- any rehabilitative care in a Hospital;
- suicide, attempted suicide or intentionally self-inflicted injury, while sane or insane (in Missouri while sane);
- expenses incurred or care received outside of the United States beyond a period of 14 days of Hospital Confinement; or
- an Injury that occurs while the Insured is committing an assault or felony.
NOTE: Any of the above Exclusions regarding mental illness, alcohol, and drug abuse do not apply to individuals who are residents of or employed in the District of Columbia.
Also, the Hospital Accident Confinement rider will not pay a benefit for Hospital Confinements caused by, resulting from or contributed to by:
(1) Sickness or its medical or surgical treatment, including diagnosis; and
(2) bacterial infection except through an accidental injury.
Please contact 1-888-292-7749 for any questions regarding the product exclusions.
This information is only an outline of The Union Labor Life Insurance Company's Hospital Daily Benefits Plan features. Once approved for coverage, it is important that you read your Certificate of Insurance for the exact benefits, terms and conditions of this insurance plan as benefits, limitations, and exclusions may vary by age and State.