Exclusions and Limitations

Medical Benefit Exclusions and Limitations

The following exclusions and limitations apply to expenses incurred by all participants. The exclusions and limitations may vary by state.

• work-related injury or sickness
• mental or nervous disorders, alcoholism or substance abuse treatment
• intentionally self-inflicted injuries, suicide or any attempt thereat while sane or insane
• declared or undeclared war; or serving on full-time active duty in the Armed Forces
• commission of a felony
• flying as a pilot or crew member of any aircraft
• eye examinations, ear examinations, or hearing aids, normal health checkups except as noted
• treatment in a hospital or facility owned or run by the United States Government
• dental care or treatment other than care of natural teeth and gums resulting from an accident
• cosmetic surgery
• services provided by an immediate family member.

Dental Exclusions and Limitations

The plan will pay only for procedures specified on the schedule of Covered Procedures in the Group Policy. The exclusions and limitations may vary by state. Many procedures covered under the plan have waiting periods and limitations on how often the plan will pay for them within a certain time frame. For more detailed information on Covered Procedures or limitations, please contact the Plan Administrator

Life Limitation

Suicide: No Life Insurance benefits will be payable under the policy for death caused by suicide or self-destruction, or any attempt at it, whether sane or insane, within 24 months after the person’s coverage under the policy became effective.

Disability Exclusions and Limitations

The exclusions and limitations may vary by state.

• attempted suicide or intentionally self-inflicted injury, while sane or insane
• voluntary taking of poison, voluntary inhalation of gas, or voluntary taking of a drug or chemical
• commission of or attempt to commit a felony, or participation in a riot
• engaging in an illegal occupation
• declared or undeclared war or act of war
• operating, riding in, or descending from any aircraft (including a hang glider). This does not apply to the insured while a passenger on a licensed, commercial, nonmilitary aircraft.
• injury or sickness for which the insured has or had a right to payment under any workers' compensation or similar law.

Vision Exclusions and Limitations

The exclusions and limitations may vary by state.

• any materials, procedures or services provided under workers' compensation or similar law
• non-prescription lenses, frames to hold such lenses, or non-prescription contact lenses
• any materials, procedures or services provided by an immediate family member or provided by you
• charges for any materials, procedures, and services to the extent that benefits are payable under any other valid and collectible insurance policy or service contract, whether or not a claim is made for such benefits.

Disclosure

This Web site gives a brief description of important features of the benefit plans. Every effort has been made to ensure its accuracy; however, it is not a contract. The contractual terms and conditions of coverage are set forth in the group policies that are issued to your company. In the event of a discrepancy, the policies would be the determining factor.

Please view the group policies for specific information detailing all of the plans’ benefits, costs, limitations and exclusions. BCS Insurance Company and BCS Life Insurance Company reserve the right to change the premiums they charge for their benefit plans.