Alcoholism, Drug or Substance Abuse
This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly, the Insured Person’s alcoholism or drug or substance abuse. In addition, the insurance does not apply to any confinement in a detoxification facility or drug or alcohol rehabilitation facility that is not also a Hospital or part of a Hospital.
Congenital Conditions
This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly a congenital condition as Diagnosed by a licensed Physician.
Cosmetic Surgery
This insurance does not apply to cosmetic surgery or care or treatment solely for cosmetic purposes or complications therefrom. This exclusion does not apply to cosmetic surgery resulting from an Accident if initial treatment of the Insured Person is begun within twelve (12) months of the date of the Accident or to treat congenital defects in covered newborns.
Experimental or Investigational
This insurance does not apply to any service, supply or Covered Condition that is experimental or investigational.
Intoxication Exclusion
This insurance does not apply to any Accident caused by or resulting from, directly or indirectly, the Insured Person being intoxicated, at the time of an Accident. Intoxication is defined by the laws of the jurisdiction where such Accident occurs.
Narcotic Exclusion
This insurance does not apply to any Sickness or Accident caused by or resulting from, directly or indirectly, the Insured Person being under the influence of any narcotic or other controlled substance at the time of the loss. This exclusion does not apply if any narcotic or other controlled substance is taken and used as prescribed by a licensed Physician.
Pregnancy
This insurance does not apply to normal pregnancy. Complications of Pregnancy are covered as any other Sickness.
Pre-Existing Condition
No Benefit Amount will be paid under this policy for a Covered Condition caused by or resulting from, directly or indirectly, a Pre-Existing Condition. This Pre-Existing Condition exclusion only applies for twelve (12) months, beginning with the effective date of the Insured Person's insurance. A Pre-Existing Condition means any illness, disease, injury, physical condition, or mental condition for which medical advice, diagnosis, care or treatment was received by an Insured Person; was recommended to an Insured Person; or would have been sought by a reasonably prudent person, during the twelve (12) month period before becoming insured under this policy.
Procedures and Diagnosis Outside the US or its Territories
This insurance does not apply to a Covered Condition that has been Diagnosed or to any surgical procedures that have been performed outside of the United States or its Territories.
Rest care or custodial care treatment
This insurance does not apply to any rest care or custodial care or treatment for any Sickness or Accident.
Refusal of Medical Treatment
This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly, the Insured Person's refusal of the following recommended medical treatment:
a. a Physician has recommended treatment with angioplasty or Coronary Artery By-Pass Graft for coronary artery disease, the Insured Person refuses treatment, and the Insured Person suffers a Heart Attack; or
b. a Physician has recommended treatment for a brain aneurysm or carotid artery stenosis, the Insured Person refuses treatment, and the Insured Person suffers a Stroke; or
c. a Physician has recommended a Diagnostic biopsy or Diagnostic/therapeutic excision of a mass or lesion suspected of being Cancer, the Insured Person refuses and the Insured Person develops Type 1 Cancer, Skin Cancer, or Type 2 Cancer.
Suicide or Intentional Injury
This insurance does not apply to a Covered Condition caused by or resulting from, directly or indirectly, an Insured Person's suicide, or attempted suicide or intentionally self-inflicted injury while the Insured Person is sane or insane.
Uninsured Critical Condition
This insurance does not apply to any loss caused by or resulting from, directly or indirectly any illness not specifically listed as a Covered Condition shown in Section C, under the Schedule of Eligible Benefits.
Workers Compensation
This insurance does not cover Sickness or Accident arising out of and in the course of any occupation for compensation, wage or profit for which are payable under Occupational Disease Law, Workers Compensation or similar law, whether or not application for such benefits have been made.
This policy does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit the provision of insurance.
This information is a brief description of the important features of this insurance plan. It is not an insurance contract. Insurance benefits are underwritten by Federal Insurance Company. Coverage may not be available in all states or certain terms may be different where required by state law. Chubb NA is the U.S.-based operating division of the Chubb Group of Companies, headed by Chubb Ltd. (NYSE: CB) Insurance products and services are provided by Chubb Insurance underwriting companies and not by the parent company itself. Please refer to your plan documents for benefit information, definitions and a complete list of exclusions.
THIS POLICY PROVIDES LIMITED BENEFITS ON A FIXED INDEMNITY BASIS. IT DOES NOT CONSTITUTE COMPREHENSIVE HEALTH INSURANCE COVERAGE (OFTEN REFERRED TO AS "MAJOR MEDICAL COVERAGE") AND DOES NOT SATISFY A PERSON’S INDIVIDUAL OBLIGATION TO SECURE THE REQUIREMENT OF MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT (ACA). FOR MORE INFORMATION ABOUT THE ACA, PLEASE REFER TO HTTPS://WWW.HEALTHCARE.GOV.
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall also be subject to criminal and civil penalties.
Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services. Insurance provided by Federal Insurance Company and its U.S. based Chubb underwriting company affiliates. All products may not be available in all states. This communication contains product summaries only. Coverage is subject to the language of the policies as actually issued. Chubb, P.O. Box 1600, Whitehouse Station, NJ 08889-1600. Underwritten by: Federal Insurance Company.
Form 44-02-2052 (Ed. 03-14)