Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 90g - INDIVIDUAL HEALTH CARE FACILITY BENEFITS PROVIDED AS ACCELERATED DEATH BENEFIT OR SETTLEMENT OF DEATH BENEFIT; PROVIDED BY RIDERS OR BUILT INTO POLICIES-STATEMENT OF POLICY › Section 90g.4 - Exclusions and restrictions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
				form contains none or one or more of the following exclusions and restrictions:
(1) War, declared or undeclared, or an act of
				war, whether or not serving in the military forces or a civilian noncombatant
				unit serving with the forces.
(2)
				Active duty as a member of the armed forces of any nation.
(3) Committing an assault or felony, whether
				sane or insane.
(4) Participating
				in a riot or insurrection.
(5) A
				fight in which the insured is a voluntary participant.
(6) Suicide or attempted suicide, whether
				sane or insane.
(7) Intentionally
				self-inflicted injury, whether sane or insane.
(8) Engaging in an illegal
				occupation.
(9) Travel or flight in
				an aircraft or spacecraft or descent from such a craft while in flight, or
				subsequent drowning, if the insured is a pilot, officer or crew member of the
				craft; is giving or receiving aviation training or instruction; has any duties
				on or relating to the craft; or is being flown for the purpose of descent from
				the craft while in flight.
(10)
				Voluntary taking or injection of drugs unless prescribed or administered by a
				licensed physician. The wording "taken as prescribed" or "taken in the manner
				prescribed" is not present.
(11)
				Voluntary taking or injection of drugs, whether legal or illegal, unless
				prescribed or administered by a licensed physician. The wording "taken as
				prescribed" or "taken in the manner prescribed" is not present.
(12) The voluntary taking of any drugs
				prescribed for the insured by a licensed physician and intentionally not taken
				as prescribed.
(13) The voluntary
				taking of any drugs, whether legal or illegal, prescribed for the insured by a
				licensed physician and intentionally not taken as prescribed.
(14) Sensitivity to drugs voluntarily taken,
				unless prescribed by a physician.
(15) Sensitivity to drugs, whether legal or
				illegal, voluntarily taken, unless prescribed by a physician.
(16) Drug addiction, unless addiction results
				from the voluntary taking of drugs prescribed or administered by a licensed
				physician or from the involuntary taking of drugs.
(17) Drug addiction, unless addiction results
				from the voluntary taking of drugs, whether legal or illegal, prescribed or
				administered by a licensed physician or from the involuntary taking of drugs,
				whether legal or illegal.
(18)
				Alcoholism treatment.
(19) Chronic
				alcoholism.
(20) Loss resulting
				directly or indirectly from the voluntary taking of alcohol alone or in
				combination with a drug, medication or sedative when that action results in
				legal intoxication as defined by Pennsylvania law. The insurer provides a
				certification that the Pennsylvania legal definition for intoxication will be
				used if the form does not refer to "intoxication as defined by Pennsylvania
				law."
(21) Care or confinement
				prescribed for convenience only.
(22) Care or confinement prescribed for
				custodial purpose only.
(23) Care
				or confinement prescribed for rest cures.
(24) Benefit payment denial if services are
				provided by a health care facility operated by a member of the insured's
				immediate family.
(25) Benefit
				payment denial if services are provided by a health care facility which does
				not maintain at least a daily record for each patient.
(26) Mental, nervous, emotional or
				personality disorder without demonstrable organic disease, including, but not
				limited to, neurosis, psychoneurosis, psychopathy or psychosis.
(27) Services provided outside either the
				United States or the United States or Canada.
(28) Reimbursement for services covered by
				Medicare or another government program.