If you are insured under the Platinum plan

If you are insured under the Platinum plan, and your pre-existing conditions have been fully disclosed on your Application and not excluded or restricted by a rider or any other provision of your Certificate, your pre-existing conditions are covered the same as any other Illness or Injury as of your effective date. If you are insured under the Premier plan, your pre-existing conditions are covered up to a lifetime limit of $25,000 after you have been insured continuously for 24 months. Pre-existing conditions include any Injury, Illness or Mental Health disorder that existed at or prior to your initial effective date, including chronic or recurring conditions.

The following charges, treatments, care, services, supplies and/or conditions are excluded from coverage:

Charges not incurred during the Certificate period

Services or treatment payable by another insurance or government

Substance abuse

Charges which exceed usual, reasonable and customary

Investigational or experimental surgeries or treatment

Custodial, educational or rehabilitative care

Weight modification

Cosmetic surgery, unless reconstructive surgery is directly related to a covered Injury or Illness

Charges for use of Emergency Room for treatment of Illness unless the patient is directly admitted to the Hospital as Inpatient for further treatment of that Illness

Individuals HIV+ at effective date

Drugs or treatment for sexual dysfunction

Drugs or treatment to promote or prevent conception

Devices or procedures to correct sight or hearing

Self-inflicted Injury or Illness

Foot care, unless related to a covered accidental Injury

Treatment or supplies not ordered by a physician or not medically necessary

Organ transplants, except for covered transplants

Speech, acupuncture, occupational or sleep therapy

Acts of terrorism, war, insurrection, riot or any variation thereof

Dental treatment, except emergency treatment following a covered accident, or unless Dental Rider is purchased

Orthodontia (Dental Rider Exclusion)

Sealants, Bleaching and oral hygiene expenses (Dental Rider Exclusion)

This is a summary of the exclusions contained in the Master Policy. See the Master Policy for a complete list of exclusions.

The following conditions which manifest themselves within the first 180 days of coverage are excluded: any condition of the breast, prostate, tonsils, adenoids, disease of sebaceous glands, acne, other acne, sebaceous cyst, seborrhea, unspecified disease of the sebaceous glands, moles, skin tags, hypertrophic and atrophic conditions of the skin, nervous, hemorrhoids, the reproductive system, hernia, gallstones or kidney stones. If you are insured under the Risk Share Plan, all illnesses are excluded for the first 90 days of coverage.

If you are insured under the Platinum plan, after 12 months of continuous coverage, and if you are at least 35 years old, you will be entitled to the following Wellness benefits: the benefit provides $150 per Certificate Period for a routine physical exam, including mamogram and OB/GYN visits for females. If you are under the age of 19, this benefit provides $50 per visit (including immunziations) with a maxmium of 3 visits per Certificate Period.

If you are insured under the Platinum plan, you are covered for emergency medical evacuation to the nearest medical facility qualified to treat your life threatening condition. All emergency medical evacuations must be approved in advance and coordinated by MultiNational Underwriters, Inc. MultiNational Underwriters, Inc. is available 24 hours a day, 7 days a week, to approve and coordinate emergency medical evacuations. Emergency medical evacuations provide you with access to care when you need it most.

In the event of a covered Emergency Evacuation, the platinum plan will provide the following benefits:the cost of an economy round trip air or ground transportation ticket for one of your relatives (parent, spouse, sibling or child age 18 years or older) for transportation to the area where you are hospitalized following Emergency Evacuation, and reasonable expenses for lodging and meals for your relative for a period not to exceed 10 days.

In the event of a covered injury or illness resulting in your death, the platinum plan will provide the following benefit: air or ground transporation of bodily remains or ashes to the area of your Principal Residence and reasonable cost of preparation of your remains necessary for transporation.