Disclosures

Limitations and Exclusions

Benefits will not be paid for:

• A diagnosis made prior to the effective date as applicable to the covered person;
• Basal cell carcinoma and squamous cell carcinoma of the skin; or
• Melanoma that is diagnosed as Clarke’s level I or II, or Breslow’s classification less than 0.75mm;
• Premalignant tumors or polyps;
• Sickness caused by alcohol, drugs, narcotics or hallucinogens not prescribed by a physician, or not used in the manner prescribed by the physician;
• Any disease, sickness or incapacity not specified in the policy;
• More than one first diagnosis occurrence after the effective date except as specified on the schedule and under the section entitled Benefit Provision;
• Transient ischemic attacks, reversible ischemic neurological deficit and attacks of vertebrobasilar ischemia.
• Balloon angioplasty, laser relief or other like procedures;
• Any invasive cancer, carcinoma in situ or critical illness* resulting from:
  • The covered person’s commission of, or attempt to commit, a felony;
  • Self-inflicted injury, while sane or insane;
  • The covered person’s committing or attempting to commit suicide;
  • The covered person engaging in an illegal occupation;
  • War or act of war, declared or undeclared;
  • The covered person’s participation in a riot.

Pre-Existing Condition Limitation

No benefit amount or partial benefit amount will be paid for any condition caused by or resulting from a pre-existing condition, which begins in the first 12 months after the coverage effective date.

A pre-existing condition is a sickness or injury for which medical care, diagnosis or advice was received or recommended during the 12 months immediately prior to the effective date.

*Cancer and cancer-related conditions are not covered conditions with all Critical Illness plans. See your policy/certificate for complete details.

Plan form CACIM-82001C and applicable riders HS-12000/R, WP-12000/R, HIV-806, SB806, R207, EZ-12000/R, SC 511, SCR 511, SCRC 511 and LCWP 5/01 KS:

EXCLUSIONS

No benefits will be paid for a diagnosis of a specified Critical Illness that occurs as a result of the following:

• A diagnosis made prior to the Effective Date, or during the Waiting Period, as applicable to the Covered Person;
• Skin cancer, malignant melanoma (Stage I); Carcinoma in Situ, except as specified under the section entitled “Benefit Provision”
• Sickness caused by alcohol, drugs, narcotics, or hallucinogens not prescribed by a Physician, or not used in the manner prescribed by the Physician;
• Any disease, Sickness or incapacity not specified in the Certificate;
• More than one First Diagnosis occurrence after the Effective Date and after the Waiting Period, except as specified on the Schedule and under the Section entitled “Benefit Provision”;
• Transient Ischemic Attacks, Reversible Ischemic Neurological Deficit, and attacks of Vertebrobasilar Ischemia.
• Balloon Angioplasty, laser relief or other like procedures;
• Any Invasive Cancer, Carcinoma in Situ or Critical Illness resulting from:
  • The Covered Person’s commission of, or attempt to commit, a felony;
  • Self-inflicted Injury, while sane or insane;
  • The Covered Person’s committing or attempting to commit suicide;
  • War or act of war, declared or undeclared;
  • The Covered Person’s participation in a riot.

PRE-EXISTING CONDITION LIMITATION

No Benefit Amount or Partial Benefit Amount will be paid for any condition caused by or resulting from a Pre-existing Condition which begins in the first twelve (12) months after the Covered Person’s coverage Effective Date.

Plan form HIV 806:

EXCLUSIONS

While this Rider is in force, the following language is added to the Exclusions in Your Policy/Certificate:

No benefits will be paid for:

Occupational Human Immunodeficiency Virus (HIV) resulting from a needle stick or sharp injury or a mucous membrane exposure to blood or bloodstained bodily fluid, which occurred prior to the effective date of this Rider;

Plan form HS-12000R:

EXCLUSION

This Rider provides benefits for only Health Screening Tests.

Plan form LCWP-5/01 KS:

LIMITATIONS

• Loss of Work occurrences in any one year are limited to 3, and the total number of months We will waive in any one year, or for any single Loss of Work occurrence, is 6. For purposes of this limitation, a Strike is considered a single Loss of Work occurrence.
• Benefits under this rider are not available before Your 18th birthday.
• In no event will the benefit under this rider be retroactive for more than 6 months after We first receive proof of Your Loss of Work.

EXCLUSIONS

The waiver of the monthly premium will not be provided, if Your Loss of Work results from:

• Your voluntary termination; or
• Your retirement; or
• Your employer terminating You for performance reasons, including performance deficiencies, attendance, or unacceptable behavior; or,
• Your employer’s routine or regularly-scheduled or seasonal shutdowns or layoffs;

or

• Your voluntary forfeiture of salary, wages or employment income; or
• Wildcat strikes or illegal walkouts.

Plan form WP-1200R:

Premiums will not be waived if the Total Disability results directly from:

• Intentionally self-inflicted Injury; or
• An act of War while the Insured is serving in:
  • the military, naval or air forces of any country at War; or
  • any civilian noncombatant unit serving with such forces; or
• The Insured’s drug abuse or drug addiction, except due to drugs prescribed by a physician and taken according to instructions.