Benefits will not be paid for a Covered Person's loss which:
(1) Is caused by or results from the Covered Person’s own:
(a) Intentionally self‐inflicted Injury, suicide or any attempt thereat. (In Missouri this applies only while sane.);
(b) Voluntary self‐administration of any drug or chemical substance not prescribed by, and taken according to the
directions of, a doctor (Accidental ingestion of a poisonous substance is not excluded.);
(c) Commission or attempt to commit a felony;
(d) Participation in a riot or insurrection;
(e) Driving under the influence of a controlled substance unless administered on the advice of a doctor; or
(f) Driving while Intoxicated. “Intoxicated” will have the meaning determined by the laws in the jurisdiction of the
geographical area where the loss occurs;
(2) Is caused by or results from:
(a) Declared or undeclared war or act of war;
(b) An Accident which occurs while the Covered Person is on active duty service in any Armed Forces. (Reserve or
National Guard active duty for training is not excluded unless it extends beyond 31 days.);
(c) Aviation, except as specifically provided in this Certificate;
(d) Sickness, disease, bodily or mental infirmity or medical or surgical treatment thereof, bacterial or viral infection,
regardless of how contracted. This does not include bacterial infection that is the natural and foreseeable result of
an accidental external bodily injury or accidental food poisoning.
(e) Nuclear reaction or the release of nuclear energy. However, this exclusion will not apply if the loss is sustained
within 180 days of the initial incident and:
(i) The loss was caused by fire, heat, explosion or other physical trauma which was a result of the release of
nuclear energy; and
(ii) The Covered Person was within a 25‐mile radius of the site of the release either:
1) At the time of the release; or
2) Within 24 hours of the start of the release.
Benefits will not be paid for:
1. Normal health check ups
2. Dental care or treatment other than care of sound, natural teeth and gums required on account of Injury resulting
from an Accident while the Covered Person is covered under this Certificate, and rendered within 6 months of the
Accident;
3. Services or treatment rendered by a doctor, nurse or any other person who is:
a. Employed or retained by the Certificateholder; or
b. Who is the Covered Person or a member of his immediate family;
4. Charges which:
a. The Covered Person would not have to pay if he did not have insurance; or
b. Are in excess of Usual, Reasonable and Customary charges.
5. An Injury that is caused by flight in:
a. An aircraft, except as a fare‐paying passenger;
b. A space craft or any craft designed for navigation above or beyond the earth's atmosphere; or
c. An ultra light, hang‐gliding, parachuting or bungi‐cord jumping;
6. Travel in or upon:
a. A snowmobile;
b. Any two or three wheeled motor vehicle;
c. Any off‐road motorized vehicle not requiring licensing as a motor vehicle;
7. Any Accident where the Covered Person is the operator of a motor vehicle and does not possess a current and valid
motor vehicle operator's license;
8. That part of medical expense payable by any automobile insurance policy without regard to fault. (Does not apply
in any state where prohibited);
9. Injury that is: a. The result of the Covered Person being Intoxicated. (“Intoxicated” will have the meaning
determined by the laws in the jurisdiction of the geographical area where the loss occurs); or
a. Caused by any narcotic, drug, poison, gas or fumes voluntarily taken, administered, absorbed or inhaled,
unless prescribed by a doctor;
10. Any sickness, except infection which occurs directly from an Accidental cut or wound or diagnostic tests or
treatment, or ingestion of contaminated food;
11. An Injury resulting from participation in or practice for non‐School sponsored skiing, ice hockey, lacrosse, soccer or
football;
12. Practice or play in any sports activity, including travel to and from the activity and practice, unless specifically
provided for in this Certificate;
13. Expenses to the extent that they are paid or payable under other valid and collectible group insurance or medical
prepayment plan;
14. Blood or Blood plasma, except for charges by a Hospital for the processing or administration of blood;
15. Elective treatment or surgery, health treatment, or examination where no Injury is involved;
16. Injury sustained while in the service of the armed forces of any country. When the Covered Person enters the
armed forces of any country, we will refund the unearned pro rata premium upon request;
17. Eyeglasses, contact lenses, hearing aids, braces, appliances, or examinations or prescriptions therefore;
18. Treatment in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay;
19. Treatment of temporomandibular joint (TMJ) disorders involving the installation of crowns, pontics, bridges or
abutments, or the installation, maintenance or removal of orthodontic or occlusal appliances or equilibration
therapy;
20. Cosmetic surgery, except for reconstructive surgery on a diseased or injured part of the body;
21. Any loss which is covered by state or federal worker's compensation, employers liability, occupational disease law, or similar laws;
22. The repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices;
23. The repair or replacement of existing dentures, partial dentures, braces or fixed or removable bridges;
24. Services and supplies furnished by a Student Infirmary, its employees, or doctors who work for the School;
25. Expenses incurred for an Accident after the Benefit Period shown in the Schedule of Benefits; or
26. Hernia of any kind; or any bacterial infection that was not caused by an Accidental cut or wound.
27. Rest cures or custodial care;
28. Prescription medicines unless specifically provided for under the Certificate:
29. Orthopedic appliances which are used mainly to protect an Injury so that a covered student can take part in
interscholastic or intercollegiate sports;
