Page 10 - Customer-Booklet_Texas
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INTENSIVE CARE UNIT INDEMNITY BENEFIT RIDER (LY-ICU-RD-FL)
We will pay the Intensive Care Unit Indemnity Benefit Amount shown on the Policy Schedule Page
for each Day that an Insured Person is confined to the Intensive Care Unit of a Hospital as an
Inpatient. For benefits to be payable, the Intensive Care Unit Confinement must:
a. be due to an injury, Sickness, or Complication of Pregnancy;
b. begin while the Rider is in force for an Insured Person;
c. be for at least twenty-four (24) hours; and
d. be at the direction of and under the supervision of a Physician.
Benefits will not be payable beyond a Maximum Benefit Period of thirty (30) Days, as shown on the
Policy Schedule Page, for any one (1) Period of Confinement.
Upon attainment of Age sixty-five (65), coverage for each Insured Person will be reduced by fifty
percent (50%) as shown on the Policy Schedule Page.
EXCLUSIONS AND LIMITATIONS The Rider is subject to the following Exclusions and Limitations in
addition to those outlined in the policy.
In addition to any benefit-specific conditions, limitations, or exclusions, no benefits will be payable
under the Rider for Confinement or loss caused directly or indirectly by:
a. suicide (while sane or insane), attempted suicide, or intentionally self-inflicted injury;
b. war or act of war (whether declared or undeclared, excludes acts of terrorism);
c. commission or attempt to commit an illegal activity or a felony;
d. commission of or active participation in a riot, insurrection, rebellion, or police action;
e. voluntary self-administration of any narcotic, drug, poison, gas, or fumes, unless prescribed or
taken under the direction of a Physician and taken in accordance with the prescribed dosage;
f. operating any type of vehicle while under the influence of alcohol or any drug, narcotic, or other
intoxicant. “Under the influence of alcohol,” for purposes of this exclusion, means intoxicated, as
defined by the law of the state in which the injury occurred;
g. mental or emotional disorders, alcoholism, and drug addiction;
h. Treatment outside the United States except for emergency care for acute onset of Sickness or
accidental injury sustained while traveling for business or pleasure;
i. travel or activity outside the United States;
j. participation in any motorized race or contest of speed on sea, land, or air;
k. travel in or on any off-road motorized vehicle not requiring licensing as a motor vehicle;
l. participation in any of the following high-risk activities: bungee jumping, parachuting, skydiving,
parasailing, hang-gliding, deep-sea scuba diving, parkour, free running, sail gliding, or parakiting;
m. flight in, boarding, or alighting from an aircraft or any craft designed to fly above the Earth’s
surface, except as a fare-paying passenger on a regularly-scheduled commercial or charter airline;
n. practicing for or participating in any semiprofessional or professional competitive athletic contest
for which such Insured Person receives any compensation or remuneration;
o. operating a motor vehicle without a valid motor vehicle operator’s license, except while
participating in a driver’s education program;
p. the following conditions if they are Diagnosed within six (6) months after the Rider Effective Date
unless Confinement is on an emergency basis: a hernia, adenoids, tonsils, varicose veins,
hemorrhoids, disorder of the reproductive organs, or elective sterilization;
q. routine pregnancy; however, Complications of Pregnancy will be considered the same as any
other Sickness;
LY-LSC-OC-B-FL 8 10/13
We will pay the Intensive Care Unit Indemnity Benefit Amount shown on the Policy Schedule Page
for each Day that an Insured Person is confined to the Intensive Care Unit of a Hospital as an
Inpatient. For benefits to be payable, the Intensive Care Unit Confinement must:
a. be due to an injury, Sickness, or Complication of Pregnancy;
b. begin while the Rider is in force for an Insured Person;
c. be for at least twenty-four (24) hours; and
d. be at the direction of and under the supervision of a Physician.
Benefits will not be payable beyond a Maximum Benefit Period of thirty (30) Days, as shown on the
Policy Schedule Page, for any one (1) Period of Confinement.
Upon attainment of Age sixty-five (65), coverage for each Insured Person will be reduced by fifty
percent (50%) as shown on the Policy Schedule Page.
EXCLUSIONS AND LIMITATIONS The Rider is subject to the following Exclusions and Limitations in
addition to those outlined in the policy.
In addition to any benefit-specific conditions, limitations, or exclusions, no benefits will be payable
under the Rider for Confinement or loss caused directly or indirectly by:
a. suicide (while sane or insane), attempted suicide, or intentionally self-inflicted injury;
b. war or act of war (whether declared or undeclared, excludes acts of terrorism);
c. commission or attempt to commit an illegal activity or a felony;
d. commission of or active participation in a riot, insurrection, rebellion, or police action;
e. voluntary self-administration of any narcotic, drug, poison, gas, or fumes, unless prescribed or
taken under the direction of a Physician and taken in accordance with the prescribed dosage;
f. operating any type of vehicle while under the influence of alcohol or any drug, narcotic, or other
intoxicant. “Under the influence of alcohol,” for purposes of this exclusion, means intoxicated, as
defined by the law of the state in which the injury occurred;
g. mental or emotional disorders, alcoholism, and drug addiction;
h. Treatment outside the United States except for emergency care for acute onset of Sickness or
accidental injury sustained while traveling for business or pleasure;
i. travel or activity outside the United States;
j. participation in any motorized race or contest of speed on sea, land, or air;
k. travel in or on any off-road motorized vehicle not requiring licensing as a motor vehicle;
l. participation in any of the following high-risk activities: bungee jumping, parachuting, skydiving,
parasailing, hang-gliding, deep-sea scuba diving, parkour, free running, sail gliding, or parakiting;
m. flight in, boarding, or alighting from an aircraft or any craft designed to fly above the Earth’s
surface, except as a fare-paying passenger on a regularly-scheduled commercial or charter airline;
n. practicing for or participating in any semiprofessional or professional competitive athletic contest
for which such Insured Person receives any compensation or remuneration;
o. operating a motor vehicle without a valid motor vehicle operator’s license, except while
participating in a driver’s education program;
p. the following conditions if they are Diagnosed within six (6) months after the Rider Effective Date
unless Confinement is on an emergency basis: a hernia, adenoids, tonsils, varicose veins,
hemorrhoids, disorder of the reproductive organs, or elective sterilization;
q. routine pregnancy; however, Complications of Pregnancy will be considered the same as any
other Sickness;
LY-LSC-OC-B-FL 8 10/13
