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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;
r. an elective abortion;
s. dental Treatment of the teeth, gums, or structures directly supporting the teeth, including dental X-
rays, examinations, repairs, orthodontics, periodontics, casts, splints, and services for dental
malocclusion for any condition are not covered, except if provided for or in connection with an
injury to sound natural teeth and a continuous course of dental Treatment is started within six (6)
months of the injury. Sound natural teeth are defined as natural teeth that are free of active clinical
decay, have at least fifty percent (50%) bony support, and are functional in the arch; or
t. cosmetic care, except when the Hospital Confinement is due to medically-necessary reconstructive
plastic surgery. Medically-necessary reconstructive surgery is defined as:
1. surgery as the result an injury; or
2. surgery to restore a normal bodily function; or
3. surgery to improve functional impairment by anatomic alteration made necessary as a result of
a congenital birth defect; or
4. breast reconstruction following mastectomy.
Also, no benefits will be payable under the Rider for:
a. loss that begins prior to the Rider Effective Date;
b. Treatment for which no charges are made by the provider of same;
c. services which are primarily for rest care, convalescent care, or for rehabilitation; or
d. any injury or Sickness paid for under any state or federal Workers’ Compensation, Employers’
Liability Law, or similar law.
PRE-EXISTING CONDITION(S) The benefits of the Rider will not be payable during the first twelve
(12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-
Existing Condition(s). This twelve (12) month period is measured from the Rider Effective Date for each
Insured Person.
LY-LSH-OC-B-FL 6 10/13
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;
r. an elective abortion;
s. dental Treatment of the teeth, gums, or structures directly supporting the teeth, including dental X-
rays, examinations, repairs, orthodontics, periodontics, casts, splints, and services for dental
malocclusion for any condition are not covered, except if provided for or in connection with an
injury to sound natural teeth and a continuous course of dental Treatment is started within six (6)
months of the injury. Sound natural teeth are defined as natural teeth that are free of active clinical
decay, have at least fifty percent (50%) bony support, and are functional in the arch; or
t. cosmetic care, except when the Hospital Confinement is due to medically-necessary reconstructive
plastic surgery. Medically-necessary reconstructive surgery is defined as:
1. surgery as the result an injury; or
2. surgery to restore a normal bodily function; or
3. surgery to improve functional impairment by anatomic alteration made necessary as a result of
a congenital birth defect; or
4. breast reconstruction following mastectomy.
Also, no benefits will be payable under the Rider for:
a. loss that begins prior to the Rider Effective Date;
b. Treatment for which no charges are made by the provider of same;
c. services which are primarily for rest care, convalescent care, or for rehabilitation; or
d. any injury or Sickness paid for under any state or federal Workers’ Compensation, Employers’
Liability Law, or similar law.
PRE-EXISTING CONDITION(S) The benefits of the Rider will not be payable during the first twelve
(12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-
Existing Condition(s). This twelve (12) month period is measured from the Rider Effective Date for each
Insured Person.
LY-LSH-OC-B-FL 6 10/13
