Page 4 - VIPplans
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Eligibility
Voluntary Insurance Protection is available to the primary applicant up to age 64, his or her spouse age 18 to 64 and dependent
children under the age of 26. Child-only plans are not available. All benefits terminate when the covered person has attained age
70.
Exclusions and Limitations
The following services are NOT covered by the Voluntary Insurance Protection plans. This is only a brief list of exclusions. For a
complete list of all policy provisions, including limitations and exclusions refer to the policy.
• Expenses incurred outside the United States, unless such expenses are incurred while traveling less than 90 days.
• Treatment which is: not medically necessary; not prescribed by a physician; received without charge; received from any family
member; not rendered in accordance with generally accepted standards of medical practice; or not specifically listed in the Policy
as a covered charge or covered loss.
• Injury received as a result of: suicide or attempted suicide; declared or undeclared war; voluntary participation in a riot or
insurrection; engaging in an illegal act; traveling or flying by air, except as a fare-paying passenger; participating in a rodeo;
participating in or practicing for any collegiate or professional sports; flying in an ultra-light aircraft, hang gliding, parachuting or
bungee-cord jumping, or by flight in a space craft; as well as work-related injury covered under workers’ compensation or incurred
while on active duty in the armed forces; or injury incurred while intoxicated or under the influence of alcohol.
• Accident Disability Income Insurance: The benefit is payable when the covered person was employed full-time when the
accident that resulted in total disability took place. Total disability must be certified by a doctor and means that the covered person
cannot engage in any employment or occupation for which he or she is qualified by reason of education, training, or experience,
and is not engaged in any occupation for wage or profit.
• Hospital Confinement, Inpatient and Outpatient Surgery and Physician Office Visit: In addition to the exclusions and
limitations above, the following treatment or services are NOT covered by the Hospital Confinement, Inpatient or Outpatient Surgical
and Physician Office Visit benefits:
Benefits will not be payable for: a weekend confinement unless medically necessary; cosmetic or plastic surgery; treatment,
services or supplies for breast augmentation or removal of breast implants; surgery to correct refractive errors; fertility or sterility;
impregnation techniques; abortion; sexual reassignments or sexual dysfunctions; obesity or weight reduction; temporomandibular
joint (TMJ) dysfunction; pregnancy; outpatient minor surgical procedures performed in a physician’s office or clinic; or a pre-existing
condition.
A pre-existing condition is defined as a sickness, disease or injury for which medical advice, diagnosis, care or treatment was
recommended or received from a physician, or symptoms that would have caused an ordinarily prudent person to seek care, during
the 12 months immediately preceding the covered person’s effective date.
10-day right to return period
If for any reason you are not satisfied with this policy, you may return it to us within 10 days after you receive it and we will refund
any premium paid. Your coverage issued under the policy will be void, as though we had not issued the coverage.
Brochure Metal Gap 2 IPAF IAIC 1118 4
Voluntary Insurance Protection is available to the primary applicant up to age 64, his or her spouse age 18 to 64 and dependent
children under the age of 26. Child-only plans are not available. All benefits terminate when the covered person has attained age
70.
Exclusions and Limitations
The following services are NOT covered by the Voluntary Insurance Protection plans. This is only a brief list of exclusions. For a
complete list of all policy provisions, including limitations and exclusions refer to the policy.
• Expenses incurred outside the United States, unless such expenses are incurred while traveling less than 90 days.
• Treatment which is: not medically necessary; not prescribed by a physician; received without charge; received from any family
member; not rendered in accordance with generally accepted standards of medical practice; or not specifically listed in the Policy
as a covered charge or covered loss.
• Injury received as a result of: suicide or attempted suicide; declared or undeclared war; voluntary participation in a riot or
insurrection; engaging in an illegal act; traveling or flying by air, except as a fare-paying passenger; participating in a rodeo;
participating in or practicing for any collegiate or professional sports; flying in an ultra-light aircraft, hang gliding, parachuting or
bungee-cord jumping, or by flight in a space craft; as well as work-related injury covered under workers’ compensation or incurred
while on active duty in the armed forces; or injury incurred while intoxicated or under the influence of alcohol.
• Accident Disability Income Insurance: The benefit is payable when the covered person was employed full-time when the
accident that resulted in total disability took place. Total disability must be certified by a doctor and means that the covered person
cannot engage in any employment or occupation for which he or she is qualified by reason of education, training, or experience,
and is not engaged in any occupation for wage or profit.
• Hospital Confinement, Inpatient and Outpatient Surgery and Physician Office Visit: In addition to the exclusions and
limitations above, the following treatment or services are NOT covered by the Hospital Confinement, Inpatient or Outpatient Surgical
and Physician Office Visit benefits:
Benefits will not be payable for: a weekend confinement unless medically necessary; cosmetic or plastic surgery; treatment,
services or supplies for breast augmentation or removal of breast implants; surgery to correct refractive errors; fertility or sterility;
impregnation techniques; abortion; sexual reassignments or sexual dysfunctions; obesity or weight reduction; temporomandibular
joint (TMJ) dysfunction; pregnancy; outpatient minor surgical procedures performed in a physician’s office or clinic; or a pre-existing
condition.
A pre-existing condition is defined as a sickness, disease or injury for which medical advice, diagnosis, care or treatment was
recommended or received from a physician, or symptoms that would have caused an ordinarily prudent person to seek care, during
the 12 months immediately preceding the covered person’s effective date.
10-day right to return period
If for any reason you are not satisfied with this policy, you may return it to us within 10 days after you receive it and we will refund
any premium paid. Your coverage issued under the policy will be void, as though we had not issued the coverage.
Brochure Metal Gap 2 IPAF IAIC 1118 4
