The following exclusions and limitations are summarized, and actual wording may vary slightly by policy. Please refer to the group master policy for fully detailed exclusions and limitations. Exclusions and Limitations may be affected by state law.

GENERAL EXCLUSIONS AND LIMITATIONS
With respect to all of the insured health indemnity, dental, and short term disability income insurance benefits provided under this plan, no benefits will be payable as the result of:

1. Suicide or attempted suicide, while sane or insane;
2. Any intentionally self-inflicted injury or sickness;
3. Participation in a riot, civil commotion, civil disobedience, or unlawful assembly;
4. Committing, attempting to commit, or taking part in, a felony or assault; or engaging in an illegal occupation;
5. Participation in a contest of speed in power-driven vehicles, parachuting, parasailing, bungee jumping, or hang gliding;
6. Air travel;
7. Any accident occurring while the covered person is intoxicated;
8. An act of war, whether declared or undeclared, or while performing police duty as a member of any military or naval organization;
9. Occupational accident or sickness; or
10. Treatment received during a period of time that coverage is not in force.

HEALTH INDEMNITY INSURANCE
EXCLUSIONS AND LIMITATIONS
In addition to the general exclusions and limitations, with respect to Health Indemnity Insurance, no benefits will be payable as the result of:

1. Rest care or rehabilitative care and treatment;
2. Cosmetic surgery or care;
3. Routine examinations, except as provided under the Wellness Indemnity Benefit;
4. Routine newborn care, including routine nursery charges;
5. Voluntary abortion;
6. Pregnancy of a dependent child;
7. Sex changes;
8. Experimental treatments or surgery;
9. The reversal of tubal ligation or vasectomy;
10. Artificial insemination, in vitro fertilization, and test tube fertilization, including related medications;
11. Treatment of exogenous obesity or weight control; or gastric bypass procedure; or any other surgical procedure for control of weight;
12. Venipuncture;
13. Ambulance service;
14. Treatment that is not medically necessary;
15. With respect to a non-emergency hospital admission during which a surgical procedure is performed: confinement, or services or treatment received more than 24 hours prior to admission;
16. Equipment or appliances;
17. Prostheses;
18. Supplies; except as provided under the Miscellaneous Hospital Services and Supplies Indemnity Benefit;
19. Visits made or examinations given while confined to a hospital; except as provided under the Inpatient Physician Indemnity Benefit;
20. Routine eye examinations, or the fitting of glasses or contact lenses;
21. Hearing examinations, or the fitting of hearing aids;
22. Dental examinations or dental care other than that resulting from accidental injury;
23. Benefits that are provided under any other part of the policy;
24. X-rays or laboratory tests while confined to a hospital;
25. X-rays or laboratory tests performed in relationship to dental care, other than expenses resulting from accidental injury;
26. “Over-the Counter” drugs and medicines;
27. Investigational or experimental drugs;
28. Drugs, medicines or insulin, in whole or in part, used by, administered to, or provided to, a covered person: (a) during an outpatient physician’s office visit; (b) during a visit to a hospital emergency room or outpatient surgical facility; or (c) while confined in a hospital, rest home, sanatorium, extended care facility, convalescent hospital, nursing home or similar institution;
29. Immunization agents (shots), biological sera, blood, or blood plasma; or
30. Contraceptive materials, devices or medications.

TERM LIFE INSURANCE EXCLUSION
With respect to Term Life Insurance, no benefits will be payable as the result of suicide or any attempt thereat, while sane or insane; or any intentionally self-inflicted injury or sickness, unless the covered person has been continuously insured under the policy for two years.

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE EXCLUSIONS AND LIMITATIONS
In addition to the general exclusions and limitations, no Accidental Death and Dismemberment Insurance benefits will be payable as the result of:

1. Infection or disease; or
2. Voluntary self-administration of any drug or chemical substance not prescribed by, and taken according to the directions of, a licensed physician.

DENTAL INSURANCE
EXCLUSIONS AND LIMITATIONS
In addition to the general exclusions and limitations, with respect to Dental Insurance, no benefits will be payable as the result of:

1. Cosmetic surgery or care;
2. Class B expenses, until the covered person has been continuously insured under this dental plan (or the dental plan this plan replaced) for 12 consecutive months;
3. Treatment started before coverage began;
4. Charges for initial installation for dentures or bridgework to replace teeth extracted prior to when coverage began;
5. Replacement of existing dentures or bridgework less than five years old, or for replacement because of loss or theft;
6. Charges for orthodontics;
7. Charges for services with respect to congenital malformations;
8. Charges for dental care which is covered under any other part of this plan;
9. Charges by anyone other than a dentist;
10. Charges for more than one fluoride treatment, one dental prophylaxis, or one bite-wing x-ray in any six-month period;
11. Charges for more than one complete mouth x-ray in any two-year period; or
12. Charges which the covered person is not legally required to pay, or charges which would not have been made if no coverage had existed.

 SHORT TERM DISABILITY INCOME INSURANCE EXCLUSIONS AND LIMITATIONS
In addition to the general exclusions and limitations, no Short Term Disability Income Insurance benefits will be paid as the result of:

1. Voluntary abortion;
2. Sex changes;
3. The reversal of tubal ligation or vasectomy;
4. Treatment of exogenous obesity or weight control; gastric bypass procedure; or any other surgical procedure for control of weight; or
5. Cosmetic surgery or care.

Additionally, no benefits will be paid:

1. For any period during which the employee is not under the regular care and attendance of a physician;
2. If the employee should fail to follow the medical treatment advice of his/her physician as it pertains to his/her disabling condition; or
3. During any period in which the employee is incarcerated.