Pre-existing conditions and exclusions
After coverage has been in effect for 24 continuous months, GMMISM provides a US$50,000 lifetime benefit for eligible pre-existing conditions that existed at or prior to the effective date, subject to a maximum of US$5,000 per period of coverage. This benefit is payable whether or not you have received consultation or treatment for the condition(s) during the 24-month period. This is important since few pre-existing conditions remain free from ongoing consultation or treatment, and often do not qualify for coverage in standard plans. GMMISM does not rider or charge additional premium for pre-existing conditions. If you properly disclose a pre-existing condition at the time of application, and are accepted into the plan, you will be covered for eligible medical expenses after 24 months of continuous coverage, subject to the foregoing limits and the other terms of the plan.*
The following illnesses which exist, manifest themselves or are treated or have treatment recommended prior to or during the first 180 days of coverage from the initial effective date are considered pre-existing conditions under the plan, and are subject to the waiting period and other limitations of coverage described above: asthma, allergies, tonsillectomy, back conditions, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the reproductive system, hysterectomy, hernia, gall stones or kidney stones, any condition of the breast, and any condition of the prostate.
OTHER EXCLUSIONS & LIMITATIONS*
Maternity and newborn care (unless the maternity rider is purchased - see details under the Benefits section)
Inpatient mental and nervous
Routine physical exams
Dental treatment unless accident related
Organized amateur or professional sports
Treatment not ordered or received by a physician
Treatment or supplies not medically necessary
Investigational, experimental or research procedures
Custodial care
Weight modification
Elective cosmetic or plastic surgery
Treatment of impotency
Contraceptive medication or treatment
Drug and alcohol abuse treatment
Organ transplants not specifically listed
Devices to correct sight or hearing
Routine foot care
Treatment by a relative or family member
Treatment as a result of war or riot
Treatment resulting from illegal activities
Speech therapy
Persons HIV+ at effective date
Services and treatment eligible for payment by any government or other insurance
* See Certificate Wording for a definition of pre-existing conditions and a complete list of exclusions and limitations, and for all other specific terms and conditions of the plan. Certificate Wording is available upon request. |