What's Not Covered
Unum will not pay benefits for a claim that is caused by, contributed to by or occurs as a result of:
- Participating or attempting to participate in a felony or
being engaged in an illegal occupation
- Committing or trying to commit suicide or injuring oneself intentionally, whether sane or not
- Participating in war or any act of war, whether declared or undeclared
- Being under the influence of or addicted to intoxicants or narcotics—this would not include physician prescribed medication, taken in the prescribed dosage
- Having a date of diagnosis during the benefit waiting period
Pre-Existing Condition Limitation
Unum will not pay benefits for a claim that is caused by, contributed to by or occurs as a result of a pre-existing condition or any medical or surgical treatment for that condition for which the date of diagnosis is in the first 12 months after your coverage effective date. However, pre-existing conditions are covered if diagnosis occurs after the insured person has been covered by the plan for 12 months.
For purposes of this plan, a pre-existing condition is defined as a sickness or injury, or symptoms of a sickness or injury, whether diagnosed or not, for which a person received any of the following during the 12 months just prior to his or her coverage effective date:
- Medical treatment
- Consultation
- Care or services, including diagnostic measures
- A prescription for medicine
A pre-existing condition can also be a sickness or injury, or symptoms of a sickness or injury, whether diagnosed or not, for which an ordinarily prudent person would have consulted a health care provider during the 12 months just prior to the his or her coverage effective date.
The pre-existing condition will apply to any new or increased coverage.
The pre-existing condition limitation does not apply for dependent children who are born or adopted while you are covered under this policy, and who are continuously covered from the date of birth or adoption.