Expenses Not Covered
No payment will be made for expenses resulting from:
1 . Any charges or services, treatment or supplies:
- for which there would be no charge except for the existence of insurance;
- which are performed or provided by an immediate family member or a person who lives with the patient;
- which are provided while confined in a hospital on an in-patient basis;
- which are not specified as an Eligible Expense under this plan .
2 . Services, treatments or supplies eligible under this Plan and payable under any government plan, whether or not the claimant is covered under such a plan . The underwriter will only consider that amount of an eligible expense which is over and above the amount that would be payable by the government plan .
3 . Intentional self-inflicted injuries or illness while sane or insane .
4 . Injury resulting directly or indirectly from insurrection, war, service in the armed forces of any country or participation in a riot .
5 . Any injury or illness for which the person is entitled to benefits under any Workers’ Compensation Act .
6 . Travel for health reasons or periodic health examination or examinations required for a third party .
7 . Cosmetic surgery or treatment (when so classified by the underwriter) unless
unless such surgery or treatment is for accidental injuries and commenced within 90 days of an accident .
8 . Charges levied by a physician or dentist for completion of medical reports and forms, time spent travelling, broken appointments, transportation costs, room rental charges or for advice given by telephone or other means of telecommunication .
9 . Drugs, sera, injectables and supplies which are not approved by Health Canada (Food and Drugs) or are experimental or limited in use whether or not so approved.
10 . Experimental medical procedures or treatment methods not approved by the Canadian Medical Association and the Newfoundland and Labrador Medical Association or the appropriate medical specialty society.
11 . Charges for intrauterine devices and diaphragms.