Exclusions and Limitations

Pre-Existing Condition Limitation

Pre-existing conditions are those medical conditions disclosed or not disclosed on the application which were diagnosed or for which medical advice or treatment was recommended or received from a Doctor within a 12-month period immediately preceding the Effective Date of Your coverage. Any loss due to a pre-existing condition is not covered unless the loss begins more than 12 months* after the Effective Date of coverage. *The pre-existing condition waiting period is 6 months in Idaho and Oregon.

Wyoming Applicants Only – Your Pre-existing Conditions Limitation reads:

The policy will not cover loss resulting from pre-existing conditions during the first year that your policy is in force. A "pre-existing condition" is any sickness or injury diagnosed for which You received medical advice and /or treatment was received from or recommended by a Physician within the 90 day period immediately before the effective date of Your coverage, or the effective date of an increase in coverage, whichever is applicable.

Exceptions and Limitations

We won't pay for charges incurred:

1. war or act of war, whether declared or not (does not apply to Oklahoma applicants);
2. intentionally self-inflicted injury;
3. mental illness or nervous disorders without demonstrable organic disease (loss due to Parkinson’s Disease, Alzheimer’s Disease or senile dementia is covered) (or for DC applicants except as state mandated; and this exception does not apply to Vermont applicants);
4. normal pregnancy and childbirth; complications of pregnancy, however, will be covered as a sickness (this exception does not apply to Montana applicants);
5. treatment of an injury that results from your commission of, or attempt to commit a felony, or from you being engaged in an illegal activity (or for Nebraska applicants, an illegal occupation; or for Vermont applicants, treatment of an injury that results from Your participation in a felony);
6. cosmetic surgery; cosmetic surgery does not include reconstructive surgery which is incidental because of previous surgery due to trauma, infection, or other disease of the involved part (or for New Hampshire applicants, reconstructive surgery because of a congenital disease or anomaly of a covered dependent child that has resulted in a functional defect);
7. confinement in a Hospital located or care received outside of the territorial limits of the United States of America, its commonwealth partners, or the countries of Canada and Mexico; or
8. you being intoxicated or under the influence of alcohol or a narcotic, unless administered on the advice of a Physician (or for DC applicants, or as state mandated; and for Nevada applicants, substance abuse, including alcoholism, drug addiction, narcotics, or hallucinogens unless administered on the advice of a Physician).

Oklahoma applicants only: We will also not be liable for any loss sustained or contracted in consequence of Your being under the influence of any narcotic, unless administered on the advice of a Doctor.

Benefit Limitations

1. Outpatient Benefit maximum is $1,000.00 per calendar year per covered adult and for each covered child.
2. Doctor's office visits are limited to 10 per calendar year for adults, 5 per calendar year for all children combined.
3. Doctor's office calls are limited to one call per week, except in Maryland.

Stable Premiums

Your premiums cannot be changed due to declining health. Your premiums can only be changed if we change the premiums of all like policies in your state. You will be notified before any changes are made.

This benefit description is a brief summary of benefits only and is subject to the terms, conditions, exclusions and limitations of your Certificate of Insurance or Insurance Policy. Coverage may not be available in all states. Please call VBA at 1-800-366-2467 if your state is not listed.