General Information - Pacific Cross Insurance Company Limited

MEDICAL PLANS

GENERAL INFORMATION


	DENTAL BENEFITS
	A completed Oral Examination Report must be submitted with the first dental claim. All conditions requiring treatment as of the first dental visit are deemed to be pre-existing conditions.
	EXCLUSIONS (Extract from the policy)
	Medical plans do not cover care, treatment, services or supplies for: Pre-existing conditions not declared to and accepted by the Company Which the Insured Person is entitled to indemnity from a third party or other benefit plan Birth control; treatment of impotence or infertility (including artificial insemination, in-vitro fertilization, embryo transfer); sterilization reversal or elective abortion Congenital conditions Custodial Care, routine medical check-ups, or any treatments considered unnecessary by the Company, vaccinations, counselling, hearing tests, refractive defects of the eye, corrective eye surgery for refractive error, corrective devices, or dental treatment unless covered under the optional benefits cover of this policy for vision, dental, or medical check-up Disability resulting from war or any act thereof, service in the military, naval or air force, riot, civil commotion Hazardous or professional sports unless declared to and accepted by the Company Intentionally self-inflicted injury, suicide, abuse of alcohol, drug addiction or venereal diseases Cosmetic or reconstructive surgery Prosthesis, orthotic devices, corrective devices and medical appliances not required for a surgical operation AIDS, AIDS Related Complex, or Human Immunodeficiency Virus (HIV) and related illness which manifests at any time within five years from the policy effective date Expenses incurred for provision of medical documentation required by the Company
	14-DAY FREE LOOK
	You may return your policy within fourteen days after receipt for a full refund of the premiums paid.
	FREE NEW BORN CHILD COVERAGE
	A child of an Insured Person is eligible for the same medical plan as the Insured Person 15 days after the later of the date of birth or the date of discharge on submission of application to the Company until the Insured Person's next renewal for free.
	GEOGRAPHICAL LOADING
	Applies to the Medical Plan (& options) premium for residents to cover the high cost of medical care in that particular area.
	OCCUPATIONAL CLASS
	Personal Accident cover is based on the hazard class associated with an occupation and its duties. Class 1: very light hazards Class 2: light hazards Class 3: non-hazardous manual labor Class 4: hazardous occupations. Class 3's are quoted on request and Class 4's have no cover.
	PRE-EXISTING CONDITION
	Any Disability which existed before the policy effective date in respect of an Insured Person, which presented signs and symptoms of which the Insured Person was aware or should reasonably have been aware
	PREMIUMS
	Are based on the Insured Person's age on the first day of the policy year; the rate table in effect on the premium due date; and, residence, family status, payment mode and other factors which affect the cost of insurance. Premiums may be revised based on claims experience or other criteria which the Company, at its sole discretion, may determine. Policies renew automatically upon payment of renewal premium.
	TREATMENT AREA LIMIT
	Does not apply to inpatient expenses incurred for emergency treatment of injury or acute illness which occurs wholly after the start of travel for up to 30 days of travel to the affected areas in any one policy year.
	WAITING PERIOD
	Benefits are not paid for sickness during the first 30 days of coverage. Benefits for injuries due to covered accidents occurring wholly after the effective date are covered immediately.