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Bulletin: 21-B-04 Extra Prescriptions During a State of Emergency or Disaster

Reminds health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency View Bulletin
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Policy Limitations and Exclusions

Policy Limitations and Exclusions

Review and study your policy. It is important for you to understand your rights, obligations, what is covered and what is not covered.

Possible Limitations on Benefits Paid

Previous Earnings

The benefit provided by the policy is typically based on your previous earnings. If you experience a decrease in earnings after you purchase your coverage, your disability benefits may be adjusted accordingly.

Multiple Policies

The amount of benefits may be reduced depending on the total amount payable by all policies in the event you are covered by multiple policies. Social Security Disability Income benefits may reduce the amount of your private disability benefits if your policy contains a social security offset provision.

Typical Exclusions

Pre-existing Conditions

The policy may deny coverage for claims due to pre-existing conditions. A pre-existing condition is generally considered a health condition for which you received medical treatment or exhibited symptoms that usually require medical care, within a time period prior to the effective date of coverage. The time period may vary from contract to contract.

Act of War

Injuries and sicknesses resulting from war are excluded.

Self-Inflicted Injuries

Any injury that is self-inflicted is excluded.

Work-Related Injuries

Work related disabilities may be excluded and receipt of workers compensation benefits may render an insured ineligible for benefits under a typical disability income insurance policy.

Related Content

Consumers Guide to Disability Insurance

Disability Income Insurance

  • Policy Limitations and Exclusions
  • Supplemental or Optional Benefits

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