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Exclusions

Limitations and Exclusions to Extended Health Benefits
No benefit is payable for:
1) expenses for which benefits are payable under a Workers' Compensation Act, Workplace Safety and Insurance Act or a similar statute;
2) expenses incurred due to intentionally self-inflicted injuries;
3) expenses incurred due to civil disorder or war, whether or not war was declared;
4) expenses for services and products, rendered or prescribed by a person who is ordinarily a resident in the patient's home or who is related to the patient by blood or marriage;
5) expenses for which benefits are payable under a government plan;
6) expenses for benefits which are legally prohibited by the government from coverage;
7) out-of-province expenses for elective (non-emergency) medical treatment or surgery;
8) expenses for drugs which, in the insurer's opinion, are experimental;
9) expenses for dietary supplements, vitamins and infant foods;
10) expenses for contraceptives (other than oral);
11) drugs for the treatment of erectile dysfunction;
12) expenses for drugs if they are used for the treatment of infertility;
13) expenses for the services of a homemaker;
14) expenses for items purchased solely for athletic use;
15) dental expenses, except those specifically provided under eligible expenses for treatment of accidental injuries to natural teeth;
16) utilization fees which are imposed by the Provincial Health Care Plan for the use of a service;
17) expenses for the regular treatment of an injury or disease which existed before the member's or dependant's departure from his/her province of residence;
18) expenses incurred on a non-emergency or referral basis;
19) immunizations and vaccines (Hepatitis B will be covered, except for Recombivax HB preservative free - DIN 02245976 and DIN 02245977); or
20) any other exclusion identified in the policy contract.

Limitations and Exclusions to Dental Benefits
No benefit is payable for:
1) any cause for which the insured may apply for and receive protection, exemption or compensation under any Workers' Compensation Act;
2) self-inflicted injuries while sane or insane;
3) war, insurrection or hostilities of any kind whether or not the insured was a participant in such actions;
4) participation in any riot or civil commotion;
5) committing or attempting to commit a criminal offence or provoking an assault;
6) any group or policyholder sponsored dental care or treatment;
7) any dental care or treatment for which the insured is not legally obliged to pay;
8) dental care, treatment or supplies primarily for cosmetic purposes;
9) any appointments not kept or for the completion of claim forms;
10) any dental treatment that has as its purpose the correction of temporomandibular joint dysfunction;
11) any services or supplies for implantology, including tooth implantation and surgical insertion of fabricated implants;
12) any endodontic treatment commencing prior to the date on which the Insured becomes insured under this provision, except as required to be consistent with the terms of the applicable Extension of Insurance on Replacement of this Policy section;
13) replacement of mislaid, lost or stolen appliances;
14) any crowns placed on teeth that are not functionally impaired by incisal or cuspal damage;
15) any crowns, dentures, and bridges for which tooth preparations were made prior to the date on which the Insured becomes insured under this provision, except as required to be consistent with the terms of the applicable Extension of Insurance on Replacement of this Policy section;
16) charges that are in excess of the fees stated in the Alberta Dental Association General Dentist Fee Guide applicable to this benefit;
17) where coverage for services is provided under any government plan;
18) where services would be provided without charge in the absence of this policy; or
19) any other exclusions identified in the policy contract.

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