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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 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 incurred due to committing a criminal offense or provoking an assault;
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) expenses for drugs which, in the insurer's opinion, are experimental;
8) expenses for dietary supplements, vitamins and infant foods;
9) expenses for contraceptives (other than oral);
10) expenses for smoking cessation aids;
11) expenses for drugs if they are used for the treatment of infertility;
12) expenses for "in vitro" or "in vivo" procedures, or any other infertility procedures;
13) dental expenses, except those specifically provided under eligible expenses for treatment of accidental injuries to natural teeth;
14) utilization fees which are imposed by the Provincial Health Care Plan for the use of a service;
15) preventative immunization vaccines and toxoids; or
16) 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, treatment or supplies primarily for cosmetic purposes;
8) failing to keep scheduled appointments;
9) file transfers, the completion of claim forms or other documentation;
10) any dental treatment for the correction of temporomandibular joint dysfunction;
11) replacement of mislaid, lost or stolen appliances;
12) expenses for full mouth reconstructions for vertical dimension correction or to repair or restore teeth damaged or worn due to attrition or vertical wear or to restore occlusion;
13) any services or supplies for implantology, including tooth implantation and surgical insertion of fabricated implants;
14) any dental procedure which is not listed in the descriptions of dental benefits indicated herein;
15) charges that are in excess of the fees stated in the Dental Association General Dentist Fee Guide applicable to this benefit;
16) where coverage for services is provided under any government plan;
17) where services would be provided without charge in the absence of this policy; or
18) any other exclusions identified in the policy contract.

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