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) 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) expenses for smoking cessation aids;
12) expenses for drugs if they are used for the treatment of infertility;
13) expenses for "in vitro" or "in vivo" procedures, or any other infertility procedures;
14) dental expenses, except those specifically provided under eligible expenses for treatment of accidental injuries to natural teeth;
15) utilization fees which are imposed by the Provincial Health Care Plan for the use of a service;
16) services required by a court, policyholder, school, or anyone other than the member's physician;
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) immunizations and vaccines (except Hepatitis B - DIN 749486 and DIN 1919431); or
19) 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) expenses for treatment of root canal therapy, inlays, onlays, crowns, veneers, and bridges started prior to becoming an insured member/dependant under this plan;
12) replacement of mislaid, lost or stolen appliances;
13) expenses for crowns, inlays, onlays and veneers placed on a tooth not functionally impaired by incisal angle or cuspal damage;
14) any charges incurred for other than metal only crowns or pontics, posterior to the second bicuspid tooth;
15) 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;
16) any services or supplies for implantology, including tooth implantation and surgical insertion of fabricated implants;
17) any dental procedure which is not listed in the descriptions of dental benefits indicated herein;
18) charges that are in excess of the fees stated in the Dental Association General Dentist Fee Guide applicable to this benefit;
19) where coverage for services is provided under any government plan;
20) where services would be provided without charge in the absence of this policy; or
21) any other exclusions identified in the policy contract.