Generally, the terms and conditions under which an insurance policy will not pay benefits:
Conditions for which a group life insurance or AD&D policy will not pay benefits:
Benefits are not paid for Losses caused directly or indirectly, wholly or partly by:
1. Physical or mental disease, pregnancy, hernia, or ptomaine;
2. Medical or surgical treatment, except surgical treatment required by the accident and performed within 90 days of the accident;
3. Infections, except those occurring through a wound at the time of the accident;
4. Suicide or intentionally self-inflicted injury, whether sane or not;
5. War or act of war, declared or not, civil or international;
6. Injury while riding in any aircraft not licensed to carry passengers or not operated by a duly licensed pilot;
7. Injury while acting as a pilot, student pilot, crew member, flight instructor, or examiner on any aircraft;
8. Committing, or attempting to commit, an assault, felony or any criminal offense, or active participation in a riot;
9. Voluntary use of any controlled substance as defined by statute, unless used as directed by a physician;
10. Operation by the insured of a automobile or boat if at the time of injury, the insured’s blood alcohol concentration exceeded the legal limit; or
11. Overdose of any medication if not taken as prescribed by a physician.
Conditions for which a long term care insurance policy will not pay benefits. Such conditions frequently include any loss of ADLs or cognitive impairment caused by the following:
1. A war or act of war
2. Self-inflicted injuries or attempted suicide
3. Commission of a crime or attempting to commit a crime
4. Psychological or mental conditions that are usually treated using psychotherapy, psychotropic drugs, or similar methods of treatment.
Long term care policies also typically exclude coverage for any period during which the insured is outside the United States and any period of hospitalization. However, long-term care policies may not exclude coverage for pre-existing conditions.