LIMITATIONS
Please see the Master Policy or your evidence of insurance coverage for individual state details.
1. Sentry will pay 80% of the Covered Charges, not to exceed the Reasonable and Customary charges, for surgical procedures. Benefits will not exceed the plan benefit limits. Surgical benefits include all
Doctor charges before and after surgery. Doctor nonsurgical treatment benefits are not payable for pre- or
post-operative care. Consultant Doctor Services are paid in addition to surgical benefits.
2. Benefits are limited to that part of such expense which is in excess of all benefits payable by any: (a) insurance company; (b) trust; (c) medical pre-payment plan covering the Insured; (d) government operated insurance plan or program, except Medicaid; (e) ERISA or other self-insured plans. This will not apply to Medicare eligible
Insureds.
3. Benefits for Doctor nonsurgical treatment primarily involving Physiotherapy are limited to a maximum of
five visits for each Accident or each Sickness.
4. Benefits for Doctor nonsurgical treatment begin with the first visit when Hospital Confined; or for
out-patient treatment for an Accident. The first visit for out-patient treatment of a Sickness is not covered. Benefits are limited to one treatment per day.
5. Accident benefits are paid only if treatment begins within 30 days after the date of the
Accident.
6. Benefits for accidental injury to Sound Natural Teeth are payable only if injury comes from outside the mouth. Breaking a tooth while eating is not covered.
7. Benefits for accidental injury to Sound Natural Teeth are limited to that part of such expense which is in excess of all benefits payable by any Amendatory Rider adding Dental
Coverage to
the Policy.
8. Benefits for the treatment of alcoholism, drug abuse, chemical
dependency or Mental Disorders are subject to certain limitations, unless
excluded.
9. Repatriation benefits are payable only if loss occurs while covered under the
Policy.
10. Each preventive cancer screening procedure is limited to one per consecutive 52 week period. Benefits will not be paid for the charge of the office visit.