Benefit Exclusions Sample Clauses

Benefit Exclusions. Marrriage or family counseling and other conditions may be specifically excluded on your certificate of coverage. It is your responsibility to call your insurance company to see what is covered and what services you are responsible for.
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Benefit Exclusions. No benefits shall be provided to you under this Agreement if (a) you terminate your employment with the Company whether or not you believe you have good reason for such termination, (b) you become entitled to the benefits described in Section 5(iii) of the Change in Control Severance Agreement between you and the Company, or (c) your employment terminates as a result of your death or your Disability (as defined in the Change in Control Severance Agreement).
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Benefit Exclusions. The following shall be excluded from the benefits to be provided to Subscribers and eligible Dependents. 1. Benefits or services for injuries or conditions compensable under Worker’s Compensation or Employers’ Liability laws. Form No. 1000.3 6 of 13 CONFIDENTIAL Appendix B Revised January 2022 2. Benefits or services available from any federal or state government agency; or from any municipality, county, or other political subdivision or community agency; or from any foundation or similar entity. 3. Charges for services or supplies for which no charge is made that the patient is legally obligated to pay or for which no charge would be made in the absence of dental coverage. 4. Benefits for services or appliances started prior to the date the patient became eligible under this Plan may be excluded. 5. Charges for services when a claim is received for payment more than twelve (12) months after services are rendered. 6. Charges for any professional services performed by a relative of the patient. 7. Charges for treatment by other than a properly licensed dentist (unless allowed by state law), except radiographic images (x-rays) ordered by a dentist, cleaning and scaling of teeth, and topical application of fluoride may be performed by a properly licensed hygienist if treatment is rendered under the supervision and guidance of the dentist, in accordance with generally accepted dental standards. 8. Charges for completion of forms or submission of documentation required by DDPOK for a benefit determination. Such charges are not billable to the patient when services are provided by a Delta Dental Participating Dentist. Such charges are denied if submitted by a Nonparticipating Dentist. 9. Charges for house calls, hospital calls, or office visits. 10. Charges for missed or cancelled appointments, hospitalization or additional fees charged for hospital treatment, or management fees. 11. Charges for bleaching of teeth. 12. Prescription drugs, premedications, and/or relative analgesia. 13. Experimental procedures. 14. Benefits or services for orthodontic treatment, unless specifically provided herein. 15. Charges for repair of an orthodontic appliance. 16. Charges for replacement of lost or missing crowns and appliances, or for stolen appliances. 17. Benefits or services to correct congenital or developmental malformations, for example, cleft palate, etc. Form No. 1000.3 7 of 13 CONFIDENTIAL Appendix B Revised January 2022 18. Services for the purpose of improving ap...
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Benefit Exclusions. Exclusions from Sick Leave Bank benefits include but are not limited to the following. a. Any illness, injury, or quarantine of anyone other than the Sick Leave Bank member. b. Any employee eligible for Worker’s Compensation is not eligible for Sick Leave Bank benefits. c. Once an employee is eligible for disability retirement, all Sick Leave Bank benefits will cease. d. An employee who at the time of Sick Leave Bank application is on an approved leave of absence, suspended, or terminated from SMCPS is not eligible for Sick Leave Bank benefits. e. Normal pregnancies and childbirth are not considered eligible reasons for Sick Leave Bank benefits. f. Members with available leave are not eligible for Sick Leave Bank benefits. Members must use all accumulated annual, personal, and sick leave before being eligible for leave from the bank. Members eligible for direct sick leave transfer from other employees must exhaust those options first. (Refer to appropriate negotiated agreements – CEAMC Article 8.3, d, 1, 5th bullet – EASMC Article VIII, C, 1, a, 5 – SMASA Article VIII, C, 1 and Article VIII, C, 1, a, 5.) g. Donated sick leave granted in one school year cannot be carried over and used in a subsequent school year. Unused Sick Leave Bank days will be returned to the bank. h. A member who is receiving benefits from the Sick Leave Bank may not work secondary employment. To do so will result in immediate termination of Sick Leave Bank benefits and revocation of any previously granted days.
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Benefit Exclusions. Covered Expenses will not include, and no payment will be made for the following: Procedures and services not included in the list of covered dental expenses;
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Benefit Exclusions. Unless specified in the Benefits Schedule/Table of Benefits, or in any written endorsement, or agreed by Alliance Health in writing, no claim can be made for compensation or payment for damage or expenses caused by or as a result of the following: Abuse of Alcohol or Any Other Substance Whether Controlled or Not: Treatment for alcoholism, narcotics, drug and substance abuse/dependency or any addictive condition of any kind and any injury or illness arising from the Insured Person being under the influence of alcohol, drugs or any other intoxicating substance, including medicines prescribed by a medical Doctor or Consultant. Including treatment for smoking, or to give up smoking. General treatment of any withdrawal symptoms brought on by a prior addiction. Acting Against Medical Advice: Failing to follow instructions or advice given to you by your family doctor, a general practitioner, specialist or therapist in regard of your diet, your exercise or any other factors. Allergic Conditions and Disorders: Desensitising, or neutralising treatment for any allergic condition.
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Benefit Exclusions. Subject to provisions to the contrary in the supplementary terms, no benefits for medical expenses and/or daily benefits are paid in the following cases: • Cost shares and benefit reductions under other insur- ance policies • Conditions existing prior to the effective date of the contract • Treatment and measures that are not effective, expe- dient or economical; the effectiveness of the treatment or measure must be scientifically proven • Interventions to remedy or improve physical defects and disfiguration, unless made necessary by an in- sured event • Treatment aimed at self-fulfilment, self-development or personality development or other purposes that do not involve the treatment of an illness • Weight reduction programmes, dietary advice, strengthening therapy, cellular therapy • Dental treatment, except in connection with compul- sory benefits under mandatory basic health insurance pursuant to the Swiss Federal Health Insurance Act (KVG/XXXxx) • Measures ordered by a judicial or administrative au- thority (therapy instead of a prison sentence, alcohol tests, etc.) • Consequences of riots, terrorist acts, crimes or of- fences of any type and measures implemented to counteract them, unless the insured can prove that he did not actively participate on the side of the perpetra- tors or incite them to further violence • Treatment during foreign military service and/or fol- low-up treatment • Illness and accidents as a consequence of acts of war – in Switzerland – in another country, unless the illness or accident oc- curs within a period of 14 days from the first out- break of warlike activities in the country in which the insured person is staying and he was taken by sur- prise by the outbreak of warlike activities while stay- ing there – For expatriates and insured persons who are work- ing abroad for a short period (up to 12 months) on behalf of their employer, coverage also extends to accidents that are the consequence of acts of war, provided that the insured person did not actively participate in or incite these acts or intentionally travel to the war zone. Sanitas may temporarily or permanently suspend this ad- ditional coverage for specific countries subject to notice of fourteen days.
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Benefit Exclusions. No benefits shall be provided to you under this Agreement if (a) you terminate your employment with the Company whether or not you believe you have good reason for such termination, (b) your employment terminates as a result of your death or your Total and Permanent Disability (as defined in the ESRIP), or (c) you become entitled to the Change in Control Severance Benefit (as defined in the ESRIP).
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Related to Benefit Exclusions

  • Service Exclusions All of an Employee's years of Service with the Employer shall be counted to determine the vested interest of such Employee except:

  • Warranty Exclusions The Limited Warranty in clauses 1.2 and 1.3 does not apply: a) if the Product was not purchased and installed in Australia; b) if You do not grant BYD or BYD Partner access to the performance data of the Product over the Internet upon request after reporting the warranty claim and/or manipulate such data; c) to wear and tear in the appearance of the Product (including but not limited to any scratches, stains, mechanical wear, rust or mould) which does not impair its function; d) to any damage to property or personal injury arising from any defect if the state of scientific and technical knowledge at the time when the Product is sold to Original Buyer was not such as to enable the defect to be discovered; e) if the invoice for the Product and the information listed in clause 4 below is not provided with the warranty claim; or f) if the serial number on the Product can no longer be identified or has been modified.

  • Additional Exclusions A Receiving Party will not violate its confidentiality obligations if it discloses the Disclosing Party’s Confidential Information if required by applicable laws, including by court subpoena or similar instrument so long as the Receiving Party provides the Disclosing Party with written notice of the required disclosure so as to allow the Disclosing Party to contest or seek to limit the disclosure or obtain a protective order. If no protective order or other remedy is obtained, the Receiving Party will furnish only that portion of the Confidential Information that is legally required, and agrees to exercise reasonable efforts to ensure that confidential treatment will be accorded to the Confidential Information so disclosed.

  • DISCLAIMERS; EXCLUSIONS; LIMITATIONS Subject to §4, neither party makes any warranties (express, implied, or otherwise), including implied warranties of merchantability, non-infringement, fitness for a particular purpose, or title, related to its performance or anything else provided under this Agreement. Neither party will be liable for any special, incidental, punitive, or consequential damages of any kind for any reason whatsoever relating to this Agreement, even if such damages were reasonably foreseeable.

  • Specific Exclusions Apart from the exclusions common to all covers, the following are also excluded. We do not intervene for: EMERGENCY SUITCASE DOMESTIC HELP DELIVERY OF HOUSEHOLD SHOPPING PSYCHOLOGICAL SUPPORT UPON YOUR RETURN HOME To allow us to intervene under the best conditions, remember to prepare the following information that will be requested when you call: When you call initially, you will be given an assistance file number. State it systematically during any subsequent contacts with our Assistance Service. - the policy came with the purchase of goods or a service sold by a supplier; - you can show that you are already covered for one of the risks covered by this new policy; - the policy you wish to cancel has not been fully established; - you have not declared any loss covered by this policy. In this situation, you can exercise your right to cancel this policy by letter or in any lasting medium sent to the insurer of the new policy, together with documentary proof that you already have cover for one of the risks covered by this new policy. The insurer must reimburse you the premium paid within thirty days of your cancellation. If you wish to cancel your policy but do not meet all the above conditions, please check the cancellation procedure stipulated in your policy.

  • Benefit Eligibility For purposes of the Benefit Plan entitlement, common-law and same sex relationships will apply as defined.

  • Benefit Level The primary care clinics available through each plan administrator are assigned a Benefit Level. The Benefit Levels are outlined in the benefit chart below. Primary care clinics may be in different Benefit Levels for different plan administrators. Family members may be enrolled in clinics that are in different Benefits Levels. Employees and their dependents may change to clinics in different Benefit Levels during the annual open enrollment. Employees and their dependents may also elect to move to a clinic in a different Benefit Level within the same plan administrator up to two (2) additional times during the plan year. Unless the individual has a referral from his/her primary care clinic, there are no benefits for services received from providers in Benefit Levels that are different from that of the primary care clinic in which the individual has enrolled.

  • GENERAL EXCLUSIONS We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss. These exclusions apply whether or not the loss event results in widespread damage or affects a substantial area.

  • Indemnity Limitation for TIPS Sales Texas and other jurisdictions restrict the ability of governmental entities to indemnify others. Vendor agrees that if any "Indemnity" provision which requires the TIPS Member to indemnify Vendor is included in any TIPS sales agreement/contract between Vendor and a TIPS Member, that clause must either be stricken or qualified by including that such indemnity is only permitted, "to the extent permitted by the laws and constitution of [TIPS Member's State]” unless the TIPS Member expressly agrees otherwise. Any TIPS Sale Supplemental Agreement containing an "Indemnity" clause that conflicts with these terms is rendered void and unenforceable.

  • Acts of Terrorism Exclusion With respect to each Mortgage Loan over $20 million, as of origination the related special-form all-risk insurance policy and business interruption policy (issued by an insurer meeting the Insurance Rating Requirements) do not specifically exclude Acts of Terrorism, as defined in the Terrorism Risk Insurance Act of 2002, as amended by the Terrorism Risk Insurance Program Reauthorization Act of 2007 and the Terrorism Risk Insurance Program Reauthorization Act of 2015 (collectively referred to as “TRIPRA”), from coverage, or if such coverage is excluded, it is covered by a separate terrorism insurance policy. With respect to each Mortgage Loan, the related Mortgage Loan documents do not expressly waive or prohibit the Mortgagee from requiring coverage for Acts of Terrorism, as defined in TRIPRA, or damages related thereto, except to the extent that any right to require such coverage may be limited by commercial availability on commercially reasonable terms, or as otherwise indicated on Schedule C; provided, that if TRIPRA or a similar or subsequent statute is not in effect, then, provided that terrorism insurance is commercially available, the Mortgagor under each Mortgage Loan is required to carry terrorism insurance, but in such event the Mortgagor shall not be required to spend on terrorism insurance coverage more than two times the amount of the insurance premium that is payable in respect of the property and business interruption/rental loss insurance required under the related Mortgage Loan documents (without giving effect to the cost of terrorism and earthquake components of such casualty and business interruption/rental loss insurance) at the time of the origination of the Mortgage Loan, and if the cost of terrorism insurance exceeds such amount, the Mortgagor is required to purchase the maximum amount of terrorism insurance available with funds equal to such amount.

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