EXCEPTIONS, REDUCTIONS, AND LIMITATIONS OF THE AGREEMENT Sample Clauses

EXCEPTIONS, REDUCTIONS, AND LIMITATIONS OF THE AGREEMENT. A. Maximums -

EXCEPTIONS, REDUCTIONS, AND LIMITATIONS OF THE AGREEMENT. 1) Pre-Existing Condition Exclusion Period—“Pre-Existing Condition” means any condition for which medical advice, care treatment, or diagnosis has been recommended or received from a provider within a five-year period immediately preceding the effective date of the coverage of the Covered Person. During an exclusion period of twelve (12) months following the Covered Person’s effective date, no benefits are provided under the Policy for care related to Pre-Existing Condition(s). The Pre-Existing Condition Exclusion Period will not be imposed on a newborn or adopted child, or a child placed for adoption, during the first thirty-one (31) days from the date of birth, adoption or placement for adoption, subject to the Continuation of Benefits provision of Section 8—General Provisions of the Policy. The Pre-Existing Condition Exclusion Period will not be applied thereafter provided that such child is enrolled within thirty-one (31) days from the date of birth, adoption or placement for adoption.

EXCEPTIONS, REDUCTIONS, AND LIMITATIONS OF THE AGREEMENT. 1. Pre-existing Conditions - A “Pre-existing Condition” means a condition for which medical advice or treatment was recommended by a physician or received from a physician within a five-year period preceding the effective date of coverage of the member. Benefits are not available under this Agreement for services furnished to a member for a Pre-existing Condition as defined in SECTION DE - DEFINITIONS of the Agreement, during an exclusion period of 12 months following the member’s effective date. The Pre-existing Condition Exclusion Period will not be imposed on a newborn or adopted child, or a child placed for adoption, during the first 31 days from the date of birth, adoption or placement for adoption.

EXCEPTIONS, REDUCTIONS, AND LIMITATIONS OF THE AGREEMENT. 1. Experimental/Investigative - KHPW does not cover services which it determines are experimental or investigative in nature because those services are not accepted by the medical community as effective treatments. However, XXXX acknowledges that situations exist when a patient and his or her physician agree to pursue an experimental treatment. If the member’s physician performs such experimental procedure, the member is responsible for charges for services considered to be experimental or investigative. The member or the member’s physician may contact KHPW to determine whether a service is considered experimental or investigative. See the Agreement for further explanation.

EXCEPTIONS, REDUCTIONS, AND LIMITATIONS OF THE AGREEMENT. 1. Pre-existing Conditions - During an exclusion period of 12 months following the subscriber’s effective date, no benefits are provided under the Agreement for care related to (a) Pre-Existing Condition(s). The Pre-Existing Condition exclusion period will not be imposed on a newborn or adopted child, or a child placed for adoption, during the first 31 days from the date of birth, adoption or placement for adoption.

EXCEPTIONS, REDUCTIONS, AND LIMITATIONS OF THE AGREEMENT