EXCLUSIONS FROM COVERED MEDICAL SERVICES. This Contract expressly excludes coverage and expenses for the following services. These Exclusions are in addition to any Exclusions specified in Part IX. COVERED MEDICAL SERVICES and any Limitations specified in Part X. LIMITATIONS OF COVERED MEDICAL SERVICES.
11.1 General Exclusions include expenses for:
a. services received prior to your effective date or after the date your coverage terminates;
b. services not within the categories described in Part IX. COVERED MEDICAL SERVICES and any amendments attached hereto, unless such services are specifically required to be covered by applicable law;
c. services which are not Medically Necessary, as defined in this Contract, and as determined by AvMed;
d. services provided by a Physician or other Health Care Provider related to you by blood or marriage;
e. services beyond the scope of practice authorized for a Health Professional under applicable state law;
f. services rendered at no charge;
g. services to diagnose or treat any Condition which initially occurred while you were (or which directly or indirectly resulted from, or is connection with you being) under the influence of any chemical substance set forth in Section 877.111, Florida Statutes, or any substance controlled under Chapter 893, Florida Statutes or, with respect to such statutory provisions, any successor statutory provisions. Notwithstanding, this Exclusion will not apply to the use of any Prescription Medication by you if such medication is taken on the specific advice of a Physician in a manner consistent with such advice;
h. services rendered by or through a medical or dental department maintained by or on behalf of an employer, mutual association, labor union, trust, or similar person or group;
i. services to diagnose or treat a Condition which, directly or indirectly, resulted from or is in connection with your participation in, or commission of, any act punishable by law as a misdemeanor or felony whether or not you are charged or convicted; or which constitutes riot or rebellion; or your engaging in an illegal occupation. Coverage will be available if a Member demonstrates that an injury resulted from an act of domestic violence or a Condition, whether or not the Condition was diagnosed before the occurrence of the injury.
j. any expenses for Claims denied because we did not receive information requested from you about whether or not you have other coverage (including personal injury protection motor vehicle insurance (PIP) or supplemen...
EXCLUSIONS FROM COVERED MEDICAL SERVICES. If a Member does not follow the access rules described herein, he risks having the services and supplies received not covered under this Contract.
EXCLUSIONS FROM COVERED MEDICAL SERVICES.
11.1 General Exclusions include expenses for:
a. services received prior to your Effective Date or after the date your coverage terminates;
b. services not within the categories described in Part IX. COVERED MEDICAL SERVICES and any amendments attached hereto, unless such services are specifically required to be covered by applicable law;
c. services which are not Medically Necessary, as defined in this Contract, and as determined by AvMed;
d. services provided by a Physician or other Health Care Provider related to you by blood or marriage;
e. services beyond the scope of practice authorized for a Health Professional under applicable state law;
f. services rendered at no charge;
g. services to diagnose or treat any Condition which initially occurred while you were (or which directly or indirectly resulted from, or is connection with you being) under the influence of alcoholic beverages, any chemical substance set forth in Section 877.111, Florida Statutes, or any substance controlled under Chapter 893, Florida Statutes or, with respect to such statutory provisions, any successor statutory provisions. Notwithstanding, this Exclusion will not apply to the use of any Prescription Medication by you if such medication is taken on the specific advice of a Physician in a manner consistent with such advice;
h. services rendered by or through a medical or dental department maintained by or on behalf of an employer, mutual association, labor union, trust, or similar person or group;
i. services to diagnose or treat a Condition which, directly or indirectly, resulted from or is in connection with your participation in, or commission of, any act punishable by law as a misdemeanor or felony whether or not you are charged or convicted; or which constitutes riot or rebellion; or your engaging in an illegal occupation. Coverage will be available if a Member demonstrates that an injury resulted from an act of domestic violence or a Condition, whether or not the Condition was diagnosed before the occurrence of the injury.
j. any expenses for Claims denied because we did not receive information requested from you about whether or not you have other coverage (including personal injury protection motor vehicle insurance (PIP) or supplemental insurance plans) and the details of such coverage.
11.2 Aids or devices that assist with nonverbal communications, including communication boards, pre- recorded speech devices, laptop computers, desktop computers, personal digital assis...
EXCLUSIONS FROM COVERED MEDICAL SERVICES. This Contract expressly excludes coverage and expenses for the following services. These Exclusions are in addition to any Exclusions specified in Part IX. COVERED MEDICAL SERVICES and any Limitations specified in P art X. LIMITATIONS OF COVERED MEDICAL SERVICES.
