$2,500 per person Emergency Medical for Unexpected Recurrence
A Pre-Existing Condition is an illness or other medical condition that was treated, diagnosed, or changed during a policy’s lookback period.
In addition to the Exclusions above, We will not pay Medical Expense Benefits, Transportation Expenses or Additional Benefits for any loss, treatment or services that is caused by, contributed by or that results from:
1. Pre-Existing Conditions, as defined.
2. chronic or recurrent Illnesses.
ADDITIONAL MEDICAL EXPENSE BENEFITS
UNEXPECTED RECURRENCE OF A PRE-EXISTING CONDITION
Benefits are payable for an Unexpected Recurrence of a Pre-Existing Condition up to the maximum as stated in the Schedule of Benefits provided the condition or event:
1. occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent and immediate medical care;
2. occurs a minimum of 48 hours after the Effective Date of the Policy; and
3.treatment is obtained within 24 hours of the sudden and unexpected outbreak or recurrence.
Any repeat/reoccurrence within the same Policy Period will no longer be considered Unexpected Recurrence of a Pre-Existing Condition and will not be eligible for additional coverage. This benefit covers only one (1) Unexpected Recurrence of a Pre-Existing Condition per Policy Period. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the Effective Date of coverage.
“Pre-Existing Condition” means any medical condition, Sickness, Injury, Illness, disease, mental Illness or mental nervous disorder, for which medical advice, diagnosis, care or Treatment was recommended or received or for which a reasonably prudent person would have sought Treatment during the 36-month period immediately preceding the Effective Date of Coverage under this Policy.
Pre-Existing shall also mean any Injury, Illness, Sickness, disease, or other physical, medical, mental or nervous disorder, condition or ailment that, with reasonable medical certainty, existed at the time of Application or at any time during the 36 months prior to the Effective Date of this insurance, whether or not previously manifested, symptomatic or known, diagnosed, Treated, or disclosed to the Company prior to the Effective Date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom.
Pre-Existing shall also include any Acute Onset of an Illness, Sickness, disease, or other physical, medical, mental or nervous disorder, condition or ailment that is an exacerbation of, due to, or associated with an underlying condition. Underlying condition shall include any condition that has been monitored by a Physician due to possible deterioration of the Covered Person’s diagnosis being changed, as a result of a previously known condition that can affect, degrade, and/or alter a Covered Person’s underlying condition, including any changes in medication.
“Acute Onset” means a sudden and unexpected outbreak or recurrence which occurs spontaneously and without advance warning.
“Unexpected Recurrence” means a sudden and unexpected outbreak or recurrence which occurs spontaneously and without advance warning.