What is not covered
This insurance does not cover injuries, nor does it cover any disease or sickness other than cancer. It does not pay benefits for cancer that was first diagnosed within 30 days of your insurance effective date (time limit does not apply in AZ or CA), nor does it pay for cancer first diagnosed when the insurance was not in force.
“Cancer” means a sickness classified as carcinoma, sarcoma, leukemia, lymphoma, or malignant tumor. It does not include conditions considered precancerous, such as leukoplakia, carcinoid, hyperplasia, polycythemia, nonmalignant melanoma, moles, or similar diseases or lesions. Cancer must be diagnosed by a physician duly licensed and legally qualified to diagnose and treat cancer. (You cannot be that person.)
Benefits are payable for confinement in any licensed and accredited hospital. Hospital benefits are not payable for confinement in a hospital or institution or a part of such hospital or institution which is licensed or used principally for the treatment or care of drug addicts or alcoholics, or as a continued or extended care facility, skilled nursing facility, convalescent home, nursing or rest home or home for the aged.
Cancer Clinical Trial Benefits
Special note to CA residents: Benefits for therapeutic intent cancer clinical trials will be paid in the same manner as other covered services. Benefits payable under more than one provision of your coverage will be paid only under the one providing the greater benefit. Benefits are not payable for clinical trial drugs or devices not approved by the Federal Food and Drug Administration, non-health care services, items or services used solely for data collection and analysis and not for patient clinical management, services excluded under your coverage or provided free by research sponsors.
Off Label Drug Benefits
Special note to residents of MO, OH, TN: Drugs not approved by the FDA for a particular indication (in MO, for treatment of a specific type of sickness), will be paid on the same basis as any other covered drug, provided the drug is recognized as effective for the treatment for that indication.
We will not pay for any drug when the FDA has determined its use to be not recommended for this treatment or experimental drugs not otherwise approved for any indication by the FDA. In MO, and TN, we also will not pay for any drug not approved by the FDA.