Exclusions

Like most long term care insurance plans, the Federal Program does not pay benefits for any of the following:

• illness, treatment or medical condition arising out of:
  • your participation in a felony, riot or insurrection;
  • your attempted suicide, while sane or insane; or
  • injuries you intentionally inflict on yourself;
     
• care or treatment for alcoholism or drug addiction;
   
• care or treatment provided in a government facility, including a Department of Defense or Department of Veterans Affairs facility, unless otherwise required by law;
   
• care you receive while in a hospital, except in a unit specifically designated as a nursing home or hospice facility;
   
• any service or supply to the extent the expense for it is reimbursable under Medicare or would be so reimbursable except for the application of a deductible, coinsurance or co-payment amount. (This exclusion will not apply in those instances where Medicare is determined to be the secondary payer under applicable law);
   
• services or supplies for which you are not obligated to pay in the absence of insurance; or
   
• services provided by any person who normally lived in your home at the time you became eligible for benefits.
   
• Your coverage may be reduced if a war (declared or undeclared), act of war, or act of terrorism is determined to be a “Catastrophic Event.”