No benefits are payable under this plan for charges for care, services or supplies:
- that were furnished without the recommendation and approval of a Physician acting within the scope of his license;
- that are not Medically Necessary, such as but not limited to, charges for a surgical procedure or treatment performed primarily for beautification, or charges for Hospital confinement for such surgical procedure or treatment;
- if payment is prohibited by law;
- that an Insured Person may obtain as a benefit under any governmental plan or law;
- for occupational injury or disease covered by Workplace Safety and Insurance law or similar legislation;
- for which no charge would have been made in the absence of this insurance;
- for dental work, except as provided under the Dental Care for Accidental Injury;
- for any drugs or services that are not approved by Health and Welfare Canada, or are experimental or limited in use whether or not so approved;
- for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical specialty society;
- for health examinations that are requested by a third party;
- for broken appointments, travel, communication costs, filling in of forms or Physician’s supplies.
- which were considered an insured service of any provincial government plan at the time this plan/benefit was issued and subsequently were modified, suspended or discontinued.
No amount will be paid for any charge incurred that results from or is contributed by:
- war, whether declared or not;
- insurrection, rebellion or participation in a riot or civil commotion;
- purposely self-inflicted injury; or
- the Insured Person’s commission of, or attempt to commit, an assault or a criminal offence.