This plan does not provide benefits for the following:

• Care specifically provided for detoxification of or rehabilitation for alcohol or drug abuse (chemical dependency), except drug abuse sustained at the hands of or while being treated by a Physician for an injury or sickness.
• Any service or supply received outside the United States or its territories.
• Illness, treatment or medical condition arising out of:
• war or act of war (whether declared or undeclared)
• participation in a felony, riot or insurrection
• service in the armed forces or auxiliary units
• attempted suicide (while sane or insane) or intentionally self-inflicted injury
• aviation (this applies only to non-fare paying passengers).
• Treatment provided in a government facility, unless otherwise required by law.
• Any care provided while in a hospital, except for confinement in a distinct part of a hospital which is licensed as a nursing home or hospice.
• Any service provided by your immediate family, unless the service is a covered service from an informal caregiver.
• Any service or supply to the extent that such expenses are reimbursable under Medicare, or would be reimbursable but for the application of a deductible, coinsurance or copayment amount. This exclusion will not apply in those instances where Medicare is determined to be secondary payor under applicable law.
• Services for which no charge is normally made in the absence of insurance.

Concurrent Review

While you receive covered services, MetLife reviews your condition to determine whether the authorization for benefits can be continued. This review may require that MetLife examine your medical records or request additional information from your doctor or other care provider. You and your doctor will be notified if MetLife made a determination to change your benefit eilgibility.

Changing Your Selections

The plan permits you to increase or decrease your daily benefit amounts. You must apply to MetLife, who will notify you if the changes are approved, what your change in premium will be and when the change becomes effective.

Inflation Increases

At least once every three years, you can increase your daily benefit amount by a specified dollar amount to protect against inflation. You may make this change without providing a statement of health as long as you have accepted this offer at least once during the last two consecutive offerings.

Reinstatement

If your coverage ends because you fail to pay the required premium, your coverage may be reinstated within 12 months of the date coverage ended if you submit all past due contributions, along with proof of good health to MetLife.

However, if you can prove that you didn't pay your premium due to a cognitive impairment or loss of functional capacity, you can request reinstatement within 5 months of the date coverage ended by paying all past due premiums. In this situation, you will not have to submit proof of good health to have your coverage reinstated.