Exclusions
Like most long term care benefits programs, Kehilla Care 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; or
- your attempted suicide, while sane or insane; or
- injuries you intentionally inflict on yourself; or
- care or treatment for alcoholism or drug addiction; or
- care or treatment provided in a government facility, including a Department of Defense or Department of Veterans Affairs facility, unless otherwise required by law; or
- care you receive while in a hospital, except in a unit specifically designated as a nursing home or hospice facility; or
- 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 payor under applicable law); or
- 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.