Arizona accident insurance limitations and exclusions
Covered conditions and related limitations, exclusions, and reductions1
Burn2 – must be diagnosed and treated by a physician within 72 hours; 150% of the benefit is payable if the burn requires a skin graft performed within 90 days; excludes 1st degree burns; there are 4 benefit levels based on the degree and extent of the burns.
Coma2 – must be diagnosed and treated by a physician within 30 days, last 15 or more consecutive days and require intubation for respiratory assistance; excludes medically-induced comas.
Concussion2 – must be diagnosed and treated by a physician using a medical imaging procedure within 72 hours.
Dental Injury2 – a broken tooth requiring extraction or repair with a crown, implant or denture must be treated by a dentist within 60 days; excludes injuries to teeth that are not sound, natural teeth and injuries caused by biting or chewing.
Dislocation3 – must be diagnosed, treated, and require correction with anesthesia by a physician within 90 days; the benefit varies based on the affected joint and whether it requires open (surgical) or closed (non-surgical) reduction; 25% benefit if physician corrects without anesthesia; 25% benefit for partial dislocation; for multiple dislocations due to the same accident, the policy pays a maximum of 200% of the dislocation with the highest benefit; subsequent dislocations of the same joint are excluded.
Eye Injury With Surgical Repair2 – must be diagnosed and treated by a physician within 90 days; excludes exams and injuries which involve only the eyelid.
Fracture4 – must be diagnosed and treated by a physician within 90 days; the benefit varies based on the location and whether it requires open or closed reduction; 25% benefit If chip fracture; the policy pays one benefit per bone, per accident; for multiple fractures due to the same accident, the policy pays a maximum of 200% of the fracture with the highest benefit; if benefits were paid for a fracture, any new claim for a fracture is payable only if it is the result of a separate and distinct accident that occurs after the previous fracture is completely healed.
Injuries Not Specifically Listed2 – must be diagnosed and treated by a physician within 30 days; pays 200% if it requires surgical repair.
Internal Injury2 – must be diagnosed and treated by a physician within 72 hours; excludes exploratory surgery without repair and injuries related to a hernia; pays 200% if requires surgical repair.
Knee Cartilage Injury With Surgical Repair2 – must be diagnosed and treated by a physician within 60 days and surgically repaired by a physician within 365 days of the accident; excludes exploratory surgery without repair.
Ruptured Disc With Surgical Repair2 – must be diagnosed and treated by a physician within 60 days and surgically repaired by a physician within 365 days; excludes exploratory surgery without repair.
Tendon / Ligament / Rotator Cuff Injury With Surgical Repair – must be diagnosed and treated by a physician within 60 days and surgically repaired by a physician within 365 days; excludes exploratory surgery without repair; pays up to two benefits per accident.
Bodily injuries must result directly from an accident and be wholly independent of sickness, disease, bodily infirmity and other causes. The injury must be incurred while insured under this policy. All time limits for diagnosis, treatment, and surgical repair are from the time or date of the accident.
If a benefit is paid for an injury and the covered person later qualifies for a higher benefit for the same accident, we’ll pay the appropriate benefit less any amount previously paid.
General limitations and exclusions
Benefits not paid for injuries caused indirectly or directly by, contributed to, or resulting from willful self-injury or self-destruction, while sane or insane; voluntary participation in an auto-erotic activity; war or act of war; voluntary participation in an assault, felony, criminal activity, insurrection, or riot; duty as a member of a military organization; injuries diagnosed outside of the United States unless the diagnosis can be confirmed by a physician in the United States; the use of any drug, narcotic, hallucinogen, or other controlled substance not prescribed for the covered person by a physician, or if prescribed, not used in a manner consistent with that prescription, directly or indirectly; deliberate use of poison, gas, fumes, or household items (such as aerosols), whether by ingestion, injection, inhalation or absorption; intoxication (a covered person will be considered intoxicated when their blood alcohol level exceeds the legal limit used for operating a motor vehicle in the jurisdiction in which the covered accident occurs regardless of whether they were actually operating a motor vehicle or not); sickness, disease, medical or surgical treatment of disease, or complications following the surgical treatment of disease; operating, learning to operate, or serving as a crew member or flight for life personnel of any aircraft or hot air balloon except as a crew member in a policyholder owned or leased aircraft on company business; jumping, parachuting, or falling from any aircraft or hot air balloon, including those which are not motor-driven; parasailing, bungee jumping or other aeronautic activities; riding in or driving any motor driven vehicle in a race, stunt show or speed test; any dental injury that occurs from biting or chewing; practicing for or participating in any semi-professional or professional competitive athletic activity, including officiating or coaching, for which any type of compensation or remuneration is received; and any injury to a dependent child received during child birth.
Employee coverage may exclude injury arising from or during employment for wage or profit (on-the-job). Coverage for spouses (if offered) excludes on-the-job injuries. Check with your employer regarding these provisions.
No benefits will be paid for any injury incurred while residing outside the United States for more than six months; incurred while incarcerated in any type of penal or detention facility; or for which proof is submitted by a physician who is part of the covered person’s immediate family.
1 Refer to the policy for definitions applicable to all terms used in this document, and for other applicable terms and conditions, and relevant clinical and diagnostic criteria. Proof of diagnosis and submission of medical records are required. Claim procedures must be satisfied. Limitations and exclusions must not apply.
2 Limit of one benefit per injury type per accident.
3 Includes dislocation of the ankle, collarbone, elbow, foot (excludes toes), hand (excludes fingers), hip, knee, lower jaw, shoulder, and wrist.
4 Includes fracture of the ankle, arm, collarbone, elbow, facial bones, foot (excludes toes), hand (excludes fingers), hip, jaw, knee cap, lower leg (fibula, tibia), pelvis, rib, shoulder blade, skull (depressed), skull (non-depressed), sternum, tailbone (coccyx), thigh (femur), vertebrae, vertebral processes, and wrist.
ACCIDENT INSURANCE PROVIDES LIMITED BENEFITS. This summary is not an insurance contract or a complete statement of its provisions. It does not modify or change the provisions of any policy or rider. If there is a discrepancy, the policy is the final arbiter of the coverage. For cost and coverage details, contact your Principal® financial representative.
Accident insurance from Principal® is issued by Principal Life Insurance Company, Des Moines, IA 50392.