Sample Long Term Care Insurance Policy, Page 18

SAMPLE POLICY

PART 3 - EXCEPTIONS
This part describes what care, treatment or services will be excluded under the Policy and when the benefit will not be paid.

Exceptions
This Policy does not cover care, treatment or charges:
• for intentionally self-inflicted injury.
• required as a result of alcoholism or drug addiction (unless drug addiction was a result of the
administration of drugs as part of treatment by a Physician).
• due to war (declared or undeclared) or any act of war, or service in any of the armed forces or
auxiliary units.
• due to participation in a felony, riot or insurrection.
• normally not made in the absence of insurance.
• provided by a member of Your Immediate Family, unless
• the family member is one of the following professionals -- a duly licensed registered
nurse, licensed vocational nurse, licensed practical nurse, physical therapist,
occupational therapist, speech therapist, respiratory therapist, licensed social worker,
or registered dietitian; and
• the family member is a regular employee of a Nursing Home, Assisted Living Facility,
Adult Day Center or Home Health Care Agency which is providing the services;
• the organization receives the payment for the services; and
• the family member receives no compensation other than the normal compensation for
employees in his or her job category.
• provided outside the fifty United States and the District of Columbia except as described in the
International Coverage Benefit section of this Policy.

Non-Duplication of Benefits
This Policy will only pay covered charges in excess of charges covered under any of the following:
• Medicare (including amounts not reimbursable by Medicare such as a Medicare deductible or
coinsurance amounts).
• any other governmental program (except Medicaid).
• any state or federal workers’ compensation, employer’s liability or occupational disease law, or
any motor vehicle no-fault law.

Coordination with Other John Hancock Individual long term care insurance Policies
We may reduce benefits payable under this Policy for Long-Term Care Services if We also pay
benefits for such services under any other individual long-term care policy issued by Us. This includes policies providing Nursing Home, Assisted Living Facility and/or Home Health Care coverage whether payable on an expense reimbursement, indemnity or any other basis.

Benefits will be reduced under this Policy, only when payment under this Policy and all other John Hancock individual long-term care policies combined would exceed the actual amount You incur for Long-Term Care Services. In no event will We pay under this Policy more than the difference between Your actual expenses and the amount payable by Your other policies with Us. In addition, if You are insured under more than one individual long term care insurance policy issued by Us with a similar Coordination provision, the policy with the earliest effective date of coverage will be deemed primary coverage and pay first. Thereafter, payment will be made under any additional policy (deemed secondary coverage) in order of effective date, from the earliest to the latest. Any policy without a similar Coordination provision will pay first without any reduction in its benefits.

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