Permissible Exclusions in Individual Accident and Health Policies
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This exhibit identifies exclusions that may be included in individual accident and health insurance policies under Texas law across nine policy classifications.
No material clinical or coverage changes in this revision.
Permitted Policy Exclusions
Core exclusions and health-related limitations
The following exclusions are permitted for the policy classifications listed in each row.
War, declared or undeclared, or any act thereof — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Disability Income
- Accident Only
- Specified Disease
- Specified Accident
Workmen's compensation, occupational disease, employers' liability, or similar law, unless prohibited by law — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Disability Income
- Accident Only
- Specified Disease
- Specified Accident
Suicide, sane or any attempt thereat — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Disability Income
- Accident Only
- Specified Disease
- Specified Accident
Intentionally self-inflicted injury — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Disability Income
- Accident Only
- Specified Disease
- Specified Accident
Service in armed forces, including active duty — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Disability Income
- Accident Only
- Specified Disease
- Specified Accident
Participation in a riot or insurrection — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Disability Income
- Accident Only
Mental, emotional, or functional nervous disorders without demonstrable organic disease — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
Pregnancy, childbirth — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Disability Income
- Accident Only
- Specified Disease
- Specified Accident
Complications of pregnancy, miscarriage — permitted for
- Accident Only
- Specified Disease
- Specified Accident
Routine physical exam and rest cures — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Disability Income
- Specified Disease
Dental limitations, except as necessitated by accidental injury — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
Drugs, narcotics, hallucinogens — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Disability Income
- Accident Only
- Specified Accident
Transportation, governmental coverage, and routine-service exclusions
The following table entries identify the policy classifications for which the listed exclusions are permitted.
Transportation limitations — permitted for
- Basic Hospital
- Hospital Indemnity
- Major Medical
- Specified Disease
Aircraft travel limitations; pilot or crewmember — permitted for
- Disability Income
- Accident Only
- Specified Accident
Veterans' facilities for treatment of veterans — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Major Medical
- Specified Disease
Services for which no charge is made in absence of insurance — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Specified Disease
Services covered under governmental plan — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Specified Disease
Eye refractions, eyeglasses, dentistry, dental X-rays, and similar services — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Accident Only
- Specified Disease
Accident, activity, territorial, and medical-necessity exclusions
The following exclusions are permitted only for the classifications shown.
Motorcycle use, racing contests, professional athletics, hazardous occupation, or avocations — permitted for
- Disability Income
- Accident Only
Hernia — permitted for
- Accident Only
Territorial limitations — permitted for
- Disability Income
Materials or services not recommended and approved by qualified physicians — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Accident Only
- Specified Disease
- Specified Accident
Services rendered by immediate relatives or members of the insured's family — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Disability Income
- Specified Disease
Aircraft travel limitation for family members
The final table entry separately addresses aircraft travel limitations for members of the insured's family.
Aircraft travel limitations; pilot or crewmember members of insured's family — permitted for
- Basic Hospital
- Basic Medical
- Basic Surgical
- Hospital Indemnity
- Major Medical
- Disability Income
- Specified Disease
- Specified Accident
Table Key and Policy Classifications
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