No benefits are payable under this Trust Fund for charges for care, services or supplies:

• that were furnished without the recommendation and approval of a physician acting within the scope of his license;
• that are not medically necessary to the care and treatment of any existing or suspected injury, disease or pregnancy, such as but not limited to, charges for a surgical procedure or treatment performed primarily for beautification, or charges for hospital confinement for such surgical procedure or treatment;
• if payment is prohibited by law;
• that an insured person may obtain as a benefit under any governmental plan or law;
• for occupational injury or disease covered by Workplace Safety and Insurance law or similar legislation;
• for which no charge would have been made in the absence of this insurance;
• for dental work, except as provided under the Dental Care for Accidental Injury;
• for any drugs or services that are not approved by Health and Welfare Canada, or are experimental or limited in use whether or not so approved;
• for experimental procedures or treatment not approved by the Canadian Medical Association or the appropriate medical specialty society;
• for health examinations that are requested by a third party;
• for broken appointments, travel, communication costs, filling in of forms or physician’s supplies;
• which were considered an insured service of any provincial government plan at the time this benefit was issued and subsequently were modified, suspended or discontinued;
• for medical treatment or surgical procedure by a physician;
• for any services covered in whole or in part by any government plan, services for which no charge is made, or services which the insurer is not permitted by law to cover.

No amount will be paid for any charge incurred that results from or is contributed by:

• war, whether declared or not;
• insurrection, rebellion or participation in a riot or civil commotion;
• purposely self-inflicted injury; or
• the insured person’s commission of, or attempt to commit, an assault or a criminal offence.