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Gap Exclusions and Limitations

Exclusions
The policy does not provide any benefits for the following:
1. Any expenses incurred during any period the Insured does not have B. By evidence of an alcohol concentration in the insured person’s
coverage under a qualifying major medical employer plan; blood, breath or urine which equals or exceeds the limits set by
2. Suicide or any attempt thereat, while sane or insane (in Colorado or applicable motor vehicle laws; or
Missouri, while sane); C. By other evidence demonstrating the insured person was under the
3. Any intentionally self-inflicted injury or sickness, while sane or insane (in influence of any alcohol, narcotic, barbiturate or hallucinatory drug,
Colorado or Missouri, while sane); unless the same was administered on the advice of a Physician and
4. Rest care or rehabilitative care and treatment; was taken according to the prescribed dosage; and the use of such
substance was a proximate cause of the Injury;
5. Voluntary abortion except, with respect to the insured or the insured’s
dependent spouse: 12. Alcoholism; or drug use, unless administered on the advice of a physician
and was taken according to the prescribed dosage;
A. Where the insured’s or the insured’s dependent spouse’s life would
be endangered if the fetus were carried to term; or 13. Procedures associated with sex changes;
B. Where medical complications have arisen from abortion; 14. Any treatment, drugs or surgery considered experimental by the
American Medical Association, the Health Care Finance Administration
6. Pregnancy of a dependent child, except complications of pregnancy; or the Federal Drug Administration;
7. Any injury or sickness as a result of participation in a riot, civil 15. Any loss while the insured person is in the service of the armed forces
commotion, civil disobedience or unlawful assembly. This does not of any country. Orders to active military service for training purposes
include a loss, which occurs while acting in a lawful manner within the of two months or less will not constitute service in the armed forces.
scope of authority. For purposes of this exclusion, “participation” means Upon notice to the company of entering the armed forces, the company
to take an active part in common with others; “riot” means any use or will return to the insured person pro rata any premium paid, less any
threat to use force or violence or disturbance by three or more persons benefits paid, for any period during which the insured person is in such
without authority of law; service;
8. An insured person engaging in any act or occupation which is a violation 16. Injury or sickness for which compensation is payable under any workers’
of the law of the jurisdiction where the loss or cause of loss occurred. compensation law, any occupational disease law or similar legislation;
A violation of law includes both misdemeanor and felony violations; 17. Mental illness or functional or organic nervous disorders, regardless of
9. Participation in a contest of speed in power driven vehicles, parachuting, the cause;
parasailing, bungee jumping, scuba diving, stunt driving, rock climbing, 18. Dental or vision services, including, but not limited to, treatment,
flying ultra-light aircraft, skydiving, hang gliding or any hazardous sports surgery, extractions or x-rays, unless:
activity for exhibition purposes; A. Resulting from an injury occurring while the insured person’s
10. Injury or sickness as a result of air travel, except; coverage under the policy is in force and if performed within 12
A. As a fare-paying passenger on a commercial airline on a regularly months of the date of such accident; or
scheduled route; or B. Due to congenital disease or anomaly of a dependent newborn
B. As a passenger for transportation only and not as a pilot or crew child;
member; 19. Routine examinations, (other than well child examinations if the
11. Any injury that occurs while an insured person has been determined to Physician Office Visit Benefit is elected by the employer) such as health
be intoxicated: exams, periodic check-ups or routine physicals; or
A. By judicial or administrative judgment or order; Any expense for which benefits are excluded under the insured person’s
qualifying employee plan.

*Not available in all states, some provisions, benefits or exclusions may vary by state.
Policy No. MG-133/MG-134
Policy Form No. M-9081/M-9082

Policies marketed by Reserve National Insurance Company, a subsidiary or Kemper Corporation.
Policies Issued by Fidelity Security Life Insurance Company (FSL):
FSL is the insurance company underwriting the Kemper Health Gap plan. FSL is located in Kansas City, Missouri, and has been rated “A-” (Excellent) based on an analysis
of financial position and operating performance by A.M. Best Company, an independent analyst of the insurance industry. For the latest rating, access www.ambest.com.
In case of conflict between this brochure, the certificate of insurance and the Master Policy, the language of the Master Policy is overriding.
A sample Master Policy is available upon request. Please verify state availability at the time of sale. Group Master Policy No: MG-158/MG-159/MG-160.
Policy Form No: M-9134/M-9135. Form numbers may vary by state.
Kemper Health, kemperbenefits.com, is part of Kemper Corporation (NYSE: KMPR) is one of the nation’s leading, with subsidiaries that provide an array of products to
the individual and business markets.
This is only a summary of products and services offered. Actual offerings may vary by group size and other underwriting considerations, and are subject to the
requirements of state insurance laws and regulations, and the benefits/provisions as described may vary due to such requirements. All products are subject to the
terms, conditions, limitations and exclusions of the specific policy. Please see the specific policy and certificate for details. Policies are not available in all states.
The Kemper Health insurance plans, either alone or in combination with each other, are not “minimum essential coverage” under the federal Affordable Care Act.
IMPORTANT: If an individual is insured under one or more Kemper Health insurance plans, and is also covered by Medicaid or a state variation of Medicaid, most
non-disability benefits are automatically assigned according to state regulations. This means that instead of paying the benefits to the insured individual, we must pay
the benefits to Medicaid or the medical provider to reduce the charges billed to Medicaid. Proposed insureds should consider their circumstances before enrolling in
Kemper Health coverage.
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