Exclusions

For the Medical Expense, Emergency Medical Evacuation, Repatriation of Remains, Emergency Reunion and Home Country benefits, no benefit shall be payable with respect to expenses incurred:

1.  For pre-existing conditions defined as an Sickness, disease or other condition of the covered person, that in the 12-month period before the covered person’s coverage became effective under the Policy: 1) first manifested itself, worsened, became acute or exhibited symptoms that would have caused a person to seek diagnosis, care or treatment; or 2) required taking prescribed drugs or medicines, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or 3) was treated by a doctor or treatment had been recommended by a doctor.  However, this limitation will not apply if the Covered Person was previously covered for such pre-existing condition under Creditable Coverage and such Creditable Coverage was continuous to a date less than 63 days prior to the effective date of coverage under the Policy.  “Creditable Coverage” means: 1) a self-funded employer group health plan under ERISA; 2) a group or individual health Insurance coverage; 3) Part A or Part B of Medicare; 4) Medicaid; 5) CHAMPUS; 6) the Indian Health Service of a tribal organization; 7) a state health benefits risk pool; 8) a health plan offered under the federal employees health benefits program (FEHBP); 9) a public health plan; or 10) a health benefit plan. (This pre-existing condition exclusion does not apply to the Emergency Medical Evacuation, Emergency Reunion, or Repatriation of Remains Benefits.);

2.  For services, supplies, or treatment, including hospital confinement, which were not recommended, approved and certified as necessary and reasonable by a doctor; or expenses which are non-medical in nature;

3.  For suicide or attempted suicide, while sane or insane;

4.  For loss incurred as a result of war or any act of war, whether declared or not;

5.  For loss incurred as a result of the covered person’s commission of, or attempt to commit, an assault or a felony;

6.  a) For injury sustained while participating in an amateur, club, intramural, interscholastic or intercollegiate sport; b) For injury sustained while participating in a professional or semi-professional sport;

7.  For loss incurred as a result of pregnancy, childbirth, or miscarriage, or any complications of any of these conditions;

8.  For routine physicals;

9.  For cosmetic or plastic surgery; except as the result of an Injury;

10. For elective surgery;

11. For any mental and nervous disorder or rest cures;

12. For dental care except as the result of Injury to natural teeth caused by an accident;

13. For eye refractions or eye examinations for the purpose of prescribing corrective lenses or for the fitting thereof, unless caused by accidental bodily injury incurred while insured under the Policy;

14. In connection with alcoholism or drug addiction; or the use of any drug or narcotic except as prescribed by a doctor;

15. For expenses as a result of, or in connection with, intentionally self inflicted injury;

16. For specific named hazards: motorcycling; scuba diving; jet, snow, and water skiing; mountain climbing (where ropes or guides are normally used); sky diving; amateur racing; piloting an aircraft; bungee jumping; spelunking; whitewater rafting; surfing; parasailing;

17. For treatment furnished under any government program or facility set up for treatment without cost to any individual;

18. For treatment by a family member;

19. For treatment relating to birth defects and congenital conditions, or complications arising from those conditions;

20. For treatment of sexually transmitted diseases or immune deficiency disorders and related conditions. This exclusion does not apply to the care or treatments of Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or Human Immunodeficiency Virus (HIV) infection, or any Sickness or disease arising from these medical conditions;

21. Any treatment, services or supplies received by the covered person with respect to an Injury or Sickness which are incurred or received by the covered person while he or she is in his or her Home Country, except as provided by the Home Country Benefits provided or if selected by the covered person.

22. Organ or tissue transplant.
23. Injury or sickness where the covered person’s trip to the host country is undertaken for treatment or advice for such injury or sickness.

For Accidental Death and Dismemberment Indemnity this plan does not cover any loss caused by or resulting from:
 
1.  Suicide or attempted suicide, intentionally self inflicted injury;

2.  War or any act of war, whether declared or not;

3.  Service in the military, naval, or air service of any country;

4.  Sickness, disease, or infection of any kind, except bacterial infections due to an accidental cut or wound, botulism or ptomaine poisoning;

5.  Piloting or acting as a crewmember or riding in any aircraft, except as a fare paying passenger on a scheduled airline.

This insurance does not apply to the extent that trade or economic sanctions or regulations prohibit Us from providing insurance, including, but not limited to, the payment of claims.