Exclusions and Limitations

With respect to Medical Expense Benefit and the Home Country Benefit, no benefit shall be payable with respect to expenses incurred:
1. For pre-existing conditions (defined as a 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. (This pre-existing condition exclusion does not apply to the Emergency Medical Evacuation, Emergency Reunion, or Repatriation of Remains Benefits.) Losses incurred for Pre-existing Conditions are covered under this plan, provided the Covered Person demonstrates that they had continuous Creditable Coverage for 63 days prior to becoming insured under this plan.  After the Pre-existing Condition requirement is met, coverage will be considered continuous provided there is not a break in coverage. “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.
2. For services, supplies, or treatment including any period of 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.
4. For loss incurred as a result of war or any act of war, whether declared or not.
5. For injury sustained while participating in professional, club, interscholastic or intercollegiate sports.
6. For cosmetic surgery, except as the result of an Injury.
7. For elective surgery.
8. For dental care, except as the result of Injury to natural teeth caused by accident.
9. For eye refractions or eye examinations for the purpose of prescribing corrective lenses for eye glasses or for the fitting thereof, unless caused by accidental bodily injury incurred while insured hereunder.
10. For expenses as a result of, or in connection with intentionally self-inflicted Injury.
11. For expenses as a result of, or in connection with, the commission of or attempt to commit an assault or a felony.
12. For specific named hazards: motorcycling; scuba diving; jet, snow and water skiing, mountain climbing, (where ropes or guides are normally used); sky diving; professional or amateur racing; and piloting an aircraft.
13. For treatment furnished under any mandatory government program or facility set up for treatment without cost to any individual.
14. For treatment by an immediate family member.
15. For treatment relating to birth defects and congenital conditions, or complications arising from such conditions.

For the Accidental Death and Dismemberment Benefit, the Policy does not cover any loss, fatal or non-fatal; caused by or resulting from:
1. Suicide or any attempt thereat; 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 crew member or riding in any aircraft, except as a fare paying passenger on a scheduled airline.