Charges for the following treatments and/or services and/or supplies and/or conditions are excluded from coverage hereunder:
- Pre-existing Conditions – Charges resulting directly or indirectly from any Pre-existing Condition, as herein defined, are excluded from this insurance during the first six (6) months of coverage.
- Coverage Area – For all non-U.S. citizens electing coverage “Excluding the U.S.” and for all U.S. citizens or residents, no coverage is provided within the U.S., except for U.S. citizens or residents during an eligible Incidental Home Country visit or an eligible Benefit Period.
- Routine pre-natal care, Pregnancy, child birth, post natal care, and routine nursery care of a newborn, unless directly related to a Covered Pregnancy as defined herein.
- Diagnosis, testing, and treatment for or related to any congenital condition, except this does not include congenital conditions for a child if the delivery is covered under this insurance.
- Charges that are not Incurred, as herein defined, by a Member during his/her Certificate Period.
- Charges for diagnosis, testing, and treatment of any condition(s) when the purpose of departing the Home Country was to obtain treatment in the destination country/countries.
- Charges for any benefit hereunder which are not presented to Underwriters for payment within 60 days beginning on the last day of the Certificate Period.
- Diagnosis, testing, and treatment, services or supplies which are not administered or ordered by a Physician.
- Diagnosis, testing, treatment, services or supplies which are not Medically Necessary as herein defined.
- Diagnosis, testing, treatment, services or supplies provided at no cost to the Member.
- Charges which exceed Usual, Reasonable and Customary as herein defined.
- Telephone consultations or failure to keep a scheduled appointment.
- Surgeries, diagnosis, testing, treatments, services or supplies which are Investigational, Experimental or for Research purposes.
- All charges Incurred while confined primarily to receive Custodial Care, Educational or Rehabilitative Care, or any medical treatment in any establishment for the care of the aged, except rehabilitative care received upon direct transfer from an acute care Hospital.
- Diagnosis, testing, or treatment of obesity or weight modification, including but not limited to wiring of the teeth and all forms of intestinal bypass Surgery.
- Modifications of the physical body in order to improve the psychological, mental or emotional well-being of the Member, including but not limited to sex-change Surgery.
- Surgeries, diagnosis, testing, treatments, services or supplies for cosmetic or aesthetic reasons, except for reconstructive Surgery when such Surgery is directly related to and follows a Surgery which was covered hereunder.
- Diagnosis, testing, or treatment for HIV, AIDS or ARC, and all diseases caused by and/or related to HIV.
- Any drug, treatment or procedure that either promotes or prevents conception including but not limited to: any form of birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal of sterilization.
- Any drug, treatment or procedure that either promotes, enhances or corrects impotency or sexual dysfunction.
- Elective termination of Pregnancy.
- Dental Treatment, except for Emergency Dental Treatment necessary to replace sound natural teeth lost or damaged
in an Accident covered hereunder or for the Emergency relief of Acute Onset of pain.
- Corrective devices and medical appliances, including eyeglasses, contact lenses, hearing aids, hearing implants, eye refraction, visual therapy, and any examination or fitting related to these devices, dentures or dental appliances, and all vision and hearing tests and examinations.
- Eye surgery, such as corrective refractive surgery, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
- Diagnosis, testing, or treatment of the temporomandibular joint.
- All expenses in excess of $5,000 for Injury or Illness sustained while taking part in intercollegiate, interscholastic, intramural, or club sports, and all expenses for any Injury or Illness sustained while taking part in any other Amateur Athletics. This does not include athletic activities which are non-contact and engaged in by the Member solely for leisure, recreational, entertainment or fitness purposes unless such sports or activities are otherwise excluded by this insurance.
- Injury sustained while taking part in the following activities:
- professional sports including practice; and
- mountaineering where a reasonably prudent person would use ropes or guides or at elevations of 4,500 meters or higher; and
- aviation (except when traveling solely as a passenger in a commercial aircraft); and
- hang gliding, sky diving, parachuting or bungee jumping; and
- snow skiing or snowboarding, except for recreational downhill and/or cross country snow skiing or
snowboarding (no cover provided whilst skiing away from prepared and marked in-bound territories and/or
against the advice of the local ski school or local authoritative body); and
- racing by any animal or motorized vehicle; and
- spelunking; and
- subaqua pursuits involving underwater breathing apparatus unless PADI/NAUI certified, accompanied by a certified instructor, and at depths of less than 10 meters; and
- jet skiing; and
- any other sport or activity, including Extreme Sports, which is undertaken for thrill seeking and exposes the Member to abnormal risk of Injury
- Injury sustained while under the influence of or due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with treatment prescribed and directed by a Physician except drugs prescribed by a Physician for the treatment of Substance Abuse.
- Costs resulting from self-inflicted Injury or Illness and/or suicide or attempted suicide whether sane or insane
- Diagnosis, testing, and treatment of venereal disease, including all Sexually Transmitted Diseases and conditions.
- Immunizations, Routine Physical Exams, and other diagnostic labs, x-rays, and procedures for screening or preventative purposes.
- Diagnosis, testing, or treatment by a chiropractor, unless ordered in advance by a Physician for Medically Necessary treatment related to an Injury or Illness covered hereunder.
- Expenses for physical therapy or treatment for Mental Health Disorders if treatment is obtained at a Student Health Center.
- Charges resulting from or occurring during the commission of a violation of law by the Member, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
- Voluntarily using any drug, narcotic or controlled substance, unless as prescribed by a Physician
- Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy.
- Any services, supplies, diagnosis, testing, or treatments performed or provided by a Relative of the Member or any family member of the Member or any person who ordinarily resides with the Member.
- Orthoptics, testing, and visual eye training.
- Diagnosis, testing, treatment or supplies for the feet: orthopedic shoes, orthopedic prescription devices to be attached to or placed in shoes, treatment of weak, strained, flat, unstable or unbalanced feet, metatarsalgia or bunions, and treatment of corns, calluses or toenails.
- Diagnostic testing or procedures, services, supplies, or treatment for hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed by a Physician.
- Diagnosis, testing, or treatment of sleep apnea or other sleep disorders.
- Exercise programs, whether or not prescribed or recommended by a Physician.
- Diagnosis, testing, or treatment required as a result of complications or consequences of a treatment or condition not covered hereunder.
- Charges for travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical Evacuation, Repatriation of Remains, and Emergency Reunion sections of this insurance.
- Diagnosis, testing, or treatment incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
- Organ or tissue transplants or related services.
- Diagnosis, testing, or treatment for acne, other acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of sebaceous glands, hypertrophic and atrophic conditions of skin, nevus.
- Medical conditions while on duty as a member of a police or military force or unit.
- Claims payable under any government system, including the Australian Medicare system, are excluded from coverage.
- Services, diagnosis, testing, supplies, or treatments that are not included as Eligible Expenses as described herein.
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