Exclusions

For benefits listed in the Schedule of Benefits, except Accidental Death & Dismemberment, this insurance does not cover:

• Pre-Existing conditions, defined as any condition for which a licensed Physician was consulted, or for which treatment or medication was prescribed, or for which manifestations of symptoms would have caused a person to seek medical advice in the 12 months prior to the Effective Date of coverage under the Policy, except as specified

a) If the Insured Person does not receive medical care or services, including prescription drugs or other medical supplies, and is not under the care of a Physician with respect to the Pre-Existing Condition or related condition(s), for a period of 12 consecutive months beginning on or after the first day of coverage, the Pre-Existing Condition exclusion will no longer apply and any eligible charges incurred after the treatment-free period will be considered for reimbursement;
or
b) If the Injured Person is covered under the Policy for 12 consecutive months, the Pre-Existing Condition exclusion will no longer apply and any eligible expenses incurred thereafter will be considered for reimbursement; or
c) Emergency Medical Evacuation/Repatriation and Return of Mortal Remains

• Charges for treatment which exceed Reasonable and Customary charges
• Charges incurred for Surgery or treatments which are Experimental/ Investigational, or for research purposes
• Services, supplies or treatment, including any period of Hospital confinement, which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician
• Suicide or any attempt thereof, while sane, or self destruction or any attempt thereof, while sane
• Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in connection with:

a) war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war or
b) mutiny, riot, strike, military or popular uprising insurrection, rebellion, revolution, military or usurped power

• Routine physicals, immunizations, or other examinations where there are no objective indications or impairment in normal health, and laboratory diagnostic or x-ray examinations, except in the course of a Disablement established by a prior call or attendance of a Physician
• Treatment of the Temporomandibular joint
• Vocational, speech, recreational or music therapy
• Services or supplies performed or provided by a Relative of the Insured Person, or anyone who lives with the Insured Person
• The refusal of a Physician or Hospital to make all medical reports and records available to the Company will cause an otherwise valid claim to be denied
• Cosmetic or plastic Surgery, except as the result of a covered Accident; for the purposes of this Policy, treatment of a deviated nasal septum shall be considered a cosmetic condition.
• Elective Surgery which can be postponed until the Insured Person returns to his/her Home County, where the objective of the trip is to seek medical advice, treatment or Surgery
• 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
• Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent
• Any Mental and Nervous disorders or rest cures including eating disorders such as anorexia and bulimia, except as described under Accident and Sickness
• Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services
• Congenital abnormalities and conditions arising out of or resulting therefrom
• The cost of the Insured Person’s unused airline ticket for the transportation back to the Insured Person’s Home Country, where an Emergency Medical Evacuation or Repatriation and/or Return of Mortal Remains benefit is provided
• Expenses as a result of or in connection with intentionally self-inflicted
  Injury or Illness
• Expenses as a result of or in connection with the commission of a felony offense
• Injury sustained while taking part in mountaineering where ropes or guides are normally used; hang gliding; parachuting; bungee jumping; racing by horse, motor vehicle or motorcycle; and parasailing
• Treatment paid for or furnished under any other individual or group policy or other service or medical pre-payment plan arranged through the employer to the extent so furnished or paid, or under any mandatory government program or facility set up for treatment without cost to any individual
• Injuries for which benefits are payable under any no-fault automobile Insurance Policy
• Dental care, except as the result of Injury to natural teeth caused by Accident
• Routine Dental Treatment
• For Pregnancy or Illness resulting from Pregnancy, childbirth or miscarriage
• Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion
• Treatment for human organ tissue transplants and their related treatment
• Weak, strained or flat feet, corns, calluses, or toenails
• Diagnosis and treatment of acne
• Injury sustained while the Insured Person is riding as a pilot, student pilot, operator or crew member, in or on, boarding or alighting from, any type of aircraft.

In addition to the exclusions listed above, the following exclusions apply to Accidental Death and Dismemberment Insurance only:

• disease of any kind
• bacterial infections except pyogenic infection which shall occur through an accidental cut or wound
• neuroses, psychoneuroses, psychopathies, psychoses or mental or emotional diseases or disorders of any type

Elective surgery means surgery or medical treatment not necessitated by a pathological or traumatic change in the function or structure in any part of the body first occurring after the insured’s effective date of coverage. Elective surgery includes, but is not limited to, circumcision, tubal ligation, vasectomy, breast reduction, sexual reassignment surgery and submucous resection and/or other surgical correction for deviated nasal septum, other than for necessary treatment of covered acute purulent sinusitis. Elective surgery does not apply to cosmetic surgery required to correct a covered accident.

Elective treatment means surgery or medical treatment not necessitated by a pathological or traumatic change in the function or structure in any part of the body first occurring after the insured’s effective date of coverage. It includes, but is not limited to, acne, nonmalignant warts and moles, weight reduction, infertility and learning disabilities.

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