Charges for the following conditions, Treatments (including diagnoses, tests, and examinations), services, supplies, acts, omissions, and/or events are excluded from coverage hereunder:
1. Pre-existing Conditions, as herein defined, except charges resulting directly from an Acute Onset of Pre-existing Condition, as herein defined, subject to the limits set forth in the Schedule of Benefits and Limits.
2. Birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions.
3. Routine medical examinations, including but not limited to vaccinations, immunizations, annual check-ups, the issue of medical certificates and attestations, and examinations as to the suitability of employment or travel.
4. Dental Treatment and Treatment of the temporomandibular joint, 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.
5. Mental Health Disorders, as herein defined.
6. Pregnancy except as covered under Complications of Pregnancy, as herein defined, termination of Pregnancy except in connection with covered Complications of Pregnancy, all charges related to Pregnancy after the 26th week of Pregnancy, routine prenatal care, child birth, postnatal care, and charges incurred by a child under the age of 14 days.
7. Promotion or prevention of conception including but not limited to: artificial insemination, treatment for infertility, sterilization or reversal of sterilization.
8. Impotency or sexual dysfunction.
9. Venereal disease, including all Sexually Transmitted Diseases and conditions.
10. HIV, AIDS or ARC, and all diseases caused by and/or related to HIV.
11. Organ or Tissue Transplants or related services.
12. All forms of cancer / neoplasm.
13. Self-inflicted Injury or Illness and/or suicide or attempted suicide whether sane or insane.
14. Substance Abuse or addiction or conditions that may be attributed to Substance Abuse or addictions and direct consequences thereof.
15. Injury sustained that is due wholly or partially to the effects of intoxication or drugs other than drugs taken in accordance with treatment prescribed by a Physician and except drugs prescribed for the treatment of substance abuse.
16. Injury sustained while operating any motorized vehicle, aircraft or water craft whether registered or not while under the influence of alcohol as defined under the law of the jurisdiction where the injury occurs or with a .08 BAC whichever is lower.
17. 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.
18. Eye surgery, such as corrective refractory surgery, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
19. 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.
20. Orthoptics and visual eye training.
21. 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.
22. Hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed.
23. Acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, hypertrophic and atrophic conditions of skin, nevus.
24. Sleep apnea or other sleep disorders.
25. Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care of any nature, massage and kines therapy.
26. Psychometric, intelligence, competency, behavioral and educational testing.
27. 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.
28. Cosmetic or aesthetic reasons, except for reconstructive Surgery when such Surgery is directly related to and follows a Surgery which was covered hereunder.
29. Modifications of the physical body intended to improve the psychological, mental or emotional well-being of the Member, including but not limited to sex-change Surgery.
30. Obesity or weight modification, including but not limited to wiring of the teeth and all forms of intestinal bypass Surgery.
31. Exercise programs, whether or not prescribed or recommended by a Physician.
32. Incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
33. ChargesresultingfromadiseaseoutbreakinacountryorlocationforwhichtheUSCentersforDiseaseControland Prevention (CDC) has issued a Level 3 Travel Warning if a) the warning has been in effect within the 6 months immediately prior to the Member’s date of arrival, or b) within 10 days following the date the warning is issued the Member has failed to depart the country or location.
34. Cryo preservation and implantation or re-implantation of living cells.
35. Genetic or predictive testing.
36. Investigational, Experimental or for Research purposes.
37. Medical expenses for Injury or Illness resulting from:
a. Amateur Athletics, Contact Sports, intercollegiate, interscholastic, intramural, and club sports or athletic activities and Professional Sports including practice;
b mountaineering at elevations of 7,000 meters or higher, and avalanche training;
c. aviation (except when traveling solely as a passenger in a commercial aircraft), and hot air ballooning as a pilot;
d. base jumping, hang-gliding, parachuting, paragliding, parasailing, kite-surfing, sky surfing;
e. heli-skiing, snow skiing, or snowboarding, except for recreational downhill and/or cross country snow skiing or snowboarding (no cover provided while skiing away from prepared and marked in-bound territories and/or against the advice of the local ski school or local authoritative body), bobsleigh, skeleton or luge;
f. sub aqua pursuits involving underwater breathing apparatus unless PADI/NAUI certified, or accompanied by a certified instructor at depths of less than 10 meters;
g. white water rafting, spelunking or cave diving;
h. off-road motorized vehicles including all-terrain vehicles, snowmobiles and motorized dirt bikes, and tractors;
i racing by any animal, motorized vehicle, or BMX, and speed trials and speedway;
j. any type of boxing or martial arts, powerlifting, and wrestling;
k. big game hunting, running with the bulls;
l. Aussie rules football, jousting, modern pentathlon, and quad biking outdoor endurance events.
38. Complications or consequences of a treatment or condition not covered hereunder.
39. Not included as Eligible Expenses as described herein.
40. Incurred, as herein defined, by a Member outside his/her Certificate Period.
41. Submitted to Underwriters for payment more than 60 days after the last day of the Certificate Period.
42. ExceedingUsual,Reasonable and Customary as here in defined.
43. Not Medically Necessary, as herein defined.
44. Not administered by or under the supervision of a Physician, and products that can be purchased without a doctor’s prescription.
45. Provided by a Relative of the Member or any family member of the Member or any person who ordinarily resides with the Member.
46. Provided by a chiropractor.
47. Provided at no cost to the Member.
48. Telephone consultations or failure to keep a scheduled appointment.
49. When Departure from the Home Country is to obtain treatment in the destination country/countries.
50. Emergency Medical Evacuation, Repatriation of Remains, or Local Burial or Cremation not approved or arranged in advance by Underwriters.
51. Travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical Evacuation, Repatriation of Remains, Emergency Reunion, Natural Disaster, Return of Minor Children, Political Evacuation, and Trip Interruption sections of this insurance.
52. Local cremation or burial if death occurs in the Member’s Home Country.
53. Payable under any government system, including the Australian Medicare system.
54. While on duty as a member of a police or military force unit.
55. The Accidental Death & Dismemberment benefit shall be excluded with respect to Accidents or loss caused by or contributed to by any of the following:
a. War or act of war, whether declared or undeclared.
b The member’s participation in a riot, insurrection or violent disorder.
c. The member’s service in the armed forces of any country.
d. Suicide or attempted suicide or self-inflicted Injury, while sane or insane.
e. The voluntary use of any chemical compound, poison or drug, unless used according to the directions of a Physician.
f. Committing or attempting to commit a felony.
g. Sickness, Mental Health Disorder, or Pregnancy.
h. As the result of Intoxication as defined by the laws of the jurisdiction in which the accident occurred of the Member, whether directly or indirectly,
i Myocardial infarction or cerebrovascular accident (CVA / Stroke).
j. Infection, except infection through a wound caused solely by an accident.
k. Injury while riding, boarding, or alighting from an aircraft if the Member was operating the aircraft, learning to operate the aircraft, serving as a member of the aircraft crew, or if the aircraft was being used for any purpose other than passenger transportation.
l. Medical or surgical treatment for any of the above.
m. Any of the activities described in Exclusion 37.
WAR, TERRORISM, BIOLOGICAL, CHEMICAL, NUCLEAR EXCLUSION
Notwithstanding any provision to the contrary within this insurance or any endorsement or rider attached hereto, it is agreed that this insurance excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing concurrently or in any other sequence to the loss, damage, cost or expense:
1. war, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power; and
2. the use of any biological, chemical, radioactive or nuclear agent, material, device or weapon; however, this exclusion shall not apply where the Member is exposed to nuclear radioactive and/or radioactive material for the purpose of medical treatment; and
3. any Act of Terrorism, except as follows:
Underwriters will pay Eligible Medical Expenses for treatment of Injuries and Illnesses resulting from an Act of Terrorism, up to the limit set forth in the Schedule of Benefits and Limits, provided all of the following conditions are met:
a. The Injury or Illness does not result from the use of any biological, chemical, radioactive or nuclear agent, material, device or weapon; and
b The Member has no direct or indirect involvement in the Act of Terrorism; and
c. The Act of Terrorism is not in a country or location where the United States government has issued a travel warning that has been in effect within the 6 months immediately prior to the Member’s date of arrival; and
d. The Member has not failed to depart a country or location within 10 days following the date a warning to leave that country or location is issued by the United States government.
For the purpose of this insurance, an “Act of Terrorism” means an act, including but not limited to, the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s) committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.
This insurance also excludes coverage for loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in any way relating to (1), (2) or (3) above.
If Underwriters allege that by reason of this exclusion, any loss, damage, cost or expense is not covered by this insurance, the burden of proving the contrary shall be upon the Member.
In the event any portion of this exclusion is found to be invalid or unenforceable, the remainder shall remain in full force and effect.