$20,000 per person Emergency Medical for Unexpected Recurrence age 64 and under
$2,500 per person Emergency Medical Unexpected Recurrence age 65 and over
A Pre-Existing Condition is an illness or other medical condition that was treated, diagnosed, or changed during a policy’s lookback period.
CC. EXCLUSIONS: Except as expressly provided for in the BENEFIT SUMMARY, all Charges, costs, expenses and/or claims incurred by the Insured Person, and any claim for death or dismemberment benefits, and directly or indirectly relating to or arising or resulting from or in connection with any of the following acts, omissions, events, conditions, Charges, consequences, claims, Treatment (including diagnoses, consultations, tests, examinations and evaluations related thereto), services and/or supplies are expressly excluded from coverage under this insurance, and the Company shall provide no benefits or reimbursements and shall have no liability or obligation for any coverage thereof or therefor:
(3) PRE-EXISTING CONDITIONS: Charges resulting directly or indirectly from or relating to any Pre-existing Condition are excluded from coverage under this insurance except and unless the Charges resulted directly from an Acute Onset of Preexisting Condition, in which case the Charges will be covered only according to the Terms of the ACUTE ONSET OF PREEXISTING CONDITIONS provision.
H. ACUTE ONSET OF PRE-EXISTING CONDITIONS:
(1) Subject to the applicable Deductible and Coinsurance and the various limits and sub-limits set forth in the BENEFIT SUMMARY, and the Terms of this insurance, including without limitation the CONDITIONS AND RESTRICTIONS subparagraph below, and in the event the Insured Person suffers or experiences an Acute Onset of a Pre-existing Condition during the Period of Coverage for which immediate Treatment is essential and necessary to stabilize the Pre-existing Condition, the Insured Person will be reimbursed up to the amount shown in the BENEFIT SUMMARY for Eligible Medical Expenses incurred during the Period of Coverage with respect to the Acute Onset of the Pre-existing Condition.
(2) CONDITIONS AND RESTRICTIONS: To be eligible for the foregoing limited coverage and benefits for an Acute Onset of a Pre-existing Condition, the Insured Person must be in compliance with all Terms of this insurance. The Company will provide such coverage and benefits only when all of the following conditions and restrictions have been met. At the time of the Acute Onset of the Pre-existing Condition:
a) Treatment must be obtained within twenty-four (24) hours of the sudden and Unexpected outbreak or reoccurrence
b) the Insured Person must be under seventy (70) years of age
c) the Insured Person must not be traveling against or in disregard of the recommendations, established Treatment programs, or medical advice of a Physician or other healthcare provider
d) the Insured Person must not be traveling with the intent or purpose to seek or obtain Treatment for the Pre-existing Condition
e) the Insured Person must not be traveling during a period of time when the Insured Person is preparing or waiting for, involved in, or undertaking a new, changed or modified Treatment program with respect to the Pre-existing Condition, and is not traveling subsequent to any such new, changed or modified Treatment program having been advised or recommended
f) the Pre-existing Condition must have been stabilized for at least thirty (30) days prior to the Effective Date without change in Treatment
g) the Insured Person must be traveling outside their Country of Residence and the United States.
In addition, in order to qualify for the higher coverage limit specified in the BENEFIT SUMMARY, a United States citizen with a Primary Health Plan must meet the following requirements:
(i) the Insured Person must be a United States citizen
(ii) the Insured Person must have a Primary Health Plan
(iii) the Primary Health Plan must have been in effect prior to the Effective Date of Coverage and must remain in force during the entire Period of Coverage
(iv) the Pre-existing Condition must be covered under the Primary Health Plan.
If these requirements cannot be substantiated at the time of claim, the benefits under this provision will be limited to the amount shown in the BENEFIT SUMMARY for Insured Persons without a Primary Health Plan.
Acute Onset of Pre-existing Condition: A sudden and Unexpected outbreak or reoccurrence that is of short duration, is rapidly progressive, and requires urgent medical care. A Pre-existing Condition that is chronic or congenital, or that gradually becomes worse over time is not an Acute Onset of Pre-existing Condition. An Acute Onset of Pre-existing Condition does not include any condition for which, as of the Effective date, the Insured Person (i) knew or reasonably foresaw he/she would receive, (ii) knew he/she should receive, (iii) had scheduled, or (iv) were told that he/she must or should receive, any medical care, drugs or Treatment.
Pre-existing Condition: Any Injury, Illness, sickness, disease, or other physical, medical, Mental or Nervous Disorder, condition or ailment that, with reasonable medical certainty, existed at the time of Application or at any time during the three (3) years prior to the Effective Date of this insurance, whether or not previously manifested, symptomatic or known, diagnosed, Treated, or disclosed to the Company prior to the Effective Date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom.