A Pre-Existing Condition is an illness or other medical condition that was treated, diagnosed, or changed during a policy’s lookback period.
Pre-existing Conditions which are excluded under this policy. This means that any claims for Pre-existing Conditions will not be covered for the duration of this policy. This exclusion does not apply to Emergency Evacuation/Repatriation or Return of Mortal Remains. Note: If You are a U.S. or Canadian citizen this exclusion is waived up to the maximum stated in the Schedule of Benefits for Eligible Medical Expenses incurred while traveling outside the United States, if resulting from a sudden, unexpected recurrence of a Pre-existing Condition. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the Effective Date of coverage and is subject to the chosen Deductible and Coinsurance. Any exclusion specifically listed below in 2 through 43 will not receive benefits from this waiver.
Pre-existing Condition benefit): 1) a condition that would have caused a person to seek medical advice, diagnosis, care or Treatment during the thirty-six (36)* months prior to the Effective Date of coverage under this policy; 2) a condition for which medical advice, diagnosis, care or Treatment was recommended or received during the thirty-six (36)* months prior to the Effective Date of coverage under this policy. *For U.S. and Canadian citizens traveling outside the United States, the Pre-existing Condition period is twelve (12) months instead of thirty-six (36) months. Reasonable and Customary shall mean the maximum amount that the plan determines is Reasonable and Customary for Covered Expenses You receive, up to but not to exceed charges actually billed. The determination considers:1) Amounts charged by other Service Providers for the same or similar service in the locality where received, considering the nature and severity of the bodily Injury or Illness in connection with which such services and supplies are received; 2) Any usual medical circumstances requiring additional time, skill or experience; and 3) Other factors included but not limited to, a resource based relative value scale