Charges for the following conditions, treatments (including diagnoses, tests, and examinations), services, supplies,
acts, omissions, and/or events are excluded from coverage hereunder:
- Pre-existing Conditions, 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.
- Birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions.
- 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.
- 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.
- Mental health disorders.
- Pregnancy except as covered under Complications of Pregnancy, as herein defined, termination of pregnancy
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
- Promotion or prevention of conception including but not limited to: artificial insemination, treatment for
infertility, sterilization or reversal of sterilization.
- Impotency or sexual dysfunction.
- Venereal disease, including all sexually transmitted diseases and conditions.
- HIV, AIDS, or ARC, and all diseases caused by and/or related to HIV
- Organ or tissue transplants or related services.
- All forms of cancer / neoplasm.
- Self-inflicted injury or illness and/or suicide or attempted suicide whether sane or insane.
- Substance abuse or addiction or conditions that may be attributed to substance abuse or addictions and direct
- 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
- Injury sustained while operating any motorized vehicle, aircraft or watercraft 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.
- Charges resulting from or occurring during the commission of a violation of law, including without limitation,
the engaging in an illegal occupation or act, but excluding minor traffic violations.
- Eye surgery, such as corrective refractory surgery, when the primary purpose is to correct nearsightedness,
farsightedness or astigmatism.
- 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, except as provided for under Emergency Eye Exam.
- Orthoptics and visual eye training.
- 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
- Hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed.
- Acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, hypertrophic and atrophic
conditions of skin, nevus.
- Sleep apnea or other sleep disorders.
- Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care
of any nature, massage and kinestherapy.
- Psychometric, intelligence, competency, behavioral and educational testing.
- 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.
- Cosmetic or aesthetic reasons, except for reconstructive surgery when such surgery is directly related to and
follows a surgery which was covered hereunder.
- Modifications of the physical body intended to improve the psychological, mental or emotional well-being,
including but not limited to sex-change surgery.
- Obesity or weight modification, including but not limited to wiring of the teeth and all forms of intestinal
- Exercise programs, whether or not prescribed or recommended by a physician.
- Incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
- Charges resulting from a disease outbreak in a country or location for which the U.S. Centers for Disease
and Prevention (CDC) has issued a Level 3 Travel Warning if a) the warning has been in effect within the 6
immediately prior to your date of arrival, or b) within 10 days following the date the warning is issued you
failed to depart the country or location.
- Cryo preservation and implantation or re-implantation of living cells.
- Genetic or predictive testing.
- Investigational, experimental or for research purposes.
- Complications or consequences of a treatment or condition not covered hereunder.
- Incurred outside your certificate period.
- Submitted to us for payment more than 60 days after the last day of the certificate period.
- Exceeding usual, reasonable and customary.
- Not medically necessary.
- Not administered by or under the supervision of a physician, and products that can be purchased without a
- Provided by a relative, family member or any person who ordinarily resides with you.
- Provided at no cost to you.
- Telephone consultations or failure to keep a scheduled appointment.
- When departure from the home country is to obtain treatment in the destination country/countries.
- 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,
Trip Interruption, Trip Delay, and Border Entry Protection sections of the insurance.
- Payable under any government system, including the Australian Medicare system.
- War, military action or while on duty as a member of a police or military force unit.
- Not included as Eligible Expenses as described herein.
Pre-existing Condition: Any (1) condition for which medical advice, diagnosis, care, or treatment (includes
receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or
received during the 2 years immediately preceding the Certificate Effective Date; (2) condition that had manifested
itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care,
or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines)
within the 2 years immediately preceding the Certificate Effective Date; (3) injury, illness, sickness, disease, or
other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with
reasonable medical certainty, existed at the time of application or within the 2 years immediately preceding the
Certificate Effective Date. For the purposes of the Complications of Pregnancy coverage offered hereunder, Pregnancy
will not be included within the definition of a Pre-existing Condition.