Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under
Student Health Advantage.
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Charges resulting directly or indirectly from or relating to any Pre-existing Condition, (whether physical or
mental, regardless of the cause of the condition) are excluded from coverage under this insurance until the
Insured Person has maintained coverage under this insurance plan continuously for at least twelve (12) months on
the Standard level or for at least six (6) months on the Platinum level.
- Congenital Diseases
- Treatment or surgeries which are elective, investigational, experimental or for research purposes.
- Preventative Care: Charges for Routine Physical Examinations and immunizations are excluded from coverage under
this insurance
- Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of
insurance.
- War, military action, political insurrection, protest, or any act thereof.
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Any sexually transmitted or venereal disease, and any testing for the following when not medically necessary:
HIV, seropositivity to the AIDS virus, AIDS related Illnesses, ARC Syndrome, AIDS Pre-natal, post-natal, and
newborn care, unless related to a Covered Pregnancy, treatment for infertility or impotency, sterilization or
reversal thereof, or abortion.
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Charges incurred for any treatment or supply that either promotes or prevents or attempts to promote or prevent
conception, insemination (natural or otherwise) or birth, including but not limited to: artificial insemination;
oral contraceptives; treatment for infertility or impotency; vasectomy, or reversal of vasectomy; sterilization;
reversal of sterilization; surrogacy or abortion
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Charges incurred for eyeglasses, contact lenses, hearing aids or hearing implants and charges for any Treatment,
supply, examination or fitting related to these devices, or for eye refraction for any reason
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Charges incurred for eye surgery, such as but not limited to radial keratotomy, when the primary purpose is to
correct or attempt to correct nearsightedness, farsightedness, or astigmatism
- Charges incurred for Dental Treatment, except as specifically provided for hereunder
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Wear and tear of teeth due to cavities and chewing or biting down on hard objects, such as but not limited to
pencils, ice cubes, nuts, popcorn, and hard candies
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Dental Treatment for services which provide oral care maintenance including tooth repair by fillings, root
canals, tooth removal and x-rays
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Charges for Treatment of an Illness or Injury for which payment is made or available through a workers'
compensation law or a similar law
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Charges for any Illness or Injury resulting from or occurring during the commission of a violation of law by the
Insured Person, including, without limitation, the engaging in an illegal occupation or act, but excluding minor
traffic violations
- Biofeedback, acupuncture, music, occupational, recreational, sleep, speech, or vocational therapy
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Any non-surgical Illness or Treatment of the feet, including without limitation: orthopedic shoes; orthopedic
prescription devices to be attached to or placed in shoes; Treatment of weak, strained, flat, unstable or
unbalanced feet; metatarsalgia, bone spurs, hammer toes or bunions; and any Treatment or supplies for corns,
calluses or toenails
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Hair loss, including without limitation wigs, hair transplants or any drug that promises to promote hair growth,
whether or not prescribed by a Physician
- Any sleep disorder, including without limitation sleep apnea
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Any Injury or Illness sustained as a result of being under the influence of or due wholly or partly to the
effects of alcohol, liquor, intoxicating substance, narcotics or drugs other than drugs taken in accordance with
Treatment prescribed and directed by a Physician but not for the Treatment of Substance Abuse
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Any Injury or Illness sustained while operating a moving vehicle after consumption of intoxicating liquor or
drugs in excess of the applicable blood/alcohol legal limit, other than drugs taken in accordance with Treatment
prescribed and directed by a Physician. For purposes of this exclusion, “vehicle” shall include motorized
devices regardless of whether or not a driver or operator license is required (including watercraft and
aircraft) and non-motorized bicycles and scooters for which no permit or license is required
- Any willfully Self-inflicted Injury or Illness
- Treatment while confined primarily to receive custodial care, educational or rehabilitative care
- Any organ or tissue or other transplant or related services, Treatment or supplies
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Any Illness or Injury sustained while taking part in, practicing or training for: Amateur Athletics (except as
otherwise expressly provided for in this insurance); Professional Athletics; or athletic activities that are
sponsored by any Governing Body or Authority including the National Collegiate Athletic Association, any other
collegiate sanctioning or Governing Body or the International Olympic Committee
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Any Illness or Injury sustained while taking part in activities designated as Adventure Sports, which are
limited to the following: abseiling; BMX; bobsledding; bungee jumping; canyoning; caving; hot air ballooning;
jungle zip lining; parachuting; paragliding; parascending; rappelling; skydiving; spelunking; whitewater
kayaking or whitewater rafting in water less than Class V difficulty; wildlife safaris; and windsurfing
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Any Illness or Injury sustained while taking part in activities designated as Extreme Sports, which include but
are in no way limited to the following (and include any combination or derivative of the following): BASE
jumping; cave diving; cliff diving; downhill mountain biking and racing; extreme skiing; freediving; free
flying; free running; free skiing; freestyle scootering; gliding; heli-skiing; ice canoeing; ice climbing;
kitesurfing; mixed martial arts; motocross; motorcycle racing; motor rally; mountaineering above elevation of
4500 meters from ground level; parkour; piloting a commercial or non-commercial aircraft; powerbocking; scuba
diving or sub aqua pursuits below a depth of 30 meters; snowmobile racing; truck racing; whitewater kayaking or
whitewater rafting Class V and higher difficulty; and wingsuit flying
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Any Illness or Injury sustained while taking part in snow skiing, snowboarding or snowmobiling where the Insured
Person is in violation of applicable laws, rules or regulations of a ski resort, out of bounds or in unmarked or
unpatrolled areas
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Any Illness or Injury sustained while participating in any sporting, recreational or adventure activity where
such activity is undertaken against the advice or direction of any local authority or any qualified instructor
or contrary to the rules, recommendations and procedures of a recognized governing body for the sport or
activity
This is a summary of the plan exclusions, for a more complete list of exclusions please view the plan
certificates here.