International Major Medical Insurance | Exclusions

For a full list of exclusions, please refer to the certificates of the plan below.

  1. Economic Sanctions
  2. War; Military Action
  3. Terrorism
  4. Pre-existing conditions: Under Bronze level, charges relating directly or indirectly to medical conditions existing at the time of Application, whether known or unknown at the time of Application and whether or not disclosed on the Application, are excluded from coverage under this insurance. Under Silver and Gold level, the Company will not pay for Treatment for a Pre-existing Condition:
    1. that is not disclosed on the Insured Person’s Application
    2. that is the subject of a special exclusion provided in a Rider to the Certificate of Insurance
  5. Illness or Surgery within 180 days: Charges for Treatment of the following Illnesses or Surgeries which manifest themselves and/or involve procedures which take place and/or are recommended during the first one-hundred eighty (180) days of coverage under this insurance plan, beginning on the Initial Effective Date: acne, asthma, allergies, any condition of the breast, any condition of the prostate, tonsillectomy, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the reproductive system, diverticulitis, hysterectomy, hernia, intervertebral disc disease, gall bladder disease or gall stones and kidney stones. Note: Coverage and/or benefits for these Illnesses or Surgeries (or for similar or different Illnesses or Surgeries) may be separately or further limited
  6. Maternity and Newborn care unless included in the plan
  7. Mental or nervous disorders unless included in the plan
  8. Preventative care in the Bronze level
  9. Charges for any Treatment or supplies that are:
    1. not incurred, obtained or received by an Insured Person during the Period of Coverage
    2. not presented to the Company for payment by way of a completed Proof of Claim within one hundred eighty (180) days from the date such Charges are incurred
    3. not administered or ordered by a Physician
    4. not Medically Necessary for the diagnosis, care or Treatment of the physical condition involved. This also applies when and if they are prescribed, recommended or approved by the attending Physician
    5. provided at no cost to the Insured Person or for which the Insured Person is not otherwise liable
    6. in excess of Usual, Reasonable, and Customary
    7. related to Hospice Care (only applies to the Bronze level)
    8. incurred by an Insured Person who was HIV + on or before the Initial Effective Date of this insurance, whether or not the Insured Person had knowledge of their HIV status prior to the Effective Date, and whether or not the Charges are incurred in relation to or as a result of said status. This exclusion includes Charges for any Treatment or supplies relating to or arising or resulting directly or indirectly from HIV, AIDS virus, AIDS related Illness, ARC Syndrome, AIDS and/or any other Illness arising or resulting from any complications or consequences of any of the foregoing conditions
    9. provided by or at the direction or recommendation of a chiropractor, unless ordered in advance by a Physician
    10. performed or provided by a Relative of the Insured Person
    11. not expressly included in the ELIGIBLE MEDICAL EXPENSES provision
    12. provided by a person who resides or has resided with the Insured Person or in the Insured Person's home
    13. required or recommended as a result of complications or consequences arising from or related to any Treatment, Illness, Injury, or supply received prior to coverage under this insurance or that is excluded from coverage or which is otherwise not covered under this insurance
    14. for Congenital Disorders and conditions arising out of or resulting therefrom
    15. incurred, obtained or received by an Insured Person for a Non-disclosed Condition (only applies to the Platinum level)
Please note: The exclusions listed above are a consolidated version of the plan exclusions. Please view the plan certificate for the full list and limitations of the plan.

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