ISI Protect
Exclusions

Unless expressly provided for herein, and in addition to all terms, clauses, conditions, restrictions and exclusions contained herein, all of the following claims, charges, expenses, reimbursements and/or circumstances are expressly excluded from coverage under this insurance and Underwriters shall have no liability or obligation for any coverage thereof or therefor. (All of the following Exclusions may apply to any claim hereunder; category headings are provided for convenient reference purposes only.)

General Exclusions

1. Other Coverage — Underwriters shall not be liable or obligated to provide any coverage or benefits or to pay or reimburse any claims if there is any other insurance, membership benefit, state and/or federal government program (including without limitation Medicare, Medicaid, Veterans Administration and CHAMPUS), right of contribution, recoupment or recovery contract, or any other third- party obligation or liability for provision of benefits (“Other Coverage”) which would, or would but for the existence of this insurance, be available or obligated to provide such benefit or to pay or reimburse or provide indemnity for such claim, except where benefit amounts provided under Other Coverage are less than the applicable benefit amount insured hereunder, in which case Underwriters will pay the difference between the benefit amounts provided under Other Coverage and the benefit amount of this insurance, subject always to the Deductible, Co-pays , Coinsurance and all other term, clauses, conditions, provisions and exclusions of this insurance. Underwriters shall not pay any claim in respect to treatment, services or supplies furnished by any program or agency funded by any government. This exclusion is waived and this insurance shall be primary for School Sports benefits, only in respect to league-required insurance provided by the Educational Institution for the benefit of student athletes.
2. Any Illness or Injury when the purpose of traveling to the Host Country was to obtain treatment.
3. Services or supplies provided by a member of the Insured Person 's Family or any person who ordinarily resides with the Insured Person.
4. Services or supplies provided at no cost to the Insured Person and/or for which the Insured Person is not otherwise liable.
5. Treatment of an Illness or Injury for which payment is made or available through a workers’ compensation law or similar law.
6. Claims of any nature that would expose the Underwriter and/or the Plan Administrator to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States.
7. Charges which exceed the Usual, Reasonable and Customary charge for the service or supply provided.
8. Services or supplies that are not Medically Necessary , whether or not administered by or under the supervision of a Physician, including, without limitation products and medications that can be purchased without a Physician’s prescription.
9. Charges incurred by an Insured Person if the Insured Person checks out of a Hospital, Emergency Room or other facility against the advice of the treating Physician or who leaves before reaching the end of Medically Necessary care for that Injury or Illness or any condition related directly or indirectly to or arising from that Injury or Illness. All coverage hereunder with respect to that Injury or Illness shall be forfeited immediately upon the Insured Person’s departure from the Hospital, Emergency Room or other facility.
10. Incurred more than thirty (30) days following the date of onset of Illness or date of Injury , unless covered services are incurred for treatment of the Illness or Injury within thirty (30) days following the date of onset of Illness or date of Injury.
11. Elective Treatment
12. Emergency Room treatment of a Non-emergency condition
13. Specialty Medications
14. Surgeries, treatments, services or supplies that are investigational, experimental or for research purposes. These are terms used to describe procedures, services or supplies that are by nature or composition, or are used or applied, in a way which deviates from generally accepted standards of current medical practice.
15. Resulting directly or indirectly, proximately or remotely occasioned by, contributed to or by, traceable to or arising in connection with the Insured Person’s active and voluntary planning or coordination of or participation in any Act of Terrorism.
16. Resulting directly or indirectly, proximately or remotely occasioned by, contributed to by, traceable to or arising in connection an Act of War.
17. Resulting directly or indirectly, proximately or remotely occasioned by, contributed to by, traceable to or arising in connection with any use of radiological, chemical, nuclear or biological weapons or any other radiological, chemical, nuclear or biological events of any type (including in connection with an Act of Terrorism).

Pre-existing Condition(s) Exclusion

Resulting from or relating, directly or indirectly, to any Pre-existing Condition , except as expressly provided for in the Schedule, or if applicable, the Acute Onset of Pre-existing Condition(s) or Pre-existing Condition(s) provision of this insurance.

Diagnosis-oriented Exclusions

1. Related in any way to birth defects, hereditary conditions and Congenital Disorders , including any conditions arising out of or resulting therefrom.
2. Any service, supply, drug, treatment or procedure, that either diagnoses, promotes or prevents conception, insemination or birth, including without limitation, artificial insemination, contraceptives, treatment for infertility or impotency, vasectomy or reversal of vasectomy, sterilization or reversal of sterilization or surrogacy.
3. Abortions, except Medically Necessary Therapeutic Termination of Pregnancy.
4. Resulting from or relating, directly or indirectly, to pregnancy , including without limitation, pre-natal care, delivery, post-natal care, care of Newborns, complications of pregnancy, miscarriage, complications of delivery and/or complications related to Newborns are excluded for Insured Persons under the plans indicated in the Schedule.
5. For Insured Persons covered under plans that provide for coverage of pre-natal, delivery and post-natal care, such coverage is excluded unless the conception occurs during the Certificate Period.
6. All charges related to care of Newborns are excluded unless the delivery of the Newborn is covered hereunder.
7. Any service, supply, drug, treatment or procedure that either diagnoses, promotes, enhances or corrects or attempts to diagnose, promote, enhance or correct impotency or sexual dysfunction.
8. Diagnosis and/or treatment of venereal disease, including all Sexually Transmitted Diseases and conditions.
9. For diagnosis and/ or treatment of fungal, viral or bacterial skin infection or inflammatory skin conditions. These include but are not limited to dermatitis, acne, rosacea, hives, rash, eczema, psoriasis, folliculitis, moles, warts, skin tags, herpes (including without limitation HSV-1 and HSV-2), carbuncle, furuncle, diseases of sebaceous glands, seborrhea, and hypertrophic and atrophic conditions of skin.
10. Non-surgical care, diagnosis and/ or treatment or supplies for 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, corns, calluses or toenails.
11. Weight modification including without limitation any Inpatient or Outpatient Surgical Procedure or other treatment of obesity (including morbid obesity), diagnostic tests and procedures, wiring of the teeth, all forms or procedures of bariatric Surgery , by whatever name called, or reversal thereof, including without limitation, intestinal bypass, gastric bypass, gastric banding, vertical banded gastroplasty, biliopancreatic diversion, duodenal switch or stomach reduction or stapling.
12. Any prescription medication that promises weight loss regardless of the Insured Person's diagnosis.
13. Modifications of the physical body in order to change or improve or attempt to change or improve the psychological, mental or emotional well-being of the Insured Person , including without limitation, sex-change Surgery and Surgery relating to sexual performance or enhancement thereof.
14. Eyeglasses, contact lenses, hearing aids or hearing implants and any diagnostic test or procedure, treatment, service or supply, or examination or fitting related to these devices or for eye refraction for any reason.
15. Orthoptics, visual eye training, and eye Surgery, such as radial keratotomy, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
16. Diagnosis and/or treatment of the temporomandibular joint, including, without limitation, TMJ syndrome, craniomandibular syndrome, chronic TMJ pain, orthognathic Surgery, Le-Fort Surgery or splint.
17. Routine Physical Exams and treatment, including without limitation, physical exams undertaken whether or not symptoms are present, vaccinations, immunizations, annual check-ups, the issue of medical certificates and attestations, and examinations as to suitability for employment, travel or any activity. This exclusion does not apply to routine care provided to Newborns, or immunizations covered under the plans indicated in the Schedule.
18. Surgeries, treatments, services or supplies for cosmetic or aesthetic reasons, except for reconstructive Surgery when such Surgery is Medically Necessary and directly related to and/or follows Surgery which was covered hereunder.
19. Diagnosis and/or treatment of any sleep disorder, including without limitation, sleep apnea and insomnia.
20. Treatment required as a result of complications or consequences of a treatment or condition not covered hereunder.
21. Services, supplies, or treatment for hair loss, including without limitation, wigs, hair transplants or any drug that promises to promote hair growth, whether or not prescribed by a Physician.
22. Organ or tissue or other transplants and/or related services and supplies and for any efforts to keep a donor alive for a transplant procedure.
23. Artificial or mechanical devices designed to replace human organs temporarily or permanently after termination of Inpatient status.
24. Accidental Death and/or Accidental Dismemberment resulting from or relating, directly or indirectly, or where there is a contribution from any of the following: (a) bodily or mental infirmity, Illness or disease; or (b) infection, other than infection occurring simultaneously with and as a direct result of the Accidental Injury.
25. Testing, serologic or otherwise, for the HIV virus, AIDS, and/or AIDS-related illnesses.
26. For an Insured Person who was HIV positive on or before the Initial Certificate Effective Date , whether or not the Insured Person had knowledge of their HIV status prior to the Initial Certificate Effective Date, all expenses incurred in relation to or arising or resulting directly or indirectly from the HIV virus, AIDS, AIDS related Illnesses, and/or any other Illness arising or resulting from any complications or consequences of any of the foregoing.

Provider-oriented Exclusions

1. Cryogenic preservation and implantation or re-implantation of living cells.
2. Telephone consultations, except Virtual Medicine Consultations through an approved telemedicine protocol system.
3. Charges for failure to keep a scheduled appointment.
4. Incurred while confined primarily to receive Custodial Care
5. Educational or Rehabilitative Care
6. Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care of any nature, massage and kinesitherapy.
7. Exercise and/or fitness programs or equipment, whether or not prescribed or recommended by a Physician.
8. Genetic medicine, genetic testing, surveillance testing and/or wellness screening procedures for genetically predisposed conditions indicated by genetic medicine or genetic testing, including but not limited to amniocentesis, genetic screening, risk assessment, preventative and prophylactic Surgeries recommended by genetic testing and/or any procedures used to determine genetic pre-disposition, provide genetic counseling, or administration of gene therapy.
9. Testing that attempts to measure aspects of an Insured Person’s mental ability, intelligence, aptitude, personality and stress management. Such testing may include, but is not limited to, psychometric, behavioral and educational testing.
10. Nonprescription drugs, medicines, vitamins, food extracts, or nutritional supplements; IV vitamin or herbal therapy, drugs or medicines not approved by the United States Food and Drug Administration, or which are considered “off-label” drug use, and for drugs or medicines not prescribed by a Physician.

Geographic Exclusions

1. Resulting from or relating, directly or indirectly, to epidemics, pandemics, public health emergencies, Natural Disaster s or other disease outbreak conditions that may affect a person’s health that are sustained and/or incurred in a location, post, area, territory or country for which a US Department of State Level 4 (do not travel) warning was issued or in effect within the thirty (30) days prior to the Insured Person’s arrival to said location, post, area, territory or country. This exclusion also applies in the event the US Department of State issues a Level 4 (do not travel) warning after the Insured Person’s arrival to said location and the Insured Person fails within a reasonable time, based on availability of appropriate transportation, and in no event more than fifteen (15) days (unless approved in advance by Underwriters) or refuses to heed such warning and thereafter remains in the affected location.
2. Resulting from or relating, directly or indirectly, Any Act of Terrorism that takes place in a location for which a Travel Warning or Emergency Travel Advisory related to an actual or potential Act of Terrorism was issued or in effect within the one hundred eighty (180) days prior to the Insured Person’s arrival to said location. This exclusion also applies in the event a Travel Warning or Emergency Travel Advisory related to an actual or potential Act of Terrorism is in effect on or after the Insured Person’s arrival to said location and the Insured Person fails within a reasonable time, based on availability of appropriate transportation, and in no event more than fifteen (15) days (unless approved in advance by Underwriters) or refuses to heed such warning and thereafter remains in the affected location.
3. Incurred in the Insured Person’s Home Country.

Activity-oriented Exclusions

1. 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.
2. Resulting or relating, directly or indirectly, from an Insured Person’s operation of a moving vehicle without possession of a valid vehicle operator’s license if licensure is required by local authorities, or operating any moving vehicle without valid registration, licensure and protective gear as required by local authorities.
3. Resulting or relating, directly or indirectly, from an Insured Person operation or riding as a passenger on any motorized vehicle not designed primarily for and licensed and/or registered for (if required by local authorities) use on public streets, highways or waterways.
4. Resulting or relating, directly or indirectly, from an Insured Person’s operation of any moving vehicle, whether or not motorized, after consumption of intoxicating liquor or drugs in excess of the applicable blood/alcohol limit, other than drugs taken in accordance with a prescription and as directed by a Physician. For purposes of this Exclusion, “vehicle” shall include without limitation, any motorized device regardless of whether an operator license is required (including watercraft and aircraft) and non-motorized bicycles, tricycles, unicycles, and scooters for which no permit or license is required.
5. Resulting or relating, directly or indirectly, from the Insured Person’s participation in Contact Sports unless the Contact Sport is undertaken as a School Sport and the Insured Person is covered under the plans indicated in the Schedule that include School Sports coverage.
6. Resulting or relating, directly or indirectly, from the Insured Person’s participation in Professional Athletics.
7. Resulting or relating, directly or indirectly, from the Insured Person’s participation in Extreme Sports.
8. Resulting or relating, directly or indirectly, from the Insured Person’s participation in Adventure Sports , unless the person has purchased the Adventure Sports option. This exclusion does not apply to: a. recreational downhill or cross-country snow skiing or snowboarding provided such activity is not in any violation of applicable laws, rules or regulations or away from prepared and marked in-bound, patrolled territories, or against the advice of the local ski school or local authoritative body; or b. Scuba-diving or sub aqua pursuits to depts of less than 10 meters; or c. mountaineering to less than 2,000 meters from ground level, or d. kayaking or rafting in waters that are less than Class IV difficulty.
9. Downhill or cross-country snow skiing, snowboarding or snowmobiling undertaken in violation of applicable laws, rules or regulations or away from prepared and marked in-bound, patrolled territories or against the advice of the local ski school or local authoritative body. This exclusion applies to all individuals including those who are covered under the Adventure Sports option.
10. Scuba-diving or sub-aqua pursuits if, during the immediately preceding twelve (12) months, the Insured Person (i) has been treated as an Inpatient for any Mental Health Disorder , (ii) is on the waiting list or scheduled for Inpatient treatment in a Hospital or any other medical facility, (iii) is pregnant or (iv) has been given a terminal prognosis. This exclusion applies to all individuals including those who have purchased the Adventure Sports option.
11. Scuba diving or sub-aqua pursuits at night or where a speargun or similar device is carried or used. This exclusion applies to all individuals, including those who have purchased the Adventure Sports option.
12. Resulting or relating, directly or indirectly, from the Insured Person’s participation in any sports or athletic or recreational activity 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 activity or in disregard or against the recommendations of a Physician or other healthcare professional.
13. Resulting or relating directly or indirectly from the Insured Person’s participation in any sports or athletic or recreational activity involving any type of competition or record-breaking or training for such. This exclusion does not include School Sports if the individual is covered under a plan that includes School Sports.

Dental Exclusions

1. Resulting or relating, directly or indirectly, from wear and tear of teeth due to cavities and/or chewing or biting down on hard objects such as, but not limited to, pencils, ice cubes, nuts, popcorn and hard candies.
2. For Traumatic Dental Treatment resulting from a covered Accident, performed in a Hospital, unless the Insured Person sustained associated face, skull, neck and/or jaw Injury.
3. For Dental Treatment relating, directly or indirectly, to oral care and maintenance, including without limitation, tooth repair by fillings, root canals, tooth removals and x-rays.

Personal Liability Exclusions

Underwriters will not pay or reimburse the Insured Person or any third person for any claims of any kind arising directly or indirectly from, happening through or as a consequence of:

1. Any criminal, fraudulent, deceptive, willful, reckless, malicious, or other unlawful acts or omissions committed by the Insured Person or any acts or omissions committed by the Insured Person in connection with the violation or breach of any laws, statutes, ordinances, legal orders, rules or regulations to which the Insured Person is subject or by which the Insured Person is bound. This includes, without limitation any criminal or disciplinary proceedings, charges, arrests, indictments, or arraignments of any kind.
2. Any loss, damage, or claim arising or resulting from hunting, the use of any firearms, fireworks, explosives, welding equipment, propane tanks, or other flammables, deadly weapons, or hazardous implements.
3. The pursuit of any trade, business, profession, or employment activity including without limitation the consequences of any breach, violation, or failure to perform any contractual undertakings or obligations of the Insured Person, whether verbal or in writing.
4. Ownership, possession, control, or occupation of any land or building, or use of any automobile, motorcycle, ATV, off-road vehicle, watercraft, aircraft, parachute, parasail, glider, or any other motorized, gravity- induced, or self-propelled vehicle or craft of any kind.
5. Resulting from any fire, flood, wind, hail, water leak, gas leak, explosion, or other catastrophe or loss occurring in or about the residence or premises of any relative, or in or about the residence or any other premises of which the Insured Person is the owner, lessee, invitee, licensee, occupant, or resident or in or about any residence or premises which are contiguous or adjacent to any of the foregoing residences or premises.
6. Gross negligence, fraud, bad faith, assault and battery, domestic disputes, and all other intentional torts or actions based or sounding in tort without regard to how named or presented.
7. Any collusion, conspiracy, deceit, or other fraudulent scheme or artifice to defraud or other fraudulent means or methods.
8. Fines, penalties, assessments, or claims by any governmental authorities or regulatory bodies including traffic fines or traffic violations or parking tickets, and the costs, fees, or expenses incurred by the Insured Person as a witness, custodian, or in any other non- party status in connection with responding to any order to appear in court, subpoena, subpoena duces tecum, notice of deposition, or any other nonparty legal or administrative proceeding or activity.
9. All non-compensatory damages including, without limitation, damages imposed as a punishment, punitive or exemplary damages, consequential damages, lost profits, criminal damages, excessive damages, expectancy damages, incidental damages, liquidated damages, presumptive damages, prospective damages, special damages, speculative damages, statutory damages, double, treble or other multiples of damages, and/or unliquidated damages, and all claims and damages for pain and suffering, loss of consortium, physical discomfort, mental or emotional distress, trauma, disfigurement, dismemberment, loss of use, or scarring.
10. Contractual or employer’s liability or workers’ compensation claims.
11. Animals or pets belonging to the Insured Person or any relative, or in the care, custody, or control of the Insured Person or any relative.
12. Arising or occurring while the Insured Person is, to any extent, under the influence of alcohol or drugs or due to the Insured Person’s use of drugs, prescription medicines, narcotics, or tranquilizers not medically prescribed for the Insured Person by a licensed Physician.
13. Caused by the Insured Person’s suicide or attempted suicide.
14. The Insured Person’s participation in gambling, gaming, or betting of any kind.
15. During the practice or participation of sports, recreational endeavors, or athletics either as a professional, amateur or novice, unless performed solely for recreational purposes or during high school activities. This includes without limitation Contact Sports, Extreme Sports , Adventure Sports or Professional Sports.
16. Occurring when the Insured Person is a passenger in an aircraft other than a commercial aircraft.
17. Judgments or damage awards that have not been ordered, declared, or entered within twelve (12) months from the date of the act, omission, occurrence, or event causing personal Injury or property damage or within twelve (12) months from the date of termination of coverage under the Certificate, whichever is earlier.
18. Any lawsuit, claim for benefits, enforcement action, complaint, or other civil or administrative proceeding of any kind brought by or on behalf of the Insured Person or any third person or relative against Underwriters or the Plan Administrator including, without limitation, any lawsuit or proceeding alleging breach of contract, bad faith, or any tortuous conduct of any kind, seeking equitable or declaratory relief, or otherwise seeking the recovery, enforcement or effectuation of any benefits or coverages under this Insurance.
19. Any loss, personal Injury , property damage, or other claim arising or resulting from any act, omission, failure to act, event or other occurrence committed or occurring at any time prior to or subsequent to the Certificate Period.
20. Any personal Injury , medical expense, damage or other loss suffered by a relative except for damage to a relative’s personal property, which shall be limited to a maximum of $2,500 and subject to the Deductible set forth in the Schedule.

This plan is underwritten by HDI Global.