All of the following Exclusions may apply to any claim hereunder; category headings are provided for convenient
reference purposes only.
War and Terrorism
Resulting directly or indirectly, proximately or remotely occasioned by, contributed to or by, traceable to or arising in connection with the following: a. The Insured Person’s active and voluntary planning or coordination of or participation in any Act of Terrorism.
Resulting directly or indirectly, proximately or remotely occasioned by, contributed to by, traceable to or arising in connection with the following: a. War, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war. b. Mutiny, riot, strike, military or popular uprising, insurrection, rebellion, revolution, military or usurped power. c. Any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of the Government de jure or de facto or to the influencing of it by violence of any nature.
Resulting from or relating, directly or indirectly, to any Pre-existing Condition, except as expressly provided for in the Acute Onset of Pre-existing Condition provision of this insurance.
Resulting from the Acute Onset of Pre-existing Condition which begins while the Insured Person is physically located in the US.
Related in any way to birth defects, hereditary conditions and Congenital Disorders, including any conditions arising out of or resulting therefrom.
For 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, surrogacy or abortion.
For 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.
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.
Resulting from or relating, directly or indirectly, to all forms of cancer/ neoplasm, including without limitation, diagnostic tests and procedures, chemotherapy, radiation treatment and any Surgical Procedure.
For diagnosis and/or treatment of acne, rosacea, eczema, psoriasis, fungal infection, moles, warts, skin tags, diseases of sebaceous glands, seborrhea, and hypertrophic and atrophic conditions of skin.
For non-surgical care, diagnosis and/or treatment or supplies for the feet, including without limitation, orthopedic shoes, orthopedic prescription devicesto 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, except as otherwise expressly set forth in this insurance.
For diagnosis and/or treatment of Mental Health Disorders.
For 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.
For weight modification or any Inpatient, Outpatient, Surgical Procedure or other treatment of obesity (including without limitation, morbid obesity), including without limitation, 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.
For 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.
For eyeglasses, contact lenses, hearing aids or hearing implants and for any diagnostic test or procedure, treatment, service or supply, or examination or fitting related to these devices or for eye refraction for any reason.
For diagnosis and/or treatment of venereal disease, including all Sexually Transmitted Diseases and conditions.
For Routine Physical Exams and treatment, including without limitation, vaccinations, immunizations, annual check-ups, the issue of medical certificates and attestations, and examinations as to suitability for employment or travel.
For diagnosis and/or treatment of Substance Abuse or addiction or conditions that may be attributed to Substance Abuse or addiction and direct consequences thereof.
For diagnosis and/or treatment of the following: HIV seropositivity to the AIDS virus, AIDS related Illnesses, ARC Syndrome and/or AIDS.
Activity Oriented Exclusions
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.
Resulting or relating, directly or indirectly, from willfully self-inflicted Injury or Illness and/or suicide or attempted suicide whether sane or insane.
Resulting or relating, directly or indirectly, from an Insured Person entering into or alighting from, operating or riding as a passenger in any motorized vehicle that does not require licensing as a motor vehicle.
Resulting or relating, directly or indirectly, from an Insured Person’s operation of a any motorized vehicle without possession of a valid motor vehicle operator’s license, except while participating in a drivers’ education program.
Resulting or relating, directly or indirectly, from an Insured Person entering into or alighting from, operating or riding as a passenger, or being struck by any 2 or 3-wheeled motorized vehicle, or any motorized vehicle not designed primarily for use on public streets and highways. (Limited coverage in respect to motorcycle riding as an operator or passenger is available under the Adventure Sports Coverage option if purchased by the Insured Person.)
Resulting or relating, directly or indirectly, from an Insured Person’s operation of any 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, 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.
For travel, meals, transportation and/or accommodations except as expressly provided herein.
Resulting or relating, directly or indirectly, from the Insured Person’s participation in Contact Sports, Amateur Athletics, Professional Athletics, Extreme Sports, Adventure Sports, unless the Insured Person has purchased the Adventure Sports Coverage or Marine Activities option.
For Dental Treatment, except as expressly provided for herein.
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.
For treatment of a Dental Injury without associated face, skull, neck and/or jaw Injury or that can be evaluated and treated in a Dental office.
For Dental Treatment relating, directly or indirectly, to oral care and maintenance, including without limitation, tooth repair by fillings, root canals, tooth removal and x-rays.
Please note: This is a summary of the exclusions of the plan. To view the full exclusions, refer to the plan master certificate.