Collegiate Care Essential

Plan Detail

Plan Administrator: Trawick International | AM Best Rating: A "Excellent" | Underwriter: GBG Insurance Limited

Exclusions


EXCLUSIONS

The Plan does not cover any loss resulting from any of the following unless otherwise covered under the Plan by Additional Benefits:

1) Suicide, attempted suicide (including drug overdose) self-destruction, attempted self-destruction or intentional self-inflicted Injury while sane or insane;

2) War or any act of war, declared or undeclared;

3) An Accident which occurs while the Plan Participant is on Active Duty Service in any Armed Forces, National Guard, military, naval or air service or organized reserve corps;

4) Injury sustained while in the service of the armed forces of any country. When the Plan Participant enters the armed forces of any country, We will refund the unearned pro rata premium upon request;

5) Voluntary, active participation in a riot or insurrection;

6) Medical expenses resulting from a motor vehicle accident in excess of that which is payable under any other valid and collectible insurance;

7) Organ transplants;

8) Treatment for an Injury or Sickness resulting from the Plan Participant's intoxication or use of illegal drugs or any drugs or medication that is intentionally not taken in the dosage recommended by the manufacturer or for the purpose prescribed by the Plan Participant's Physician;

9) Commission or attempt to commit an assault or felony, or that occurs while being engaged in an illegal occupation;

10) Eligible Expenses for which the Plan Participant would not be responsible in the absence of the Policy;

11) Treatment of acne;

12) Charges which are in excess of Usual, Reasonable and Customary charges;

13) Charges that are not Medically Necessary;

14) Charges provided at no cost to the Plan Participant;

15) Expenses incurred for an Accident or Sickness after the Benefit Period shown in the Schedule of Benefits or incurred after the termination date of coverage;

16) Regular health checkups, routine physical, immunizations or other examination where there are no objective indications or impairment in normal health;

17) Services or treatment rendered by a Physician, Registered Nurse or any other person who is employed or retained by the Policyholder; or an Immediate Family member of the Plan Participant;

18) Duplicate services actually provided by both a certified nurse midwife and Physician;

19) Injuries paid under Workers’ Compensation, Employer’s liability laws or similar occupational benefits or while engaging in an occupation for monetary gain;

20) Benefits for enrolling solely for the purpose of obtaining medical treatment, while on a waiting list for a specific treatment, or while traveling against the advice of a Physician;

21) Aggravation or re-injury of a prior Injury that the Plan Participant suffered prior to his or her coverage Effective Date, unless We receive a written medical release from the Plan Participant’s Physician;

22) Pre-Existing conditions; however, a Pre-Existing condition will be covered after the Covered Person has been continuously insured for 6 months under the same insurance plan;

23) Treatment of a hernia, including sports hernia, whether or not caused by a Covered Accident;

24) Pregnancy or childbirth, except when conception occurs while covered under the Policy; elective cesarean section; or any complications of any of these conditions; pregnancy or childbirth or a dependent when dependent child of an Plan Participant (except for complications arising there from); except as stated in the summary of benefits

 25) Treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof except as stated in the summary of benefits

26) Charges incurred for Surgery or treatments which are, Experimental/Investigational, or for research purposes;

27) Expense incurred for treatment of temporomandibular joint (TMJ) disorders or craniomandibular joint dysfunction and associated myofascial pain;

28) Dental care or treatment other than care of sound, natural teeth and gums required on account of Injury resulting from an Accident while the Plan Participant is covered under the Policy, and rendered within 6 months of the Accident;

29) Eyeglasses, contact lenses, hearing aids braces, appliances, or examinations or prescriptions therefore;

30) Weak, strained or flat feet, corns, calluses, or toenails.

31) Travel in or upon: (a) A snowmobile; (b) A water jet ski (c) Any two or three wheeled motor vehicle, other than a motorcycle registered for onroad travel; (d) Any off-road motorized vehicle not requiring licensing as a motor vehicle; when used for recreation competition.

32) Injury sustained while taking part in: mountaineering; hang gliding; parachuting; bungee jumping; racing by horse, motorcycle; snowmobiling; motorcycle/motor scooter riding; scuba diving, involving underwater breathing apparatus, ; scuba diving, involving underwater breathing apparatus; snorkeling; water skiing; snow skiing; spelunking; parasailing; white water rafting; surfing, unless part of a school credit course; and snowboarding.

33) Practice or play in any amateur, intercollegiate, professional or semiprofessional sports contest or competition;

34) Rest cures or custodial care;

35) Elective or Cosmetic surgery and Elective Treatment or treatment for congenital anomalies (except as specifically provided), except for reconstructive surgery on a diseased or injured part of the body (Correction of a deviated nasal septum is considered cosmetic surgery unless it results from a covered Injury or Sickness);

36) Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste, from combustion of nuclear fuel, the radioactive, toxic, explosive or other hazardous properties of any nuclear assembly or nuclear component of such assembly;

 37) Plan Participant being exposed to the Utilization of nuclear, chemical or biological weapons of mass destruction

38) Chemotherapy, radiation, and other oncology related treatments