Diplomat Long Term - Excluding USA

Plan Detail

Plan Administrator: Global Underwriters | AM Best Rating: A+ "Superior" | Underwriter: United States Fire Insurance Company

Exclusions


EXCLUSIONS AND LIMITATIONS

No Benefit will be payable for Accident Medical, Sickness Medical, In-Hospital Indemnity, Sudden Recurrence of a Preexisting Condition, Emergency Dental Treatment (Palliative), Emergency Medical Evacuation/Repatriation, Return of Mortal Remains, Return of Minor Child, Incidental Trips, Emergency Medical Reunion, Home Country Coverage, and Athletic Sports & Hazardous Activity Benefits as the result of: 

  1. Any Pre-existing Condition as defined hereunder. This exclusion does not apply to Emergency Evacuation/Repatriation.
  2. Injury or Illness which is not presented to Us for payment within 90 days of receiving Treatment.
  3. Charges for Treatment which is not Medically Necessary.
  4. Charges provided at no Expense to You.
  5. Charges for Treatment which exceeds Reasonable and Customary charges.
  6. Charges incurred for Surgery or Treatments which are, Experimental/Investigational, or for research purposes.
  7. Services, supplies or Treatment, including any period of Hospital confinement, which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician.
  8. Suicide or any attempt thereof, while sane or self-destruction or any attempt thereof, while insane.
  9. This plan does not insure against loss or damage (including death or Injury) from any consequences, whether direct or indirect, invasion, act of foreign enemy, hostilities, or warlike operation (whether War be declared or not), “armed conflict” by military forces, civil war, mutiny, military or usurped power, martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege, except as provided under the Political and Natural Disaster Evacuation and/or optional War Risk Coverage Rider.
  10. Injury or Illness sustained while participating in professional athletics, Intercollegiate, Interscholastic Athletics, Club Sports, and Organized Amateur Sports except as provided under the optional Athletic Sports & Hazardous Activity Rider.
  11. Injury or Illness sustained while participating in Athletic Sports and Hazardous Activities except as provided under the optional Athletic Sports & Hazardous Activity Rider. Including but not limited to: Arial Photograph (Use of proper restraints required); BMX (Racing or Competitive); Bobsledding; Bungee Jumping; Canopying; Diving with Sharks; Flying in any Chartered or Leased Aircraft or Helicopter; Hang Gliding; Heli-skiing; Horseback Riding;  Jet, Snow, and Water Skiing; Kayaking; Martial Arts; Motorcycling & Motor Scooter; Mountain Bike; Mountain Climbing (if over 14 thousand feet, guide required); Mountain Climbing (under 14 thousand feet); MX; Paragliding; Parasailing; Piloting any Non-commercial Aircraft; Running with Bulls; Safari; Safari & Big Game Hunting (use of firearms); Scuba Diving; Security Detail (use of firearms); Skydiving; Snowboarding; Snowmobiling; Spelunking; Surfing; Trekking; Whitewater Rafting (up to and including class V rapids only); Wind Surfing; Zip Lining.
  12. Routine physicals, immunizations or other examinations where there are no objective indications or impairment in normal health, and laboratory diagnostic or x-ray examinations, except in the course of a Disablement established by a prior call or 
    attendance of a Physician.
  13. Treatment of the Temporomandibular joint.
  14. Vocational, speech, recreational or music therapy.
  15. Services or supplies performed or provided by a Relative of Yours, or anyone who lives with You.
  16. Cosmetic or plastic Surgery, except as the result of a Covered Accident; for the purposes of this Plan, Treatment of a deviated nasal septum will be considered a cosmetic condition.
  17. Elective Surgery which can be postponed until You return to Your Home County, where the objective of the trip is to seek medical advice, Treatment or Surgery.
  18. Treatment and the provision of false teeth or dentures, normal ear tests and the provision of hearing aids.
  19. Eye refractions or eye examinations for the purpose of prescribing corrective lenses for eye glasses or for the fitting thereof, unless caused by Accidental bodily Injury incurred while covered hereunder.
  20. Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent.
  21. Injury sustained while under the influence of or Disablement due wholly or partly to the effects of intoxicating liquor or drugs 
    other than drugs taken in accordance with Treatment prescribed and directed by a Physician for a condition which is covered hereunder, but not for the Treatment of drug addiction.
  22. Any Mental and Nervous disorders or rest cures.
  23. Congenital abnormalities and conditions arising out of or resulting therefrom.
  24. Expenses which are non-medical in nature. Including but not limited to: taxes, administration fees, and service fees.
  25. Expenses as a result or in connection with intentionally self-inflicted Injury or Illness.
  26. Expenses as a result or in connection with the commission of a felony offense.
  27. Treatment paid for or furnished under any other individual or group policy or other service or medical pre-payment plan arranged through the employer to the extent so furnished or paid, or under any mandatory government program or facility set up for Treatment  without Expense to You.
  28. Treatment of venereal disease.
  29. Dental care, except as the result of Injury to natural teeth caused by Accident, unless otherwise covered under this Plan.
  30. Routine Dental Treatment.
  31. For Pregnancy or Illness resulting from Pregnancy, childbirth, or miscarriage.
  32. For miscarriage resulting from Accident.
  33. Drug, 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.
  34. Treatment for human organ tissue transplants and their related Treatment.
  35. Expenses incurred while in Your Home Country, except as provided under the Home Country Coverage.
  36. Expenses incurred during a Hospital emergency visit which is not of an emergency nature.
  37. Expenses incurred for which the Trip to the Host Country was undertaken to seek medical Treatment for a condition.
  38. Expenses incurred during a Trip after Your Physician has limited or restricted travel.
  39. Sex change operations, or for Treatment of sexual dysfunction or sexual inadequacy.
  40. Weight reduction programs or the surgical Treatment of obesity.
  41. Expenses resulting from Acquired Immune Deficiency Syndrome (AIDS), Aids-Related Complex (ARC) or the Human Immunodeficiency Virus (HIV).
  42. For any violent or unlawful act of an Immediate Family Member, another insured, or an individual that resides with the insured on a permanent basis.
  43. For the ordinary Expense of a one-way airplane ticket used in the transportation back to the insured's country where an air ambulance benefit is provided.
  44. Long or short term care outside of the Hospital. Included but not limited to: 1) Home health care; 2) Convalescent, nursing, or rest home facilities; 3) Rehabilitation Centers; and 4) Hospice Care facilities.
No Benefit will be payable for Accidental Death and Dismemberment, Paralysis, Coma, and Seat Belt and Airbag Benefits as the result of:
  1. Suicide or an attempt thereof while sane or self destruction or any attempt thereof while insane.
  2. Disease of any kind; Bacterial infections except pyogenic infection which will occur through an accidental cut or wound.
  3. Hernia of any kind.
  4. Injury sustained while You are riding as a pilot, student pilot, operator or crew member, in or on, boarding or alighting from, any  type of aircraft.
  5. Injury sustained while You are riding as a passenger in any aircraft. (a) Not having a current and valid Airworthy Certificate and (b) Not piloted by a person who holds a valid and current certificate of competency for piloting such aircraft.
  6. This plan does not insure against loss or damage (including death or Injury) from any consequences, whether direct or indirect, invasion, act of foreign enemy, hostilities, or warlike operation (whether War be declared or not), “armed conflict” by military forces, civil war, mutiny, military or usurped power, martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege, except as provided under the Political and Natural Disaster Evacuation and/or optional War Risk Coverage Rider.
  7. Service in the military, naval, or air service of any country.
  8. Flying in any aircraft being used for or in connection with acrobatic or stunt flying, racing or endurance tests; Flying in any rocket-propelled aircraft; Flying in any aircraft being used for or in connection with crop dusting or seeding or spraying, fire fighting, exploration, pipe or power line inspection, any form of hunting or herding, aerial photography (except as provided under the optional Athletic Sports & Hazardous Activity Rider), banner towing or any experimental purpose; Flying in any aircraft which is engaged in any flight which requires a special permit or waiver from the authority having jurisdiction over civil aviation, even though granted.
  9. Sickness of any kind.
  10. Being under the influence of alcohol or having taken drugs or narcotics unless prescribed by a legally qualified Physician or surgeon.
  11. Injury occasioned or occurring while You are committing or attempting to commit a felony or to which a contributing cause was You being engaged in an illegal occupation.
  12. Pregnancy, childbirth, miscarriage or abortion.
  13. This plan does not insure against loss or damage (including death or Injury) and any associated Expense or expense resulting directly or indirectly from the discharge, explosion or use of any device, weapon or material employing or involving nuclear fission, nuclear fusion or radioactive force, or chemical, biological, radiological or similar agents, whether in time of peace or war, and regardless of who commits the act, regardless or any other cause or event contributing concurrently or in any other sequence thereto.
  14. For any violent or unlawful act of an Immediate Family Member, another insured, or an individual that resides with the insured on a permanent basis.
  15. While riding or driving in any competition except as provided under the optional Athletic Sports & Hazardous Activity Rider.
  16. Injury or Illness sustained while participating in professional athletics, Intercollegiate, Interscholastic Athletics, Club Sports, and Organized Amateur Sports except as provided under the optional Athletic Sports & Hazardous Activity Rider.
  17. Injury or Illness sustained while participating in Athletic Sports and Hazardous Activities except as provided under the optional Athletic Sports & Hazardous Activity Rider. Including but not limited to: Arial Photograph (Use of proper restraints required); BMX (Racing or Competitive); Bobsledding; Bungee Jumping; Canopying; Diving with Sharks; Flying in any Chartered or Leased Aircraft or Helicopter; Hang Gliding; Heli-skiing; Horseback Riding; Jet, Snow, and Water Skiing; Kayaking; Martial Arts; Motorcycling & Motor Scooter; Mountain Bike; Mountain Climbing (if over 14 thousand feet, guide required); Mountain Climbing (under 14 thousand feet); MX; Paragliding; Parasailing; Piloting any Non-commercial Aircraft; Running with Bulls; Safari; Safari & Big Game Hunting (use of firearms); Scuba Diving; Security Detail (use of firearms); Skydiving; Snowboarding; Snowmobiling; Spelunking; Surfing; Trekking; Whitewater Rafting (up to and including class V rapids only); Wind Surfing; Zip Lining.
No Benefit will be payable under the Loss of Baggage Benefit for the following items:
  1. Animals.
  2. Artificial teeth or limbs, hearing aids.
  3. Sunglasses, contact lenses or eyeglasses.
  4. Documents of any kind, including but not limited to documents, bills, currency, deeds, evidence of debt, letters of credit, stamps, credit cards, money, notes, securities, transportation, or other tickets.
  5. Household furniture or furnishings.

No Benefit will be payable for Trip Interruption as the result of:

  1. You, Your family, Your Traveling Companion or Your Traveling Companion’s family has made changes to personal plans; having business or contractual obligations; being unable to obtain necessary travel documents (passports, visas, etc.); being detained or having property confiscated by customs authorities; carrier caused delays (including bad weather).
  2. Prohibition or regulatory by any government; default of yacht charter companies; default of the organization from which You have purchased Your trip arrangements.

No Benefit will be payable for Home Alteration and Vehicle Modification, as the result of:

  1. Any condition for which the Insured Person is entitled to benefits under any Workers’ Compensation Act or similar law.

Excess Benefits:

All coverage, except Accidental Death and Dismemberment, will be in excess of all other valid and collectible Insurance Indemnity and will apply only when such benefits are exhausted. The policy is not in lieu of and does not affect any requirement for coverage by Worker’s Compensation insurance.

Other valid and collectable Insurance Indemnity for which benefits may be payable are Insurance programs provided by: 
  1. Individual, group or blanket Insurance or coverage.
  2. Other prepayment coverage provided on a group or individual basis.
  3. Any coverage under labor management trusted plans, union welfare plans, employer organizational plans, employee benefit organization plans, or other arrangement of benefits for individuals of a group.
  4. Any coverage required or provided by any statute, socialized Insurance program.
  5. Any no-fault Automobile Insurance.
  6. Any third party liability Insurance.