Inbound USA Basic

Plan Detail

Plan Administrator: Seven Corners | AM Best Rating: A "Excellent" | Underwriter: Lloyd's

Exclusions


Unless otherwise specifically provided for therein, the coverage provided by the Certificate under Sections 3.2, 3.3, 3.5, 3.6, 4.1, 4.2, 5.1 through 5.4, 6.2, and 6.3, excludes Expenses that are for, resulting from, related to, or incurred for the following:

(a) Pre-Existing Condition(s) except as waived under Sections 3.6, 5.2 and 5.3 above.

(b) Claims not received by the Company or Administrator within ninety (90) days of the date of service;

(c) Treatment that is Investigational, Experimental, or for research purposes;

(d) Treatment, services, or supplies that are not administered by or under the supervision of a Physician or Surgeon and products that can be purchased without a Physician’s or Surgeon’s prescription;

(e) Routine physicals, inoculations, or other examinations or tests conducted when there is no objective indications or impairments in normal health;

(f) Chiropractic care or acupuncture;

(g) Services, supplies, medications, testing, or Treatment prescribed, performed, or provided by a Relative or Immediate Family Member;

(h) False teeth, dentures, dental appliances, dental expenses, normal ear or hearing tests, hearing aids, hearing implants, eye refractions, eye examinations for prescribing corrective lenses or eye-

glasses unless caused by Accidental Injury, eyeglasses, contact lenses, or eye surgery when the primary purpose is to correct nearsightedness, farsightedness, or astigmatism;

(i) Replacement of artificial limbs, eyes, larynx, and orthotic appliances;

(j) Custodial Care, Educational or Rehabilitative Care, or any Treatment in any establishment for the care of the aged;

(k) Vocational, occupational, sleep, speech, recreational, art, or music therapy;

(l) Pregnancy, Illness or complications from Pregnancy, childbirth, abortion, miscarriage including that resulting from an Accident, postnatal care, preventing conception or childbirth, artificial insemination, infertility, impotency, sexual dysfunction, or sterilization or reversal thereof;

(m) Sleep apnea or other sleep disorders;

(n) Mental and Nervous Disorders unless specifically covered herein, Rest Cures, learning disabilities, attitudinal disorders, or disciplinary problems;

(o) Congenital abnormalities and conditions arising out of or resulting therefrom.

(p) Temporomandibular joint;

(q) Occupational Diseases;

(r) Exposure to non-medical nuclear radiation or radioactive materials;

(s) Sexually transmitted diseases, venereal diseases, and conditions and any consequences thereof;

(t) Acquired Immune Deficiency Syndrome (AIDS), AIDS-Related Complex (ARC), or the Human Immunodeficiency Virus (HIV);

(u) Human organ or tissue transplants.

(v) Exercise programs whether prescribed or recommended by a Physician or therapist;

(w) Weight reduction programs or the surgical Treatment of obesity including, but not limited to, wiring of the teeth and all forms of intestinal bypass Surgery;

(x) Cosmetic or plastic Surgery including deviated nasal septum; modifications of Your physical body intended to improve Your psychological, mental, or emotional well-being including, but not limited to, sex-change Surgery;

(y) Acne, moles, skin tags, disease of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of the sebaceous glands, hypertrophic and atrophic conditions of skin, nevus;

(z) Hazardous Activities;

(aa) Injuries sustained while participating in professional Athletics, amateur Athletics, or interscholastic Athletics including, but not limited to, events, games, matches, practice, training camps, sport camps, conditioning, and any other activity related thereto and excluding non-competitive, recreational, or intramural activities;

(bb) Abuse, misuse, illegal use, overuse, or being under the influence of alcohol, drugs, chemicals, or narcotic agents unless administered under the advice of a Physician and taken in accordance with the proper dosing as directed by the Physician;

(cc) Suicide or any attempt thereof; self-destruction or any attempt thereof; or any intentionally self-inflicted Injury or Illness;

(dd) Terrorist Activity except as provided under Section 5.4; War, Hostilities, or War-Like Operations;

(ee) Commission of a criminal offense or any other criminal or illegal activity as defined by the local governing body;

(ff) You unreasonably fail or refuse to depart a country or location following the date a warning to leave that country or location is issued by the United States government or similar warnings issued by other appropriate authorities of either Your Host Country or Your Home Country;

(gg) Service in the military, naval, coast guard, or air service of any country or while on duty as a member of a police force or unit;

(hh) Treatment paid for or furnished under any other individual, government, or group policy or Expenses incurred at no cost to You;

(ii) You while in Your Home Country unless covered under Section 3.5;

(jj) Conditions for which travel was undertaken to seek Treatment after Your Physician has limited or restricted travel;

(kk) Travel accommodations;

(ll) 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;

(mm) Injury sustained while You are riding as a passenger in any aircraft (i) not having a current and valid Airworthy Certificate and (ii) not piloted by a person who holds a valid and current certificate of competency for piloting such aircraft;

(nn) Flying in any aircraft being used for acrobatic or stunt flying, racing, endurance tests, rocket-propelled aircraft, crop dusting or seeding or spraying, firefighting, exploration, pipe or power line inspection, any form of hunting or herding, aerial photography, banner towing, or any experimental purpose;

(oo) Participating in contests of speed or riding or driving in any type of competition; and

(pp) Charges incurred for treatment or surgeries which are Experimental/Investigational, or for research purposes; expenses which are non-medical in nature, expenses for Custodial Care, vocational, speech, recreational or music therapy.