Student Secure - Select Including USA

Plan Detail

Plan Administrator: Tokio Marine HCC Medical Insurance Services Group | AM Best Rating: A "Excellent" | Underwriter: Lloyd's

Exclusions


WAR, TERRORISM, BIOLOGICAL, CHEMICAL, NUCLEAR EXCLUSION

War, Terrorism, Biological, Chemical, Radioactive, Nuclear: Notwithstanding any provision to the contrary within this insurance or any endorsement or rider attached hereto, it is agreed that this insurance excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing concurrently or in any other sequence to the loss, damage, cost or expense:

  1. war, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power and
  2. the use of any biological, chemical, radioactive or nuclear agent, material, device or weapon; however, this exclusion (2) shall not apply where the Member is exposed to nuclear radioactive and/or radioactive material for the purpose of medical treatment and
  3. any Act of Terrorism, except as follows: Underwriters will pay Eligible Medical Expenses for treatment of Injuries and Illnesses resulting from an Act of Terrorism, up to the limit set forth in the Schedule of Benefits and Limits, provided all of the following conditions are met:
    • The Injury or Illness does not result from the use of any biological, chemical, radioactive or nuclear agent, material, device or weapon and
    • The Member has no direct or indirect involvement in the Act of Terrorism and
    • The Act of Terrorism is not in a country or location where the United States government has issued a travel advisory that has been in effect within the 6 months immediately prior to the Member’s date of arrival and
    • The Member has not unreasonably failed or refused to depart a country or location following the date an advisory to leave that country or location is issued by the United States government.

For the purpose of this insurance, an “Act of Terrorism” means an act, including but not limited to, the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s) committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.

This insurance also excludes coverage for loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in any way relating to (1), (2) or (3) above.
 
If Underwriters allege that by reason of this exclusion, any loss, damage, cost or expense is not covered by this insurance, the burden of proving the contrary shall be upon the Member.
 
In the event any portion of this exclusion is found to be invalid or unenforceable, the remainder shall remain in full force and effect.
 
OTHER EXCLUSIONS
 
Charges for the following treatments and/or services and/or supplies and/or conditions are excluded from coverage hereunder:
  1. Pre-existing Conditions – Charges resulting directly or indirectly from any Pre-existing Condition, as herein defined, are excluded from this insurance during the first 12 months of coverage.
  2. Coverage Area – For all non-US citizens electing the Coverage Area “Excluding the US” and for all US citizens or residents, no coverage is provided within the United States, except for US citizens or residents during an eligible Incidental Home Country visit or an eligible Benefit Period.
  3. Routine pre-natal care, Pregnancy, child birth, post natal care, and routine nursery care of a newborn, unless directly related to a Covered Pregnancy as defined herein.
  4. Treatment for or related to any congenital condition, except this does not include congenital conditions for a child if the delivery is covered under this insurance.
  5. Charges which are not Incurred, as herein defined, by a Member during his/her Certificate Period.
  6. Charges for treatment of any condition(s) when the purpose of departing the Home Country was to obtain treatment in the destination country/countries.
  7. Charges for any benefit hereunder which are not presented to Underwriters for payment within 60 days beginning on the last day of the Certificate Period.
  8. Treatment, services or supplies which are not administered or ordered by a Physician.
  9. Treatment, services or supplies which are not Medically Necessary.
  10. Treatment, services or supplies provided at no cost to the Member.
  11. Charges which exceed Usual, Reasonable and Customary.
  12. Telephone consultations or failure to keep a scheduled appointment.
  13. Surgeries, treatments, services or supplies which are Investigational, Experimental or for Research purposes.
  14. While confined primarily to receive Custodial Care, Educational or Rehabilitative Care.
  15. Weight modification or surgical treatment of obesity, including but not limited to wiring of the teeth and all forms of intestinal bypass Surgery.
  16. Modifications of the physical body in order to improve the psychological, mental or emotional well-being of the Member, including but not limited to sex-change Surgery.
  17. Surgeries, treatments, services or supplies for cosmetic or aesthetic reasons, except for reconstructive Surgery when such Surgery is directly related to and follows a Surgery which was covered hereunder.
  18. Treatment of Members who are HIV+ or have AIDS or ARC.
  19. Any drug, treatment or procedure that either promotes or prevents conception including but not limited to: any form of birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal of sterilization.
  20. Any drug, treatment or procedure that either promotes, enhances or corrects impotency or sexual dysfunction.
  21. Elective termination of pregnancy.
  22. Dental Treatment, except for Emergency Dental Treatment necessary to replace sound natural teeth lost or damaged in an Accident covered hereunder or for the Emergency relief of Acute Onset of Pain.
  23. Eyeglasses, contact lenses, hearing aids, hearing implants, eye refraction, visual therapy, and for any examination or fitting related to these devices.
  24. Eye surgery, such as radial keratotomy, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
  25. Treatment of the temporomandibular joint.
  26. Expenses in excess of $5,000 for Injury or Illness sustained while taking part in intercollegiate, interscholastic, intramural, or club sports, and all expenses for any Injury or Illness sustained while taking part in any other Amateur Athletics. This does not include athletic activities which are non-contact and engaged in by the Member solely for leisure, recreational, entertainment or fitness purposes unless such sports or activities are otherwise excluded by this insurance.
  27. Injury sustained while taking part in the following activities:
    • professional sports and
    • mountaineering where a reasonably prudent person would use ropes or guides or at elevations of 4,500 meters or higher and
    • aviation (except when traveling solely as a passenger in a commercial aircraft) and
    • hang gliding, sky diving, parachuting or bungee jumping and
    • snow skiing or snowboarding, except for recreational downhill and/or cross country snow skiing or snowboarding (no cover provided whilst skiing away from prepared and marked in-bound territories and/or against the advice of the
      local ski school or local authoritative body) and
    • racing by any animal or motorized vehicle and
    • spelunking and
    • subaqua pursuits involving underwater breathing apparatus unless PADI/NAUI certified, accompanied by a certified
      instructor, and at depths of less than 10 meters and
    • jet skiing and
    • any other sport or activity, including Extreme Sports, which is undertaken for thrill seeking and exposes the Member
      to abnormal risk of Injury.
  28. Injury sustained while under the influence of or 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 but not for the treatment of Substance Abuse.
  29. Willfully self-inflicted Injury or Illness and/or any complications or consequences thereof.
  30. Venereal disease and sexually transmitted disease.
  31. Immunizations, Routine Physical Exams, and other diagnostic labs, x-rays, and procedures for screening or preventative purposes.
  32. Treatment by a chiropractor, unless ordered in advance by a Physician for Medically Necessary treatment related to an Injury or Illness covered hereunder.
  33. Expenses for physical therapy or treatment for Mental Health Disorders if treatment is obtained at a Student Health Center.
  34. Charges resulting from or occurring during the commission of a violation of law by the Member, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
  35. Treatment of Substance Abuse.
  36. Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy.
  37. Any services, supplies, or treatments performed or provided by a Relative of the Member or any family member of the Member or any person who ordinarily resides with the Member.
  38. Orthoptics and visual eye training.
  39. Services, supplies, or treatment that are not included as Eligible Expenses as described herein.
  40. The following care, treatment or supplies for the feet: orthopedic shoes, orthopedic prescription devices to be attached to or placed in shoes, treatment of weak, strained, flat, unstable or unbalanced feet, metatarsalgia or bunions, and treatment of corns, calluses or toenails.
  41. Services, supplies, or treatment for hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed by a Physician.
  42. Treatment of sleep disorders.
  43. Exercise programs, whether or not prescribed or recommended by a Physician.
  44. Treatment required as a result of complications or consequences of a treatment or condition not covered hereunder.
  45. Charges for travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical Evacuation, Repatriation of Remains, and Emergency Reunion sections of this insurance.
  46. Treatment incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
  47. Organ or Tissue Transplants or related services.
  48. Treatment for acne, other acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of sebaceous glands, hypertrophic and atrophic conditions of skin, nevus.