USAway International Major Medical

Plan Detail

Plan Administrator: Petersen International Underwriters | AM Best Rating: A "Excellent" | Underwriter: Lloyd's of London

Exclusions


LIMITATIONS & EXCLUSIONS

Limitations

Pre-existing Conditions Limitations

A preexisting condition means a condition, disease or Injury for which medical advice, diagnosis, care or treatment, including the use of prescription medication including but not limited to ongoing condition(s), was recommended by or received from a licensed health care practitioner, and/or any symptom(s) and/or any condition(s) which would have caused a reasonable prudent person to seek medical attention during the 12 months immediately preceding the Ef ective Date of the insurance described in this Certii cate, whether disclosed or not on Your application.

Exclusions
  • Any expense which You are not legally obligated to pay.
  • Services which are not Medically Necessary or are not furnished by and under supervision of a Physician.
  • Expenses for services and supplies for which You are entitled to benei ts, services or reimbursement through the Veterans’ Administration, Workers’ Compensation insurance, any private health plan or from any other source except Medicaid.
  • Expenses in excess of UCR.
  • Self-inflicted injuries while sane or insane.
  • Treatment for alcoholism, drug addiction, allergies, and/or Mental or Nervous Disorders.
  • Rest cures, quarantine or isolation.
  • Cosmetic surgery unless necessitated by an accidental Injury.
  • Dental exams, dental x-rays and general dental care except as a result of an accidental Injury.
  • Eye glasses or eye examinations.
  • Hearing aids or hearing examinations.
  • General or routine examinations.
  • Injuries sustained from participation in Hazardous Sports or Activities.*
  • Pregnancy and pregnancy-related conditions including but not limited to fertility, pre-natal care, childbirth, miscarriage, abortion or postpartum conditions.
  • Injuries or Illnesses due to War or any act of War whether declared or undeclared.*
  • Injuries or Illnesses due to Terrorism or any act of Terrorism whether declared or undeclared.*
  • Injuries or Illnesses due to an act of Terrorism involving the use or release of any nuclear weapon or device or chemical or biological agent, regardless of any contributory cause(s).
  • Injuries or Illnesses sustained while committing a criminal or felonious act.
  • Expenses incurred for or resulting from pain which is not supported by medical diagnosis.
  • Cataract surgery.
  • Any elective surgery, including but not limited to complications of previous elective or cosmetic surgeries.
  • Custodial Care.
  • Expenses for supplies and services that were not incurred with in the specii ed Geographic Area.
  • Pre-existing conditions.
  • Racing of any kind, all professional or semi-professional sports, and collegiate, sponsored, or interscholastic athletics.**

* This exclusion can be removed if the appropriate additional premium has been paid and the optional benei t is indicated on the Schedule or attached by an endorsement.

**This exclusion can be removed if the appropriate additional premium has been paid and the optional benei t is indicated on the Schedule or attached by an endorsement.  Please note this exclusion cannot be removed with the online enrollment.