|
|
|
|
|
|
|
|
|
|
|
|
Exclusions
No benefits will be paid for loss or expense caused by, contributed to, or
resulting from:
-
Pre-existing Conditions; however, a Pre-Existing Condition will be covered
after the person has been continuously insured for 6 months under this
policy issued to the Policyholder, provided continuous insurance is maintained;
-
No benefits will be paid for loss or expense caused by, 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;
-
For routine physical or other examination where there are no objective
indications or impairment in normal health, and laboratory diagnostic or X-ray
examination except in the course of a disability established by the prior call
or attendance of a physician;
-
Eye examinations; prescriptions or fitting of eyeglasses and contact lenses; or
other treatment for visual defects and problems. "Visual Defects" means any
physical defect of the eye which does or can impair normal vision;
-
Hearing examinations or hearing aids; or other treatment for hearing defects
and problems. "Hearing Defects" means any physical defect of the ear which does
or can impair normal hearing;
-
Dental treatment, except as the result of Injury to Sound, Natural Teeth as
stated in the Schedule of Benefits;
-
Professional services rendered by a member of the Insured Person's immediate
family, or anyone who lives with the Insured Person;
-
Services or supplies not necessary for the medical care of the patient's Injury
or Sickness;
-
Weak, strained or flat feet, corns, calluses, or toenails;
-
Cosmetic surgery, or treatment for congenital anomalies (except a specifically
provided), except reconstructive surgery as the result of a covered Injury or
Sickness. Correction of a deviated nasal septum is considered cosmetic surgery
unless it results from a covered Injury or Sickness;
-
Diagnostic or surgical procedures in connection with infertility unless
infertility is a result of a covered Injury or Sickness;
-
Birth control, including surgical procedures and devices;
-
Routine newborn baby care, well-baby nursery, well-baby care, and related
Physician charges;
-
Participation in professional or intercollegiate athletics;
-
Injury or Sickness for which benefits are paid or payable under any Worker's
Compensation or Occupational Disease Law or Act, or similar legislation;
-
Organ transplants;
-
War or any act of war, declared or undeclared; or while in the armed forces of
any country (a pro-rate premium will be refunded upon request for such period
not covered);
-
Participation on a riot or civil disorder; commission of or attempt to commit a
felony in the country in which it was attempted or committed;
-
Suicide or attempted suicide (including drug overdose) while sane or insane
(while sane in Missouri); or intentionally self-inflicted Injury;
-
Charges of an institution, health service, or infirmary for whose service
payment is not required in the absence of insurance;
-
Treatment of nervous or mental disorders, except as stated in the Schedule of
Benefits, or treatment of alcoholism or drug abuse, except as provided for
treatment of mental or nervous disorders, according to the Schedule of
Benefits;
-
Loss incurred from riding in any aircraft, other than as a passenger in an
aircraft licensed for the transportation of passengers;
-
Duplicate services actually provided by both a certified nurse-midwife and
Physician;
-
Expenses payable under any prior policy which was in force for the person
making the claim;
-
Expenses incurred during a Hospital emergency room visit which is not of an
emergency nature;
-
Expenses incurred for outpatient treatment in connection with the detection or
correction by manual or mechanical means of structural imbalance, distortion or
subluxation in the human body for purposes of removing nerve interference and
the effects thereof, where such interference is the result of or related to
distortion, misalignment or subluxation of or in the vertebral column;
-
Medical expense resulting from a motor vehicle accident except for that in
excess of what is payable under any valid and collectable insurance;
-
Pregnancy or childbirth (except when conception occurs while insured
hereunder); elective abortion; elective cesarean section; pregnancy or
childbirth for a dependent when dependent child of an Insured Student (except
for complications arising there from);
-
Expenses covered by any other valid and collectible medical, health or accident
insurance;
-
Expenses incurred after the date insurance terminates for an Insured Person
except as may be specifically provided;
-
Expenses incurred for injuries resulting from the use of alcohol or
intoxicants, or any drugs unless prescribed by a Physician;
-
Sexually transmitted diseases;
-
HIV infection, HIV-related illnesses and AIDS;
-
For services, supplies or treatment, including any period of hospital
confinement, which were not recommended, approved and certified as necessary
and reasonable by a physician;
-
For miscarriage resulting from accident, which exceed $500;
-
For the ordinary cost of a one way airplane ticket used in the transportation
back to the Insured's country where an air ambulance benefit is provided;
-
For specific named hazards: motorcycle driving, scuba diving, skiing, mountain
climbing, sky diving, professional or amateur racing, and piloting an aircraft;
-
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 the treatment without cost to any individual;
-
Treatment of Acne
-
Elective Surgery and Elective Treatment*.
* For details on what is determined to be Elective Surgery and Elective
Treatment contact AIG claims department at (800) 551-0824.
|
|
|
|