Exclusions and Limitations

   
With respect to Medical Expense, Emergency Medical Evacuation, Emergency Reunion and Repatriation of Remains Benefits, no benefit shall be payable with respect to expenses incurred:

1. For pre-existing conditions defined as an Sickness, disease or other condition of the covered person, that in the 12 month period before the covered person’s coverage became effective under the Policy: 1) first manifested itself, worsened, became acute or exhibited symptoms that would have caused a person to seek diagnosis, care or treatment; or 2) required taking prescribed drugs or medicines, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or 3) was treated by a doctor or treatment had been recommended by a doctor.  (This pre-existing condition exclusion does not apply to the Emergency Medical Evacuation, Emergency Reunion, or Repatriation of Remains Benefits);
2. For services, supplies, or treatment, including any period of hospital confinement, which were not recommended, approved and certified as necessary and reasonable by a doctor, or expenses which are non-medical in nature;
3. For loss incurred as a result of  war or any act of war, whether declared or not;
4. For injury sustained while participating in professional, club, interscholastic or intercollegiate sports;
5. For routine physicals;
6. For cosmetic except for reconstructive surgery needed as the result of an Injury;
7. For elective surgery;
8. For dental care, except as the result of Injury to natural teeth caused by an accident;
9. For eye refractions or eye examinations for the purpose of prescribing corrective lenses for eyeglasses or for the fitting thereof, unless caused by accidental bodily injury incurred while insured hereunder;
10. For expenses as a result of, or in connection with, intentionally self-inflicted injury;
11. For suicide or attempted suicide, while sane or insane;
12. For expenses as a result of, or in connection with, the commission  or attempt to commit an assault or a felony;
13. For scuba diving, jet, and water skiing, mountain climbing (where ropes or guides are normally used), sky diving, and professional or amateur racing;
14. For treatment furnished under any mandatory government program or facility set up for treatment without cost to any individual;
14. For treatment by an immediate family member;
15. Piloting or acting as a crew member or riding in any aircraft, except as a fare-paying passenger on a scheduled airline.

For the Accidental Death and Dismemberment Benefit, the Policy does not cover any loss, fatal or non-fatal, caused by or resulting from:

1. Intentionally self-inflicted injury;
2. Suicide or attempted suicide, while sane or insane;
3. War or any act of war, whether declared or not;
4. Service in the military, naval, or air service of any country;
5. Sickness, disease, or infection of any kind, except bacterial infections due to an accidental cut or wound, botulism or ptomaine poisoning;
6. Piloting or acting as a crew member or riding in any aircraft; except as a fare paying passenger on a scheduled airline.