These set out the Exclusions to cover under this Policy. The following Exclusions apply to the whole of this Policy.
(1) We will not pay any claim under this Policy which would result in Us being exposed to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America.
(2) We will not provide cover for any benefits for any loss or Injury that is caused by or results from:
(a) Intentionally Self-inflicted Injury; suicide or attempted suicide.
(b) War/Extreme Acts of Violence:
(i) War, or any act or war (whether declared or not), invasion, act of foreign enemy hostilities, warlike operations, civil war;
(ii) Mutiny, riot, strike, military or popular uprising, insurrection, rebellion, revolution, military or usurped power, civil commotion;
(iii) Attempted overthrow of government, any act directed towards overthrow of government or influencing any overthrow by violence; martial law or state of siege;
(iv) Any use of or exposure to any radiological, chemical, nuclear or biological weapons or any other radiological, chemical, nuclear or biological events; or
(v) Confiscation or nationalization; requisition or destruction of or damage to property by or under the order of any government or local authority.
(vi) Your breaking or failing to comply with any law whatsoever.
(vii) Any act of Terrorism. For the purpose of this Endorsement 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.
(viii) Commission of, or active participation in a riot, civil commotion assuming the proportions of or amounting to an uprising or an insurrection.
(c) An Accident or Illness that occurs while You are on active-duty service in the military, naval or air force of any country or international organization. Upon receipt of proof of service, We will refund any Premium paid for this time.
(d) Piloting or serving as a crewmember in any aircraft or watercraft.
(e) Riding in any aircraft or watercraft except as a fare-paying passenger on a regularly scheduled or charter airline.
(f) Your commission of, or attempt to commit, a felony.
(g) Sickness, disease or Mental Health Disorder, bacterial or viral infection, or medical or surgical treatment thereof which results in the amputation of an extremity; coverage provided under dismemberment benefit.
(h) You being legally intoxicated as determined according to the laws of the jurisdiction in which the Injury occurred.
In addition, We will not pay Medical Expense Benefits for any loss, treatment, or services resulting from:
(i) Routine physicals and care of any kind.
(j) Routine dental care and treatment.
(k) Cosmetic surgery, except for reconstructive surgery needed as the result of an Injury resulting from an Accident.
(l) Eye refractions or eye examinations for the purpose of prescribing corrective lenses or for the fitting thereof; eyeglasses, contact lenses, and hearing aids.
(m) Services, supplies, or treatment including any period of Hospital confinement which is not recommended, approved, and certified as Medically Necessary and reasonable by a Doctor, or expenses which are non-medical in nature.
(n) Treatment or service provided by a private duty nurse.
(o) Treatment by any Immediate Family Member or member of Your household.
(p) Expenses incurred during travel for purposes of seeking medical care or treatment.
(q) Expenses incurred for services provided by any government Hospital or agency, or government sponsored plan for which, and to the extent that, You are eligible for reimbursement.
(r) Any treatment provided under any mandatory government program or facility set up for treatment without cost to any individual.
(s) Custodial care.
(t) Calculus of gallbladder and nephroscopy.
(u) Services or expenses incurred in Your Home Country.
(v) Elective treatment, exams or surgery; elective termination of pregnancy.
(w) Expenses for services, treatment or surgery deemed to be experimental or which are not recognized and generally accepted medical practices in the United States or in the Host Country.
(x) Expenses payable by any automobile insurance policy without regard to fault.
(y) Organ or tissue transplants and related services.
(z) Any expense paid or payable by any other valid and collectible group insurance plan.
(aa) Injury or Illness for which benefits are paid or payable under any WorkersâÃÂàCompensation or Occupational Disease Law or Act, or similar legislation, whether United States federal or foreign law.
(bb) Any Illness or Injury sustained while taking part in:
(i) Dangerous Occupations;
(ii) athletic or sporting activities engaged in by You solely for recreational, entertainment or fitness purposes;
(iii) Amateur Athletics, Professional Athletics, athletic activity that is sponsored or sanctioned by any collegiate sanctioning or Governing Body, or the International Olympic Committee;
(cc) Adventure sports and activities:
(i) Abseiling;
(ii) BMX;
(iii) Bobsledding;
(iv) Bungee jumping;
(v) Canyoning;
(vi) Caving;
(vii) Hot air ballooning;
(viii) Jungle zip lining;
(ix) Parachuting;
(x) Paragliding;
(xi) Parascending;
(xii) Rappelling; and
(xiii) Sky diving.
(dd) Extreme sports and activities:
(i) Aviation piloting a commercial or non-commercial aircraft; or engaged in any lesson, practice session or training exercise during which the Insured Person is training to become a pilot or attempting to earn a license, permit, certification, and/or authorisation to pilot commercial or non-commercial aircraft;
(ii) BASE jumping;
(iii) Big game hunting;
(iv) Hang gliding;
(v) Heli-skiing;
(vi) Luge;
(vii) Motocross (MOTO-X);
(viii) Mountaineering above an elevation of 4500 meters; or mountaineering activities where specialized climbing equipment, ropes or guides are normally used by a prudent person but were not used;
(ix) Racing of any kind, including but not limited to by horse, motor or other vehicle (of any type), or motorcycle;
(x) Rodeo activities;
(xi) Ski jumping;
(xii) Snow skiing, snowboarding or snowmobiling where You are in violation of applicable laws, rules or regulations of a ski resort, out of bounds or in unmarked or unpatrolled areas; taking part in backcountry skiing; taking part in skiing off-piste;
(xiii) Sub aqua pursuits below a depth of 50 meters; and
(xiv) Trekking above an elevation of 4500 meters.
(ee) Expenses incurred for services related to the diagnostic treatment of infertility or other problems related to the inability to conceive a child, including but not limited to, fertility testing and in-vitro fertilization.
(ff) Orthopedic shoes or devices, or expenses incurred in connection with weak, strained or flat feet, corns, calluses or toenails.
(gg) Expenses incurred for birth control including surgical procedures and devices.
(hh) Expenses related to any rental or purchase of durable medical equipment.
(ii) Birth defects and congenital anomalies, or complications which arise from such conditions.
(jj) Sexually transmitted diseases or immune deficiency disorders and related conditions.
(kk) Care or treatment of Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC), or Human Immunodeficiency Virus (HIV) infection, or any illness or disease arising from these medical conditions.
(ll) Pregnancy, childbirth, miscarriage, abortion or any complications of any of these conditions, except to the extent otherwise provided in the in the Policy.
(mm) Mental Health Disorders.
(nn) Expenses incurred for any condition directly or indirectly related to or caused by cancer, dialysis, or on-going and preventive care.
(oo) Alcohol and Substance Abuse.
(pp) Expenses incurred for cataract surgeries, eye sickness or treatments.
(qq) Pre-existing Conditions, unless otherwise provided in the Policy. If coverage is provided, it must be as a result of Acute Onset of a Pre-existing Condition.
(rr) Any sickness which was known or unknown to the Insured Person which requires immediate medical attention within 2 days after the policy Effective Date.
(ss) Exercise programs, whether or not prescribed by a Doctor.
(tt) Failure to keep a scheduled appointment.
(uu) Dialysis, Eye Sickness, or Cancer treatment
(vv) Any treatment which is not Medically Necessary, or costs which are in excess of the Usual, Reasonable and Customary amounts.
(ww) Epidemic and pandemic or other disease outbreaks when prior to the Effective Date, warning or Alert Level 3 or higher was issued by the US Center for Disease, Control and Prevention.
(xx) Medical expenses related to complications or consequences of a treatment or condition not covered by this Policy.
If We determine the benefits paid under the Policy are eligible benefits under any benefit plan, We may seek to recover any expenses covered by another plan to the extent that You are eligible for reimbursement.
