Unless otherwise specifically provided for therein, the coverage provided under Sections 3.2 through 3.6, 4.1, 5.1 through 5.3, 6.2, and 6.3 excludes Expenses that are for, resulting from, related to, or incurred for the following:
(a) Against Medical Advice Exclusion: You are not covered for Expenses incurred after you go against medical advice of a Physician, which shall begin the earlier of the following:
(b) Aircraft Pilot or Crew Exclusion: You are not covered for Injury sustained while You are riding as a pilot, student pilot, operator, or crew member, in or on, boarding or alighting, from any type of aircraft.
(c) Airworthy Exclusion: You are not covered for Injury sustained while You are riding as a passenger in any aircraft which:
(d) Athletics Exclusion: You are not covered for Athletics.
(e) Cancer Exclusion: You are not covered for any form of cancer or neoplasm
(f) Chiropractic Care Exclusion: You are not covered for Chiropractic Care.
(g) Competition Exclusion: You are not covered for Injury while participating in contests of speed or riding or driving in any type of competition.
(h) Congenital Exclusion: You are not covered for Congenital abnormalities and conditions arising out of or resulting therefrom.
(i) Contributory Negligence Exclusion: You are not covered for Injury if the proximate cause of the Injury is due to Your failure to take reasonable care with Your own safety, including but not limited to following applicable laws, safety regulations, and/or signed waivers.
(j) Cosmetic Exclusion: You are not covered for cosmetic or plastic Surgery including deviated nasal septum or breast reduction, or modifications of Your physical body intended to improve Your psychological, mental, or emotional well-being including, but not limited to, gender reassignment Surgery and related Treatment.
(k) Dental Exclusion: You are not covered for:
(l) Durable Medical Equipment Exclusion: You are not covered for Durable Medical Equipment.
(m) Exercise Exclusion: You are not covered for exercise programs whether prescribed or recommended by a Physician or therapist.
(n) Extreme Activities Exclusion: You are not covered for Extreme Activities.
(o) Financial Risk Exclusion: You are not covered for financial guarantee, financial default, bankruptcy, or insolvency risks.
(p) Foot-Related Exclusion: You are not covered for:
(q) Genetic Medicine Exclusion: You are not covered for Genetic Medicine.
(r) Hair-Related Exclusion: You are not covered for:
(s) Hearing Exclusion: You are not covered for:
(t) HIV/AIDS Exclusion: You are not covered for Acquired Immune Deficiency Syndrome (AIDS), AIDSRelated Complex (ARC), or the Human Immunodeficiency Virus (HIV), or any Illness resulting therefrom.
(u) Home Country Exclusion: You are not covered while in Your Home Country. This exclusion is waived for Section 3.4.
(v) Homeopathic Exclusion: You are not covered for Treatment which includes acupuncture, biofeedback, dry needling, massage, or Reiki.
(w) Hospice Exclusion: You are not covered for hospice care, whether Inpatient or Outpatient.
(x) Illegal Activity Exclusion: You are not covered for Injury or Illness resulting from the commission of a criminal offense or any other criminal or illegal activity as defined by the local governing body.
(y) Kidney Stone and Gallstone Exclusion: You are not covered for calculus of ureter, kidney stones, or gallstones within the first thirty (30) days from Your Effective Date. This exclusion does not apply beginning on Your thirty-first (31st) day of coverage.
(z) Long-Term Disability Exclusion: You are not covered for long-term disability.
(aa) Loss of Life Exclusion: You are not covered for loss of life. This exclusion is waived for Section 6.2.
(bb) Medical Supervision Exclusion: You are not covered for Treatment, services, or supplies that are not administered by or under the supervision of a Physician or Surgeon and products that can be purchased without a Physicianâs or Surgeonâs prescription.
(cc) Medical Tourism Exclusion: You are not covered for conditions for which travel was undertaken to seek Treatment.
(dd) Military Exclusion: You are not covered while engaging in military activities in service of any country, including while using or discharging a weapon, while responding to local civil unrest, at any time while You are stationed in a country or territory with an armed conflict, or while actively training for the aforementioned, or while on active duty as a member of a police force or unit.
(ee) Missed Appointment Exclusion: You are not covered for Expenses incurred due to Your failure to
keep a scheduled appointment.
(ff) No Cost Exclusion: You are not covered for Treatment paid for or furnished under any other individual, government, or group policy or Expenses incurred at no cost to You.
(gg) Occupational Risk Exclusion: You are not covered for Occupational Risk. This exclusion only applies during instances of Occupational Risk and shall not change or nullify coverage during instances where no Occupational Risk exists.
(hh) Pandemic Exclusion: You are not covered for any Illness incurred in the Destination Country or Home Country as a result of an Epidemic, Pandemic, public health emergency, or other disease outbreak that may affect Your health, except for charges resulting from COVID-19/SARS-CoV-2.
(ii) Period of Coverage Exclusion: You are not covered for Expenses for any Treatment or supplies which are incurred or obtained outside Your Period of Coverage.
(jj) Pre-Existing Conditions Exclusion: You are not covered for Pre-Existing Condition(s). This exclusion is waived for Sections 3.5 and 5.1 through 5.3.
(kk) Prosthesis Exclusion: You are not covered for replacement of artificial limbs, eyes, larynx, and orthotic appliances.
(ll) Proximity Exclusion: You are not covered for services, supplies, medications, testing, or Treatment prescribed, performed, or provided by a Relative, Family Member, or a person whom You directly supervise at Your place of employment.
(mm) Psychological Assessment Exclusion: You are not covered for testing which attempts to measure aptitude, competency, intelligence, personality, or stress management.
(nn) Quarantine Exclusion: You are not covered for Expenses associated with Quarantine, isolation, or other confinement outside of a Hospital setting; including without limitation: lodging, meals, or other incidentals.
(oo) Radiation Exclusion: You are not covered for exposure to non-medical nuclear radiation or radioactive materials.
(pp) Reckless Endangerment Exclusion: You are not covered for Injury if You unreasonably fail or refuse to depart a country or location following the date a warning to leave is issued and such failure causes or contributes to Your Injury. Applicable warnings include those issued by the United States government, the appropriate authorities of either Your Destination Country or Your Home Country, or by a global governing body.
(qq) Reproductive Exclusion: You are not covered for Pregnancy, childbirth, abortion, or Illness or complications resulting from these conditions, miscarriage including that resulting from an Accident, postpartum care, preventing conception or childbirth, artificial insemination, infertility, impotency, sexual dysfunction, circumcision, or sterilization or reversal thereof.
(rr) Restricted Travel Exclusion: You are not covered for travel after Your Physician has limited or restricted travel.
(ss) Routine Exclusion: You are not covered for routine and preventative care, vaccinations, sports or school-required physicals, the issue of medical certificates or attestations, examinations for the purposes of employment or travel, or other examinations or tests conducted when there are no objective indications or impairments in normal health.
(tt) Self-Harm Exclusion: You are not covered for suicide, attempted suicide, self-destruction, or any attempt thereof, or any intentionally self-inflicted Injury or Illness.
(uu) Sexually Transmitted Infection (STI) Exclusion: You are not covered for sexually transmitted infections, sexually transmitted diseases, venereal diseases, and conditions and any consequences thereof.
(vv) Skin Exclusion: You are not covered for acne, hypertrophic scars, moles/nevus, pigmentation disorder, pityriasis alba, Psoriasis, seborrhea or dandruff, skin atrophy, skin tags, xerosis cutis, vitiligo or any cosmetic procedures that are not Medically Necessary.
(ww) Sleep Disorder Exclusion: You are not covered for sleep apnea or other sleep disorders.
(xx) Specialty Aircraft Exclusion: You are not covered for Injury while flying in any aircraft being used for acrobatic or stunt flying, racing, endurance tests, rocket-propelled aircraft, crop dusting or seeding or spraying, firefighting, exploration, pipe or power line inspection, any form of hunting or herding, professional aerial photography, banner towing, or any experimental purpose.
(yy) Specialty Care Exclusion: You are not covered for Custodial Care, Educational or Rehabilitative Care, or any Treatment in any establishment for the care of the aged.
(zz) Substance Exclusion: You are not covered for:
(aaa) Temporomandibular Joint (TMJ) Exclusion: You are not covered for Treatment of the Temporomandibular joint.
(bbb) Terrorist Activity and War Exclusion: You are not covered for Terrorist Activity or War, Hostilities, and War-like Operations. This exclusion is waived for Section 3.6.
(ccc) Therapy Exclusion: You are not covered for art, music, occupational, recreational, sleep, speech, or vocational therapy.
(ddd) Timely Filing Exclusion: You are not covered for claims which are not received by the Company or Us within fifteen (15) months of the date of service.
(eee) Transplant Exclusion: You are not covered for human organ transplants, marrow procedures, or tissue transplants.
(fff) Travel Accommodations Exclusion: You are not covered for travel accommodations.
(ggg) Usual, Reasonable, and Customary Exclusion: You are not covered for Treatment which:
(hhh) Vision Exclusion: You are not covered for:
(iii) Weight Reduction Exclusion: You are not covered for weight reduction programs or the surgical Treatment of obesity including, but not limited to, wiring of the teeth and all forms of intestinal bypass Surgery.
