Exclusions and Limitations
Charges for certain services, treatments and/or conditions, among
others, are excluded from coverage under the Patriot plans and
include but are not limited to:
- A Pre-existing Condition which is any injury, illness, sickness,
disease, or other physical, medical, mental or nervous condition,
disorder or ailment that, with reasonable medical certainty, existed
at the time of application or at any time during the three
years prior to the effective date of the insurance, including any
subsequent, chronic or recurring complications or consequences
related thereto or arising therefrom, whether or not previously
manifested or known, diagnosed, treated, or disclosed.
- Treatment or surgeries which are elective, investigational, experimental or for research purposes.
- War, military action, terrorism, political insurrection, protest, or any act thereof. The Company will not pay for a Political Evacuation if there is a travel advisory in effect on or within six (6) months prior to the Insured Person’s date of arrival in the Host Country.
- Immunizations and routine physical exams.
- Treatment of Temporomandibular Joint or dental treatment,
except as expressly provided for in the Certificate of Insurance.
- Venereal disease, AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, and the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured who was HIV+ at time of enrollment into this insurance.
- Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
- Any Injury sustained while taking part in: Amateur
Athletics, Professional Athletics, or other athletic activity that is
sponsored or sanctioned by the National Collegiate Athletic
Association (and/or any other collegiate sanctioning or governing
body), or the International Olympic Committee.
Injury sustained while participating in contact sports of any kind, racing of
any kind, any rodeo activity, BASE jumping, kiteboarding, mountaineering
or climbing or trekking above elevation 4500 meters above ground level
or without proper ropes or guides; luge, motocross, Moto-X, ski jumping,
sub-aquatic activities below 50 meters, whitewater rafting exceeding Class V difficulty; and/or adventure sports activity not expressly covered hereunder
are excluded regardless of which plan is selected.
- Vision or hearing tests and the provision of visual or hearing aids.
- Vocational, recreational, speech or music therapy.
- Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
- Charges, injuries and/or illnesses resulting or arising from or occurring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
- Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
- Injury and/or illness resulting or arising from or sustained while under the influence of or disablement of drugs or alcohol.
- willful self-inflicted injury or illness, and injury due to reckless endangerment or needless peril.
- Treatment required as a result of or arising from complications from a treatment or condition not covered hereunder.
- Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
- Treatment for mental and nervous disorders.
- Organ or tissue transplants or related services.
- Illness or injury where the trip to the host country is undertaken for treatment or advice for such illness or injury, except as provided for herein.
- Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).
This invitation to inquire allows eligible applicants an opportunity to inquire further about the insurance offered and is limited to a brief description of any loss for which benefits may be payable. Benefits are offered as described in the insurance contract. Benefits are subject to all deductibles, coinsurance, provisions, terms, conditions, limitations, and exclusions in the insurance contract. The contract does contain a pre-existing condition exclusion and does not cover losses or expenses related to a pre-existing condition.
IMPORTANT NOTICE REGARDING PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA): This insurance is not subject to, and does not provide benefits required by, PPACA. On January 1, 2014, PPACA will require U.S. citizens and certain U.S. residents to obtain PPACA compliant insurance coverage unless they are exempt from PPACA. Penalties may be imposed on U.S. citizens and U.S. residents who are required to maintain PPACA compliant coverage but do not do so. Eligibility to purchase, extend or renew this product, or its terms and conditions, may be modified or amended based upon changes to applicable law, including PPACA. Please note that it is solely your responsibility to determine if PPACA is applicable to you.