Global Educators Medical (GEM)

Exclusions and Limitations

The following is a summary of services that are not covered under GEM:

  • War and terrorism (limited "innocent bystander" coverage is included under the plan)
  • Treatment, services or supplies that are not administered or ordered by a licensed physician, or services or supplies performed or provided by a relative
  • Treatment, services, or supplies that are not medically necessary or charges that exceed Usual, Reasonable, and Customary charges
  • Surgeries or treatments that are investigational, experimental, or for research purposes
  • Confinement primarily for custodial, educational or rehabilitative care
  • Exercise programs, weight modification or treatment for obesity
  • Treatment or surgery for cosmetic or aesthetic reasons, except for reconstructive surgery incidental to or following other covered surgery
  • Treatment for a person who was HIV+ prior to the person's effective date
  • Artificial insemination, infertility, impotency, sterilization or reversal of sterilization
  • Hearing aids, TMJ dysfunction, orthoptics and visual eye training
  • Injury sustained from Hazardous Sports activities
  • Self-inflicted injury or illness, charges resulting from or during the commission of a crime or felony, or injury sustained while under the influence of alcohol or drugs
  • Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy
  • Certain care, treatment or supplies for the feet
  • Care and treatment for hair loss
  • Injury or illness that is covered under workers’ compensation or similar laws

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.