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Inbound Exclusions - Page 2 of 2

 

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18 Organ Transplants Organ transplants;
19 Pre-Existing Condition "Pre-Existing Condition" shall mean:
1) A condition that would have caused a person to seek medical advice, diagnosis, care or Treatment within the 6 months (or 12 months for persons 70 and older) prior to the Individual Effective Date of Coverage under this program;
2) A condition for which medical advice, diagnosis, care or Treatment, including Medication, was sought, recommended or received within the 6 months (or 12 months for persons age 70 and older) prior to the Individual Effective Date of Coverage under this program;
3) the symptoms which occurred within the 6 months (or 12 months for persons 70 and older) prior to the Individual Effective Date of the Coverage under this Certificate would have allowed a person trained in medicine to make a diagnosis of the condition producing the symptoms:
4) a condition which manifested within the 6 months (or 12 months for persons 70 and older) prior to the Individual Effective Date of Coverage under this Certificate;
20 Pregnancy Expenses Pregnancy expenses or Sickness resulting from pregnancy, childbirth, or miscarriage; or for miscarriage resulting from Injury; or voluntary or elective abortion;
21 Pregnancy Prevention Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth;
22 Riding an Aircraft other than as a passenger Loss incurred from riding in any aircraft, other than as a passenger in an aircraft licensed for the transportation of passengers
23 Riot and Civil disorder Participation in a riot or civil disorder, commission of or attempt to commit a felony in the country in which it was attempted or committed;
24 Routine Physicals, inoculations etc. Routine physicals, inoculations, or other examinations where there are no objective indications of impairment of normal health, or well baby care, new-born baby care; well-baby nursery and related Physician charges;
25 Services by relative Services or supplies performed or provided by a Member of the Insured Person’s family, or anyone who lives with the Insured Person;
26 Speech Therapy, Vocational Rehabilitation Expenses for Speech therapy, Occupational therapy or Vocational Rehabilitation.
27 Structural Imbalance Expenses incurred for outpatient treatment in connection with the detection or correction by manual or mechanical means of structural imbalance, distortion or sublimation in the human body for purposes of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column;
28 Suicide Suicide or attempted suicide (including drug overdose), while sane or insane (while sane in Missouri), or intentionally self-inflected Injury;
29 Travel Solely for Treatment Any expenses incurred when travel was undertaken solely for the purpose obtaining medical treatment or while traveling against the advise of a Physician;
30 Treatment by Veteran’s Administration Treatment services, supplies or facilities in a hospital owned or operated by: a) The Veteran’s Administration; or b) A national government or any of its agencies. (This exclusion does not apply to treatment when a charge is made which the Insured is required by law to pay);
31 Treatment covered under a Group Policy Treatment paid for or furnished under any other individual, government, or group policy; previous policy; payable under any Worker’s Compensation or Occupational Disease Law or Act; or charges provided at no cost to the Insured Person;
32 Treatment in Emergency Room for Non-Emergency Expenses incurred during a hospital emergency room visit which is not of an emergency nature;
33 War, Invasion Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in connection with war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war;