Covered Medical Expenses

1. Inpatient and Outpatient charges made by a Hospital.
2. Charges made by a Physician, surgeon, radiologist, anesthesiologist, and any other medical specialist to whom the Physician has referred the case.
3. Charges made for dressings, sutures, casts or other supplies prescribed by the attending Physician or Medical Specialist, but excluding nebulizers, oxygen tanks, diabetic supplies and all devices for repeat use at home.
4. Charges for diagnostic testing using radiology, ultrasonographic or laboratory services.
5. Charges for oxygen and other gases and anesthetics and their administration.
6. Charges for prescription drugs, for treatment of a covered Injury or Illness, but not for the replacement of lost, stolen, damaged, expired or otherwise compromised drugs.
7. Charges made by a licensed Extended Care Facility upon direct transfer from an Acute Care Hospital.
8. Emergency local ambulance transport incurred in connection with Injury or Illness resulting in hospitalization.

Exclusions

The following charges, treatments, surgeries, medications, conditions and circumstances are excluded:

1. Pre-existing Conditions – Charges resulting directly or indirectly from any Pre-existing Condition are excluded from this insurance during the first 12 months of coverage. A Pre-existing Condition is any Injury or Illness which, within the 12 months prior to the Effective Date of Coverage, manifested itself, exhibited symptoms, or required medical treatment or medication, or for which a Physician was consulted.
2. Treatment for or related to any congenital condition, except for a newborn child insured under the Policy.
3. Pre-natal, delivery, post-natal, and newborn care, unless related to a Covered Pregnancy.
4. Birth control, artificial insemination, infertility, impotency or sexual dysfunction, sterilization or reversal thereof.
5. Substance Abuse.
6. Charges which are not incurred during the Certificate Period or the applicable Benefit Period, and charges which are not presented to Underwriters for payment within 60 days from the end of the Certificate Period or the applicable Benefit Period.
7. Charges for use of Emergency Room for treatment of Illness within the United States unless the patient is directly admitted to the Hospital as Inpatient for further treatment of that Illness.
8. Services that are not Medically Necessary and administered or ordered by a Physician or Medical Specialist, and services that are provided at no cost, by a family member, or by a person who ordinarily resides with you, or which are attributable to or recoverable from any other party including government-sponsored plans.
9. Charges which exceed Usual, Reasonable and Customary.
10. Investigational, Experimental or for Research purposes.
11. Venereal Disease, AIDS or ARC.
12. Treatment by a Chiropractor unless ordered in advance by a Physician.
13. Physical therapy and treatment for Mental Health Disorders if treatment is obtained at a Student Health Center.
14. Diseases of the skin.
15. Dental treatment, including treatment of the temporomandibular joint, except for Emergency Dental treatment for the relief of acute, spontaneous and unexpected onset of pain.
16. Eyeglasses, vision exams, contact lenses, hearing tests, hearing aids, hearing implants, eye refraction, visual therapy, orthoptics or visual eye training or eye surgery (including cataract surgery and radial keratotomy) or for any examination or fitting related to these devices or procedures.
17. Immunizations and Routine Physical Exams.
18. Expenses in excess of $5,000 for Injury or Illness sustained while taking part in intercollegiate, interscholastic, intramural, or club sports, and all expenses for any Injury or Illness sustained while taking part in any other Amateur Athletics. Amateur Athletics is defined as sports or other athletic activities that are organized and/or sanctioned, involving regular or scheduled practices and/or regular or scheduled games. This definition does not include athletic activities that are non-contact and engaged in by a Member solely for recreational, entertainment or fitness purposes and not for wage, reward or profit.
19. Injury sustained while taking part in: professional sports; mountaineering where ropes or guides are normally used or at elevations of 4,500 meters or higher; aviation, except when traveling solely as a passenger in a commercial aircraft; hang gliding, sky diving, parachuting, or bungee jumping; snow skiing or snowboarding, except for recreational downhill and/or cross-country snow skiing or snowboarding (no cover provided whilst skiing away from prepared and marked in-bound territories and/or against the advice of the local ski school or local authoritative body); racing by any animal or motorized vehicle; spelunking; subaqua pursuits involving underwater breathing apparatus unless NAUI/PADI certified, accompanied by a certified instructor, and at depths of less than 10 meters; jet skiing; and any other sport or athletic activity which is undertaken for thrill seeking and exposes you to abnormal or extreme risk of injury.
20. Injury sustained while under the influence of or due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with treatment prescribed and directed by a Physician but not for the treatment of Substance Abuse.
21. Willfully self-inflicted Injury or Illness and/or any complications or consequences thereof.
22. The Deductible, Coinsurance and charges which are not included as Eligible Expenses as described in the Master Policy, and charges which exceed the limits set forth in the Schedule of Benefits and Limits.
23. Treatment required as a result of complications or consequences of a treatment or condition not covered hereunder.
24. Charges for travel or accommodations, except as provided for in the Local Ambulance, Emergency Medical Evacuation, Repatriation of Remains, and Emergency Reunion sections of this insurance.
25. Treatment incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
26. Organ or tissue transplants or related services.
27. Acts of Terrorism, except as provided for herein, war, insurrection, riot or any variation thereof.