Seven Corners Travel Medical Choice Insurance

1. Pre-Existing Condition(s) except as waived under Waiver of Pre-Existing Conditions and Acute Onset of Pre-Existing Conditions.
2. Claims not received by the Company or Administrator within ninety (90) days of the date of service:
3. Treatment that (i) exceeds Usual, Reasonable, and Customary Expenses; (ii) is Investigational, Experimental, or for research purposes; or (iii) received in a Hospital emergency room visit that is not a Medical Emergency;
4. 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 Physician’s or Surgeon’s prescription;
5. Routine physicals, inoculations, or other examinations or tests conducted when there is no objective indications or impairments in normal health;
6. Chiropractic care or acupuncture;
7. Services, supplies, medications, testing, or Treatment prescribed, performed, or provided by a Relative or Immediate Family Member;
8. Durable medical equipment;
9. False teeth, dentures, dental appliances, dental expenses, normal ear or hearing tests, hearing aids, hearing implants, eye refractions, eye examinations for prescribing corrective lenses or eye- glasses unless caused by Accidental Injury, eyeglasses, contact lenses, or eye surgery when the primary purpose is to correct nearsightedness, farsightedness, or astigmatism;
10. Replacement of artificial limbs, eyes, larynx, and orthotic appliances;
11. Custodial Care, Educational or Rehabilitative Care, or any Treatment in any establishment for the care of the aged;
12. Vocational, occupational, sleep, speech, recreational, or music therapy;
13. Pregnancy, Illness or complications from Pregnancy, childbirth, abortion, miscarriage including that resulting from an Accident, postnatal care, preventing conception or childbirth, artificial insemination, infertility, impotency, sexual dysfunction, or sterilization or reversal thereof;
14. Sleep apnea or other sleep disorders;
15. Mental and Nervous Disorder, Rest Cures, learning disabilities, attitudinal disorders, or disciplinary problems;
16. Congenital abnormalities and conditions arising out of or resulting therefrom;
17. Temporomandibular joint;
18. Occupational Diseases;
19. Exposure to non-medical nuclear radiation or radioactive materials;
20. Sexually-transmitted diseases, venereal diseases, and conditions and any consequences thereof;
21. Acquired Immune Deficiency Syndrome (AIDS), AIDS-Related Complex (ARC), or the Human Immunodeficiency Virus (HIV);
22. Human organ or tissue transplants;
23. Exercise programs whether prescribed or recommended by a Physician or therapist;
24. 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;
25. Cosmetic or plastic Surgery including deviated nasal septum; modifications of Your physical body intended to improve Your psychological, mental, or emotional well-being including, but not limited to, sex-change Surgery;
26. Acne, moles, skin tags, disease of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of the sebaceous glands, hypertrophic and atrophic conditions of skin, nevus;
27. Hazardous Activities unless You purchase optional hazardous activities coverage and then only for the activities covered under that option under Optional Coverage – Hazardous Activities;
28. Injuries sustain while participating in professional Athletics, amateur Athletics, or interscholastic Athletics including, but not limited to, events, games, matches, practice, training camps, sport camps, conditioning, and any other activity related thereto but excluding non-competitive, recreational, or intramural activities;
29. Abuse, misuse, illegal use, overuse, dependency upon, or being under the influence of alcohol, drugs, chemicals, or narcotic agents unless administered under the advice of a Physician and taken in accordance with the proper dosing as directed by the Physician;
30. Suicide or any attempt thereof; self-destruction or any attempt thereof; or any intentionally self- inflicted Injury or Illness;
31. Terrorist Activity except as provided under Terrorist Activity; War, Hostilities, or War-Like Operations;
32. Commission of a criminal offense or any other criminal or illegal activity as defined by the local governing body;
33. You unreasonably fail or refuse to depart a country or location following the date a warning to leave that country or location is issued by the United States government or similar warnings issued by other appropriate authorities of either Your Host Country or Your Home Country;
34. Service in the military, naval, coast guard, or air service of any country or while on duty as a member of a police force or unit;
35. Treatment paid for or furnished under any other individual, government, or group policy or Expenses incurred at no cost to You;
36. You while in Your Home Country unless covered under Extension of Benefits in Home Country or Incidental Trips to Home Country;
37. Conditions for which travel was undertaken to seek Treatment after Your Physician has limited or restricted travel; Travel accommodations;
38. 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;
39. Injury sustained while You are riding as a passenger in any aircraft (i) not having a current and valid Airworthy Certificate and (i) not piloted by a person who holds a valid and current certificate of competency for piloting such aircraft;
40. 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, aerial photography, banner towing, or any experimental purpose; and
41. Participating in contests of speed or riding or driving in any type of competition;
42. Loss of life;
43. Long-term disability; or
44. Financial guarantee, financial default, bankruptcy, or insolvency risks.

• State Restrictions: The plan will not accept a mailing address in Maryland, Washington, New York, South Dakota, and Colorado.
• Country Restrictions: The plan will not accept an address in Cuba, Islamic Republic of Iran, Syrian Arab Republic, United States Virgin Islands, Gambia, Ghana, Nigeria, and Sierra Leone.
• Destination Restrictions: The plan will not cover trips to Islamic Republic of Iran and Syrian Arab Republic.

Travel Medical Choice Insurance Pre-Certification

The following expenses must always be pre-certified in the U.S. only:

1. Outpatient surgeries or procedures;
2. Inpatient surgeries, procedures, or stays including those for rehabilitation;
3. Diagnostic procedures including MRI, MRA, CT, and PET Scans;
4. Chemotherapy;
5. Radiation therapy;
6. Physical and occupational therapies;
7. Home infusion therapy;
8. Home Health Care.

1. Contact Seven Corners Assist before the expense is incurred;
2. Comply with Seven Corners Assist’s instructions;
3. Notify all medical providers of the pre-certification requirements and ask them to cooperate with Seven Corners Assist.

Once we pre-certify your expenses, we will review them to determine if they are covered by the plan. Failure to comply with pre-certification requirements

If you do not comply with the pre-certification requirements or if the expenses are not pre-certified, we will review the expenses to determine if they are covered by the plan. If covered:

1. Eligible medical expenses will be reduced by 25%; and
2. The deductible will be subtracted from the remaining amount; and
3. Coinsurance will be applied.

Pre-certification does not guarantee benefits – Pre-certification does not guarantee coverage for, or payment of expenses.