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International Citizen Economy Exclusions & Limitations

Pre-existing Conditions:

If your Pre-existing Conditions have been fully disclosed on your Application and not excluded or restricted by any other provision of your Certificate, your Pre-existing Conditions are covered up to $5,000 per Certificate Period and $50,000 Lifetime limit after you have been insured continuously for 24 months. Pre-existing Conditions include any Injury, Illness or Mental Health disorder that existed at or prior to your initial Effective Date, including chronic or recurring conditions.

Acute Onset of Pre-existing Condition:

If your Pre-existing Conditions have been fully disclosed on your Application and the conditions are not excluded or restricted by any other provision of your Certificate, you are covered for an Acute Onset of Pre-existing Condition up to $1,000 during the first 12 months of coverage and up to $2,500 during the second 12 months of coverage hereunder. An Acute Onset of a Pre-existing Condition is a sudden, unexpected outbreak or recurrence of a Pre-existing Condition, which occurs spontaneously and without advance warning, either in the form of Physician recommendations or symptoms which would have caused a prudent person to seek medical attention prior to the outbreak or recurrence. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.

Exclusions and Limitations:

The following charges, treatments, care, services, supplies and/or conditions are excluded from coverage:

• Charges not incurred during the Certificate Period
• Services or treatment payable by another insurance or government
• Substance abuse
• Charges which exceed usual, reasonable and customary
• Investigational or experimental surgeries or treatment
• Custodial, educational or rehabilitative care
• Weight modification
• Cosmetic surgery, unless reconstructive surgery is directly relating to a covered Illness or Injury
• Individuals HIV+ at effective date
• Drugs or treatment for sexual dysfunction
• Charges for use of Emergency Room for treatment of Illness unless the patient is directly admitted to the Hospital as Inpatient for further treatment of that Illness
• Drugs or treatment to promote or prevent conception
• Devices or procedures to correct sight or hearing
• Self-inflicted Injury or Illness
• Foot care, unless related to a covered accidental Injury
• Treatment or supplies not ordered by a Physician or not Medically Necessary, except for Wellness benefits provided herein.
• Organ transplants, except for covered transplants
• Speech, acupuncture or sleep therapy
• Acts of terrorism, war, insurrection, riot or any variation thereof
• Dental treatment, except emergency treatment following a covered accident, or unless Dental Rider is purchased
• Orthodontia (Dental Rider Exclusion)
• Sealants, Bleaching and oral hygiene expenses (Dental Rider Exclusion)

This is a summary of the exclusions contained in the Certificate of Insurance. See the Certificate of Insurance for a complete list of exclusions.

Special Illness Exclusion:

The following conditions which manifest themselves within the first 180 days of coverage are excluded: any condition of the breast, prostate, the reproductive system, hernia, gallstones, kidney stones, glaucoma, cataracts, disk disease, tonsils, adenoids, hemorrhoids, all types of cysts and any disorder or disease of the skin.