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Online Major Medical Plan from Petersen International Underwriters

Limitations

Expenses which have limitations are as follows:

1. Services and supplies for Cardiac Related Conditions and Cancer Related Conditions a 1. re limited to either (i) the medical costs of stabilizing your condition and the transportation costs of returning you to your Home Country or (ii) a maximum reimbursement for Eligible Expenses of $25,000, at the option of Underwriters.
2. The maximum Eligible Expense for Repatriation of Remains or Global Medical Transportation is $100,000 in the aggregate.
3. The maximum Eligible Expense for room and board charges is $450 per day.
4. The maximum Eligible Expense for room and board charges for an intensive care unit is the lesser of three times the Provider’s semi-private room and board charge or $1,350 per day.
5. Insured age 70-79 is limited to $50,000 maximum benefit or as shown on the Schedule of Benefits page, whichever is the least. All other terms and conditions apply.

Pre-existing Conditions Limitations

Preexisting Condition means a condition, disease or injury for which medical advice, diagnosis, care or treatment, including the use of prescription medications, was recommended by or received from a licensed health care practitioner during the 12 months immediately preceding the Effective Date of the insurance described in this Certifi cate, whether disclosed or not on your application.

Exclusions

Expenses which are not eligible for reimbursement are as follows:

1. Any expense which You are not legally obligated to pay.
2. Services which are not Medically Necessary or are not furnished by and under supervision of a Physician.
3. Expenses for services and supplies for which You are entitled to benefits, services or reimbursement through the Veterans' Administration, Workers' Compensation insurance, any private health plan or from any other source except Medicaid.
4. Expenses in excess of UCR.
5. Outpatient drugs, except following a hospitalization if prescribed for the same Illness or Injury.
6. Self-inflicted injuries while sane or insane.
7. Treatment for alcoholism, drug addiction, allergies, and/or Mental or Nervous Disorders.
8. Rest cures, quarantine or isolation.
9. Cosmetic surgery unless necessitated by an accidental Injury.
10. Dental exams, dental x-rays and general dental care except as a result of an accidental Injury.
11. Eye glasses or eye examinations.
12. Hearing aids or hearing examinations.
13. General or routine examinations.
14. Injuries sustained from participation in Hazardous Sports or Activities.
15. Pregnancy and pregnancy-related conditions including but not limited to fertility, pre-natal care, childbirth, miscarriage, abortion or postpartum conditions.
16. Injuries or Illnesses due to War or any act of War whether declared or undeclared.
17. Injuries or Illnesses due to an Act of Terrorism.
18. Injuries or Illnesses involving the use or release of any nuclear weapon or device or chemical or biological agent, regardless of any contributory cause(s).
19. Injuries or Illnesses sustained while committing a criminal or felonious act.
20. Expenses incurred for or resulting from pain which is not supported by medical diagnosis.
21. Cataract surgery.
22. Any elective surgery.
23. Custodial Care.
24. Expenses for supplies and services that were not incurred with in the specified Geographic Area.
25. Pre-existing conditions.