Pre-Existing Conditions are defined as any medical condition, sickness, Injury, Illness, disease, Mental Illness or Mental Nervous Disorder, regardless of the cause, including any congenital, chronic, subsequent, or recurring complications or consequences related thereto or resulting therefrom that with reasonable medical certainty existed at the time of application or any time prior to the Individual Effective Date of Coverage under this Certificate, whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosed. This specifically includes but is not limited to any medical condition, sickness, Injury, Illness, disease, Mental Illness or Mental Nervous Disorder for which medical advice, diagnosis, care or treatment was recommended or received or for which a reasonably prudent person would have sought treatment prior to the Individual Effective Date of Coverage under this Certificate.
All Pre-Existing Conditions will be considered, provided the Insured Person has not:
- suffered symptoms, consulted any Physician for Treatment, advice or check-ups for these Pre-Existing Conditions
- taken Medication (including drugs, Medicines, special diets or injections) for a continuous period of twenty-four (24) months prior to the date of the Treatments and Expenses, that are being considered for Coverage under this Certificate.
This means that when you submit a claim to Seven Corners for processing, we will look back 24 months from the date of service and determine if you suffered symptoms or were treated, medicated or diagnosed for the condition within the last 24 months. If you were not symptomatic, treated, medicated or diagnosed for the condition in the last 24 months, the eligible claim expense would be payable under the provisions and benefit limits of the Certificate. However, if you were treated, medicated or diagnosed for the condition within the last 24 months, the claim expense would be considered pre-existing, and the expenses would not be covered.
The following conditions, treatments, supplies, services, and/or expenses are not covered and are a summary of the Exclusions contained in the Certificate of Coverage.
Charges for treatment of the following illnesses or surgeries, which manifest themselves or are recommended, or symptoms occur during the first 180 days of coverage: any condition of the breast, any condition of the prostate, disorders of the reproductive system, gall stones or kidney stones, any acne diagnosis or acne-related condition, or any surgery that is not emergency in nature, as emergency is defined hereunder.
The following conditions, treatments, supplies, services, and/or expenses are not covered:
(This is a Summary of the Exclusions contained in the Certificate of Coverage.)
- Pre-existing conditions as defined above.
- Expenses for Pregnancy within the first 364 days of coverage.
- Claims not presented to the Company within ninety (90) days following incident.
- Treatment not medically necessary, which exceeds reasonable and customary charges, provided at no cost to the Insured Person, or performed by a relative or anyone who lives with the insured Person.
- Experimental treatment.
- Suicide or any attempted suicide.
- War or warlike operations.
- Injury in organized, professional, amateur, or interscholastic athletics.
- Routine physicals or procedures, unless otherwise listed in the Schedule of Benefits.
- Treatment of the Temporomandibular joint.
- Vocational, Speech, Recreational or Music Therapy.
- Cosmetic surgery except as a result of a covered accident.
- Dental or eye treatment unless otherwise covered.
- Telephone consultations.
- Treatment for and injuries/illnesses due to alcohol, chemical, or drug use.
- Treatment or services relating to custodial, rehabilitative, or nursing home care.
- Congenital conditions.
- Non-medical expenses.
- Self-inflicted injury or illness.
- Expenses in connection with the commission or attempt of a criminal offense.
- Injury while taking part in mountaineering, hang gliding, parachuting, bungee jumping, racing by horse, motor or motorcycle, SCUBA diving (unless PADI, NAUI, YMCA, SSI or PDIC certified).
- Treatment of venereal or sexually transmitted disease.
- Treatment due to HIV or AIDS.
- Drug treatment relating to infertility.
- Treatment for Chronic Fatigue Syndrome.
- Occupational Diseases.
- Expenses in connection with weight control.
To ensure that you receive the best care possible, Reside requires that you (or someone on your behalf) contact Seven Corners Assist prior to incurring any medical expenses. Contact information for Seven Corners Assist appears on the back of your ID Card. Seven Corners Assist will also be able to help you locate the approved medical care providers in the United States.
Reside Worldwide is underwritten by Certain Underwriters at Lloyd's of London and Tramont Insurance Company Limited. Your residence address determines which insurance carrier will provide your coverage. Pricing and benefits are identical for both Lloyd's of London and Tramont Insurance Company Limited.
It is important to note that Reside is a program for international citizens, and Lloyd's of London and Tramont Insurance Company Limited are both international insurance entities. Lloyd's of London operates as a surplus lines insurer in most U.S. states. Tramont Insurance Company Limited operates as an authorized insurer worldwide (coverage with Tramont cannot be initiated and purchased in the British Virgin Islands, U.S. Virgin Islands, and the U.S., although you are covered in these areas per the plan requirements). Coverage and benefits under Reside are not regulated by any U.S. state insurance department.
The information concerning Reside is not intended to be an offer to sell Reside or a solicitation by Seven Corners, Inc., Lloyd's of London, or Tramont Insurance Company Limited in any jurisdiction where any such sale would be unlawful, or in which Seven Corners, Lloyd's of London, and Tramont Insurance Company Limited are not qualified to do so. Reside may not be available in all situations or jurisdictions. Reside is intended for persons living or traveling outside the United States.
The Program Administrator
Seven Corners, Inc. has administered the Reside Worldwide Medical Plan since its inception. With 19 years of experience in the international insurance market, Seven Corners is well equipped to handle the unique requirements of international citizens. We have a strong history of providing innovative solutions necessary to address foreign currencies, international medical providers, and nonstandard records and documents often encountered in the international arena. Our staff of professionals serves the needs of thousands of policyholders throughout the world. We have provided international insurance plans for private citizens, governments, missionaries, students, and corporations of various nations around the globe. You can feel confident knowing that Seven Corners is here to assist you with your needs from the time you complete your application through the claims payment process.
In California, operating under the name Seven Corners Insurance Services.