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Reside Worldwide Limitations & Exclusions

Pre-existing Conditions:

If an existing condition is fully and accurately disclosed on the application, and the condition is not excluded or restricted by a rider, your pre-existing condition will be covered up to a lifetime maximum of $50,000 ($5,000 limit per year) after you have been continuously insured for 24 months.

Pre-existing conditions are any Injury(ies) or Illness(es) which meets the following criteria:

1. A condition that would have caused a person to seek medical advice, diagnosis, care or Treatment(s) prior to the Individual Effective Date of Coverage under this Certificate;
2. A condition for which medical advice, diagnosis, care or Treatment(s), including Medication, was sought, recommended or received prior to the Individual Effective Date of Coverage under this Certificate;
3. The symptoms that occurred prior to the Individual Effective Date of the Coverage under this Certificate would have allowed a person trained in medicine to make a diagnosis of the condition producing the symptoms;
4. A condition that manifested prior to the Individual Effective Date of Coverage under this Certificate;
5. Expenses for Pregnancy within twelve (12) months after the Individual Effective Date of Coverage under this Certificate.

All Pre-Existing Conditions will be considered, provided the Insured Person has not:

1. suffered symptoms, consulted any Physician for Treatment, advice or check-ups for these Pre-Existing Conditions
2. 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.

Meaning, at the time that you submit a possible pre-existing claim to Seven Corners for processing, we will look back 24 months from the date of service and determine if you had been treated, medicated or diagnosed for the condition within the last 24 months. If you have not been treated, medicated or diagnosed for the condition in the last 24 months, the eligible claim expense will be payable under the provisions and benefit limits of the Certificate. However, if you have been treated, medicated or diagnosed for the condition within the last 24 months, the claim expense shall be considered pre-existing and the expenses will not be considered eligible under the provisions of the Certificate.

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 hereunder beginning on the initial effective date: 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. Note: coverage for such illnesses or surgeries may be further limited under the pre existing condition exclusion and definition contained herein, or other exclusions contained herein;

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.
• Claims not presented to 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 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.
• Injuries as a result of disablement due to liquor or drugs.
• Telephone consultations.
• 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 of a felony offense.
• Injury while taking part in mountaineering, hang gliding, parachuting, bungee jumping, racing, 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.

PRE-NOTIFICATION PROGRAM/PPO

To ensure that you receive the best care possible, Reside requires that the Insured Person (or someone on the Insured Person’s behalf) contact Seven Corners Assist for notification prior to all hospital admissions worldwide and any medical expenses incurred within the United States. The methods of contacting Seven Corners Assist will appear on the back of your ID Card. Seven Corners Assist will also be able to assist you in locating the approved Seven Corners medical care providers in the United States.

Utilize an approved PPO Service Provider within the United States Services and Treatment in the United States must be received at an approved PPO Service Provider facility, if one exists within a 50-mile radius of where the Insured Person is located.  To obtain a list of approved PPO Service Providers contact the Administrator or visit the approved PPO Service Provider website at: www.sevencorners.com/ppo

If Services and Treatment eligible for coverage under this Certificate are received directly from an approved PPO Service Provider while the Insured Person is in the United States: (a) the Company will reduce by 50% any part of the Deductible applicable to such Eligible Benefits, and (b) the Company will waive any and all Coinsurance applicable to such Eligible Benefits.

Failure to follow the Pre-Notification Program and to utilize an approved PPO Service Provider will result in a 25% reduction of the Eligible Benefits stated in the Schedule of Benefits.

THE UNDERWRITER

The Reside Worldwide Medical Plan is underwritten by Certain Underwriters at Lloyds, London. As the largest insurance entity in the world, Lloyds has earned an A (Excellent) rating from AM Best and an A+ (Strong) rating from Standard and Poors.

THE PROGRAM ADMINISTRATOR

Properly serving the medical needs of international citizens requires specialization. Most companies are not prepared to meet the unique needs of these customers. An organization must be equipped to address foreign currencies, international doctors and hospitals, as well as unusual claim forms and documents. The Reside Worldwide Medical Plan is administered worldwide by Seven Corners, Inc.. The professionals at Seven Corners have over 250 years of experience in claim processing and administration. Seven Corners currently serves the needs of thousands of policyholders throughout the world.