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Liaison Majestic Exclusions & Limitations

EXCLUSIONS

For Medical benefits, this Insurance does not cover:

1. Any Injury or Illness which meets the following criteria: a) condition(s), including any related conditions, associated complications or consequences, which manifested during the thirty-six (36) months prior to the Effective Date of coverage under this policy; (b) condition(s) including any related conditions, associated complications or consequences, that should have caused a person to seek medical advice, diagnosis, care or treatment during the thirty-six (36) months prior to the Effective Date of coverage under this Policy; (c) condition(s) including any related conditions, associated complications or consequences, for which medical advice, diagnosis, care or treatment was recommended, received, or noticed during the thirty-six (36) months prior to the Effective Date of coverage under this Policy; (d) the symptoms which occurred during the thirty-six (36) months prior to the Effective Date of coverage under this policy would have allowed a person trained in medicine to make a diagnosis of the condition, including any associated complications or consequences, producing the symptoms.;
   
   If you are traveling outside the United States and Canada, the period is twelve (12) months instead of thirty-six (36) months.
   
   If you are a United States citizen and the United States is your Home Country, this exclusion is waived for Eligible Benefits incurred outside the United States and Canada as defined below:

   a) For persons less than age 65 with a Primary Health Plan as defined in the policy, Pre-Existing Conditions are waived up to the medical maximum selected.
   b) For persons less than age 65 without a Primary Health Plan as defined in the policy, Pre-Existing Conditions are waived up to the first $20,000.
   c) For persons age 65 and over, Pre-Existing Conditions are waived up to the first $2,500 regardless of whether there is a Primary Health Plan.

   This waiver does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to the effective date of this program.
   
   The term "Primary Health Plan" is a Group Health Benefit Plan, an individual health benefit plan, or a governmental health plan designed to be the first payor of claims (such as Medicare*.) for an Insured Person in effect prior to the effective date of this Policy and continuing as long as this Policy is in effect. Such plans must have coverage limits in excess of $50,000 per incident or per year to be considered a Primary Plan. *In order for Medicare to be considered as a Primary Health Plan, the policyholder must have parts A, B, and C. Medicare is not considered a Primary Health Plan for the following: 1. Insured Persons who are receiving treatment for end-stage renal disease. 2.) Insured Persons who are entitled to Medicare benefits as disabled persons. 3. Insured Persons who are less than 65 years and are entitled to Medicare for any other reason.
   
   If you are a non-United States citizen visiting the United States and suffer a Myocardial Infarction or Stroke and are admitted to a Hospital, this exclusion is waived in order to pay a $200 per night benefit for each night spent in the Hospital, up to a maximum benefit of $3,000. The term "Myocardial Infarction" shall mean an acute and emergent onset of any of the conditions. The term "Stroke" shall mean an acute and emergent onset of any of the conditions. This waiver does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to the effective date of this program.

2. Charges for Treatment(s) of the following Illness(es) or Surgery(ies), which Manifest(ed) themselves or are recommended, or symptoms occur during the first one hundred and eighty (180) days of Coverage hereunder beginning on the initial Effective Date: any condition of the breast; any treatment of all forms of cancer/neoplasm; any condition of the prostate; disorders of the reproductive system; hysterectomy; gall stones or urologic stones (kidney, ureteral, bladder or urethral stones) and any associated complications; any acne diagnosis or acne related condition; asthma; allergies; tonsillectomy; back conditions; adenoidectomy; hemorrhoids; hemorrhoidectomy; hernia, or any Surgery(ies) that is(are) not Emergency in nature, as Emergency is defined hereunder. (Does not apply to United States citizens traveling outside of the United States and Canada)
   
3. Claims not received by Seven Corners within ninety (90) days of the date of service;
   
4. Charges for treatment which exceed Reasonable and Customary charges; or charges incurred for Surgeries or treatments which are Investigational, Experimental, or for research purposes; expenses which are non-medical in nature;
   
5. Expenses for Vocational, Speech, Recreational or Music Therapy.
   
6. Expenses which were not recommended, approved and certified as Medically Necessary and reasonable by a Physician.
   
7. Suicide or any attempt thereof, self destruction or any attempt thereof, intentionally self-inflicted Injury or Illness;
   
8. Expenses as a result of, or in connection with, the commission of a felony offense or any other criminal or illegal activity as defined by the local governing body;
   
9. Any consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to, or arising in connection with war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war.
   
10. Injury sustained while participating in professional, sponsored and/or organized Amateur or Interscholastic Athletics.
    
11. Routine physicals, inoculations, or other examinations where there are no objective indications or impairment in normal health.
    
12. Treatment of the Temporomandibular joint.
    
13. Services or supplies performed or provided by a Relative of the Insured Person, or anyone who lives with the Insured Person.
14. Treatment and the provision of false teeth or dentures, normal ear tests and the provision of hearing aids, cosmetic or plastic Surgery (including deviated nasal septum), routine dental expenses, eye refractions or examinations for the purpose of prescribing corrective lenses or for the fitting thereof, unless caused by Accidental bodily Injury incurred while insured hereunder.
15. Treatment in connection with alcoholism and drug addiction, or use of any drug or narcotic agent; Injury sustained while under the influence of or Disablement due wholly or partly to the effects of intoxicating liquor or drugs or narcotic agent, unless administered under the advice of a Physician and said narcotic agent was taken in accordance with the proper dosing as directed by the Physician;
    
16. Any Mental and Nervous disorders or rest cures;
    
17. Congenital abnormalities and conditions arising out of or resulting therefrom.
    
18. Weight reduction programs or the surgical treatment of obesity;
    
19. Expenses incurred during a hospital emergency room visit which is not of an emergency nature.
    
20. Injury sustained while taking part in mountaineering, hang gliding, parachuting, bungee jumping, racing by any animal or motor vehicle, or motorcycle, snowmobiling, motorcycle / motor scooter riding (whether as a passenger or as a driver), scuba diving involving underwater breathing apparatus (unless PADI or NAUI certified), water skiing, snow skiing and snow boarding, luge, motocross, Moto X, skateboarding, and any other sport or athletic activity which is undertaken for thrill seeking and exposes the insured to abnormal or extreme risk of injury and/or is in violation of applicable laws, rules, or regulations. (Please see Optional Hazardous Sports Coverage to include some of these sports) walking, hiking, and climbing up mountains either: 1) utilizing harnesses, ropes, crampons or ice axes; or 2) ascending 4500 meters or above.
    Parachuting shall mean an activity involving the breaking of a free fall from an airplane using a parachute.
    
21. Treatment paid for or furnished under any other individual, government, or group policy or charges provided at no cost to the Insured Person.
    
22. Treatment of venereal or sexually transmitted disease.
    
23. Sex change operations, or for treatment of sexual dysfunction or sexual inadequacy;
    
24. Expenses resulting from Acquired Immune Deficiency Syndrome (AIDS), Aids-Related Complex (ARC) or the Human Immunodeficiency Virus (HIV).
    
25. Pregnancy expenses or Illness resulting from pregnancy, childbirth, or miscarriage; or for miscarriage resulting from an Accident.
    
26. Drug, treatment or procedure that either promotes or prevents conception, or prevents childbirth, including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof;.
    
27. Expenses incurred while you are in your Home Country (except after approved Emergency Medical Evacuation / Repatriation or if treatment is a follow-up to a covered disablement during coverage (see Home Country Coverage benefit) or if the expenses pertain to the Home Country Coverage Benefit);
    
28. Expenses incurred for which travel was undertaken to seek medical treatment for a condition; or incurred after the Covered person's physician has limited or restricted travel.
    
29. Expenses incurred as a result of the Insured's failure to accept or follow a Physician's advice, treatment, or recommended treatment. .

Liaison^® Majestic is underwritten by The Insurance Company of the State of Pennsylvania, a member company of Chartis Insurance and is rated A "Excellent" by the A.M. Best Company.

Notice to Florida residents: the benefits of this policy providing Your coverage are governed by the law of a state other than Florida. Your Homeowners policy, if any, may provide coverage for loss of personal effects provided by the Loss of Checked Luggage coverage. This insurance is not required in connection with the purchase of Your travel arrangements.