Trip Interruption

• Cancellation
  • Trip Interruption

  • No coverage

• What is Trip Interruption?
  Trip Interruption provides reimbursement for prepaid and non-refundable trip payments if a portion of a trip is missed, or the traveler must return home early due to unforeseen circumstances, including illness, injury, or death.

• What am I covered for?
  There is no Trip Interruption coverage with this plan.

• Definitions
  Accidental Injury means an accidental bodily Injury sustained by a Covered Person which is the direct cause of a loss independent of disease, bodily infirmity, or any other cause.

  Age means the Covered Person’s attained age.

  Ambulatory Surgical Center is a freestanding outpatient surgical facility. It must be licensed as an outpatient clinic according to state and local laws and must meet all requirements of an outpatient clinic providing surgical services. It also must meet accreditation standards of the Joint Commission on Accreditation of Health Care Organizations or the Accreditation Association of Ambulatory Health Care.

  Certificate of Coverage is the document issued to each Eligible Participant outlining the benefits under the Group Certificate.

  Coinsurance is the percentage of Covered Expenses the Covered Person is responsible for paying (after the applicable Deductible is satisfied and/or Copayment paid). Coinsurance does not include charges for services that are not Covered Services or charges in excess of Covered Expenses. These charges are the Covered Person’s responsibility and are not included in the Coinsurance calculation.

  Complications of Pregnancy are conditions, requiring hospital confinement (when the pregnancy is not terminated), whose diagnoses are distinct from the pregnancy, but are adversely affected by the pregnancy, including, but not limited to, acute nephritis, nephrosis, cardiac decompression, missed abortion, pre-eclampsia, intrauterine fetal growth retardation, and similar medical and surgical conditions of comparable severity. Complications of Pregnancy also include termination of ectopic pregnancy, and spontaneous termination of pregnancy, occurring during a period of gestation in which a viable birth is not possible. Complications of Pregnancy do not include elective abortion, elective cesarean section, false labor, occasional spotting, morning sickness, physician prescribed rest during the period of pregnancy, hyperemesis gravidarium, and similar conditions associated with the management of a difficult pregnancy not constituting a distinct complication of pregnancy.

  A Continuing Hospital Confinement means consecutive days of in-hospital service received as an inpatient, or successive confinements for the same diagnosis, when discharge from and readmission to the Hospital occurs within 24 hours.

  Cosmetic and Reconstructive Surgery. Cosmetic Surgery is performed to change the appearance of otherwise normal looking characteristics or features of the patient’s body. A physical feature or characteristic is normal looking when the average person would consider that feature or characteristic to be within the range of usual variations of normal human appearance. Reconstructive Surgery is surgery to correct the appearance of abnormal looking features or characteristics of the body caused by birth defects, Injury, tumors, or infection. A feature or characteristic of the body is abnormal looking when an average person would consider it to be outside the range of general variations of normal human appearance. Note: Cosmetic Surgery does not become Reconstructive Surgery because of psychological or psychiatric reasons.

  Covered Expenses are the expenses incurred for Covered Services. Covered Expenses for Covered Services will not exceed Reasonable Charges. In addition, Covered Expenses may be limited by other specific maximums described in this Plan under section IV, How the Plan Works and section V, Benefits: What the Plan Pays. Covered Expenses are subject to applicable Deductibles, penalties and other benefit limits. An expense is incurred on the date the Covered Person receives the service or supply.

  Covered Person means an Individual Insured and any Eligible Dependents as described in the appropriate eligibility section, for whom premium is paid and who is covered under the Group Certificate

  Covered Services are Medically Necessary services or supplies that are listed in the benefit sections of this Certificate, and for which the Covered Person is entitled to receive benefits.

  Custodial Care is care provided primarily to meet the Covered Person’s personal needs. This includes help in walking, bathing, or dressing. It also includes preparing food or special diets, feeding, administration of medicine that is usually self-administered, or any other care that does not require continuing services of a medical professional.

  Deductible means the amount of Covered Expenses the Covered Person must pay for Covered Services before benefits are available to him/her under this Certificate.

  Dental Prostheses are dentures, crowns, caps, bridges, clasps, habit appliances, and partials.

  Domestic Partner means an unmarried same or opposite sex adult who resides with the Insured Participant and has registered in a state or local domestic partner registry with the Insured Participant.

  Durable Medical Equipment means medical equipment which:

  1. Is prescribed by the Physician who documents the necessity for the item including the expected duration of its use;

  2. Can withstand long term repeated use without replacement;

  3. Is not useful in the absence of Injury or Sickness; and

  4. Can be used in the home without medical supervision.

  The Insurer will cover charges for the purchase of such equipment when the purchase price is expected to be less costly than rental.

  Excluded durable medical equipment includes, but is not limited to: orthopedic shoes or shoe inserts; air purifiers, air conditioners, humidifiers; exercise equipment, treadmills; spas; elevators; supplies for comfort, hygiene or beautification; disposable sheaths and supplies; correction appliances or support appliances and supplies such as stockings.

  The Effective Date of Coverage is the date on which coverage under this Certificate begins for the Eligible Participant and any other Covered Person.

  Eligible Dependent (See ‘Eligibility Rules’ in Section II of this Certificate)

  Eligible Participant (See ‘Eligibility Rules’ in Section II of this Certificate)

  Emergency Hospitalization and Emergency Medical Care means hospitalization or medical care that is provided for an Injury or a Sickness condition manifesting itself by acute symptoms of sufficient severity including without limitation sudden and unexpected severe pain for which the absence of immediate medical attention could reasonably result in:

  1. Permanently placing the Covered Person’s health in jeopardy, or

  2. Causing other serious medical consequences; or

  3. Causing serious impairment to bodily functions; or

  4. Causing serious and permanent dysfunction of any bodily organ or part.

  Previously diagnosed chronic conditions in which subacute symptoms have existed over a period of time shall not be included in this definition of a medical emergency, unless symptoms suddenly become so severe that immediate medical aid is required.

  Experimental or Investigative Procedure is treatment, a device or prescription medication which is recommended by a Physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device or prescription medication is being used, including any treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice; and any of those items requiring federal or other governmental agency approval not received at the time services are rendered. The Insurer will make the final determination as to what is Experimental or Investigative.

  Foreign Country is a country other than the United States of America.

  Foreign Country Provider is any institutional or professional provider of medical or psychiatric treatment or care who practices in a country outside the United States of America. A Foreign Country Provider may also be a supplier of medical equipment, drugs, or medications. GeoBlue provides Covered Persons with access to a database of Foreign Country Providers.

  A Full Time Student is a student enrolled at an accredited college, university, or trade school. The student must be currently attending classes, carrying at least 12 units per term.

  GeoBlue. This is the entity that provides the Covered Person with access to online databases of travel, health, and security information and online information about physicians and other medical providers. GeoBlue is the trade name of Worldwide Insurance Services, LLC (Worldwide Insurance Services Agency, LLC in California and New York), an independent licensee of the Blue Cross and Blue Shield Association.

  GeoBlue International Healthcare Community consists of physicians, dentists, mental health professionals, other allied health professionals, hospitals, health systems and medical practices countries throughout the world, all dedicated to providing high quality medical care to international travelers, employees and students. The providers are accessed through the GeoBlue online database or through the GeoBlue customer services.

  Group Health Benefit Plan means a group, blanket, or franchise insurance policy, a certificate issued under a group policy, a group hospital service contract, or a group subscriber contract or evidence of coverage issued by a health maintenance organization that provides benefits for health care services. The term does not include:

  1. accident-only, credit or disability insurance coverages;

  2. specified disease coverage or other limited benefit policies;

  3. coverage of Medicare services under a federal contract;

  4. Medicare Supplement and Medicare Select policies regulated in accordance with federal law;

  5. long-term care, dental care, or vision care coverages;

  6. coverage provided by a single service health maintenance organization;

  7. insurance coverage issued as a supplement to liability insurance;

  8. insurance coverage arising out of a workers’ compensation system or similar statutory system;

  9. automobile medical payment insurance coverage;

  10. jointly managed trusts authorized under 29 U.S.C. Section 141 et seq. that contain a plan of benefits for employees that is negotiated in a collective bargaining agreement governing wages, hours, and working conditions of the employees that is authorized under 29 U.S.C. Section 157;

  11. hospital confinement indemnity coverage; or

  12. reinsurance contracts issued on a stop-loss, quota share, or similar basis.

  Home Country means the Covered Person’s country of domicile named on the enrollment form or the roster, as applicable. However, the Home Country of an Eligible Dependent who is a child is the same as that of the Eligible Participant.

  A Hospital is a facility which provides diagnosis, treatment and care of persons who need acute inpatient hospital care under the supervision of Physicians. It must:

  1. be licensed as a hospital and operated pursuant to law; and

  2. be primarily engaged in providing or operating (either on its premises or in facilities available to the hospital on a contractual prearranged basis and under the supervision of a staff of one or more duly licensed physicians) medical, diagnostic, and major surgery facilities for the medical care and treatment of sick or injured persons on an inpatient basis for which a charge is made; and

  3. provide 24-hour nursing service by or under the supervision of a registered graduate professional nurse (R.N.); and

  4. be an institution which maintains and operates a minimum of five beds; and

  5. have X-ray and laboratory facilities either on the premises or available on a contractual prearranged basis; and

  6. maintain permanent medical history records.

  This definition excludes convalescent homes, convalescent facilities, rest facilities, nursing facilities, or homes or facilities primarily for the aged, those primarily affording custodial care or educational care.

  An Illness is a sickness, disease, or condition of a Covered Person which first manifests itself after the Covered Person’s Effective Date.

  Injury (See Accidental Injury)

  Immediate Family Member means Your spouse; Partner; parent; child(ren), including children who are, or are in the process of becoming, adopted; Your siblings; Your grandparent or grandchild(ren). Adopted, half and step members are also included as an Immediate Family Member.

  Insurance Coverage Area is the primary geographical region in which coverage is provided to the Covered Person.

  Insured Dependents are members of the Eligible Participant’s family who are eligible and have been accepted by the Insurer under this Certificate.

  Insured Participant is the Eligible Participant whose application has been accepted by the Insurer for coverage under this Certificate.

  The Insurer means 4 Ever Life International Limited, a Bermuda insurer not admitted in any U.S. jurisdiction.

  Investigative Procedures (See Experimental/Investigational).

  Medically Necessary services or supplies are those that the Insurer determines to be all of the following:

  1. Appropriate and necessary for the symptoms, diagnosis or treatment of the medical condition.

  2. Provided for the diagnosis or direct care and treatment of the medical condition.

  3. Within standards of good medical practice within the organized community.

  4. Not primarily for the patient’s, the Physician’s, or another provider’s convenience.

  5. The most appropriate supply or level of service that can safely be provided. For Hospital stays, this means acute care as an inpatient is necessary due to the kind of services the Covered Person is receiving or the severity of the Covered Person’s condition and that safe and adequate care cannot be received as an outpatient or in a less intensified medical setting.

  The fact that a Physician may prescribe, authorize, or direct a service does not of itself make it Medically Necessary or covered by the Policy.

  Mental Illness and Mental and Nervous Disorder means any psychiatric disease identified in the most recent edition of the International Classification of Diseases or of the American Psychiatric Association Diagnostic and Statistical Manual. Mental Illness and Mental and Nervous Disorder does not mean or include developmental disorders, learning disabilities, attitudinal disorders or disciplinary problems.

  A Newborn is a recently born infant within 31 days of birth.

  Office Visit means a visit by the Covered Person, who is the patient, to the office of a Physician during which one or more of only the following three specific services are provided:

  1. History (gathering of information on an Illness or Injury).

  2. Examination.

  3. Medical Decision Making (the Physician’s diagnosis and Plan of treatment).

  This does not include other services (e.g. X-rays or lab services) even if performed on the same day.

  Other Plan is an insurance plan other than this plan that provides medical and/or repatriation of remains, and/or medical evacuation benefits for the Covered Person.

  The Period of Insurance Maximum Benefit is the maximum amount of benefits available to each Covered Person during the person’s Period of Coverage. All benefits furnished are subject to this maximum amount.

  Physical and/or Occupational Therapy/Medicine is the therapeutic use of physical agents other than drugs. It comprises the use of physical, chemical and other properties of heat, light, water, electricity, massage, exercise, spinal manipulation and radiation.

  A Physician means a physician licensed to practice medicine or any other practitioner who is licensed and recognized as a provider of health care services in the state and/or country the Covered Person resides or is treated; and provides services covered by this Certificate of Coverage that are within the scope of his/her licensure.

  Plan is the set of benefits described in the Certificate of Coverage booklet and in the amendments to this booklet (if any). This Plan is subject to the terms and conditions of the Group Certificate the Insurer has issued to the Global Citizens Association. If changes are made to the Policy or Plan, an amendment or revised booklet will be issued to the Group for distribution to each Insured Participant affected by the change.

  Policy is the Group Certificate the Insurer has issued to the Global Citizens Association.

  Pre-existing Condition means any disease, illness, sickness, malady or condition which was diagnosed or treated by a legally qualified physician prior to the effective date of coverage with consultation, advice or treatment by a legally qualified physician occurring within 6 months prior to the Coverage Date for the Covered Person.

  A Primary Plan is a Group Health Benefit Plan, an individual health benefit plan, or certain governmental health plan (including Medicare Supplements and Medicare Advantage plans) designed to be the first payor of claims for a Covered Person prior to the responsibility of this Plan. Medicaid, state run Medicaid programs, and Veterans Administration health benefit plans are not considered a primary plan under this Certificate of Coverage.

  A Reasonable Charge, as determined by the Insurer, is the amount the Insurer will consider a Covered Expense with respect to charges made by a Physician, facility or other supplier for Covered Services. In determining whether a charge is Reasonable, the Insurer will consider all of the following factors:

  1. The actual charge.

  2. Specialty training, work value factors, practice costs, regional geographic factors and inflation factors.

  3. The amount charged for the same or comparable services or supplies in the same region or in other parts of the country.

  4. Consideration of new procedures, services or supplies in comparison to commonly used procedures, services or supplies.

  5. The Average Wholesale Price for Pharmaceuticals.

  Reconstructive Surgery (See Cosmetic and Reconstructive Surgery)

  Sexually transmitted disease: Any disease transmitted by sexual contact; caused by microorganisms that survive on the skin or mucus membranes of the genital area; or transmitted via semen, vaginal secretions, or blood during intercourse.

  Special Care Units are special areas of a Hospital that have highly skilled personnel and special equipment for acute conditions that require constant treatment and observation.

  Spouse means the Eligible Participant’s lawful spouse as defined in the state or jurisdiction where the marriage occurred. This term includes a common law spouse if recognized by the state in which the Eligible Participant resides.

  Substance Abuse is defined as the psychological or physical dependence on alcohol or other mind-altering drugs that requires diagnosis, care, and treatment. In determining benefits payable, Charges made for the treatment of any physiological conditions related to rehabilitation services for alcohol or drug abuse or addiction will not be considered to be Charges made for treatment of Substance Abuse.

  Terrorism or Terrorist Activity shall mean an act or acts, of any person, or group(s) of persons, committed for political, religious, ideological or similar purposes with the intention to influence any government and/or to put the public, or any section of the public, in fear. Terrorism can include, but not be limited to, the actual use of force or violence and/or the treat of such use. Furthermore, the perpetrators of terrorism can either be acting alone, or on behalf of, or in connection with any organization(s) or government(s).

  Totally Disabled or Total Disability means:

  1. As applied to an Insured Participant, any period of time during the Insured Participant’s lifetime in which he/she is unable to perform substantially all the duties required by his/her usual occupation, provided the disability commences within twelve (12) months from the date the disabling condition occurred;

  2. As applied to a Dependent, not being able to perform the normal activities of a like person of the same age and sex.

  The patient must be under the care of a Physician.

  Trip Coverage Period the period in which the Eligible Participant is covered under this Certificate of Coverage

  The Trip Coverage Period Maximum Benefit is the maximum amount of benefits available to each Covered Person during the person’s Trip Coverage Period. All benefits furnished are subject to this maximum amount.

  United States (U.S.) of America means the 50 states of the United States of America, and the District of Columbia, Puerto Rico and the US Virgin Islands.

  We, Us and Our means 4 Ever Life International Limited.

  You, Your means an Eligible Participant or Eligible Dependent.

• Exclusions
  The Plan does not provide benefits for:

  1. Any amounts in excess of maximum amounts of Covered Expenses stated in this Plan.

  2. Services not specifically listed in this Plan as Covered Services.

  3. Expenses incurred in the Home Country.

  4. Services or supplies that are not Medically Necessary as defined by the Insurer.

  5. Services or supplies that the Insurer considers to be Experimental or Investigative.

  6. Expenses incurred for elective treatment or elective surgery.

  7. Services received before the Effective Date of coverage or during an inpatient stay that began before that Effective Date of Coverage.

  8. Services received after coverage ends unless an extension of benefits applies as specifically stated under Extension of Benefits in the ‘Who is Eligible for Coverage’ section of this Plan.

  9. Services for which the Insured Person has no legal obligation to pay or for which no charge would be made if he/she did not have a health policy or insurance coverage.

  10. Services for any condition for which benefits are recovered or can be recovered, either by adjudication, settlement or otherwise, under any workers’ compensation, employer’s liability law or occupational disease law, even if the Insured Person does not claim those benefits.

  11. Treatment or medical services required while traveling against the advice of a Physician, while on a waiting list for a specific treatment, or when traveling for the purpose of obtaining medical treatment.

  12. Services related to pregnancy or maternity care other than for complications of pregnancy that may arise during a Trip Coverage Period.

  13. Conditions caused by or contributed by a) The inadvertent release of nuclear energy when government funds are available for treatment of Illness or Injury arising from such release of nuclear energy; b) An Insured Person participating in the military service of any country; c) An Insured Person participating in an insurrection, rebellion, or riot; d) Services received for any condition caused by an Insured Person’s commission of, or attempt to commit a felony or to which a contributing cause was the Insured Person being engaged in an illegal occupation; e) An Insured Person voluntarily using illegal drugs; intentionally taking over the counter medication not in accordance with recommended dosage and warning instructions; and intentionally misusing prescription drugs.

  14. Any services provided by a local, state or federal government agency except when payment under this Plan is expressly required by federal or state law.

  15. Professional services received or supplies purchased from the Insured Person, a person who lives in the Insured Person’s home or who is related to the Insured Person by blood, marriage or adoption, or the Insured Person’s employer.

  16. Inpatient or outpatient services of a private duty nurse.

  17. Inpatient room and board charges in connection with a Hospital stay primarily for environmental change, physical therapy or treatment of chronic pain; Custodial Care or rest cures; services provided by a rest home, a home for the aged, a nursing home or any similar facility service.

  18. Inpatient room and board charges in connection with a Hospital stay primarily for diagnostic tests which could have been performed safely on an outpatient basis.

  19. Treatment of Mental, Emotional of Functional Nervous Conditions or Disorders.

  20. Treatment of Drug, alcohol, or other substance addiction or abuse.

  21. Dental services, dentures, bridges, crowns, caps or other dental prostheses, extraction of teeth or treatment to the teeth or gums, except as specifically stated under Dental Care and/or Dental Care for Accidental Injury in the Benefits section of this Plan.

  22. Dental and orthodontic services for Temporomandibular Joint Dysfunction (TMJ).

  23. Orthodontic Services, braces and other orthodontic appliances.

  24. Dental Implants: Dental materials implanted into or on bone or soft tissue or any associated procedure as part of the implantation or removal of dental implants.

  25. Routine hearing tests or hearing aids.

  26. Optometric services, eye exercises including orthoptics, eyeglasses, contact lenses, routine eye exams, and routine eye refractions, except as specifically stated in this Plan.

  27. An eye surgery solely for the purpose of correcting refractive defects of the eye, such as near-sightedness (myopia), astigmatism and/or farsightedness (presbyopia).

  28. Outpatient speech therapy.

  29. Any Drugs, medications, or other substances dispensed or administered in any outpatient setting except as specifically stated in this Plan. This includes, but is not limited to, items dispensed by a Physician.

  30. Any intentionally self-inflicted Injury or Illness. This exclusion does not apply to the Medical Evacuation Benefit, to the Repatriation of Remains Benefit and to the Bedside Visit Benefit.

  31. Cosmetic surgery or other services for beautification, including any medical complications that are generally predictable and associated with such services by the organized medical community. This exclusion does not apply to Reconstructive Surgery to restore a bodily function or to correct a deformity caused by Injury or congenital defect of a newborn child, or to Medically Necessary reconstructive surgery performed to restore symmetry incident to a mastectomy.

  32. Procedures or treatments to change characteristics of the body to those of the opposite sex. This includes any medical, surgical or psychiatric treatment or study related to sex change.

  33. Treatment of sexual dysfunction or inadequacy.

  34. All services related to the evaluation or treatment of fertility and/or Infertility, including, but not limited to, all tests, consultations, examinations, medications, invasive, medical, laboratory or surgical procedures including sterilization reversals and In vitro fertilization

  35. Cryopreservation of sperm or eggs.

  36. All contraceptive services and supplies, including but not limited to, all consultations, examinations, evaluations, medications, medical, laboratory, devices, or surgical procedures.

  37. Orthopedic shoes (except when joined to braces) or shoe inserts, including orthotics.

  38. Services primarily for weight reduction or treatment of obesity including morbid obesity, or any care which involves weight reduction as a main method of treatment.

  39. Routine physical exams or tests that do not directly treat an actual Illness, Injury or condition, including those required by employment or government authority.

  40. Charges by a provider for telephone consultations.

  41. Items which are furnished primarily for the Eligible Participant’s personal comfort or convenience (air purifiers, air conditioners, humidifiers, exercise equipment, treadmills, spas, elevators and supplies for hygiene or beautification, etc.).

  42. Educational services except as specifically provided or arranged by the Insurer.

  43. Nutritional counseling or food supplements.

  44. Durable medical equipment not specifically listed as Covered Services in the Covered Services section of this Plan. Excluded durable medical equipment includes, but is not limited to: orthopedic shoes or shoe inserts; air purifiers, air conditioners, humidifiers; exercise equipment, treadmills; spas; elevators; supplies for comfort, hygiene or beautification; disposable sheaths and supplies; correction appliances or support appliances and supplies such as stockings.

  45. All infusion therapy, chemotherapy, radiation therapy, hemodialysis together with any associated supplies, Drugs or professional services are excluded.

  46. Joint replacement or arthroplasty surgery of any kind.

  47. Surgical treatment to the spine, back, or discs of the spine, unless it is the result of an accident that occurred during the Trip Period..

  48. Growth Hormone Treatment.

  49. Routine foot care including the cutting or removal of corns or calluses; the trimming of nails, routine hygienic care and any service rendered in the absence of localized Illness, Injury or symptoms involving the feet.

  50. Charges for which the Insurer are unable to determine the Insurer’s liability because the Eligible Participant or an Insured Person failed, within 90 days, or as soon as reasonably possible to: a) authorize the Insurer to receive all the medical records and information the Insurer requested; or b) provide the Insurer with information the Insurer requested regarding the circumstances of the claim or other insurance coverage.

  51. Charges for the services of a standby Physician.

  52. Charges for animal to human organ transplants.

  53. Under the medical treatment benefits, for loss due to or arising from a motor vehicle Accident if the Insured Person operated the vehicle without a proper license in the jurisdiction where the Accident occurred.

  54. Loss arising from
  a. participating in any intercollegiate/interscholastic sport, contest or competition;
  b. participating in any intramural sport competition, contest or competition;
  c. participating in any club sport competition, contest or competition;
  d. participating in any professional sport, contest or competition;
  e. while participating in any practice or condition program for such sport, contest or competition;
  f. Racing or speed contests;
  g. sky diving, mountaineering (where ropes are customarily used), ultra light aircraft, parasailing, sail planning, hang gliding, bungee cord jumping, spelunking, extreme skiing.

  55. Claims arising from loss due to riding in any aircraft except one licensed for the transportation of passengers.

  56. Treatment for or arising from sexually transmittable diseases. (This exclusion does not apply to HIV, AIDS, ARC or any derivative or variation.)

  57. Under the Accidental Death and Dismemberment provision, for loss of life or dismemberment for or arising from an Accident in the U.S.

  58. Treatment of Congenital Conditions.

  59. Whenever coverage provided by this Certificate would be in violation of any U.S. economic or trade sanctions, such coverage shall be null and void.

  Pre-existing Condition Limitation

  Pre-existing conditions are covered under this plan as any other condition, subject to the terms and exclusions listed in the policy.

  General Limitations/ Exclusions for Emergency Medical Evacuation and Repatriation after an Emergency Medical Evacuation Benefits

  In addition to any of the general exclusions listed in Section VI. of this certificate, the following exclusions also apply to the Emergency Medical Transportation benefit:

  1. Transportation shall not be considered Medically Necessary if We or Our designee’s medical director determines that the Covered Person is receiving adequate care in their current location.

  2. Transportation shall not be considered Medically Necessary if We or Our designee’s medical director determines that the Covered Person can continue his/her trip or can use the original transportation arrangements that he/she purchased.

  3. No more than one Emergency Medical Evacuation and/or Repatriation is allowed for any single medical condition of a Covered Member while covered under this Certificate.

  4. No payment will be made for charges for:

  a) services rendered without the authorization or intervention of Us or Our designee;

  b) non-emergency, routine or minor medical problems, tests and exams where there is no clear or significant risk of death or imminent serious Injury or harm to You;

  c) a condition which would allow for treatment at a future date convenient to You and which does not require emergency evacuation or repatriation;

  d) expenses incurred if the original or ancillary purpose of Your trip is to obtain medical treatment;

  e) Any expense for medical evacuation or repatriation if the Covered Member is not suffering from a Serious Medical Condition, and/or in the opinion of Our designee’s medical director, the Covered Member can be adequately treated locally, or treatment can be reasonably delayed until the Covered Member returns to his/her Home Country or Country of Assignment.

  Prescription Drug Exclusions and Limitations

  Prescription Drug reimbursement is subject to and treated as part of any benefit maximums, limitations on Pre-existing Conditions or any other exclusions or limitations contained in this entire Plan. In addition, reimbursement will not be provided for:

  1. Drugs and medications not requiring a Prescription, except insulin.

  2. Non-medical substances or items.

  3. Contraceptive Drugs and devices prescribed for birth control, even if prescribed for other than contraceptive purposes, Drugs and medications used to induce non-spontaneous abortions.

  4. Dietary supplements, cosmetics, health or beauty aids.

  5. Any vitamin, mineral, herb or botanical product which is believed to have health benefits, but does not have Food and Drug Administration (FDA) approved indication to treat, diagnose or cure a medical condition.

  6. Drugs taken while the Eligible Participant or Eligible Dependents are in a Hospital, Skilled Nursing Facility, rest home, sanitarium, convalescent hospital or similar facility.

  7. Any Drug labeled “Caution, limited by federal law to investigational use” or Non-FDA approved investigational Drugs, any Drug or medication prescribed for experimental indications (such as progesterone suppositories).

  8. Syringes and/or needles, except those dispensed for use with insulin.

  9. Durable medical equipment, devices, appliances and supplies.

  10. Immunizing agents, biological sera, blood, blood products or blood plasma.

  11. Anti-malarial drugs, unless the Covered Person has been diagnosed with malaria.

  12. Oxygen.

  13. Professional charges in connection with administering, injecting or dispensing of Drugs.

  14. Drugs and medications dispensed or administered in an outpatient setting, including but not limited to outpatient hospital facilities and doctor’s offices.

  15. Drugs used for cosmetic purposes.

  16. Drugs used for the primary purpose of treating infertility.

  17. Drugs used for the purpose of treating hair loss.

  18. Drugs used for sexual stimulation.

  19. Anorexiants or Drugs associated with weight loss.

  20. Allergy desensitization products, allergy serum.

  21. Drugs for treatment of a condition, Illness, or Injury for which benefits are excluded or limited by a Pre-existing Condition, or other contract limitation.

  22. Growth Hormone Treatment.

  23. Prescription Drugs with a non-prescription (over the counter) chemical and dose equivalent.