Exclusions

All charges, costs, expenses and/or claims (collectively “Charges”) incurred by the Insured Person and directly or indirectly relating to or arising from or in connection with any of the following acts, omissions, events, conditions, charges, consequences, claims, Treatment (including diagnoses, consultations, tests, examinations and evaluations related thereto), services and/or supplies are expressly excluded from coverage under this insurance, and the Company shall provide no benefits and shall have no liability therefor:

1. War; Military Action

   The Company shall not be liable for and will not provide coverage or benefits for any claim or Charges incurred with respect to any Illness, Injury or other consequence, whether directly or indirectly, proximately or remotely occasioned by, contributed to by, or traceable to or arising or incurred in connection with or as a result of any of the following acts or events (collectively, “Occurrences”):

   1. war, invasion, act of foreign enemy hostilities, warlike operations (whether war be declared or not), or civil war;
   2. mutiny, riot, strike, military or popular uprising, insurrection, rebellion, revolution, military or usurped power;
   3. any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of the Government de jure or de facto or to the influencing of it by violence of any type;
   4. martial law or state of siege or any events or causes which determine the proclamation or maintenance of martial law or state of siege; or
   5. Terrorism.

   Any claim or Charges incurred with respect to any Illness, Injury or other consequence happening or arising during the existence of abnormal conditions (whether physical or otherwise), whether or not directly or indirectly, proximately or remotely occasioned by, or contributed to by, traceable to, or arising in connection with, any of the said Occurrences shall be deemed and considered to be consequences for which the Company shall not be liable under the Master Policy or this Certificate, except to the extent that the Insured Person shall prove that such claim, Charges, Illness, Injury or other consequence happened independently of the existence of such abnormal conditions and/or Occurrences; and

2. Pre-existing Conditions

   (i) For medical conditions existing at the time of Application which are fully disclosed on the Application and are not excluded or restricted through a Rider attached to this Certificate and for medical conditions which existed but that were unknown at the time of Application, charges resulting directly or indirectly from or relating to any such Pre-existing Condition are excluded from coverage under this insurance until the Insured Person has maintained coverage under this insurance plan continuously for at least twenty-four (24) months, and thereafter such Charges are limited in coverage as provided in Section C, Schedule of Benefits/Limits, above; and (ii) Any expenses incurred, obtained, or received by an Insured Person for any Non-Disclosed conditions will be excluded under this insurance; and

3. Illness or Surgery Within 180 Days

   Charges for Treatment of the following Illnesses or Surgeries which manifest themselves and/or involve procedures which take place and/or are recommended during the first one-hundred eighty (180) days of coverage under this insurance plan, beginning on the Initial Effective Date: asthma, allergies, any condition of the breast, any condition of the prostate, tonsillectomy, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the reproductive system, diverticulitis, hysterectomy, hernia, intervertebral disc disease, gall stones or kidney stones. Note: Coverage and/or benefits for these Illnesses or Surgeries (or for similar or different Illnesses or Surgeries) may be separately or further limited and/or excluded under the Pre-existing Conditions exclusion and definition; and

4. Maternity and Newborn Care

   Charges for pre-natal care, pregnancy, post-natal care, and care of Newborns, except as expressly provided in Section K; and

5. Mental or Nervous Disorders

   Charges for Treatment of Mental or Nervous Disorders are excluded from coverage under this insurance until the Insured Person has maintained coverage under this insurance plan continuously for at least twelve (12) months; and

6. Wellness

   Charges for Routine Physical Exams are excluded from coverage under this insurance until the Insured Person has maintained coverage under this insurance plan continuously for at least twelve (12) months, and except as otherwise expressly provided in Section I, above. In no event will the Company reimburse the Insured Person for more than one Routine Physical Exam during any twelve (12) month period; and

7. Charges for any Treatment or supplies that are:

   1. not incurred, obtained or received by an Insured Person during the Period of Insurance; and/or
   2. not presented to the Company for payment by way of a complete Proof of Claim within one hundred and eighty (180) days of the date such Charges are incurred; and/or
   3. not administered or ordered by a Physician; and/or
   4. not Medically Necessary; and/or
   5. provided at no cost to the Insured Person or for which the Insured Person is not otherwise liable; and/or
   6. in excess of Usual, Reasonable, and Customary; and/or
   7. incurred by an Insured Person who was HIV + at the Initial Effective Date of this insurance; whether or not the Insured Person had knowledge of his/her HIV status at that time and whether or not the Charges are incurred in relation to or as a result of said status; and/or
   8. provided by or at the direction or recommendation of a chiropractor in excess of the the maximum limits as stated in Section M; and/or
   9. performed or provided by a Relative of the Insured Person; and/or
   10. not expressly included as Eligible Medical Expenses as defined in Section H, above; and/or
   11. provided by a person who resides or has resided in the Insured Person's home; and/or
   12. required or recommended as a result of complications or consequences arising from or related to any Treatment, Illness, Injury, or supply excluded from coverage or which is otherwise not covered under this insurance; and

8. Charges incurred for telephone consultations or due to a failure to keep a scheduled appointment; and

9. Charges incurred for Surgeries or Treatment or supplies which are:

   1. Investigational, Experimental, or for Research Purposes, and/or
   2. related to genetic medicine, genetic testing, surveillance testing and/or wellness screening procedures for genetically predisposed conditions indicated by genetic medicine or genetic testing, including, but not limited to amniocentesis, genetic screening, risk assessment, preventive and prophylactic surgeries recommended by genetic testing, and/or any procedures used to determine genetic pre-disposition, provide genetic counseling or administration of gene therapy; and

10. Charges incurred while confined primarily to receive Custodial Care or Educational Care; and

11. Charges incurred for any surgery, Treatment or supplies relating to, arising from or in connection with, for, or as a result of:

    1. weight modification or any Inpatient, Outpatient, Surgical or other Treatment of obesity (including without limitation morbid obesity), including without limitation wiring of the teeth and all forms or procedures of bariatric Surgery by whatever name called, or reversal thereof, including without limitation intestinal bypass, gastric bypass, gastric banding, vertical banded gastroplasty, biliopancreatic diversion, duodenal switch, or stomach reduction or stapling; and/or
    2. modification of the physical body in order to change or improve or attempt to change or improve the physical appearance or psychological, mental or emotional well-being of the Insured Person (such as but not limited to sex-change Surgery or Surgery relating to sexual performance or enhancement thereof); and/or
    3. cosmetic or aesthetic reasons, except for reconstructive Surgery when such Surgery is Medically Necessary and is directly related to and follows a Surgery which was covered under this insurance; and/or
    4. any Injury or Illness sustained while taking part in mountaineering activities where specialized climbing equipment, ropes or guides are normally or reasonably should have been used, Amateur Athletics, professional athletics, aviation (except when traveling solely as a passenger in a commercial aircraft), hang gliding and parachuting, snow skiing except for recreational downhill and/or cross country snow skiing (no cover provided whilst skiing in violation of applicable laws, rules or regulations; away from prepared and marked in-bound territories; and/or against the advice of the local ski school or local authoritative body), racing of any kind (except as otherwise expressly set forth in Section V 1. Amateur Sailboat Racing, above) including by horse, motor vehicle (of any type) or motorcycle, spelunking, and subaqua pursuits involving underwater breathing apparatus (except as otherwise expressly set forth in Section V 2. Recreational Underwater Activities, above); Practice or training in preparation for any excluded activity which results in injury will be considered as activity while taking part in such activity; and/or
    5. any Illness or Injury sustained while participating in any sporting, recreational or adventure activity where such activity is undertaken against the advice or direction of any local authority or any qualified instructor or contrary to the rules, recommendations and procedures of a recognized governing body for the sport or activity; and/or
    6. any Illness or Injury sustained while participating in any activity where such activity is undertaken against medical advice; and/or
    7. any Injury or Illness sustained as a result of being under the influence or due wholly or partly to the effects of intoxicating liquor or drugs other than drugs taken in accordance with Treatment prescribed and directed by a Physician but not for the Treatment of Substance Abuse; and/or
    8. any Injury or Illness sustained while operating a moving vehicle after consumption of intoxicating liquor or drugs other than drugs taken in accordance with Treatment prescribed and directed by a Physician. For purposes of this exclusion, “vehicle” shall include both motorized devices for which a driver or operator license is required (including watercraft and aircraft) and non-motorized bicycles and scooters for which no permit or license is required; and/or
    9. any willfully Self-inflicted Injury or Illness; and/or
    10. any venereal disease; and/or
    11. any Illness or Injury resulting from or occurring during the commission of a violation of law by the Insured Person, including, without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations; and/or
    12. any Substance Abuse; and/or
    13. speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy; and/or
    14. orthoptics, visual therapy or visual eye training; and/or
    15. the feet, including without limitation: orthopedic shoes; orthopedic prescription devices to be attached to or placed in shoes; Treatment of weak, strained, flat, unstable or unbalanced feet; metatarsalgia, bone spurs, hammer toes or bunions; and any Treatment or supplies for corns, calluses or toenails; provided, however, that claims for Treatment or supplies for the feet may be eligible for coverage under this insurance at the sole option of the Company and subject to all other Terms of this insurance when related to:
        1. an Injury to the foot arising from an Accident covered hereunder; or
        2. an Illness for which foot Surgery is Medically Necessary and determined to be the only appropriate method of Treatment; and/or
    16. hair loss, including without limitation wigs, hair transplants or any drug that promises to promote hair growth, whether or not prescribed by a Physician; and/or
    17. any sleep disorder; and/or
    18. any exercise program, whether or not prescribed or recommended by a Physician; and/or
    19. any exposure to any non-medical nuclear or atomic radiation, and/or radioactive material(s); and/or
    20. any organ or tissue or other transplant or related services, Treatment or supplies, except for Covered Transplants as defined herein and covered pursuant to the Terms of this insurance; and/or
    21. any artificial or mechanical devices designed to replace human organs temporarily or permanently; and/or
    22. any efforts to keep a donor alive for a transplant procedure, whether or not the transplant procedure is a Covered Transplant; and/or
    23. any transplant expenses incurred outside the Company’s approved independent Managed Transplant System Network; and/or
    24. any Covered Transplant in excess of one (1) during any twelve (12) month period of coverage under this insurance plan, except re-transplantation Charges if incurred during the initial Covered Transplant Hospitalization; and

12. Charges incurred for any Treatment or supply that either promotes or prevents or attempts to promote or prevent conception or birth; including but not limited to: artificial insemination; oral contraceptives, Treatment for infertility or impotency; vasectomy or reversal of vasectomy; sterilization or reversal of sterilization; surrogacy; or abortion; and

13. Charges incurred for any Treatment or supply that either promotes, enhances or corrects or attempts to promote, enhance or correct impotency or sexual dysfunction; and

14. Charges incurred for Dental Treatment, except for as expressly provided by in Section L. Dental Treatment; and

15. Charges incurred for eyeglasses, contact lenses, hearing aids, hearing implants and Charges for any Treatment, supply, examination or fitting related to these devices, or for eye refraction for any reason; and

16. Charges incurred for eye Surgery, such as but not limited to radial keratotomy, when the primary purpose is to correct or attempt to correct nearsightedness, farsightedness, or astigmatism; and

17. Charges incurred for Treatment of the temporomandibular joint; and

18. Charges incurred by the Insured Person for the Treatment of his/her Newborns (or for supplies related thereto); and

19. Charges incurred for any immunizations and/or routine physical exams except for the eligible benefits and covered expenses provided for under I. Wellness Expenses, or as otherwise expressly provided for hereunder; and

20. Charges incurred for any travel, meals, transportation and/or accommodations, except as otherwise expressly provided for in this insurance; and

21. Any taxes, assessments, charges, fees or surcharges imposed by any governmental agency or authority:

    1. arising out of or as a result of any Treatment or supplies received by the Insured Person, or
    2. based upon the Company’s election hereunder, if any, to pay benefits directly to providers, or
    3. for any other reason; and

22. Unless otherwise expressly included under Section M. Complementary Medicine Benefit, Charges or expenses incurred for nonprescription drugs, medicines, vitamins, food extracts, or nutritional supplements; IV vitamin or herbal therapy; drugs or medicines not approved by the U.S. Food and Drug Administration or which are considered “off-label” drug use; and for drugs or medicines not prescribed by a Physician