Intrax - Work and Travel

2021-2022 Brochure
EECAF00269847
Using Your Insurance

If you need to seek medical treatment, please be sure to seek care appropriately Need Help?
for the condition/situation that you are experiencing, as this will make the billing You can either visit your Student
and payment process much smoother. Here are some guidelines for choosing Zone or call the 24-Hour assistance
appropriate medical care. line:

Teladoc Student Zone

Your plan includes free access to Teladoc, virtual telemedicine. If you The Student Zone is your one-stop
have a minor or non-urgent medical need, you can use Teladoc to resource for information, advice and
see a doctor or get a prescription from anywhere, at any time using assistance with your insurance plan.
your phone or computer. Please visit our website for more details.

Student Zone
Non-Emergency Care
For immediate care in non-emergency situations, you SHOULD go to
a Walk-in Clinic, Urgent Care center or local doctor. Urgent Care and 24-Hour Assistance
Walk-in Clinics are often the best places to seek medical care as you
IMG are available 24-hours a day to
can walk right in and they require no appointment.
assist you with your insurance
needs, including pre-certification,
You SHOULD NOT go to the Emergency Room (ER) for this type of
claims, emergency evacuation and
care unless it is a real emergency situation!
much more.

Emergency Care You can contact IMG at:

The Emergency Room (ER) is designed for medical emergencies. If
you need emergency care for any reason, please get to the nearest Toll-free: (855) 731-9445
Emergency Room (ER) or call the emergency services (911 in the Direct Dial: + 1 (317) 927-6806
USA) for immediate treatment. [email protected]


PLEASE NOTE – an additional $250 Deductible will apply for each

Emergency Room visit.

ID Card
It is extremely important that you carry your insurance ID card with
you at all times and make sure to show it when you seek
treatment. Your ID card will be emailed to you before you travel and
should be kept with you at all times.

Doctor/Hospital Search
You have the freedom of choice to visit any provider you wish,
however you are strongly encouraged to visit medical providers who
are part of the insurance plan network, especially in the USA This will
allow direct billing and can remove the need for you to pay up front for
medical expenses.

• Inside the USA, you can search for a network provider

online. 
• Outside the USA, you can seek treatment from any
provider of your choices, pay up front and then file
a claim for reimbursement.
Benefit Summary
Benefit Limit

Certificate Maximum Limit 365 days

Maximum Limit $5,000,000

Per Illness or Injury Limit $100,000

The per Illness or Injury limits accumulate towards the Maximum Limit.

Area of coverage Worldwide excluding Country of Residence

Deductible for Eligible Medical Expenses

Deductible $100
(per Illness or Injury)

Coinsurance for Eligible Medical Expenses

Coinsurance Plan pays 100%

(in addition to Deductible) Insured pays 0%
Pre-Certification

Pre-certification • Interfacility Ambulance Transfer: No coverage if Pre-

certification requirements are not met.
• Medical Evacuation: No coverage if not approved by the
Company. Refer to the EMERGENCY MEDICAL
EVACUATION provision for complete requirements and
coverage.
• All other Treatments & supplies: fifty percent (50%)
reduction of Eligible Medical Expenses if Pre-certification
requirements are not met. Maximum Penalty: $1,000
• Deductible is taken after reduction.
• Coinsurance is applied to remainder of the reduced
amount.
• Refer to PRE-CERTIFICATION REQUIREMENTS
provision for a complete list of services that require Pre-
certification.
Pre-Existing Conditions

Pre-existing Conditions Charges resulting directly or indirectly from or relating to

any Pre-existing Condition that existed within twelve (12)
months prior to the Initial Effective Date are excluded from
coverage under this insurance
• Does not apply to Emergency Medical Evacuation or
Return of Mortal Remains
Inpatient or Outpatient Services
Subject to Deductible unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable and Customary
Limits per Period of Coverage unless stated as Maximum Limit

Eligible Medical Expenses 100%

Physician/ Specialist Visit 100%

• Maximum Visits per Day: 1
• Unless visit is for a different medical/surgical
specialty
Urgent Care 100%

Walk-in Clinic 100%

Teladoc Consultation 100%

• Not subject to Deductible or Coinsurance
• Coverage for a Teladoc Consultation is not a
determination that any specific condition
discussed, raised or identified during such
consultation is covered under this insurance.
The Company reserves the right to decline
future claims relating to or arising from any
condition discussed, raised or identified during
a Teladoc Consultation where the Illness or
Injury is directly or indirectly related to any Pre-
existing Condition or is otherwise excluded
under this Certificate of Insurance

Hospital Emergency Room 100%

• Deductible: $250 per injury or illness
(regardless if the insured person is directly
admitted to the hospital as inpatient for further
treatment of that injury or illness)
• In addition to plan Deductible

Hospitalization / Room & Board 100%

• Average semi-private room rate
• Includes nursing, miscellaneous and Ancillary
Services

Intensive Care 100%

Outpatient Surgical / Hospital Facility 100%

Laboratory 100%

Radiology / X-Ray 100%

Pre-Admission Testing 100%

Surgery 100%

Reconstructive Surgery 100%

• Surgery is incidental to or follows Surgery
that was covered under the Plan

Assistant Surgeon 100%

• 20% of the primary surgeon’s eligible fee

Anesthesia 100%

Durable Medical Equipment 100%

Chiropractic Care 100%

• Medical order or Treatment plan required

Physical Therapy (United States) 100%

• Maximum Visits per Day: 1
• Medical order or Treatment plan required

Extended Care Facility 100%

• Upon direct transfer from acute care Hospital

Home Nursing Care 100%

• Provided by a Home Health Care Agency
• Upon direct transfer from an acute care
Hospital
 Prescription Drugs and Medications
Subject to Deductible unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable and Customary
Limits per Period of Coverage unless stated as Maximum Limit

Prescriptions 100%
• Dispensing Day Maximum: 90 days

Mental or Nervous / Substance Abuse

Subject to Deductible unless otherwise noted

Eligible Medical Expenses are limited to Usual, Reasonable and Customary Limits per Period of Coverage unless stated
as Maximum Limit

Inpatient Mental or Nervous / 100%

Substance Abuse
• Up to Maximum Limit
• Not covered if incurred at the Student Health
Center

Outpatient Mental and Nervous / 100%

Substance Abuse
• Maximum Limit: $2,500
• Not covered if incurred at the Student Health
Center

Emergency Services
NOT Subject to Deductible unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable and Customary
Limits per Period of Coverage unless stated as Maximum Limit

Emergency Local Ambulance 100%

• Subject to Deductible
• Maximum Limit: $5,000

Emergency Medical Evacuation / 100%

Repatriation
• Maximum Limit: $100,000
• In addition to plan Maximum Limit
• Must be approved in advance and coordinated
by the Company

Emergency Reunion 100%

• Maximum Limit: $2,500
• Reasonable and necessary travel costs and
accommodations limit per day: $200
• Must be approved in advance by the
Company

Interfacility Ambulance Transfer 100%

• Services rendered in the United States
• Transfer must be a result of an Inpatient
Hospitalization

Repatriation for Medical Treatment 100%

• Maximum Limit: $100,000
• Approved in advance and coordinated by the
Company

Return of Mortal Remains 100%

• Maximum Limit: $100,000
• Return of Insured Person’s Mortal Remains to
Country of Residence
• Must be approved in advance by the
Company

Other Services
NOT subject to Deductible unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable and Customary
Limits per Period of Coverage unless stated as Maximum Limit
Accidental Death & Dismemberment Accidental Death Principal Sum: 100% of Principal Sum
• Principal Sum Maximum: $15,000 Accidental Dismemberment: Loss of;
• Death must occur within 90 days of the Sight of one eye - 50% principal sum

Accident
One hand or one foot - 50% principal sum

One hand and loss of sight of one eye - 100%
principal sum
One foot and loss of sight of one eye - 100%
principal sum
One hand and one foot - 100% principal sum

Both hands or both feet - 100% principal sum

Sight of both eyes - 100% principal sum
Baggage / Personal Effects 100%
• Period of Coverage Limit: $3,000 (combined
limit for Baggage and Personal Effects)
• Personal Effects:
•Maximum Limit per article: $500
•Combined Maximum Limit: $1,000
•For jewelry, furs, watches, personal
computers, and cameras

Dental Treatment 100%

• Treatment due to an Accident
• Maximum Limit per tooth: $200
• Maximum Limit: $400

Dental Treatment 100%

• Treatment due to Unexpected pain to sound
natural teeth
• Maximum Limit per tooth: $200
• Maximum Limit: $800

Sports 100%
• Recreational, Amateur Athletics and
Interscholastic Sports
• Maximum Limit: $100,000

Trip Interruption 100%

• Period of coverage limit: $2,000
• Air only

Personal Liability Coverage

NOT subject to Deductible unless otherwise noted
Eligible Medical Expenses are limited to Usual, Reasonable and Customary
Limits per Period of Coverage unless stated as Maximum Limit

Personal Liability Aggregate Maximum $200,000

Limit
Personal Liability Maximum Limit per $100,000
Occurrence
• Deductible per occurrence: $100

Medical Payments $25,000

Additional Living Expenses $10,000

Payment of Deductible under $1,000

Homeowner’s Insurance
Claims
Inside the USA Claim Forms
If you sought treatment from an in-network provider, and You can download a copy of the claim form from the
provided your insurance ID card at the time of treatment, Student Zone and submit it with your receipts to:
they should be able to bill the IMG claims team directly with Email - [email protected] (recommended)
no payment up front.
Fax: (+1) 317 655 4505
PLEASE NOTE - After seeking treatment, even if you are
not required to pay up front, please complete a claim form International Medical Group
and email these documents to the claims email for Claims Department
processing. P.O. Box 9162
Farmington Hills, MI 48333-9162 USA

Outside the USA

When outside the USA, please seek treatment from a
Claims Update
provider that is nearest to you, pay for the services upfront Your claims tracking portal, MyIMG, is available in your
and then submit a claim for reimbursement. Student Zone and allows you to view your claims activity
and contact the claims team directly with any questions.

Prescription Medications You can also email the claims team at

You will need to pay for any prescription medication up [email protected] for an update on any claims
front and then submit the Rx information and receipt from that have been submitted.

the pharmacy with your claim to be reimbursed.

Pre-Certification
The following events needs to be pre-certified by calling IMG directly:
• Interfacility Ambulance Transfer: No coverage if Pre-certification requirements are not met.
• Medical Evacuation: No coverage if not approved by the Company. Refer to the EMERGENCY MEDICAL 

EVACUATION provision for complete requirements and coverage.
• The following must always be Pre-certified for Medical Necessity by the Company through the Plan Administrator before
admission or receiving the Treatments and/or supplies: (a) Chemotherapy (b) Extended Care Facility (c) Home Nursing Care
(d) Inpatient Hospitalization (e) Interfacility Ambulance Transfer (f) Radiation Therapy (g) Surgery or Surgical procedure.
• If these treatment and supplies are not pre-certified: fifty percent (50%) reduction of Eligible Medical Expenses if Pre-
certification requirements are not met. Maximum Penalty: $1,000
• Deductible is taken after reduction.
• Coinsurance is applied to remainder of the reduced amount. 


Refer to PRE-CERTIFICATION REQUIREMENTS provision for a complete list of services that require Pre-certification. 

Exclusions
Except as expressly provided for in the BENEFIT SUMMARY, all Charges, costs, expenses and/or claims incurred by the
Insured Person, and any claim for death or dismemberment benefits, and directly or indirectly relating to or arising or resulting
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 or reimbursements
and shall have no liability or obligation for any coverage thereof or therefor:

1. ECONOMIC SANCTIONS: Notwithstanding any other Terms Illness, Injury or other consequence, whether directly or
under this insurance, the Company shall not provide coverage indirectly, proximately or remotely occasioned by, contributed
or make any payments or provide any service or benefit to to by, or traceable to or arising in connection with the
any Insured Person, beneficiary, or third party who may have following:
any rights under this insurance to the extent that such a. the Insured Person’s active and voluntary planning or
coverage, payment, service, or benefit would violate any coordination of or participation in any act of Terrorism
sanction, prohibition or restriction under United Nations b. any act of Terrorism that takes place in a location, post,
resolutions or the trade or economic sanctions, laws, or area, territory or country for which a Travel Warning or
regulations of the European Union, United Kingdom or the Emergency Travel Advisory was issued or in effect on or
United States of America. within six (6) months prior to the Insured Person’s date of
2. WAR; MILITARY ACTION: The Company shall not be liable arrival in said location, post, area, territory or country
for and will not provide coverage or benefits for any claim or c. any act of Terrorism that takes place in a location, post,
Charges incurred with respect to any Illness, Injury, death and area, territory or country for which a Travel Warning or
dismemberment, or other consequence, whether directly or Emergency Travel Advisory becomes effective or is in
indirectly, proximately or remotely occasioned by, contributed effect on or after the Insured Person’s date of arrival in
to by, or traceable to or arising or incurred in connection with said location, post, area, territory or country, and the
or as a result of any of the following acts or occurrences: Insured Person unreasonably fails or refuses to heed such
a. war, invasion, act of foreign enemy hostilities, warlike warning and thereafter remains in said location, post,
operations (whether war be declared or not), or civil war area, territory or country.
b. mutiny, riot, strike, military or popular uprising, 4. PRE-EXISTING CONDITIONS: Charges resulting directly or
insurrection, rebellion, revolution, military or usurped indirectly from or relating to any Pre-existing Condition,
power (whether physical or mental, regardless of the cause of the
c. any act of any person acting on behalf of or in connection condition) are excluded from this insurance. This exclusion
with any organization with activities directed towards the does not apply to Emergency Medical Evacuation or Return of
overthrow by force of the Government de jure or de facto Mortal Remains.
or to the influencing of it by violence of any type 5. MATERNITY AND NEWBORN CARE: Charges for pre-natal
d. martial law or state of siege or any events or causes care, delivery, post-natal care, and care of Newborns,
which determine the proclamation or maintenance of including complications of Pregnancy, miscarriage,
martial law or state of siege complications of delivery and/or of Newborns are excluded
e. any use of radiological, chemical, nuclear or biological from this insurance.
weapons or any other radiological, chemical, nuclear or 6. PREVENTATIVE CARE: Charges for Routine Physical
biological events of any type (including in connection with Examinations and immunizations are excluded from coverage
an act of Terrorism). under this insurance
Any claim, Charges, Illness, Injury or other consequence 7. Charges for any Treatment or supplies that are:
happening or arising during the existence of abnormal a. not incurred, obtained or received by an Insured Person
conditions (whether physical or otherwise), whether or during the Period of Coverage
not directly or indirectly, proximately or remotely b. not presented to the Company for payment by way of a
occasioned by, or contributed to by, traceable to, or completed Proof of Claim within one hundred eighty (180)
arising in connection with, any of the said occurrences days from the date such Charges are incurred
shall be deemed and considered to be consequences c. not administered or ordered by a Physician
for which the Company shall not be liable under the d. not Medically Necessary for the diagnosis, care or
Master Policy or this Certificate, except to the extent that Treatment of the physical or mental condition involved.
the Insured Person shall prove that such claim, Charges, This also applies when and if they are prescribed,
Illness, Injury or other consequence happened recommended or approved by the attending Physician
independently of the existence of such abnormal e. provided at no cost to the Insured Person or for which the
conditions and/or occurrences. Insured Person is not otherwise liable
3. TERRORISM: The Company shall not be liable for and will f. in excess of Usual, Reasonable, and Customary
not provide coverage or benefits for any claim or Charges, g. related to Hospice care
Illness, Injury or other consequence, whether directly or h. incurred by an Insured Person who was HIV + on or
indirectly, proximately or remotely occasioned by, contributed before the Initial Effective Date of this insurance, whether
to by, or traceable to or arising in connection with any act of or not the Insured Person had knowledge of his/her HIV
Terrorism. Further, the Company shall not be liable for and will status prior to the Effective Date, and whether or not the
not provide any coverage or benefits for any claim, Charges, Charges are incurred in relation to or as a result of said
 status. This exclusion includes Charges for any Treatment conception, insemination (natural or otherwise) or birth,
or supplies relating to or arising or resulting directly or including but not limited to: artificial insemination; oral
indirectly from HIV, AIDS virus, AIDS related Illness, ARC contraceptives; Treatment for infertility or impotency;
Syndrome, AIDS and/or any other Illness arising or vasectomy, or reversal of vasectomy; sterilization; reversal of
resulting from any complications or consequences of any sterilization; surrogacy or abortion
of the foregoing conditions 20. Charges incurred for any Treatment or supply that either
i. provided by or at the direction or recommendation of a promotes, enhances or corrects or attempts to promote,
chiropractor, unless ordered in advance by a Physician enhance or correct impotency or sexual dysfunction
j. performed or provided by a Relative of the Insured Person 21. any Illness or Injury sustained while taking part in, practicing
k. not expressly included in the ELIGIBLE MEDICAL or training for: Amateur Athletics (except as otherwise
EXPENSES provision expressly provided for in this insurance); Professional
l. provided by a person who resides or has resided with the Athletics; or athletic activities that are sponsored by any
Insured Person or in the Insured Person's home Governing Body or Authority including the National Collegiate
m. required or recommended as a result of complications or Athletic Association, any other collegiate sanctioning or
consequences arising from or related to any Treatment, Governing Body or the International Olympic Committee
Illness, Injury, or supply excluded from coverage or which 22. any Illness or Injury sustained while taking part in activities
is otherwise not covered under this insurance designated as Adventure Sports, which are limited to the
n. for Congenital Disorders and conditions arising out of or following: abseiling; BMX; bobsledding; bungee jumping;
resulting therefrom canyoning; caving; hot air ballooning; jungle zip lining;
8. Charges incurred for failure to keep a scheduled appointment parachuting; paragliding; parascending; rappelling; skydiving;
9. Telehealth or Telemedicine services not considered Medically spelunking; whitewater kayaking or whitewater rafting in water
Necessary as determined by the Company under the plan less than Class V difficulty; wildlife safaris; and windsurfing
10. Charges incurred for Surgeries, Treatment or supplies which 23. any Illness or Injury sustained while taking part in activities
are Investigational, Experimental, and for research purposes designated as Extreme Sports, which include but are in no
11. Charges incurred related to genetic medicine, genetic testing, way limited to the following (and include any combination or
surveillance testing and/or wellness screening procedures for derivative of the following): BASE jumping; cave diving; cliff
genetically predisposed conditions indicated by genetic diving; downhill mountain biking and racing; extreme skiing;
medicine or genetic testing, including, but not limited to freediving; free flying; free running; free skiing; freestyle
amniocentesis, genetic screening, risk assessment, preventive scootering; gliding; heli-skiing; ice canoeing; ice climbing;
and prophylactic surgeries recommended by genetic testing, kitesurfing; mixed martial arts; motocross; motorcycle racing;
and/or any procedures used to determine genetic pre- motor rally; mountaineering above elevation of 4500 meters
disposition, provide genetic counseling, or administration of from ground level; parkour; piloting a commercial or non-
gene therapy commercial aircraft; powerbocking; scuba diving or sub aqua
12. Charges incurred for testing that attempts to measure pursuits below a depth of 50 meters; snowmobile racing;
aspects of an Insured Person’s mental ability, intelligence, truck racing; whitewater kayaking or whitewater rafting Class
aptitude, personality and stress management. Such testing V and higher difficulty; and wingsuit flying
may include but is not limited to psychometric, behavioral and 24. any Illness or Injury sustained while taking part in snow skiing,
educational testing snowboarding or snowmobiling where the Insured Person is
13. Charges incurred for Custodial Care in violation of applicable laws, rules or regulations of a ski
14. Charges incurred for Educational or Rehabilitative Care that resort, out of bounds or in unmarked or unpatrolled areas
specifically relates to training or retraining an Insured Person 25. any Illness or Injury sustained while taking part in backcountry
to function in a normal or near-normal manner. Such care may skiing
include but is not limited to job or vocational training, 26. any Illness or Injury sustained while taking part in skiing off-
counseling, occupational therapy and speech therapy piste
15. Charges for weight modification or any Inpatient, Outpatient, 27. any Illness or Injury sustained while taking part in athletic or
Surgical or other Treatment of obesity (including without recreational activities where the Insured Person is not
limitation morbid obesity), including without limitation wiring of physically or medically fit or does not hold the necessary
the teeth and all forms or procedures of bariatric Surgery by qualifications to engage in said activities
whatever name called, or reversal thereof, including without 28. any Illness or Injury sustained while taking part in Collision
limitation intestinal bypass, gastric bypass, gastric banding, Sports
vertical banded gastroplasty, biliopancreatic diversion, 29. any Illness or Injury sustained while participating in any
duodenal switch, or stomach reduction or stapling sporting, recreational or adventure activity where such activity
16. Charges for modification of the physical body in order to is undertaken against the advice or direction of any local
change or improve or attempt to change or improve the authority or any qualified instructor or contrary to the rules,
physical appearance or psychological, mental or emotional recommendations and procedures of a recognized governing
well-being of the Insured Person (such as but not limited to body for the sport or activity
sex-change Surgery or Surgery relating to sexual performance 30. any Illness or Injury sustained while participating in any activity
or enhancement thereof) where such activity is undertaken in disregard of or against
17. Charges or Treatment for cosmetic or aesthetic reasons, the recommendations, Treatment programs, or medical
except for reconstructive Surgery when such Surgery is advice of a Physician or other healthcare provider
Medically Necessary and is directly related to and/or follows a 31. any Injury or Illness sustained as a result of being under the
Surgery which was covered under this insurance influence of or due wholly or partly to the effects of alcohol,
18. Elective Surgery or Treatment of any kind liquor, intoxicating substance, narcotics or drugs other than
19. Charges incurred for any Treatment or supply that either drugs taken in accordance with Treatment prescribed and
promotes or prevents or attempts to promote or prevent
 directed by a Physician but not for the Treatment of 51. Charges incurred in the Insured Person’s Country of
Substance Abuse Residence, except as otherwise expressly provided for in this
32. any Injury or Illness sustained while operating a moving insurance
vehicle after consumption of intoxicating liquor or drugs in 52. Charges for Treatment of an Illness or Injury occurring after
excess of the applicable blood/alcohol legal limit, other than the Insured Person is no longer an active Participant because
drugs taken in accordance with Treatment prescribed and of an Illness, Injury or need for ongoing medical Treatment
directed by a Physician. For purposes of this exclusion, 53. Charges incurred for any travel, meals, transportation and/or
“vehicle” shall include motorized devices regardless of accommodations, except as otherwise expressly provided for
whether or not a driver or operator license is required in this insurance
(including watercraft and aircraft) and non-motorized bicycles 54. Charges or expenses incurred for nonprescription drugs,
and scooters for which no permit or license is required medicines, vitamins, food extracts, or nutritional supplements;
33. any willfully Self-inflicted Injury or Illness IV vitamin or herbal therapy; drugs or medicines not approved
34. any sexually transmitted or venereal disease by the United States Food and Drug Administration or which
35. any testing for the following when not Medically Necessary: are considered “off-label” drug use; and for drugs or
HIV, seropositivity to the AIDS virus, AIDS related Illnesses, medicines not prescribed by a Physician
ARC Syndrome, AIDS 55. Charges and all costs related to or arising from or in
36. any Illness or Injury resulting from or occurring during the connection with all trips to the Destination Country
commission of a violation of law by the Insured Person, undertaken for the purpose of securing medical Treatment or
including, without limitation, the engaging in an illegal supplies
occupation or act, but excluding minor traffic violations 56. Charges incurred for Dental Treatment, except as specifically
37. biofeedback, acupuncture, music, occupational, recreational, provided for hereunder
sleep, speech, or vocational therapy 57. Wear and tear of teeth due to cavities and chewing or biting
38. orthoptics, visual therapy or visual eye training down on hard objects, such as but not limited to pencils, ice
39. any non-surgical Illness or Treatment of the feet, including cubes, nuts, popcorn, and hard candies
without limitation: orthopedic shoes; orthopedic prescription 58. Dental Injury without associated face, skull, neck and/or jaws
devices to be attached to or placed in shoes; Treatment of Injury or that can be evaluated and treated in a dental office
weak, strained, flat, unstable or unbalanced feet; 59. Dental Treatment for services which provide oral care
metatarsalgia, bone spurs, hammer toes or bunions; and any maintenance including tooth repair by fillings, root canals,
Treatment or supplies for corns, calluses or toenails; except tooth removal and x-rays
as otherwise expressly set forth 60. Charges for Treatment of an Illness or Injury for which
40. hair loss, including without limitation wigs, hair transplants or payment is made or available through a workers'
any drug that promises to promote hair growth, whether or compensation law or a similar law
not prescribed by a Physician 61. Charges incurred for massage therapy
41. any sleep disorder, including without limitation sleep apnea 62. Accidental Death or Dismemberment when the Insured
42. any exercise and/or fitness program or equipment, whether or Person’s death or dismemberment is caused directly or
not prescribed or recommended by a Physician indirectly by, results from, or where there is a contribution
43. any exposure to any non-medical nuclear or atomic radiation, from, any of the following:
and/or radioactive material(s) a. bodily or mental infirmity, Illness or disease
44. any organ or tissue or other transplant or related services, b. infection, other than infection occurring simultaneously
Treatment or supplies with, and as a direct result of, the accidental Injury.
45. any artificial or mechanical devices designed to replace 63. the following Charges related to Personal Liability:
human organs temporarily or permanently after termination of a. for Injury or Property Damage arising out of the
Inpatient status ownership, maintenance, operation, use, loading or
46. any efforts to keep a donor alive for a transplant procedure unloading of any automobile, watercraft, mobile
47. any Illness or Injury incurred in the Destination Country, equipment or aircraft owned or operated by or rented or
Affected Area or Country of Residence as a result of a Public loaned to any Insured Person, other than as a passenger
Health Emergency of International Concern, Epidemic, b. based on or arising out of liability assumed by the Insured
Pandemic, other disease outbreak, or Natural Disaster, that Person under any contract or agreement, except liability
may affect an Insured Person’s health, unless coverage is arising out of the performance of written duties required
expressly provided under the PUBLIC HEALTH EMERGENCY by the Insured Personas part of the covered trip
provision of this insurance This exclusion DOES NOT apply to c. arising out of discrimination on the basis of age, sex,
Charges resulting from COVID-19/SARS-CoV-2. race, creed, religion, marital status, national origin or
48. Charges incurred for eyeglasses, contact lenses, hearing aids sexual preference by any Insured Person, including Injury
or hearing implants and Charges for any Treatment, supply, resulting therefrom
examination or fitting related to these devices, or for eye d. arising from the transmission of or infection by, or the
refraction for any reason testing or failure to test for the presence of AIDS, any
49. Charges incurred for eye Surgery, such as but not limited to AIDS related virus, or any other disease transmitted
radial keratotomy, when the primary purpose is to correct or through sexual contact or another person’s bodily fluids
attempt to correct nearsightedness, farsightedness, or e. based on or arising out of an actual or attempted
astigmatism dishonest, fraudulent, criminal act, act of violence, or
50. Charges incurred for Treatment or supplies for malicious act or omission or deliberate misrepresentation
temporomandibular joint (TMJ) including but not limited to committed by, at the direction of, or with the knowledge
TMJ syndrome, craniomandibular syndrome, chronic TMJ of any Insured Person, including intentional tortious acts
pain, orthognathic Surgery, Le-Fort Surgery or splints f. arising out of acts by any Insured Person expected or
intended to cause Injury or Property Damage sustained
 (this exclusion does not apply to Injury resulting from the controlled substances except as administered by a
use of reasonable force to protect person or property) Physician
g. arising from any obligation for which the Insured Person k. for Injury or Property Damage arising from the use of
or any carrier as their insurer may be held liable under alcohol, intoxicants drugs or narcotics, except as
any worker’s compensation, unemployment prescribed by a Physician
compensation or disability benefits law, or under any l. for Injury or Property Damage due to war, whether or not
similar law declared, civil insurrection, rebellion or revolution or to
h. any Property Damage to: any act or condition incidental to any of the foregoing
a. property owned or being transported by the Insured m. for Injury or Property Damage to the Insured Person or to
Person; or a Spouse or Child of the Insured Person
b. property rented to, occupied by or in the care of the n. brought against any Insured Person arising out of the
Insured Person Insured Person’s business pursuits, investments, or other
i. brought against any Insured Person alleging, in whole or forprofit activities
part sexual assault, abuse, molestation, corporal o. for Injury or Property Damage caused directly or indirectly
punishment or physical or mental abuse, or habitual by pollution or asbestos, regardless of how it was caused
neglect, or licentious, immoral, amoral other behavior that p. the Insured Person’s rendering of day care services when
was threatened, committed, or alleged to have been such services are for persons other than the Host
committed, by any Insured Person or by any person for Family’s children
whom the Insured Person is legally responsible; however, q. for Injury or Property Damage arising out of or
notwithstanding the foregoing, the Insured Person shall participating in high-risk sports including: hunting
be protected under the Terms of this insurance as to any activities, boxing, combat sports, mountaineering or rock
claim and/or allegation which may be covered by the climbing, potholing, aerial sports, heli-skiing, motorized
insurance upon which suit may be brought against him/ racing or speed trials, bungee jumping, scuba diving
her, for any such alleged behavior by an Insured Person (unless the Insured Person has qualifications recognized
unless a judgment or a final adjudication adverse to the by the competent local authority in the contracted
Insured Person shall establish that such behavior destination), wild water rafting, jet-skiing, Professional
occurred as an essential element of the cause of action Athletics, and participation in competitive sporting events
so adjudicated of any kind
j. for Injuries caused by or contributed to by the use, sale, r. for Injury or Property Damage among or between Insured
manufacture, delivery, transfer or possession of Person’s traveling together and Insured Person’s and
their accompanying Relatives. 


PLEASE NOTE: This document is being provided for informational purposes only and does not supersede in any way the
terms in the governing documents for your insurance plan. Please visit the Student Zone for a copy of your insurance
certificate which includes the full plan wording and exclusions.