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There are some expenses that are not reimbursable, due to the provisions of the policy. These exclusions include, but are not limited to the following:
- Expenses covered under Workers' Compensation or similar law or programs
- Health check-ups, inoculations, visits and tests necessary for administrative purposes (determining insurability.
- Those for plastic surgery; reconstructive surgery; cosmetic surgery; or other services and supplies which improve, alter, or enhance appearance, whether or not for psychological or emotional reasons, unless required because of a non-occupational injury that occurs while covered under the policy.
- Travel and hotel expenses related to medical or dental care
- Treatment for or in connection with pregnancy or childbirth during the first 12 months a person is insured unless so indicated under "Waiting Periods"
- Anything not ordered by a doctor or not necessary for medical care, as well as medical and dental services that do not meet professionally recognized standards or are not considered as being necessary for proper treatment
- Unusual or excessive charges as determined by the Insurer
- Expenses covered by a government program such as Social Security, whether or not a covered person applies for reimbursement from that program
- Care provided in a government hospital or medical facility for which an individual would not be charged in the absence of this coverage
- Expenses reimbursed or reimbursable by another insurance contract or program
- Missed appointments
- Pre-existing conditions are not covered by the Policy unless (a) there was a 180-day period prior to the effective date of the Policy where no treatment or diagnosis of an injury or illness was received. If treatment or diagnosis was received prior to the effective date of the Policy, a 180-day period which the insured receives no treatment, incurs no expenses and receives no diagnosis from a physician in connection with the previously treated injury or sickness; or, (b) a one year period during which a person is continuously insured for these benefits and receiving treatment
- For or in connection with an Injury or Sickness caused by war or an act of war whether declared or undeclared, terrorism, acts of violence, riot, civil commotion, or police action whether participating or not.
- Organ transplant expenses are limited to a US$250,000 lifetime maximum for the Insured only. Donor expenses are not covered
- Any expense for male or female reversal of sterilization, sex change or implantation, or treatment for sexual transformation, sexual dysfunctions or inadequacies.
- Charges for breast reduction or augmentation and complications arising from this procedures
- Personal or comfort items such as radio, television, barber or beauty services or supplies.
- An injury or illness that is self-inflicted, or an attempt at self-destruction, while sane or insane
- Due to participation in an assault, felony or illegal act, including but not limited to injuries sustained in fights initiated by you or your dependent.
- Any treatment for Alcoholism or drug addiction
- Over-the-counter (OTC) drugs or supplies, which do not require a physician prescription, smoking cessation drugs, appetite suppressant, hair regenerative drugs, anti-photo aging drugs, cosmetics and beauty aids, acne drugs (retin A for cosmetic purposes), Megavitamins, vitamin, prenatal vitamins prescribed or not, nutritional supplements.
- Treatment by naturopaths, homeopaths, naturopathic or homeopathic medications or supplements and any other alternative methods of treatment not recognized by Colonial Medical.
- Any condition, illness, injury or emergency air services related to a nuclear accident.
- Allergy testing and treatment.
- Elective abortions and complications thereof
- Those for or in connection with services or supplies that are, as determined by Colonial Medical, to be experimental or investigational. These will be determined to be experimental or investigational if a) required by the FDA, approval has not been granted for marketing; or b) not recognized by the medical community as potentially safe and efficacious for the care and treatment of the Injury or Sickness; or c) not approved for reimbursement under National Medical Programs.
(This list is extensive but not complete. Should you require a complete list, please contact us)
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