Are the pre-existing conditions covered under the Global Medical Silver, Gold, and Platinum plans? What are the exclusions?
Silver and Gold:
After coverage has been in effect for 24 continuous months, the Silver and Gold plan options provide a US$50,000 lifetime benefit for eligible pre-existing conditions that existed at or prior to the effective date, subject to a maximum of US$5,000 per period of coverage. This benefit is payable whether or not you have received consultation or treatment for the condition(s) during the 24-month period. The Silver and Gold plan options do not rider or charge additional premium for pre-existing conditions. If you properly disclose a pre-existing condition at the time of application and are accepted into the plan, you will be covered for eligible medical expenses after 24 months of continuous coverage, subject to the foregoing limits and the other terms of the plan.*
The following illnesses which exist, manifest themselves or are treated or have treatment recommended prior to or during the first 180 days of coverage from the initial effective date are considered pre-existing conditions and are subject to the waiting period and other limitations of coverage described above: asthma, allergies, tonsillectomy, back conditions, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders of the reproductive system, hysterectomy, hernia, gall stones or kidney stones, any condition of the breast, and any condition of the prostate.
Platinum:
On the Platinum plan option, conditions that are fully disclosed on the application and have not been excluded or restricted by a rider will be covered the same as any illness. Conditions, including any complications therefrom, that are not fully disclosed on the application will not be covered.
OTHER EXCLUSIONS & LIMITATIONS*
Treatment not ordered or received by a physician
Treatment or supplies not medically necessary
Investigational, experimental or research procedures
Custodial care
Weight modification
Elective cosmetic or plastic surgery
Treatment of impotency
Contraceptive medication or treatment
Drug and alcohol abuse treatment
Organ transplants not specifically listed
Routine foot care
Treatment by a relative or family member
Treatment as a result of war or riot
Treatment resulting from illegal activities
Speech therapy
Persons HIV+ at effective date
Organized amateur or professional sports
Maternity and newborn care (unless the maternity rider or Platinum plan option is purchased - see Summary Schedule of Benefits)
Services and treatment eligible for payment by any government or other insurance
Adult routine physical examinations are excluded under the Silver plan option and for the first 12 months for the Gold and Platinum plan options
Devices to correct sight or hearing are excluded under the Silver and Gold plan options
Inpatient mental and nervous is excluded under the Silver plan option and for the first 12 months for the Gold and Platinum plan options
Outpatient mental and nervous for the first 12 months on all plan options