This plan includes coverage for a sudden and unexpected outbreak or reoccurrence of pre-existing conditions for insured persons under the age of 70 years. You can better understand the coverage for an acute onset of a pre-existing condition by knowing how it relates to a pre-existing condition.
Any Injury, Illness, sickness, disease, or other physical, medical, Mental or Nervous Disorder, condition or ailment that, with reasonable medical certainty, existed at the time of Application or at any time during the three (3) years prior to the Effective Date of this insurance, whether or not previously manifested, symptomatic or known, diagnosed, Treated, or disclosed to the Company prior to the Effective Date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom.
Acute Onset of a Pre-existing Condition
A sudden and Unexpected outbreak or reoccurrence that is of short duration, is rapidly progressive, and requires urgent medical care. A Pre-existing Condition that is chronic or congenital, or that gradually becomes worse over time is not an Acute Onset of Pre-existing Condition. An Acute Onset of Pre-existing Condition does not include any condition for which, as of the Effective date, the Insured Person (i) knew or reasonably foresaw he/she would receive, (ii) knew he/she should receive, (iii) had scheduled, or (iv) were told that he/she must or should receive, any medical care, drugs or Treatment.
- Coverage for Non-U.S. citizens age 69 and younger is up to $1,000,000
- Coverage for U.S. citizens varies:
- The maximum amount for age 64 and younger without a Primary Health Plan is $20,000
- The maximum amount for age 64 and younger with a Primary Health Plan is $1,000,000
- For age 65 through age 69, the maximum amount is $2,500
Conditions and Restrictions
To be eligible for the foregoing limited coverage and benefits for an Acute Onset of a Pre-existing Condition, the Insured Person must be in compliance with all Terms of this insurance. The Company will provide such coverage and benefits only when all of the following conditions and restrictions have been met. At the time of the Acute Onset of the Pre-existing Condition:
- Treatment must be obtained within twenty-four (24) hours of the sudden and Unexpected outbreak or reoccurrence
- the Insured Person must be under seventy (70) years of age
- the Insured Person must not be traveling against or in disregard of the recommendations, established Treatment programs, or medical advice of a Physician or other healthcare provider
- the Insured Person must not be traveling with the intent or purpose to seek or obtain Treatment for the Pre-existing Condition
- the Insured Person must not be traveling during a period of time when the Insured Person is preparing or waiting for, involved in, or undertaking a new, changed or modified Treatment program with respect to the Pre-existing Condition, and is not traveling subsequent to any such new, changed or modified Treatment program having been advised or recommended
- the Pre-existing Condition must have been stabilized for at least thirty (30) days prior to the Effective Date without change in Treatment
- the Insured Person must be traveling outside their Country of Residence.
- In addition, in order to qualify for the higher coverage limit specified in the BENEFIT SUMMARY, a United States citizen with a Primary Health Plan must meet the following requirements:
- the Insured Person must be a United States citizen
- (ii) the Insured Person must have a Primary Health Plan
- (iii) the Primary Health Plan must have been in effect prior to the Effective Date of Coverage and must remain in force during the entire Period of Coverage
- (iv) the Pre-existing Condition must be covered under the Primary Health Plan.
If these requirements cannot be substantiated at the time of claim, the benefits under this provision will be limited to the amount shown in the BENEFIT SUMMARY for Insured Persons without a Primary Health Plan.
Any infection of the urinary tract (including, without limitation, infection of the kidney, ureter, bladder, prostate or urethra) and any complication, medical condition or other Illness directly or indirectly arising therefrom, that occurs within ninety (90) days of the Effective Date of this Insurance and that requires Treatment of the Insured Person in a Hospital as an Inpatient