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International Student Insurance


International Citizens Platinum Plan

Plan Exclusions

What Are the Exclusions and Limitations?


The following charges, treatments, care, services, supplies and/or conditions are excluded from coverage:

  1. Charges not incurred during the Certificate period
  2. Services or treatment payable by another insurance or government
  3. Substance abuse
  4. Charges which exceed usual, reasonable and customary
  5. Investigational or experimental surgeries or treatment
  6. Custodial, educational or rehabilitative care
  7. Weight modification
  8. Cosmetic surgery, unless reconstructive surgery is directly related to a covered Injury or Illness
  9. Charges for use of Emergency Room for treatment of Illness unless the patient is directly admitted to the Hospital as Inpatient for further treatment of that Illness
  10. Individuals HIV+ at effective date
  11. Drugs or treatment for sexual dysfunction
  12. Drugs or treatment to promote or prevent conception
  13. Devices or procedures to correct sight or hearing
  14. Self-inflicted Injury or Illness
  15. Foot care, unless related to a covered accidental Injury
  16. Treatment or supplies not ordered by a physician or not medically necessary
  17. Organ transplants, except for covered transplants
  18. Speech, acupuncture, occupational or sleep therapy
  19. Acts of terrorism, war, insurrection, riot or any variation thereof
  20. Dental treatment, except emergency treatment following a covered accident, or unless Dental Rider is purchased
  21. Orthodontia (Dental Rider Exclusion)
  22. Sealants, Bleaching and oral hygiene expenses (Dental Rider Exclusion)

Special Ilness Exclusion:

The following conditions which manifest themselves within the first 180 days of coverage are excluded: any condition of the breast, prostate, tonsils, adenoids, disease of sebaceous glands, acne, other acne, sebaceous cyst, seborrhea, unspecified disease of the sebaceous glands, moles, skin tags, hypertrophic and atrophic conditions of the skin, nervous, hemorrhoids, the reproductive system, hernia, gallstones or kidney stones. If you are insured under the Risk Share Plan, all illnesses are excluded for the first 90 days of coverage.

 

This is a summary of the exclusions contained in the Certificate of Insurance. See the Certificate of Insurance for a complete list of exclusions.

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     The Witherington Insurance Group

     Street Address:  (Map To This Location)
     1200 Elba Highway
     Troy, Alabama 36079

     Mailing Address:
     P. O. Box 448
     Troy, Alabama 36081-0448

     Phone: (334)566-1477
     Toll-Free: (800)239-1477
     Fax: (334)566-7986