Terms & Exclusions

EXCLUSIONS
  • Cases that involve fraud and abuse will be excluded, such as injuries caused by a third party with the knowledge of the person with Second Medical Opinion coverage.
  • Cases involving self inflicted intentional injury; or intentional injury inflicted by other.
  • Cases with inadequate information in the medical judgment of AXA Assistance USA Medical Director.
  • Cases associated with alcohol or drug abuse
  • AIDS, AIDS related complex, sexually transmitted diseases
  • Radioactive Contamination
  • War or warlike operations
  • Poisoning or poisonous gas inhalation
  • Congenital abnormalities or birth defects

AXA Assistance USA may at the discretion of its medial staff offer an additional 2nd opinion for conditions that are not on the list of covered pathology. The decision to offer such additional opinions would be based primarily on one of the following criteria:

  • Lack of availability of initial resources for medical evaluation or conventional medical treatment in home country
  • Inability to definitively diagnose or evaluate medical condition
  • Initial/conventional treatment has failed
TERMS & CONDITIONS
  • Only one Second Medical Opinion (SMO) will be rendered per member per diagnosis with a limit of two unrelated SMOs per 12 months.
  • Membership is effective from date of enrollment onward. If any diagnosis or treatment has occurred or has been administered prior to enrollment or renewal, a SMO will not be rendered on the prior diagnosis.
  • AXA Assistance USA will not be liable for any costs incurred from member as a result of member following suggested treatment as a result of a SMO.
  • AXA Assistance USA and its medical staff of physicians and nurses do not render medical opinions or provide medical services. They act as the liaison and partner between member and center of excellence.
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