| EXCLUSIONS |
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Exclusions (applicable for Section
A & Section B)
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This policy shall not cover:-
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| 1. |
Dental conditions including dental
treatment or oral surgery except as necessitated
by Accidental Injuries to sound natural teeth occurring
wholly during the Period of Insurance.
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| 2. |
Private nursing, rest cures or
sanitaria care, illegal drugs, intoxication, sterilization,
venereal disease and its sequelae, and any communicable
diseases required quarantine by law.
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| 3. |
Any treatment or surgical operation
for congenital abnormalities or deformities including
hereditary conditions.
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| 4. |
Pregnancy, child birth (including
surgical delivery), miscarriage, abortion and prenatal
or postnatal care and surgical, mechanical or chemical
contraceptive methods of birth control or treatment
pertaining to infertility. Erectile dysfunction and
tests or treatment related to impotence or sterilization.
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| 5. |
Suicide, attempted suicide or
intentionally self-inflicted injury while sane or
insane.
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| 6. |
War or any act of war, declared
or undeclared, criminal or terrorist activities,
active duty in any armed forces, direct participation
in strikes, riots and civil commotion or insurrection.
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| 7. |
Ionizing radiation or contamination
by radioactivity from any nuclear fuel or nuclear
waste from process of nuclear fission or from any
nuclear weapons material.
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| 8. |
Investigation and treatment
of sleep and snoring disorders, hormone replacement
therapy and alternative therapy such as treatment,
medical service or supplies, including but not limited
to chiropractic services, acupuncture, acupressure,
reflexology, bonesetting, herbalist treatment, massage
or aroma therapy or other alternative treatment.
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| 9. |
Care or treatment for which
payment is not required or to the extent which is
payable by any other insurance or indemnity covering
the Insured Person and Disabilities arising out of
duties of employment or profession that is covered
under a Workman's Compensation Insurance Contract.
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| 10. |
Psychotic, mental or nervous
disorders, (including any neuroses and their physiological
or psychosomatic manifestations).
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| 11. |
Sickness or Injury arising from
racing of any kind (except foot racing), hazardous
sports such as but not limited to skydiving, water
skiing, underwater activities requiring breathing
apparatus, winter sports, professional sports and
illegal activities.
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| 12. |
Private flying other than as
a fare-paying passenger in any commercial scheduled
airlines licensed to carry passengers over established
routes.
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Exclusions (applicable
for Section A only)
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This Policy shall not cover:-
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| 1. |
Pre-existing illness.
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| 2. |
Any medical or physical conditions
arising within the first 30 days of the Insured Person's
cover or date reinstatement whichever is latest except
for accidental injuries.
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| 3. |
Specified Illnesses occurring
during the first 120 days of continuous cover.
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| 4. |
Plastic/Cosmetic surgery, circumcision,
eye examination, glasses and refraction or surgical
correction of nearsightedness (Radial Keratotomy
or Lasik) and the use or acquisition of external
prosthetic appliances or devices such as artificial
limbs, hearing aids, implanted pacemakers and prescriptions
thereof.
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| 5. |
Hospitalization primarily for
investigatory purposes, diagnosis, x-ray examination,
general physical or medical examinations, not incidental
to treatment or diagnosis of a covered Disability
or any treatment which is not Medically Necessary
and any preventive treatments, preventive medicines
or examinations carried out by a Physician, and treatments
specifically for weight reduction or gain.
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| 6. |
Expenses incurred for donation
of any body organ by an Insured Person and costs
of acquisition of the organ including all costs incurred
by the donor during organ transplant and its complications.
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| 7. |
Costs/expenses of services of
a non-medical nature, such as television, telephones,
telex services, radios or similar facilities, admission
kit/pack and other ineligible non-medical items.
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| 8. |
Expenses incurred for sex changes. |
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Exclusions (applicable
for Section B only)
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This Policy shall not cover:-
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| 1. |
Plastic/Cosmetic surgery, circumcision,
eye examination, glasses and refraction or surgical
correction of nearsightedness (Radial Keratotomy
or Lasik) and the use or acquisition of external
prosthetic appliances or devices such as artificial
limbs, hearing aids, aero chambers, equipment from
nebulising, implanted pacemakers and prescriptions
thereof.
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| 2. |
Consultation primarily for investigatory
purposes, diagnosis, x-ray examination, general physical
or medical examinations, not incidental to treatment
or diagnosis of a covered disability or any treatment
which is not Medically Necessary and any preventive
treatments, preventive medicines or examinations
carried out by a physician, and treatments specifically
for weight reduction or gain.
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| 3. |
Long term medications for the
following conditions are excluded: Arthritis, Asthma,
High Blood Pressure, Coronary Artery Disease, Cerebrovascular
Disease, Cerebrovascular Accident, Diabetes Mellitus,
Epilepsy, Gout, Hyperlipidemia, Parkinson, Peptic
Ulcer, Psoriasis and Thyroid.
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| 4. |
Personal comfort and convenience
items (e.g. soaps, shampoos, vitamin creams and vitamin
ointment) or services and similar incidental services
and supplies, durable medical equipment including
supplement medication even though prescribed by a
physician.
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| 5. |
Upper and lower jaw bone surgery
(including that related to the temporomandibular
joint) except for direct treatment of acute traumatic
injury or cancer. Orthognathic surgery, jaw alignment,
or treatment for the temporomandibular joint.
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| 6. |
Services and supplies for smoking
cessation programs and the treatment of nicotine
addiction.
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| 7. |
Services rendered by a provider
with the same legal residence as an insured person
or who is a member of a insured person's family,
including spouse, brother, sister, parent or child.
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| 8. |
Education services such as speech
improvement, diabetic classes and nutritional services,
or group support services, unless authorized by the
company.
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| 9. |
Out-patient prescribed or non-prescribed
medical supplies including elastic stockings, ace
bandages, gauze, syringes, diabetic test strips,
and like products; over the counter drugs and treatments.
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| 10. |
Any preventive vaccination or
childhood immunization (unless specifically included
in the Schedule of Benefit).
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| 11. |
Health services for treatment
of illnesses caused directly or indirectly, wholly
or partly, by Acquired Immune Deficiency Syndrome
(AIDS) or any Human Immune-Deficiency Virus (HIV).
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| 12. |
Topical skin testing at a GP clinic. |
| 13. |
General screening profiles at
a GP clinic (unless specifically included in the
Schedule of Benefit).
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| 14. |
Growth hormone therapy. |
| 15. |
Out-patient physical therapy,
physiotherapy and/or rehabilitation therapy is not
covered and cannot be referred at general practitioner
level. This service would only be covered when referred
by a specialist and treatment must be provided by
a registered physiotherapist.
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| "Pre-Existing Illness" shall mean: |
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Disabilities that the Insured
Person has reasonable knowledge of. An Insured Person may
be considered to have reasonable knowledge of a pre-existing
condition where the condition is one for which:
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| (a) |
the Insured Person had received or is receiving treatment; |
| (b) |
medical advice, diagnosis, care
or treatment has been recommended;
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| (c) |
clear and distinct symptoms are
or were evident; or
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| (d) |
its existence would have been
apparent to a reasonable person in the circumstances.
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| "Specified Illnesses" shall mean: |
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The following disabilities
and its related complications, occurring within the first
120 days of Insurance of the Insured Person:
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| (a) |
Hypertension, diabetes mellitus
and cardiovascular disease
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| (b) |
All tumours, cancers, cysts, nodules,
polyps, stones of the urinary system and biliary system
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| (c) |
All ear, nose (including sinuses)
and throat conditions
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| (d) |
Hernias, haemorrhoids, fistulae,
hydrocele, varicocele
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| (e) |
Endometriosis including disease
of the reproduction system
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| (f) |
Vertebro-spinal disorders (including
disc) and knee conditions
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