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You are here: Skip Navigation LinksHome > Insurance > Products > Product Gallery > MediGuard Premier
MEDIGUARD PREMIER
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POLICY DETAILS
Product Details
Description of Benefits
Exclusions
Special Provision & Conditions
mediGUARD Premier


EXCLUSIONS back to top
 
Exclusions (applicable for Section A & Section B)
 
This policy shall not cover:-
 
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.
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.
3.
Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions.
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.
5.
Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
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.
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.
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.
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.
10.
Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations).
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.
12.
Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes.
 
Exclusions (applicable for Section A only)
 
This Policy shall not cover:-
 
1.
Pre-existing illness.
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.
3.
Specified Illnesses occurring during the first 120 days of continuous cover.
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.
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.
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.
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.
8. Expenses incurred for sex changes.
 
Exclusions (applicable for Section B only)
 
This Policy shall not cover:-
 
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.
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.
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.
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.
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.
6.
Services and supplies for smoking cessation programs and the treatment of nicotine addiction.
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.
8.
Education services such as speech improvement, diabetic classes and nutritional services, or group support services, unless authorized by the company.
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.
10.
Any preventive vaccination or childhood immunization (unless specifically included in the Schedule of Benefit).
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).
12. Topical skin testing at a GP clinic.
13.
General screening profiles at a GP clinic (unless specifically included in the Schedule of Benefit).
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.
 
"Pre-Existing Illness" shall mean:
 
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:
 
(a) the Insured Person had received or is receiving treatment;
(b)
medical advice, diagnosis, care or treatment has been recommended;
(c)
clear and distinct symptoms are or were evident; or
(d)
its existence would have been apparent to a reasonable person in the circumstances.
 
"Specified Illnesses" shall mean:
 
The following disabilities and its related complications, occurring within the first 120 days of Insurance of the Insured Person:
 
(a)
Hypertension, diabetes mellitus and cardiovascular disease
(b)
All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and biliary system
(c)
All ear, nose (including sinuses) and throat conditions
(d)
Hernias, haemorrhoids, fistulae, hydrocele, varicocele
(e)
Endometriosis including disease of the reproduction system
(f)
Vertebro-spinal disorders (including disc) and knee conditions




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