1.73
Psychiatry and psychotherapy
is the treatment of mental disorders carried out by a psychiatrist or
clinical psychologist. The condition must be clinically significant and not related to bereavement,
relationship or academic problems, acculturation difficulties or work pressure. All day-care or
in-patient admissions must include prescription medication related to the condition. Psychotherapy
treatment (on an in-patient or out-patient basis) is only covered where you or your dependants are
initially diagnosed by a psychiatrist and referred to a clinical psychologist for further treatment.
In addition, out-patient psychotherapy treatment (where covered) is initially restricted to 10 sessions
per condition, after which treatment must be reviewed by the referring psychiatrist. Should further
sessions be required, a progress report must be submitted to us, which indicates the medical
necessity for any further treatment.
1.74
Rehabilitation
is treatment in the form of a combination of therapies such as physical, occupational
and speech therapy and is aimed at the restoration of a normal form and/or function after an acute
illness or injury. The rehabilitation benefit is only payable for treatment that starts within 14 days of
discharge after the acute medical and/or surgical treatment ceases and where it takes place in a
licensed rehabilitation facility.
1.75
Repatriation of mortal remains
is the transportation of the insured member’s mortal remains from
the principal country of residence to the country of burial. Covered expenses include, but are not
limited to, expenses for embalming, a container legally appropriate for transportation, shipping costs
and the necessary government authorisations. Cremation costs will only be covered in the event that
this is required for legal purposes. Costs incurred by any accompanying persons are not covered,
unless this is listed as a specific benefit in your Table of Benefits.
1.76
Routine maternity
refers to any medically necessary costs incurred during pregnancy and childbirth,
including hospital charges, specialist fees, the mother's pre- and post-natal care, midwife fees (during
labour only) as well as newborn care. Costs related to complications of pregnancy or complications of
childbirth are not payable under routine maternity. In addition, any non-medically necessary
caesarean sections will be covered up to the cost of a routine delivery in the same hospital, subject to
any benefit limit in place. If the home delivery benefit is included in your plan, a lump sum up to the
amount specified in the Table of Benefits will be paid in the event of a home delivery. Please note that
for multiple birth babies born as a result of medically assisted reproduction, in-patient treatment is
limited to £24,900/€30,000/US$40,500/CHF39,000 per child for the first three months following
birth. Out-patient treatment is paid within the terms of the Out-patient Plan.
1.77
Specialist
is a qualified and licensed medical physician possessing the necessary additional
qualifications and expertise to practice as a recognised specialist of diagnostic techniques, treatment
and prevention in a particular field of medicine. This benefit does not include cover for psychiatrist or
psychologist fees. Where covered, a separate benefit for psychiatry and psychotherapy will appear in
the Table of Benefits.
1.78
Specialist fees
refers to non-surgical treatment performed or administered by a specialist.
1.79
Speech therapy
refers to treatment carried out by a qualified speech therapist to treat diagnosed
physical impairments, including, but not limited to, nasal obstruction, neurogenic impairment (e.g.
lingual paresis, brain injury) or articulation disorders involving the oral structure (e.g. cleft palate).
1.80
Surgical appliances and prostheses
refers to artificial body parts or devices, which are an integral
part of a surgical procedure or part of any medically necessary treatment following surgery.
1.81
Therapist
is a chiropractor, osteopath, Chinese herbalist, homeopath, acupuncturist, physiotherapist,
speech therapist, occupational therapist or oculomotor therapist, who is qualified and licensed under
the law of the country in which treatment is being given.
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