15
Exclusions
Although we cover most medically necessary treatment, expenses incurred for
the following treatments, medical conditions and procedures are not covered
under the policy unless confirmed otherwise in the Table of Benefits or in any
written policy endorsement.
a) The following exclusions apply to
all our plans
, unless stated otherwise:
1.
Any form of
treatment
or
drug therapy
which in our reasonable opinion is
experimental
or
unproven
based on generally accepted medical practice.
2.
Any
treatment carried out by a plastic surgeon
, whether or not for medical/psychological purposes and
any cosmetic or aesthetic treatment to enhance your appearance, even when medically prescribed.
The only exception is reconstructive surgery necessary to restore function or appearance after a disfiguring
accident, or as a result of surgery for cancer, if the accident or surgery occurs during your membership.
3.
Care and/or treatment of drug addiction or alcoholism
(including detoxification programmes and
treatments related to the cessation of smoking), instances of death, or the treatment of any condition that in
our reasonable opinion is related to, or a direct consequence of, alcoholism or addiction (e.g. organ failure or
dementia).
4.
Care and/or treatment of
intentionally caused diseases
or
self-inflicted injuries
, including a suicide
attempt.
5.
Complementary treatment
, with the exception of those treatments indicated in the Table of Benefits.
6.
Consultations performed
, as well as
any drugs or treatments prescribed, by you, your spouse,
parents or children
.
7.
Costs in respect of a
family therapist or counsellor
for out-patient psychotherapy treatment.
8.
Developmental delay
, unless a child has not attained developmental milestones expected for a child of
that age, in cognitive or physical development. We do not cover conditions in which a child is slightly or
temporarily lagging in development. The developmental delay must have been quantitatively measured by
qualified personnel and documented as a 12 month delay in cognitive and/or physical development.
9.
Expenses for the
acquisition of an organ
including, but not limited to, donor search, typing, harvesting,
transport and administration costs.
10.
Expenses incurred because of
complications directly caused by an illness, injury or treatment for
which cover is excluded or limited
under your plan.
11.
Genetic testing
, except where specific genetic tests are included within your plan, or where DNA tests are
directly linked to an eligible amniocentesis i.e. in the case of women aged 35 or over.
12.
Home visits
, unless they are necessary following the sudden onset of an acute illness, which renders the
insured incapable of visiting their medical practitioner, physician or therapist.
13.
Infertility treatment
including medically assisted reproduction or any adverse consequences thereof,
unless you have a specific benefit for infertility treatment, or have selected an Out-patient Plan (whereby
you are covered for non-invasive investigations into the cause of infertility within the limits of your
Out-patient Plan). These exceptions do not apply to members of the Channel Islands Plan, for whom
investigation into infertility is excluded.
