46
47
Exclusion
Notes
rules
Personal exclusions
Please check your membership certificate to see if you have any personal exclusions or restrictions on your plan. The
exclusions in this section apply in addition to and alongside any such personal exclusions and restrictions.
For all exclusions in this section, and for any personal exclusions or restrictions shown on
your
membership certificate,
please note that:
{
{
we
do not pay for conditions which are directly related to excluded conditions or
treatments
{
{
we
do not pay for any additional or increased costs arising from excluded conditions or
treatments
{
{
we
do not pay for complications arising from excluded conditions or
treatments
.
Example:
You
have a personal exclusion for diabetes
{
{
If
your
diabetes were to cause kidney problems,
we
would not pay for the
treatment
of such kidney problems.
{
{
If while receiving
treatment
for another condition,
you
need to stay extra nights in
hospital
because of
your
diabetes
we
would not pay for these extra nights.
Exceptions
This section describes some circumstances where exceptions can be made to exclusions or restrictions. Where this is the
case, benefit is payable up to the limits set out in
your
Table of Benefits.
Personality disorders
Any
treatment
for personality disorders, including but not limited to:
{
{
affective personality disorder
{
{
schizoid personality (not schizophrenia), or
{
{
histrionic personality disorder
Pre-existing conditions
Any
treatment
for a
pre-existing condition
, related symptoms, or any condition that results from or is related to a
pre-existing condition
, unless:
{
{
we
were given all the information, including details of any symptoms, that
we
asked for during
your
application for the
current continuous period of membership before
we
sent
you your
first membership certificate which lists the person
with the
pre-existing condition
{
{
you
have been sent
your
membership certificate which lists the person with the
pre-existing condition
and the
option(s) to which that applies; and
{
{
we
did not specifically exclude cover for the costs of
treatment
of the
pre-existing condition
on
your
membership
certificate under the '
pre-existing conditions
' section
Please contact
us
before
your
next renewal date if
you
have previously disclosed a
pre-existing condition
of
yours
to
us
but believe that there will be no further
treatment
for that
pre-existing condition
after
your
next renewal date. In order for
us
to review whether to remove the
pre-existing condition
,
we
must receive full current clinical details from
your medical
practitioner
. There are some
pre-existing conditions
that, due to their nature,
we
will not review.
Preventive
treatment
Health screening, including routine health checks and vaccinations, or any preventive
treatment
, except if
you
have bought
the Worldwide Wellbeing option.
We
may pay for
prophylactic surgery
when:
{
{
there is a significant family history of the disease, for example ovarian cancer, which is part of a genetic cancer
syndrome, and/or
{
{
you
have positive results from genetic testing (please note that
we
will not pay for the genetic testing)
The limit shown under Worldwide Medical Insurance will apply for
prophylactic surgery
for congenital and hereditary
conditions other than cancer.
Please contact
us
for prior approval before proceeding with
treatment
. It may be necessary for
us
to seek a second opinion
as part of
our
approval process. Benefit will not be paid unless prior approval has been received.
