48
49
Exclusion
Notes
rules
Reconstructive or remedial surgery
Treatment
to restore
your
appearance after an illness, injury or surgery.
We
may pay for surgery when the original illness, injury or surgery and the reconstructive surgery take place during
your
current continuous membership.
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.
Self-inflicted injuries
Treatment
for or as a result of an injury
you
have knowingly caused to yourself, such as in an attempted suicide.
Sexual problems/gender issues
{
{
sexual problems, such as impotence, whatever the cause, or
{
{
sex changes or gender reassignments
Sleep disorders
{
{
insomnia
{
{
snoring
{
{
sleep-related disorders including sleep apnoea, or
{
{
participation in sleep studies beyond the initial study
We
may pay for
treatment
of sleep apnoea when
your specialist
believes this to be life-threatening.
We
will only pay for:
{
{
an initial sleep study
{
{
surgery, if medically appropriate, and
{
{
equipment hire, such as a Continuous Positive Airway Pressure (CPAP) machine (only if
you
have bought the Worldwide
Medicines and Equipment option)
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.
Stem cells
We
do not pay for the harvesting or storage of stem cells. For example ovum, cord blood or sperm storage.
Temporomandibular joint (TMJ) disorders
Temporomandibular joint (TMJ) disorders
Travel costs for
treatment
Any travel costs related to receiving
treatment
.
Examples:
{
{
we
do not pay for taxis or other travel expenses for
you
to visit a
medical practitioner
{
{
we
do not pay for travel time or the cost of any transport expenses charged by a
medical practitioner
to visit
you
Exceptions:
{
{
Road Ambulance cover
{
{
Air Ambulance cover
{
{
you
have bought Worldwide Evacuation cover and
your
travel meets the qualifying conditions of that cover
Unrecognised medical practitioner, provider or facility
{
{
Treatment
provided by a
medical practitioner
, provider or facility who is not recognised by the relevant authorities
in the country where the
treatment
takes place as having specialised knowledge, or expertise in, the
treatment
of the
disease, illness or injury being treated.
{
{
Treatment
provided by anyone with the same residence as
you
or who is a member of
your
immediate family.
{
{
Treatment
provided by a
medical practitioner
, provider or facility to whom
we
have sent a written notice that
we
no
longer recognise them for the purposes of
our
plans. Details of
treatment
providers
we
have sent written notice to are
available on MembersWorld or by telephoning general enquiries. Please see the ‘Quick reference guide’ booklet for how
to contact
us.
