Page 6 - ALC Health

Exclusions Specific to Each Section of Cover - continued
Out-patient Treatment
If Out-patient Treatment has been selected the following
exclusions will apply in addition to the General Exclusions on page
10. We do not cover the following:
Applicable to Prima Premier and Prima Classic
1 Any costs associated with routine pregnancy & childbirth,
unless Routine Pregnancy & Childbirth has been selected.
2 Any costs associated with any form of dental treatment, unless
Dental Treatment has been selected or treatment is covered
under Emergency Dental Treatment. If Dental Treatment
option has been selected Emergency Dental Treatment is not
applicable. Any benefits payable will be paid under the Dental
Treatment Benefit.
3 Any costs associated with evacuation or repatriation unless
Evacuation or Repatriation has been selected.
4 The policy excess specified on the Certificate of Insurance for all
eligible expenses incurred for each insured person per policy year.
5 Any second or subsequent medical opinions from a medical
practitioner or specialist for the same medical condition,
unless agreed in writing by us.
6 Any treatment for cosmetic pedicures, surgical footwear
including but not limited to corrective footwear eg. corn
plasters, insoles, dressings etc.
Routine Pregnancy & Childbirth
If Routine Pregnancy & Childbirth has been selected the following
exclusions will apply to this benefit in addition to General
Exclusions on page 10. We do not cover the following:
1 Any costs incurred for the initial 11 months of cover from
purchase date of this benefit or date of entry, whichever is
the latter. Conception may take place during this initial period,
but only costs incurred after the period will be considered for
reimbursement.
2 Antenatal and postnatal classes.
3 Midwifery costs when not associated with the childbirth /
delivery.
4 Treatment consequent from the well-baby examination, unless
the newborn is added within 30 days of birth to the policy as an
insured person.
Dental Treatment
If Dental Treatment has been selected the following exclusions
will apply in addition to General Exclusions on page 10. We do not
cover the following:
1 Dental costs incurred within the first six months from the
purchase date of this benefit or date of entry whichever is the
latter (excluding Accidental Damage to Teeth ).
2 Dental procedures other than those specified in the schedule of
benefits.
3 Gingivitis, periodontitis or gum disease of any kind.
4 The cost of any precious metals (excluding gold) used in any
dental procedure.
5 Any dental treatment which was recommended by your dental
practitioner or that you were aware (or ought reasonably to
have been aware) required treatment before you purchased
this benefit or during the first six months of your purchase of
this benefit. In the event of a claim, you may be required to
provide evidence that you have completed all necessary dental
work recommended prior to your purchase of this benefit.
6 Orthodontic treatment of any kind.
7 Dental surgery when not performed by an oral and maxillofacial
surgeon or surgical dentist.
8 Dentures where a set or sets have been worn previously.
9 Implants.
Evacuation or Repatriation
If Evacuation or Repatriation has been selected the following
exclusions will apply in addition to General Exclusions on page 10.
We do not cover the following:
1 Travel and subsequent accommodation costs unless specifically
agreed by us , or our appointed Assistance Company, in writing
prior to travel. Any costs incurred without our prior agreement
shall not be considered for reimbursement.
2 The cost of any airline tickets other than economy class, unless
we have provided written approval in advance of the date
of travel.
3 Burial and cremation costs shall not include the costs of
a religious practitioner, floral tributes, musical provision,
headstones or food and beverages.
4 Any costs incurred where the death has occurred within the
insured person’s country of nationality.
5 Any costs incurred as a result of engaging in any sports or
activity as a professional or taking part in base jumping, cliff
diving, flying in an unlicensed aircraft or as a learner, martial arts,
free climbing, mountaineering with or without ropes, scuba
diving to a depth of more than 10 metres, trekking to a height
of over 2,500 metres, bungee jumping, canyoning, hangliding,
paragliding or microlighting, parachuting, potholing, skiing off
piste or any other winter sports activity carried out off piste.
6 Moving you from a ship, oil-rig platform or similar off-shore
location.
7 We will not be liable in respect of the overseas evacuation or
repatriation service for:
a Any failure to provide the overseas evacuation or repatriation
service or for any delays in providing it, unless the failure
or delay is caused by our negligence (including that of the
international assistance company we have appointed to act for
us), or of agents appointed by either party.
b Failure or delay in providing the overseas evacuation or
repatriation service if:
n by law the overseas evacuation or repatriation service
cannot be provided in the country in which it is needed;
or
n the failure or delay is caused by any reason beyond our
control including, but not limited to, strikes and flight
conditions.
c Injury or death caused while you are being moved unless it is
caused by our negligence or the negligence of anyone acting
on our behalf.
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