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.
9
1,2,3,4,5 7,8,9,10,11,12