General Exclusions
These exclusions apply to the whole of this insurance. Each section
also has its own exclusions.
1
Any
medical condition
or specified
related condition for which
you
have received medical
treatment
, had symptoms (whether
investigated or not) or sought
advice
in the 5 years prior to
your
date of entry
(pre-existing
medical condition
). However, after a
continuous period of 2 years as an
insured person
, all pre-existing
conditions will become eligible for benefit provided
you
have not:
a.
consulted a
medical practitioner
or
specialist
for medical
treatment
or
advice
; or
b. suffered symptoms; or
c.
taken
medication
(including drugs, medicines, special diets or
injections) for that condition for a continuous period of two
years after the
date of entry
.
If
your
pre-existing condition is one of those shown below,
we
will
also exclude
treatment
for the specified related conditions shown:
In some circumstances
you
may have joined on different terms
to those described above and
you
will find those terms on
your
Certificate of Insurance
. For example, if
you
have joined from
another insurer
we
may have transferred the medical underwriting
terms from
your
previous
policy
for
medical conditions
that existed
prior to
you
joining that policy.
2
Genetic deformities,
birth injuries
or birth defects.
3
Elective caesarean section deliveries and
treatment
consequent
upon such deliveries.
4
Foetal surgery
.
5
Costs for genetic testing.
6
Treatment
for, or arising from, deafness caused by ageing.
7
Treatment
for any illness, diseases or injuries arising from a
procedure that is not covered under this
policy
.
8
Experimental, unlicensed or unproven
treatment
, regardless of
whether they are medically recommended or prescribed.
9
Home visits, unless they are necessary following the sudden
onset of an
acute
illness, which renders the insured incapable
of visiting their
medical practitioner
or
physician
. The doctor’s
visit must take place within 24 hours of the start of the condition.
10
Treatment
when performed by a
medical practitioner
or
specialist
who is in any way related to the
insured person
.
11
Investigations into and
treatment
for loss of hair and any hair
replacement unless the loss of hair is due to cancer
treatment
.
Wigs are not covered.
12
Treatment
received in health hydros, nature cure clinics, spas
or similar establishments or private beds registered as a nursing
home attached to such establishments or a
hospital
where the
hospital
has effectively become the
insured person’s
home or
permanent abode or where admission is arranged wholly or
partly for domestic reasons.
13
Cosmetic
treatment
, obesity, removal of fat or other surplus
tissue from any part of the body, whether or not for medical or
psychological purposes, and any associated
treatment
costs
consequent of such
treatment
.
14
Treatment
which is not medically necessary or which may be
considered a matter of personal choice.
15
Any
treatment
carried out by a plastic surgeon, whether or
not for medical/psychological purposes. 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 period
of cover
and has been covered by
us
.
16
Costs of providing or fitting any external prostheses, corrective
devices or appliances.
17
Treatment
for any illness, diseases or injuries arising from ear or
body piercing and tattooing.
18
Treatment
for cryopreservation, implantation or reimplantation
of living cells or living tissue, whether autologous or provided
by a donor.
19
Routine physical examinations (other than those covered within
the ‘Well-being benefit’ included under Prima Premier
Out-patient
benefit if selected), including gynaecological investigations and
tests, inoculations, vaccinations and other preventative medicines
and tests. Routine hearing tests and the provision of hearing aids.
20
Treatment
to change the refraction of one or both eyes (laser
eye correction) including refractive keratectomy (RK) and
photorefractive keratectomy (PRK), macular degeneration and
similar conditions. However,
we
will pay for corrective sight
surgery consequent of an
accident
.
21
Claims for any supplements or substances which are available
naturally. This includes, but is not limited to: vitamins, minerals
and organic substances except where prescribed under
complementary treatment
.
22
Nutritional supplements including but not limited to special infant
formula and cosmetic products even if medically recommended
or prescribed or acknowledged as having therapeutic effects.
23
Investigations, diagnostics and
treatment
directly or indirectly
arising from or connected with male or female birth control
(including insertion and removal of contraceptive devices and
all other contraceptives, even if prescribed for medical reasons),
infertility and any form of assisted reproduction.
24
Treatment
directly related to surrogacy whether
you
are acting
as surrogate, or are the intended parent.
25
Investigations, diagnostics and
treatment
of impotence, sexual
dysfunctionor any consequence thereof,
treatment
for sterilisation
or fertilisation, vasectomy or other sexually related conditions or
gender reassignment.
26
Treatment
directly or indirectly associated with sexually
transmitted diseases.
27
We
do not cover
treatment
for conditions such as conduct
disorder, attention deficit hyperactivity disorder, autism
spectrum disorder, oppositional defiant disorder, antisocial
behaviour, obsessive-compulsive disorder, attachment disorder,
adjustments disorders, as well as all
treatments
that encourage
positive social-emotional relationships, such as communication
therapies, floor time and family therapy.
10
If
you
have the following
pre-existing condition:
We
will not pay for
treatment
of
the following specified related
conditions:
have been diagnosed
with diabetes
•
Diabetes
•
Ischaemic heart disease
•
Cataract
•
Diabetic retinopathy
•
Diabetic renal disease
•
Arterial disease
•
Stroke
are currently undergoing
treatment
for raised blood
pressure (hypertension)
•
Raised blood pressure (hypertension)
•
Ischaemic heart disease
•
Stroke
•
Hypertensive renal failure
are under investigation,
having
treatment
or
undergoing monitoring
as a result of a Prostate
Specific Antigen (PSA) test
•
Any disorder of the prostate
1,2,3,4,5,6 8,9,10,11,12