General Conditions
1
Policy Term
The
policy
is an annual contract and is effective for twelve months
from the
commencement date
. The
policy
can be renewed
each
year
on the
renewal date
, subject to the
policy
terms, conditions
and premium rates in force at the time and as notified to
you
in
your
renewal invitation.
2
Premium Payment
Premiums can either be payable monthly, quarterly or annually
and are due to be paid on or before the
commencement date
or
renewal date
. However, as
your policy
is an annual contract
you
are responsible for the whole years’ premium even if
we
have
agreed that
you
may pay by a monthly or quarterly premium.
Failure to comply with this will result in automatic termination of
your
cover. Reinstatement upon subsequent receipt of funds shall
warrant the application of General Exclusion 1 with effect from the
date of reinstatement. No
insured person
shall have automatic
right to continue the cover with
us
. Please refer to the Payment
Terms & Conditions.
3
Taxes
We
reserve the right to reflect any changes in insurance premium
tax or other government levies as may be imposed upon
us
.
4
Alterations
At each
renewal date
,
we
reserve the right to alter or discontinue
the benefits, terms, conditions and premiums of this
policy
and
we
shall notify
you
of such changes at least 21 days prior to the
renewal date
to
your
last known address. If
you
fail to receive such
notice for whatever reason this shall not invalidate the change.
5
Change of Risk
The
policyholder
must inform
us
as soon as reasonably practical
of any material change relating to any
insured person
covered
under this
policy
. Such change may affect information given in
connection with the original application. This may include any
information as documented on the Application Form which may
have altered prior to the
commencement date
of the
policy
.
6
Cancellation & Fraud
Whilst
we
will not cancel this
policy
because of eligible claims
made by the
insured person
,
we
may at any time terminate the
policy
if an
insured person
has:
a. misled
us
by mis-statement; or
b. submitted a claim which is, in any respect, false, fraudulent,
intentionally exaggerated and/or, if fraudulent means/devices
have been used by
you
or
your dependants
or anyone acting
on
your
or their behalf to obtain benefit under this
policy
.
We
will not pay any benefits for that claim. The amount of any claim
settlement made to
you
, before the fraudulent act or omission
was discovered, will become immediately payable to
us
. If the
contract is rendered void due to false, fraudulent, intentionally
exaggerated claims or if fraudulent means/devices have been
used, the premium will not be refunded, in part or in whole,
and any pending claims settlements will be void. In the event of
fraudulent claims, the contract will be cancelled from the date
of our discovery of the fraudulent event.
In such circumstances, cover shall be cancelled void ab inito, with
refund of premium minus any claim payments paid.
These conditions apply to all sections of this insurance.
11
28
Speech therapy is only eligible for reimbursement in the context
of a diagnosed physical impairment, such as, but not limited to,
nasal obstruction, neurogenic impairment (e.g. lingual paresis,
brain injury) or articulation disorders involving the oral structure
(e.g cleft palate).
We
do not pay for speech therapy related to
developmental delay, dyslexia, dyspraxia or expressive language
disorder.
29
Any
treatment
of,orrelatedto,orcausedby,eatingdisordersofany
kind. This includes but is not limited to the
treatment
of conditions
such as anorexia nervosa, bulimia, bariatrics, and any
treatment
required for any condition caused as a result of these conditions.
30
Costs which arise from or are directly or indirectly caused
by an attempt at suicide or bodily injury or illness, which is
wilfully self-inflicted or due to negligent or reckless behaviour.
31
Treatment
for dependency on or abuse of alcohol, drugs or
any other addictive substances and any injury or illness arising
directly or indirectly from such abuse or addiction.
32
Any
treatment
arising from or related to injuries sustained
whilst engaged in a criminal, illegal or unlawful act.
33
Costs which arise from or are directly or indirectly caused by
self-exposure to needless danger, except in an attempt to
save a human life.
34
Treatment
directly or indirectly arising from or required
as a consequence of war, invasions, acts of foreign enemy,
hostilities (whether or not war is declared), civil war, rebellion,
revolution, insurrection or military or usurped power, mutiny,
riot, strike, martial law or state of siege or attempted overthrow
of government or any acts of terrorism, unless the
insured
person
sustains bodily injury whilst an innocent bystander.
35
Treatment
directly or indirectly arising from or required as
a result of chemical contamination or contamination by
radioactivity from any nuclear material whatsoever or from the
combustion of nuclear fuel, asbestosis or any related condition.
36
Costs directly or indirectly resulting from the release of
weapon(s) of mass destruction, whether such involves an
explosive sequence(s) or not.
37
Expenses incurred because of complications directly caused
by an illness, injury or
treatment
for which cover is excluded
or limited under
your
policy.
38
Treatment
required as a result of failure to seek or follow
medical advice.
39
Costs and expenses incurred where an
insured person
has
travelled against medical
advice
.
40
Travel costs to and frommedical facilities (including parking
and taxi costs) for eligible
treatment
, other than any travel
costs covered under transportation or
Evacuation or
Repatriation
benefit.
41
Any costs incurred outside
your area of cover
other than eligible
emergency
treatment
costs covered under the
in-patient &
day-patient
benefit.
We
will not cover any costs associated
with curative
treatment
or follow-up of emergency
treatment
outside
your area of cover
or travel costs to return to
your area
of cover
.
42
Treatment
costs which are incurred outside of the
period of
cover
or after termination of the
policy
for whatever reason,
including non-renewal and non-payment of premium.
43
Losses not incurred within the
period of cover
and claims
submitted later than 6 months after the end of the
period
of cover
(unless this was not reasonably possible).
44
Medical practitioner
fees for the completion of a Claim Form
or other administration charges.
45
Treatment
or diagnostic procedures of injuries arising from an
engagement in professional sports.
1,2,3,4,5,6,7 9,10,11,12