Page 8 - ALC Health

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.