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Terms & Conditions

Terms

EXCLUSIONS LIST

The following services are not covered/reimbursable by the Company:

  1. Cosmetic surgery for aesthetic purposes and reconstructive procedures.
  2. Medical devices for secondary management (e.g., Hearing aids, contact lenses, braces, Zimmer frames, wheel chairs, self-use monitors) and dietary supplements for non-anaemic purposes.
  3. Investigations, treatments, and surgery for obesity or slimming medications.
  4. Intentional self-injury or illness resulting from alcoholism, drunkenness, drug addiction, or non-medically prescribed drug use.
  5. Treatment available as free public health services (e.g., Immunization, TB, Buruli Ulcer, VCT for HIV, Family planning, etc.).
  6. Mental health/psychiatric conditions unless explicitly covered by the plan.
  7. Anticoagulants and DDP-4 inhibitors not on the standard treatment guidelines (Heparin, Warfarin are covered).
  8. Herbal/homeopathic or chiropractic procedures and alternate medicine (unless explicitly covered by the plan).
  9. Medical examinations for non-medical purposes (e.g., Pre-marital, pre-employment, visa).
  10. Neurosurgery, cardiothoracic, colorectal surgery, joint replacement surgery, minimally invasive surgical procedures, organ transplant, chronic renal dialysis, spinal surgery, except when specifically pre-authorized.
  11. Congenital abnormalities.
  12. Assisted reproduction, fertility treatment, and treatment of sexual dysfunction.
  13. Termination of pregnancy except where there is an immediate threat to maternal life.
  14. Treatment which involves rehabilitation other than physiotherapy.
  15. Diagnosis and treatment overseas.
  16. All endoscopic procedures (scoping procedures), except pre-authorized.
  17. Cancers and all cancer-related treatment.
  18. Treatment of Hepatitis B and C except pre-authorized.
  19. Mortuary services.
  20. Any benefit not specified within the benefit option selected, including Over the Counter medications.
  21. Expenses related to injury or illness caused or contributed to by war, invasion, or whilst engaging in military service, riot, or civil commotion.
  22. Dental Exclusions: Orthodontics (cosmetic dental surgery), dentures, artificial teeth, bridges, crowns, and braces except pre-authorized.
  23. Sickness or injury where any other party is liable (e.g., motor accident, workman compensation), unless otherwise provided for under the policy.