Exclusions

The Company shall not cover any Medical Condition or Treatment of Life Assured that is caused directly or indirectly, wholly or partly, by any of following events:

1. Any pre-existing condition unless the Life Assured has been continuously insured under this Supplementary Contract or the Policyholder’s group hospital and surgical insurance for at least 12 (twelve) months with the previous insurer; or
2. Cosmetic surgery or Treatment, or complication Treatment except Complication of Pregnancy, Treatment to remove hair or grow hair, change skin or eye color with exception or reconstructive surgery after an accident or an Eligible Treatment; or
3. Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions; or
4. Treatment needed as a result of nuclear contamination, biological contamination or chemical contamination, whilst engaging in or taking part in any conflict, war, act of foreign enemy, invasion, civil war, riot, rebellion, insurrection, revolution, overthrow of a legally constituted government, explosions of war weapons, or any event similar to one of those listed, This includes any treatment needed as a result of the Life Assured exposing himself to needless peril, such as going to a place of civil unrest as an active onlooker or a spectator. For clarity, there is cover for Treatment required as a result of a terrorist act providing that terrorist act does not result in nuclear, biological or chemical contamination; or
5. Treatment resulting from engaging in military activity or professional sport activities; or
6. The use of a drug which has not been established as being effective or which is experimental. This means they must be licensed by the European Medicines Agency if the Life Assured is receiving Treatment in Europe, or the US Food and Drug Administration (FDA) if the Life Assured is receiving Treatment anywhere else in the world, and be used within the terms of that license; or
7. Treatment which has not been established as being effective or which is experimental. For established Treatment, this means procedures and practices that have undergone appropriate clinical trial and assessment, sufficiently evidenced in published medical journals for specific purposes to be considered proven safe and effective therapies; or
8. Fertility Treatment, sterility and contraception Treatment, sex change, impotence; or
9. Treatment provided by a non-medical or non-licensed medical professional; or
10. Foetal surgery; or
11. Medical expenses that arise from, or are in any way related to, Human Immunodeficiency Virus (HIV) and/or HIV related Illnesses, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) and/or any mutant derivative or variations thereof; or
12. Expenses that are not for medical Treatment such as telephone, TV rent, newspaper, moisturizer, creams, toiletries, dietary supplements and vitamins, toothpaste or soap; or
13. Costs that are not usual, Reasonable and Customary in the area where Treatment is received; or
14. Treatment against obesity such as, but not limited to, gastric banding or surgery, removal of surplus tissue and fat; or
15. Treatment that is not Medical Necessary; or
16. Treatment that is customarily done as an out-patient including drugs, dressings, consultations and investigations, including pre- and post-natal visits except those out-patient Treatments allowed as stated in the Policy Schedule; or
17. Mental illness even if it requires Hospital admission; or
18. Medical expenses incurred during the Waiting Period except for medical expenses arising following an accident occurred within the Waiting Period and subject to other exclusions; or
19. External prosthetics and durable medical appliances and support appliances other than those that are part of the surgical procedure and integral to the Treatment; or
20. The cost of collecting donor organs or tissue or for any related administration costs (such as, but not limited to, the cost of a donor search); or
21. Additional charges for obtaining medical reports or filling in claim forms or other administrative charges; or
22. Treatment for addictions (such as alcohol addiction or drug addiction) or substance abuse (such as alcohol abuse or solvent abuse), or Treatment of any Illness or injury needed directly or indirectly as a result of any such abuse or addiction; or
23. Pregnancy, abortion, non-accidental miscarriage during the waiting period, mechanical or chemical contraceptive methods of birth control or treatment pertaining to infertility, and erectile dysfunction and tests or treatment related to impotence or sterilization; or
24. Suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane; or
25. Investigation and treatment of sleep and snoring disorders and hormone replacement therapy; or
26. Treatment for which payment is not required or to the extent which is payable by any other insurance or indemnity covering the Life Assured and arising out of duties of employment or profession that is covered under a Worker’s Compensation insurance contract; or
27. Non-commercial flights; or
28. Illegal and criminal activities.