1.
Any Medical Condition or Related Condition for which You have received Treatment, had symptoms of, to the best of Your knowledge existed or You sought Advice for prior to Your Date of Entry (pre-existing Medical Condition), except where such Medical Conditions have been declared to Us and accepted in writing. After two years’ continuous membership, any pre-existing Medical Conditions (and Related Conditions) will become eligible for Benefit provided (in respect of that condition) You have not during that period:
a) consulted any Medical Practitioner or Specialist for Treatment or Advice (including check-ups) or
b) experienced further symptoms or
c) taken medication (including drugs, medicines, special diets or injections).
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2.
a). Treatment of a Medical Condition which We, on Advice or General Advice determine is Palliative Treatment or a Chronic Medical Condition.
b)We will, however, pay for the stabilisation of Acute exacerbations of Chronic Medical Conditions that are not pre-existing Medical Conditions. This exclusion does not apply to the Benefit for AIDS.
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3.
Chronic supportive Treatment of renal failure, including dialysis. We will, however, pay for the cost of renal dialysis incurred:
a) immediately pre and post-operatively
b) in connection with Acute secondary failure when dialysis is part of intensive care.
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4.
Treatment, which We determine on General Advice is either experimental or unproven.
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5.
Birth injuries, Congenital Anomalies, genetic deformities or diseases or Hereditary Medical Conditions.
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6.
Routine physical examination by a Medical Practitioner, including gynaecological investigations, normal hearing tests, routine tests, New Born neo-natal care, inoculations, vaccinations and preventative medicines, Normal eye tests, non-medical/natural degenerative eye defects, including, but not limited to myopia, presbyopia and astigmatism and any corrective surgery for non-medical/natural degenerative sight defects.
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7.
Rehabilitation except as provided under Benefit 20 of the Policy.
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8.
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 arrangedwholly or partly for domestic reasons.
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9.
Cosmetic Treatment, and any consequence thereof and/or Treatment for weight loss or weight problems whether or not for psychological purposes and any associated Treatment costs consequent of cosmetic surgery or arising as a result of an eating disorder or weight problem.
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10.
Alternative medicines including, but not limited to, chiropodists, optometrists and podiatrists. Cover is extended to include chiropractors, osteopaths, homeopaths, podiatrists, acupuncturists and traditional Chinese practitioners registered in China, as provided for in Benefit 1, g) and h).
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11.
Costs of providing, maintaining or fitting any external prostheses or Appliance, hearing and/or visual aids, or other equipment, medical or otherwise except as specified in Benefit 21 - Ancillary Charges.
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12.
Costs incurred in connection with locating a replacement organ or any costs incurred for removal of the organ from the donor, transportation costs of same and all associated administration costs.
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13.
Any second or subsequent medical opinions from a Medical Practitioner or Specialist for the same condition unless it has been authorised by Us in writing.
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14.
Normal pregnancy and childbirth.
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15.
Voluntary caesarean section costs.
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16.
Pregnancy terminations on non medical grounds, antenatal classes, midwifery costs when not associated with delivery.
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17.
Complications of pregnancy costs arising where the date of conception is within the first 12 months from the Commencement Date or Date of Entry, whichever is the later.
For compulsory group schemes of more than five employees complications of pregnancy costs arising during the first 12 months from the Commencement Date or Date of Entry, whichever is the later.
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18.
Treatment directly or indirectly arising from or required in connection with male and female birth control, infertility and/or fertility and sterilisation (or its reversal).
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19.
Any form of assisted conception or any complications thereof including, but not limited to, premature or multiple births following assisted conception. A declaration of health is required in respect of all Dependants who are born following assisted conception. We reserve the right to reject any application without giving any reason.
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20.
Treatment of impotence or any Related Condition or consequence thereof.
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21.
Treatment directly or indirectly associated with a sex change and any consequence thereof.
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22.
Venereal disease or any other sexually transmitted diseases or any Related Condition.
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23.
Routine or restorative dental Treatment, whether or not performed by a Medical Practitioner or Dental Practitioner or a Specialist or an oral and maxillofacial surgeon.
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24.
Orthodontic Treatment, gingivitis, and periodontitis or any Related Condition.
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25.
Costs in respect of a psychotherapist, psychologist (unless referred to by and under a psychiatrist under Benefit 6 of the Policy), family therapist or bereavement counselor.
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26.
Treatment for learning difficulties, hyperactivity, attention deficit disorder, speech therapy, developmental, social or behavioural problems in children.
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27.
Treatment for alcoholism, drug or substance abuse or any addictive condition of any kind and any injury or illness arising directly or indirectly from such abuse or addiction.
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28.
Suicide or attempted suicide, wilfully self-inflicted Bodily Injury or illness or injury sustained directly or indirectly as a result of the Insured Person committing a criminal offence.
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29.
Travel and accommodation costs unless specifically agreed by Us in writing prior to travel. No travel and accommodation costs are payable where Treatment is obtained solely as an Out-Patient, including the costs of a hire car.
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30.
Costs and expenses incurred where an Insured Person has travelled against medical Advice.
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31.
Elective Treatment in the United States of America. However, Accident and Emergency Treatment is covered in full where the Treatment is given immediately in the Accident and Emergency unit of a Hospital, unless they are pre-existing Medical Conditions, or where symptoms existed prior to travel. In the event of Accident and Emergency Treatment being required in the USA You should contact Us or Our 24 hour medical helpline either before or as soon as possible after admission to the Accident and Emergency unit of the Hospital. Complications of pregnancy and/or childbirth are not deemed to be Accident and Emergency Treatment for the purposes of this Policy.
Additionally Benefit is payable for medical expenses which arise as a result of an Emergency, which do not require You to seek Treatment in the Accident and Emergency unit of a Hospital whilst You are temporarily travelling in the United States of America and where the Medical Condition did not exist prior to travel. Benefit is limited to £315, €/US$500 per Insured Person and an Excess of £50, €/US$80 per Medical Condition.
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32.
Treatment and expenses directly or indirectly arising from or required as a consequence of: war, invasion, 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 Act of Terrorism, unless the Insured Person sustains Bodily Injury whilst an innocent bystander resulting from an Act of Terrorism only up to a maximum amount £30,000, €/US$50,000 per Insured Person per incident.
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33.
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.
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34.
Regardless of any contributory clause(s), this insurance does not cover Treatment of a Medical Condition which is in any way caused or contributed to by an Act of Terrorism involving the use or release or the threat thereof of any nuclear weapon or device or chemical or biological agent. If We allege that by reason of this exclusion any claim is not covered by this insurance the burden of proving the contrary shall be upon You.
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35.
Treatment for sleep related breathing disorders, including snoring, fatigue, jet lag or work related stress or any Related Condition.
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36.
Dietary supplements and substances which are available naturally, and can be purchased without prescription including but not limited to vitamins, minerals and organic substances.
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37.
Home visits by a Medical Practitioner, Specialist or Qualified Nurse unless specifically agreed by Us in writing prior to consultation.
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38.
The Excess amount as shown in Your Policy Schedule will be deducted from all eligible medical expenses in respect of each new Medical Condition.
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