Outpatient Exclusions
Exclusions List – Applicable to Outpatient General Practitioner
This coverage plan does NOT COVER any treatment, surgery or charges caused directly or indirectly, wholly or partly, by any one (1) of the following occurrences:
- OP Treatment within 14 days of waiting period shall apply to
- New registered students AND
- Existing students who registered 2 months after policy commencement/renewal date.
- Outpatient specialist visit in any private hospital and/or specialist clinic in private hospital.
- Plastic/Cosmetic Surgery or Treatment of their complications (inclusive of double eyelids, acne, keloid etc), circumcision unless Medically Necessary, eye examination, glasses and refraction or surgical correction of near-sightedness (Radial Keratotomy), longsightedness, astigmatism and the use, rental or acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids, aero chambers, equipment for nebulising, implanted pacemakers, lens (except for basic lens) and prescriptions thereof.
- Dental conditions including dental treatment or oral surgery except as necessitated by Accidental Injuries to sound natural teeth occurring wholly during the Period of Insurance.
- Treatment, therapy for congenital or hereditary Diseases, deformities and Disabilities and any medical or surgical complication arising therefrom e.g. childhood hernias, clubfoot, Ventricular Septal Defect, Atrial Septal Defect, Thalassemia etc.
- Pregnancy, pregnancy related or its complications, child birth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care and surgical, mechanical or chemical contraceptive methods of birth control or treatment pertaining to infertility. Erectile dysfunction and tests or treatment related to impotence or sterilization.
- Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
- War or any act of war, declared or undeclared, criminal or terrorist activities, active duty in any armed forces, direct participation in strikes, riots and civil commotion or insurrection.
- Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material.
- Expenses incurred for donation of any body organ by an Insured Person and costs of acquisition of the organ including all costs incurred by the donor during organ transplant and its complications.
- Investigation and treatment of sleep and snoring disorders, hormone replacement therapy and alternative therapy such as treatment, medical service or supplies, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, bonesetting, herbalist treatment, massage or aroma therapy or other alternative treatment.
- Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations) and any other conditions classified under the “Diagnostic & Statistical Manual of Mental Disorders (DSM-IV Codes) as published by American Psychiatric Association.”
- Costs/expenses of services of a non-medical nature, such as newspapers, television, telephones, telex services, radios or similar facilities, admission/inpatient kit/pack, discharge pack, laundry, electricity, extra meal and other ineligible non-medical items.
- Expenses incurred for sex changes.
- Circumcision unless medically necessary for treatment of a disease.
- Any treatment directed towards developmental delays and/or learning disabilities in Insured children.
- Cosmetic (aesthetic) surgery or treatment, or any treatment which relates to or is needed because of previous cosmetic treatment. However, we will pay for reconstructive surgery if:
- it is carried out to restore function or appearance after an accident or following surgery for a medical condition, provided that member has been continuously covered under a plan of ours since before the accident or surgery happened; and
- it is done at a medically appropriate stage after the accident or surgery; and
- we agree to the cost of the treatment in writing before it is done.
- Private nursing care and house calls by doctors for any reasons.
- Hormone therapy
- Vitamins, Food Supplement, Herbal Cures, Anti-Obesity/Weight Reducing Agents including off the counter medications.
- Soaps, shampoos, vitamin creams and vitamin ointment.
- Blood and topical allergy testing.
- Routine physical examination, health check-ups including Gynae check-ups or tests not incidental to Treatment or diagnosis of a covered Disability.
- Outpatient physical therapy or physiotherapy is not covered under Outpatient General Practitioner Clinical Treatment.
- Care and Treatment that is experimental, investigative and not according to accepted professional standards and care that is not Medically Necessary.
- Any Treatment for or arising from substance abuse such as alcohol, narcotics, etc.
- Diseases or Disabilities of a newborn Child contracted prior to or during birth of within the first 14 days hereafter.
- Speech and Occupational Therapy.
- Outpatient rehabilitation therapy, chemotherapy, radiation therapy and kidney dialysis are not covered under Outpatient General Practitioner Clinical Treatment.
- Preventive Vaccinations / Immunisations except for the following that are applicable to eligible Children only (subject to Outpatient Benefit limit, if any):
- BCG (booster);
- Hepatitis B (infants up to 1 year old)
- Triple Antigen & TETRAct-HIB (infants up to 1 year old);
- Double Antigen (booster), including Oral Polio;
- MMR;
- Rubella.
