Policy Exclusions - GHS
This contract does not cover any hospitalization, surgery or charges cause directly or indirectly, wholly or partly, by any one (1) of the following occurrences:
1. 30 days “Waiting Period”
- Any treatment/admission in any Hospital occurring during the first 30 days period from the policy commencement date or registration date is not covered by the Plan except for treatment/admission due to accidental cases only.
- This clause shall not be applicable after the first year of cover. However, if there is a break in between the takaful/insurance cover from one period to another, the Waiting Period shall apply again.
2. Pre-existing illness.
- Any treatment / admission in any hospital due to pre-existing illness are not covered for 1st one (1) year coverage period.
- Pre-existing Illness Condition means the disability existed or have developed symptoms or there exist manifestation of illness before the effective date of cover in respect to a covered person of which the covered person was aware or should reasonable have been aware, or based on normal medically accepted pathological development of the illness or illnesses.
- Consultation with a medical doctor for any sign or pain or discomfort shall constitute a manifestation or symptom of a disability.
- The status of pre-existing illness will be confirmed by the doctor who treated the patient prior to admission or before requesting for a guarantee letter.
3. 120 days Specific Illness
- Any admission in any hospital occurring during the first 120 days period from policy commencement date or registration date due to Specific Illnesses are not covered.
- Specific Illness means the disabilities occurring within the first 120 days of this takaful/insurance contract or from policy commencement date or from student registration date, irrespective of whether the covered person/student was aware of the disability or not. The specific illness specified in the policy contract are as follows
- Endometriosis/Adenomyosis
- Hernia / Hemorrhoids / Fistulae
- Tumour/ Cysts/ Nodules/ Polyps / Lumps of all kinds
- Stones in the Urinary / Biliary Systems
- Gastric / Duodenal Ulcers
- Cataracts
- Cholecystitis/ Cholelithiasis/ Calculi of the Urinary Organ
- Spinal Disorders requiring surgery
- Diabetes Mellitus
- Nasal Conditions requiring surgery
- Tonsils requiring surgery
- Hypertension or Cardio-vascular Diseases
4. Plastic/Cosmetic surgery, circumcision, eye examination, glasses and refraction or surgical correction of nearsightedness (Radial Keratotomy or Lasik) and the use or acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions thereof.
5. 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.
6. Private nursing, rest cures or sanitaria care, illegal drugs, intoxication, sterilization, venereal disease and its sequelae, AIDS (Acquired immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV related diseases, and any communicable diseases required quarantine by law.
7. Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions.
8. Pregnancy, child birth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care and surgical, mechanical or chemical contraceptive methods or birth control or treatment pertaining to infertility. Erectile dysfunction and tests or treatment related to impotence or sterilization.
9. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
10. Hospitalization primarily for investigatory purposes, diagnosis, X-ray examination, general physical or medical examinations, not Incidental to treatment or diagnosis of a covered Disability or any treatment which is not Medically Necessary and any preventive treatments, preventive medicines or examinations carried out by a Physician, and treatments specifically for weight reduction or gain.
11. War or any act of war, declare or undeclared, criminal or terrorist activities, active duty in any armed forces, direct participation in strikes, riots and civil commotion or insurrection.
12. Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material.
13. 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.
14. 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, Bone setting, herbalist treatment, massage or aroma therapy or other alternative treatment.
15. Care or treatment or which payment is not required or to the extent which is payable by any other insurance or indemnity covering the insured and Disabilities arising out of duties of employment or profession that is covered under a Workman’s Compensation Takaful Contract.
16. Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations).
17. Costs/expenses of services of a non-medical nature, such as television, telephones, telex services, radios or similar facilities, admission kit/pack and other ineligible non-medical items.
18. Sickness or injury arising from racing of any kind (except foot racing), hazardous sports such as but not limited to skydiving, water skiing, underwater activities requiring breathing apparatus, winter sports, professional sports and illegal activities.
19. Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes.
20. Expenses incurred for sex changes.
21. Terrorism.
22. Any treatment arising from alcoholic or drug addiction.
23. Any breach of the civil or Syariah Law by the members.
For detail description of the covered benefits, please refer to the Policy Contract/ Policy Information Statement.
