Last Updated on: Tuesday, 19 Mar 2024

The following Treatments, events, conditions, activities and their related or consequential expenses are excluded from the Policy, unless specifically agreed upon in writing by the Company:

Pre-existing Medical Condition, except if covered by the Company, in writing, after four policy years.

• Any charges in respect of the donor for organ transplant Claims.


• Any medical condition diagnosed or treated within the General Waiting Period of fifteen (15) days from the effective date of this policy, except for the Accidental Emergencies. This exclusion will not apply for subsequent renewals with the Company without a break.


• Any increase in the expenses incurred for Treatment on account of the Insured Member being admitted to more expensive accommodation than allowed by his room and board entitlement.


• Routine medical examinations or check-ups including charges arising out of any Hospital confinement or admission primarily for diagnostic purposes unless specifically authorized by the company, routine eye or ear examinations, vaccinations, medical certificates, examination for employment or travel, spectacles, contact lenses, hearing aids. Cost of correction of refractive errors of the eye and procedures such as Radial Keratotomy and Excimer Laser and any Treatment not considered Medically Necessary.


• All dental Treatment or oral surgery apart from Emergency Accidental Dental Treatment for pain relief only within forty eight (48) hours of an Accident.


• Any Out-Patient Treatment, except Emergency Accidental Out-Patient Treatment within forty eight hours of the Accident.


• Cosmetic or plastic surgery, unless it is re-constructive surgery that is medically necessary and results as a consequence of an Accidental Injury that occurred within the duration of the Policy.


• Pregnancy and complications thereof, childbirth (including surgical delivery), miscarriage, abortion and/or any related prenatal or postnatal care.


• Tests or Treatment relating to fertility, infertility, contraception or sterilisation.


• Birth defects or congenital Illness.


• Prostheses, corrective devices and medical appliances which are not surgically required.


• Any Treatment or test in connection with Acquired Immune Deficiency Syndrome (“AIDS”), any AIDS-related Complex Syndrome (ARCS) and any other AIDS-related conditions or diseases.


• Self-inflicted Injury, attempted suicide, abuse of alcohol, drug addiction or abuse and Treatment of any sexually transmitted diseases.


• Psychotic, mental or nervous disorders (including any neuroses and their physiological or psychosomatic manifestations) or sexual reassignment (whether or not for psychological reasons).


• Any experimental or unproven Treatment.


• Injury or Illness due to participation in or training for any dangerous or hazardous sport pastime or competition or any professional sport (for example: sky diving, mountaineering, boxing, scuba diving etc).


• Injury or Illness resulting from war, riots, invasion, act of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, mutiny, civil commotion assuming the proportions of or amounting to a popular uprising, military uprising, insurrection, rebellion, military or usurped power or any act of any person acting on or on behalf of or in connection with any organization actively directed towards the overthrow or to the influencing of any government or ruling body by force, terrorism or violence.


• Injury or Illness due to Natural Catastrophes, Epidemic, including, but not limited to, flood, earthquake, avalanche and cyclone.


• Aviation other than as a fare-paying passenger of a recognized commercial airline or a chartered service.


• Injuries as a result of an illegal act of an Insured Member.


• Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste, from the process of nuclear fission or from any nuclear weapons material.


• Services or Treatment in any spa, hydro clinic, sanatorium, nursing home or long-term care facility that is not a Hospital.