What is excluded?
Certain benefit sections might have specific exclusions that apply in
addition to these general exclusions. In addition to any specific exclusions
set out in each benefit section, we will not pay a claim for or in the event
of any of the exclusions listed below.
1. Cosmetic surgery.
2. Suicide, attempted suicide or willful injury to oneself.
3. The use of any drug or narcotic, legal or illegal, unless prescribed by and taken in according to the instructions of a medical practitioner.
4. The failure of the insured person to follow any medical advice given by a medical practitioner.
5. Any incident, illness, accidental harm or event directly or indirectly caused by the excessive consumption of alcohol or alcoholism.
6. Participation, or attempted participation, by
any insured in any of the following: - Any
defense force, police force, medical rescue
service, firefighting service, correctional
services facility or the disarming of
explosives; - Aviation activities where any
medical expense is insured by another party
(excludes fare- paying passengers in a
licensed passenger carrying aircraft).
incident, Illness, accidental harm or event as
a result of professional participation in
8. Riots, wars, political acts, public disorder,
or any acts, or attempted acts, of any of the
Civil commotion, labour disturbances, riot,
strike, lock-out or public disorder or any act
to bring about any of the above;
War, invasion, act of foreign enemy,
hostilities, civil war;
Mutiny, military rising or usurped power,
martial law or state of siege, insurrection,
rebellion or revolution;
Any act directed to overthrow or influence
any state or government or any provincial,
local or tribal authority with force or by
means of fear, terrorism or violence;
Any act to further any political aim,
objective or cause, or to bring about any
social or economic change, or in protest
against any state or government, or any
provincial, local or tribal authority, or for the
purpose of inspiring fear in the public
9. Any claim, service or benefit
that does not form part of this policy.
10. Any claim for unapproved tests or
11. The following procedures, items, services,
service providers or events:
All specialised dental procedures like
crowns, bridges, dental implant related
procedures, orthognathic surgery, temporo
-mandibular joint (“TMJ”) surgery, labial
frenectomy, bone augmentations, bone or
Step-down facilities if not medically
required, for example frail care;
TTO (to-take-out) medicines exceeding six
All services obtained from a noncontracted
provider, where no pre-authorisation was
obtained for treatment at a contracted
12. Any criminal act or attempted criminal
act by an Insured, which include the
submission of any fraudulent information, or
other fraudulent means, to get any benefit
or service under this policy.
13. Expenses incurred for non-emergency
transport charges whether or not such
vehicle, vessel or craft is specifically
designed for the purposes of medical
14. Any act by an Insured that wilfully
exposed the Insured to danger, except
where such act was in order to save human
life or prevent accidental harm.