Health Insurance Policy: Exclusions & Limitations

Exclusions 

• Accident and Emergency Services.
• Alcohol, drug, substance abuse and treatment required for any related conditions.
• Amounts claimed in excess of the overall maximum annual limit for any given policy year. Any continuing treatment or other medical conditions are excluded thereafter.
• Allergic conditions that the insured is aware of.
• Birth control of any form for both male and female (e.g. Vasectomy, sterilisation) or reversing the process.
• Claim for benefits once treatment has already taken place on the National Health Service.
• Congenital birth defects, including the correction of congenital abnormalities.
• Cosmetic surgery or any treatment intended to improve a patient’s appearance for psychological or personal reasons and not due to medical necessity.
• Dental treatment and/or investigation including periodontal treatment or malocclusions other than covered in-patient procedures.
• Dialysis for renal failure, other than acute, reversible kidney failure.
• Eye surgery for the corrective purpose of refracting defects of the eye or routine sight testing.
• Experimental, unproven treatment or drug therapy.
• Failure to follow medical advice, prescribed care and complications arising from ignoring such advice.
• GP charges (including administrative) and GP referrals except physiotherapy.
• Growth hormone treatment.
• HIV/AIDS/ related conditions and any other sexually transmitted diseases.
• HRT (Hormone Replacement Therapy) and any treatment for menopausal symptoms.
• Infertility and sub-fertility. This includes treatments such as IVF.
• Learning difficulties, behavioural and development problems, dyslexia and ADHD (Attention Deficit Hyperactivity Disorder).
• Organ transplant procedures including stem cell and bone marrow transplants. We will pay benefits for corneal and skin grafts.
• Out-patient drugs or dressings.
• Out-patient treatment received outside the UK.
• Palliative care.
• Pre-existing conditions unless such conditions have previously manifested themselves but have been declared to and accepted by us in writing. However, after two years continuous cover, all pre-existing conditions (and related conditions) will become eligible for benefit providing you have not:

1. Consulted any general practitioner or specialist treatment or advice (including check-ups) or from which you have suffered symptoms; or

2. Taken medication (including drugs, medicines, special diets or injections)

For a continuous period of two years after the start of your cover (known as the Moratorium period) Unless: 

3. Such medical conditions have previously manifested themselves but have been declared and accepted by us in writing.

• Pregnancy and childbirth unless complications occur in which case benefit will be paid if the policy has been in force for a minimum of 11 months. We will not pay benefits for childbirth complications arising from a pre-existing anatomical abnormality nor for foetal surgery.
• Pregnancy termination.
• Preventative treatment or procedures.
• Primary care.
• Professional sports injury.
• Psychiatric, psychological or mental illness, or any other condition normally treated by a psychiatrist or psychologist.
• Recuperative care.
• Removal of fat or healthy tissue from any part of the body whether or not it is needed for medical or psychological reasons (including but not limited to breast reduction).
• Repatriation. The costs of being transported back to the UK.
• Routine monitoring or occupational check-ups carried out over a long period of time or for screening purposes whether or not they have been approved by a GP or specialist (e.g. routine mammogram or prostate specific antigen tests).
• Self-inflicted conditions or any injury incurred from attempted suicide.
• Services or treatment at any long term care facility, nursing home, spa, hydro-clinic or sanatorium that is not a hospital.
• Sex change or gender reassignment whether or not for psychological reasons.
• Sexual problems: impotence, psycho-sexual dysfunction, whether or not for psychological reasons.
• Sleep apnoea, snoring.
• Surgical/medical appliances, such as aids or equipment, including optical and hearing aids, dentures and dental appliances. (Artificial apparatus or prostheses inserted during a surgical procedure are covered).
• Terrorism which involves the use or release or threat thereof of any nuclear weapon or any chemical or biological agents.
• Treatment of a non-acute condition or a chronic condition.
• Treatment received outside the UK except when benefit for in-patient treatment has been pre-authorised.
• Treatment diagnosed outside the UK.
• Treatment received from a chiropractor, osteopath, homeopath or any other alternative therapy practitioner.
• Treatment required directly or indirectly as a result of not undergoing authorised in-patient treatment within six months of the date approval.
• Varicose vein treatments.
• War, invasion, acts of foreign enemies, hostilities (whether war declared or not), civil war, rebellion, revolution, insurrection, military or usurped power.
• Weight control surgery, special diets, weight loss prescription medicines and weight loss programmes.
• Winter sports.