Exclusions & Limitations of Private Health Insurance

Private Healthcare Insurance covers you for many illnesses, injuries and treatments. However, as with any medical insurance, there are exclusions and limitations to our policies.

Exclusions & Limitations

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:

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

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:

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.