When exclusions apply ?

Depending on the healthcare program chosen by the policyholder, please see below the list of the main exclusions:

– treatment performed by any person who is not legally licensed to carry out the said treatment ;
– any/all medical treatment that are not ordered by a doctor or that are not a medical necessity ;
– treatment for which the insured did not obtain prior approval or for which such approval was denied ;
– aesthetic treatment and cosmetic surgery of any type or nature, except following an accident (that occurs while this policy is in effect), with prior approval from the insurer and according to the terms, conditions and limitations as stipulated by the contract ;
– non emergency surgery for which no prior approval was given;
– charges for services or supplies ordered or received prior to the effective date of coverage or after the termination of coverage;
– para-pharmaceutical items such as cotton, rubbing alcohol, sunscreen… ;
– in the event of hospitalization, personal expenses such as telephone calls and television rental ;
– expenses considered as unusual and excessive with respect to the country in which they were incurred ;
– treatment against obesity or anorexia ;
– treatment for infertility (IVF) ;
– travel and accommodation expenses in relation with medical care ;
– laser refractive surgery / radial keratotomy (myopia surgery) ;
– orthodontic treatment (Platinum and Diamond included) ;
– Spas and thermal cure ;
– in-patient prescribed psychiatric treatment (Diamond included) ;
– expenses reimbursed or likely to be reimbursed by any other health plan or accident coverage ;
– medical care given in nursing homes or old-age homes or resulting from help provided to people in their everyday life, even if those people are suffering from permanent or temporary disability ;
– treatment considered as experimental ;
– room & board, treatment in a specialized establishment after a spa ;
– room & board, treatment in a physical therapy or rehabilitation facility ;
– all type of genetic testing ;
– dental prostheses (Platinum and Diamond included) ;
– speech or oculomotor or occupational therapies ;
– non prescribed inoculations or travel related inoculations ;
– pre-existing conditions are not covered or limited refund as stated in plan details and general conditions ;
– medical or dental care that is not up to the professional standards of the country where they were provided ;
– periodontics ;
– detoxification treatment ;
– all other psychiatric treatment, prescribed or non-prescribed ;
– pre operative care ;
– surgical prostheses not required intra – operatively ;
– chronic or end-stage kidney failure which has required regular or long-term dialysis ;
– long term care for chronic conditions & for disability are covered up to the maximum of the chronic conditions benefit ;
– chronic conditions are not covered or limited refund as stated in plan details and general conditions ;
– alternative medicine treatment when unrelated to an illness or accident ;
– hormone replacement therapy when considered as not a medical necessity or for gender re-alignment ;
– Any Claim arising from:

  • (i) self-inflicted Injury (including suicide or attempted suicide) ;
  • (ii) needless self-exposure to peril (except in an attempt to save human life);
  • (iii) travel undertaken against medical advice ;

For any further information please refer to the General Conditions or contact the Plan Administrator.

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