Under this plan, we will not cover conditions that result from any of the following events:
All benefits exclusions
- Any benefit not available under an insured member’s plan or charges exceeding the limits specified in the benefits schedule.
- Any claim arising directly or indirectly as a result of HIV/AIDS.
Life benefit exclusions
- Any pre-existing condition, which directly or indirectly, wholly or partly, caused the death of the insured employee, unless the insured employee affected by such condition has been covered under this policy continuously for 12 months.
- Suicide, whether while sane or insane, within 1 year from the effective date of the insured employee’s cover. In such event, AIA’s liability shall be limited to a refund of the total premiums paid for the life insurance coverage for the insured employee. (For any subsequent increase in life insurance coverage within 1 year from the effective date of the increase in coverage, AIA’s liability in respect of the increase in cover shall be limited to a refund of the total premiums paid in respect of such increase for the insured employee.)
Accident benefits exclusions
- Suicide, self-inflicted injuries or any attempt thereat, while sane or insane.
- War, declared or undeclared, revolution or any warlike operations.
- Riot and civil commotion, strikes or terrorist activities.
- Violation or attempted violation of the law or resistance to arrest.
- Entering, operating or serving, riding in or on, ascending or descending from or with any aerial device, or conveyance except while the insured employee is a fare-paying passenger in an aircraft operated by a commercial passenger airline on a regular scheduled passenger trip over its established passenger route.
- Racing on horse or wheels.
Medical benefits exclusions
Medical benefits include hospital income and surgical benefits, network outpatient benefits and worldwide emergency assistance services.
- Pre-existing conditions for which the insured member showed symptoms or received medical treatment, diagnosis, consultation or prescribed drugs within the 12 months preceding the effective date of the policy, unless the insured member has been insured under the policy continuously for 12 months.
- Investigation and treatment of psychological, emotional, mental or behavioral conditions; alcoholism or drug addiction; rest cure or sanitaria care; treatment of an optional nature; intentionally self-inflicted Injuries while sane or insane.
- Injuries arising directly or indirectly from war, declared or undeclared.
- Special nursing care; general physical or medical check-up or tests that are not incidental to treatment or diagnosis of an actual sickness or injury, or not medically necessary; immunisation, vaccination or inoculation.
- Procurement or use of any special braces, appliances, equipment, prosthetic devices, implants, contact lenses, eye glasses, hearing aids or the fitting of the same and non-medical services such as television, telephone and the like.
- Any dental or eye examination/treatment, surgical procedure for correction of eye refraction, cosmetic procedures or plastic surgery, unless such surgery is necessary for the repair of damage caused solely by accidental injury covered under the policy.
- Any investigation, treatment or surgery for congenital defect that gives rise to signs or symptoms, or is diagnosed, before the insured member reaches the age of 17.
- Birth control measures, investigation or treatment pertaining to infertility, genetic testing or counseling, treatment occasioned by or resulting from pregnancy, childbirth or abortion.
- Non-medically necessary health services.
- Experimental, investigational or unproven services unless authorised by the Company.
- Services and supplies for smoking cessation programmes and the treatment of nicotine addiction.
- Services rendered by a doctor, Surgeon or Chinese Medicine Practitioner (whether legally registered or not) with the same legal residence as the insured member, or is his family member, including spouse, brother, sister, parent or child; or services delivered by an agent of the Company.
- Acupuncture, tui na, hypnotism, massage therapy, aroma therapy, and other forms of alternative treatments.
- Clinical home care, custodial care in any setting, day care, hospice, private duty nursing or respite care unless prior approval is obtained from the Company.
- Other education services such as speech improvement, diabetic classes and nutritional services, or group support services.
Additional network outpatient benefits exclusions
- Treatment arising from infertility including in-vitro fertilisation or any other artificial method of inducing pregnancy.
- Charges related to birth control or sterilisation of either sex.
- Pregnancy and all matters related to pregnancy, childbirth, abortion or miscarriage.
- Accommodation, nursing and services received in health hydro, nature cure clinics, convalescent homes, rest home or similar establishments.
- Treatment arising from the abuse of drugs or alcohol.
- Treatment arising from self-inflicted injuries, whether sane or insane.
- Treatment arising from sexually transmitted diseases.
- Treatment arising from Human Immunodeficiency Virus Infection.
- Treatment for congenital abnormalities and complications arising from congenital abnormalities.
- Treatment arising from any psychogeriatric or psychiatric condition, including but not limited to psychoses, neuroses, depression, anxiety, anorexia nervosa, schizophrenia, behavioural disorders etc.
- Treatment arising from sexual dysfunction including but not limited to impotence, erectile dysfunction, premature ejaculation, regardless of cause.
- Charges for blood or blood plasma.
- Treatment arising from war, invasion, acts of foreign enemies, hostilities (whether war is declared or not), civil war, rebellion, revolution, insurrection or military or usurped power; or racing on horses or wheels or any form of powered water sports.
- Procurement or use of special braces, appliances, spectacles, hearing aids, wheelchairs, crutches or other equipment.
- Cosmetic surgery or treatment for cosmetic purpose such as consultation for Acne Vulgaris, weight problem, hair loss etc.
- Routine eye or hearing tests, routine or screening blood test, general check-ups, vaccination or inoculations.
- Correction of vision or eye refraction error such as myopia, hyperopia, presbyopia.
- Dental treatment unless necessitated by accidental injury to healthy teeth.
- Routine physical examinations and investigations.
- X-ray using contrast media such as Ba Meal, intravenous pyelogram etc.; advanced imaging including but not limited to computerised axial tomography scan, magnetic resonance imaging scan, positron emission tomography scan, and investigations involving radioactive substances.
- Radiotherapy and chemotherapy.
- Chronic illness; any diseases and disorders, with or without signs and symptoms, that persists for more than 6 months and requires regular medical attention, including but not limited to:
- AIDS • Chronic Hepatitis • Hyperthyroidism
- Allergic Rhinitis • Coronary Heart Disease • Hypothyroidism
- Alzheimer’s Disease • Diabetes Mellitus • Arthritis
- Mental Illness & Psychiatric Disorder • Asthma
- Gout • Onychomycosis • Cancer
- Heart Disease • Parkinson’s Disease • Chronic Bronchitis
- Heart Failure • Psoriasis • Chronic Eczema
- Hyperlipoidema • Renal Failure
- Hypertension • Systemic Lupus Erythematosus
The above list is for reference only. Please refer to the policy contract of this plan for the complete list and details of exclusions.