Under this plan, we will not cover conditions that result from any of the following events:
All benefits exclusion
Any claim directly or indirectly, wholly or partly caused by AIDS or HIV.
Life benefit exclusions
- If the death was caused, directly or indirectly, wholly or partly, by a pre-existing condition for which the insured employee showed symptoms or received medical treatment, diagnosis, consultation or prescribed drugs during the 12 months preceding the effective date of the cover, unless the insured employee affected by such pre-existing condition has been insured under this policy continuously for 12 months.
- In case of suicide, whether while sane or insane, within 1 year from the effective date of the cover, we will only offer a refund limited to the total premiums paid for life insurance benefit for the insured employee. This also applies to any subsequent increase in life insurance benefit that comes into effect within 1 year.
Accident benefit 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 servicing, 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 hospitalisation and surgical benefits, other benefits, increased overseas hospitalisation benefit (due to accident), extended benefits, supplementary major medical benefits, optional outpatient benefits and optional dental benefits.
- 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 cover, unless the insured member has been insured under the policy continuously for 12 months.
- Investigation and treatment of psychological, emotional, mental or behavioural 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.
- General physical or medical check-up or tests not incidental to treatment or diagnosis of an actual Sickness or Injury or any treatment which is not medically necessary; immunisation, vaccination or inoculation.
- Procurement or use of special braces, any appliances, any equipment or prosthetic devices, any 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 (except where and as covered under optional benefit) or eye examination/treatment, surgical procedure for correction of eye refraction, cosmetic procedures or plastic surgery except to the extent that such surgery is necessary for the repair of damage caused solely by accidental bodily injuries 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 counselling, treatment occasioned by or resulting from pregnancy, childbirth or abortion.
- Non-medically necessary health services inclusive of treatment, investigation, supplies and admission.
- Experimental, investigational or unproven services except when authorised by the Company.
- Services and supplies for smoking cessation programmes and the treatment of nicotine addiction.
- Services rendered by a Physician, Surgeon, or Chinese Medicine Practitioner (whether legally registered or not) with the same legal residence as the insured member or who is a member of the insured member’s family, including spouse, brother, sister, parent or child; or services delivered by an agent of the Company.
- Chinese Medicine Practitioner treatment, including Chinese herbal medicine, bonesetting, acupuncture and tui na (except where and as covered under optional benefit), hypnotism, massage therapy, aroma therapy, and other forms of alternative treatments.
- Clinical home care; convalescence or custodial care in any setting; day care; hospice, private duty nursing; 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 dental benefits exclusions
- Dental appliances.
- Charges for any dental procedures which are not included in the Benefits Schedule.
- Treatment by any person other than a dentist.
- Charges for dentures (except when necessitated by an accident).
- Charges for services and supplies that are partially or wholly cosmetic in nature, including charges for personalisation or characterisation of dentures, unless the services are recommended as necessary by a dentist.
The above list is for reference only. Please refer to the policy contract of this plan for the complete list and details of exclusions.