Group Medical (Group Outpatient Medical, Group Basic Medical and Group Major Medical)
We will not pay any benefit under this Policy for any of the following occurrences:
1. Pre-existing Conditions, the cause or pathology of which already existed prior to the Effective Date, whether the Insured Person was aware of it or not; unless he has already been insured continuously for 12 months
- under this Policy; or
- under any Group Hospital & Surgical Insurance Policy issued in Singapore immediately prior to the Effective Date. This waiver is not applicable if You have less than 11 Insured Persons at the Policy Commencement Date.
The above exclusion is not applicable to Group Outpatient Medical.
Pre-existing Conditions which existed prior to the commencement of insurance coverage of the Insured Person under this Policy whether known or unknown to the Insured Person will be permanently excluded under Group Major Medical.
2. Intentional, self-inflicted injury sustained as a result of a criminal act of the Insured Person, suicide or attempted suicide, whether the Insured Person is sane or insane; psychological, emotional, behavioural or mental problems or conditions of the Insured Person; alcoholism or over indulgence in alcohol, drug abuse or addiction of the Insured Person.
3. Congenital anomalies or genetic defects, including hereditary conditions of the Insured Person present at or existing from the time of his birth irrespective of when the Insured Person discovered or underwent treatment or surgical procedure for the same.
4. Treatment relating to assisted reproduction, sterilization (or its reversal), birth control, infertility and impotency including treatment or surgical procedures done at fertility clinics, in-vitro fertilization clinics, reproductive medicine or assistance clinics or centres or any treatment or procedures occasioned by or resulting from pregnancy, childbirth ,abortion or termination of pregnancy, or any form of related hospitalisation or treatment including any complications arising from any of the above.
5. Any dental work or treatment, oral surgery, periodontics, endodontics, preventative dentistry, orthodontics and orthognathic surgery or temporo-mandibular joint disorder unless it is an accidental injury due to natural teeth caused by an external trauma.
6. Eye examination, surgical procedure for any corrective treatment for refractive errors inclusive of but not limited to the following such as myopia, hypermetropia, visual stimulation, radial keratotomy, lasik, surgical correction of squint for reasons other than vision impairment, procurement or use of all corrective glasses or contact lenses, except monofocal non-toric intraocular lenses in cataract surgery, (unless the Insured Person is below 8 years old) and plastic/cosmetic surgery or treatment including but not limited to double eyelids, acne, xanthelasma, syringoma, keloids, scars, skin tags, gynaecomastia, breast reduction mammoplasty, diffused alopecia / hair loss, etc., or treatment of their complications. The exclusions include surgical excision or reformation of any sagging skin on any part of the body, including, the eyelids, face, neck, abdomen, arms, legs or buttocks; and services performed in connection with the enlargement, reduction, implantation, or change in appearance of portion of the body, including, the breast, face, lips, jaw, chin, nose, ears or genital except to the extent that such surgery is necessary for the repair of damage caused solely by bodily injuries sustained in an Accident.
7. Treatment of xanthelasma, syringoma, acne, alopecia, cosmetic skin surgeries, inguinal hernia and hydrocele and all complications arising from any of the same; except where the Insured Person who is under treatment for inguinal hernia and hydrocele is more than five (5) years old.
8. Hospitalisation primarily for investigatory purposes, routine physical examinations, health check-ups, genetic or health screening (irrespective of whether there is Hospital confinement), preventive treatments and diagnostic tests not incidental to treatment or diagnosis of a covered Disability. Vaccination/immunization and any complications thereof are not payable.
Alternative therapies such as but not limited to acupuncture, acupressure, chiropractic, osteopathy, reflexology, bone setting, massage, aroma therapy, herbal, podiatric, dietetic consultation and treatment, education services/therapies and traditional complimentary medicine and the like and other unconventional medical practices not normally practiced by a Registered Medical Practitioner are not payable.
9. Rest cures, sanatoria care or special nursing care or any treatment or services that are not medically necessary or reasonably required for Illness or bodily injury caused by an Accident.
10. Treatment of all sleep disorders, including sleep apnoea, sleep study test and insomnia. Treatment for all types of learning disorders, behavioural and developmental conditions including physical and psychological developments, this includes assessment and grading of such conditions. Treatment of obesity or any medical condition which arises from, or is related to, obesity in anyway including but not limited to the use of gastric banding or bypass or stapling, removal of fat or surplus tissue from any part of the body, weight control services including medical treatments, weight control/loss programs, dietary regimens and supplements, medications; food or food supplements, exercise programs, exercise or other equipment; and other services and supplies that are primarily intended to control weight or treat obesity, including severe obesity, or for the purpose of weight reduction, regardless of the existence of co-morbid conditions, medical or psychological reasons.
11. Circumcision (except where it is medically necessary) or treatment relating to the same.
12. Sexually transmitted diseases, Acquired Immune Deficiency Syndrome (AIDS), AIDS related complexes and all illnesses or diseases associated with the Human Immuno Deficiency Virus (HIV).
13. Injuries and disabilities sustained from direct participation in a strike, riot or civil commotion, insurrection, hostilities or any war-like operations (whether war be declared or not) or in the commission of any criminal offence.
14. Implants (homograft, heterograft, artificial) and prosthesis (except as provided under PART III – BENEFIT PROVISIONS, Section 2 - Benefits, Clause 2A(xiv) under Hospital Miscellaneous Services); procurement or use of wheel-chair, dialysis machine and any other hospital-type equipment.
15. Non-medical items such as, but not limited to, parking fees, Hospital Administration ((such as General Admission procedure and admission assessment fee) and Registration fees, laundry, rental of television, newspaper, medical report fees (for reports not requested by us). vitamins/supplements, herbal cures, anti-obesity / weight reducing agents, eye lubricants, soaps, shampoos, cleansers, moisturizers, scar creams, anti-aging, fairness cream and any over the counter purchases of supplements, medicines or outpatient prescribed and nonprescribed medical supplies.
16. Any charges made by Registered Medical Practitioner, Hospital, or any such medical service which are not reasonable and customary; including but not limited to inpatient treatment for medical condition which can be properly treated as an outpatient.
17. Experimental or pioneering medical or surgical techniques; and medical devices including medical treatments that were of an investigational or research nature, not approved by Health Sciences Authority or any other authority and the Centre of Medical Device Regulation; as well as clinical trials for medicinal products, whether or not these trails have a clinical trial certificate issued by the Health Sciences Authority.
18. Hormone therapy and hormone replacement therapy except for medical reasons or maintenance therapy post- surgery of approved medical condition.
19. Gender re-assignment or gender confirmation including treatment which arises from or is directly or indirectly made necessary by a gender re-assignment or gender confirmation.
