Exclusion

 

 No benefit shall be payable for any of the following services, products or conditions or injuries resulting from:

1.1 Cosmetic surgery or treatment including (but not limited to) for e.g. double eyelids, acne, keloids, scars, skin tags, diffused alopecia /  hair loss, etc., or treatment of their complications except as medically necessitated by accidental injuries within six months from primary treatment. For the purposes of this exclusion “primary treatment” means the first treatment receives in treating an accidental injury.

 

1.2 Care and treatment that is experimental, investigative and not according to accepted professional standards and / or is not medically necessitated. This exclusion includes (but is not limited to) treatments such as:

      1.2.1 stem cell treatment, related workout and any complications arising thereafter;

      1.2.2 blood surety;

      1.2.3 treatment for menopause disorders, except for surgically induced menopause.

 

1.3 Treatment arising from injuries sustained while committing a crime or felony, or while under the influence of alcohol, narcotics, or mind altering substance or injuries which are self-inflicted while sane or insane.

 

1.4 Private nursing care or house calls engaged by Participant(s) or services for rest cure provided by rest / nursing home purely for recuperative purposes. Otherwise a Participant(s) must have a private nursing care coverage subject to its limitations.

 

1.5 Contraceptive medications and devices, sterilization procedures or treatment for its complications, reversal of such procedures and the work up or treatment of sexual dysfunction or infertility, sex transformation surgery and sex hormone therapy.

 

1.6 Investigation and treatment relating to pregnancy including childbirth, Ectopic Pregnancy and Vesicular Mole and all complications arising therefrom. However this exclusion does not apply to any miscarriage of below 28 weeks due to accidental causes under the Basic Group Health Plan coverage but is subject to its limitations for such coverage.

 

1.7 Circumcision unless Medically Necessary for treatment of a disease.

 

1.8 Conditions related to sexually transmitted diseases, AIDS and AIDS Related Complex or its sequelae, and any communicable diseases requiring quarantine by Malaysian law.

 

1.9 Alternative therapies such as (but not limited to) Acupuncture, Acupressure, Chiropractic, Osteopathy, Reflexology, Bone-setting, Massage, Aroma Therapy, Herbal, Podiatric, Dietetic consultation and treatment, etc. Otherwise, a Participant(s) must have traditional medical accidental treatment coverage subject to its limitation.

 

1.10 Vitamins and related creams or ointments, Food Supplements, Herbal Cures, Anti Obesity / Weight Reducing Agents, Eye Lubricants, cleansing or cosmetic products and any off the counter purchases of supplements or medicines.

 

1.11 Psychotic, mental or nervous disorders and behavioral conditions including any neurosis and their physiological or psychosomatic manifestations, and sleep disorders.

 

1.12 Any treatment or assessment for congenital, hereditary or developmental aliments, deformities and any disability or complications arising there from inclusive of but not restricted to such as dermoid cycts, childhood hernias / hydrocele (all hernia up to age of six is not covered), clubfoot, Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD), Thalassemia, Squint, Haemangioma etc.

 

1.13 Diseases or disabilities of a newborn child contracted prior to or during birth or within the first 15 days thereafter.

 

1.14 Routine physical examinations, health check-ups, preventive treatments, vaccinations and diagnostic tests not incidental to treatment or diagnosis of a covered disability.

 

1.15 Speech and Occupational therapy when not part of a rehabilitation program following hospitalization due to trauma, unless it is a follow-up to an inpatient disability and subject to its limitations.

 

1.16 Any corrective treatment including glasses or contact lenses for refractive errors inclusive of but not limited to the following such as Orthoptics, Visual stimulation, Radial Keratotomy, Lasik, Intralase, Zyoptics, PhakiclOL implant or intr-ocular lense replacement surgery

 

1.17 Any dental treatment or surgery except when required due to an injury sustained in an accident under Basic Group Health Plan coverage, subject to its limitations.

 

1.18 Use or acquisition of all external appliances (e.g. artificial limbs, hearing aids, aero chambers and equipment for nebulising, continuous positive airway pressure (CPAP), continuous ambulatory peritoneal dialysis (CAPD), orthopedic pads) and the rental charges of such devices except during Hospital confinement under the Basic Group Health Plan coverage but is subject to its limitation for such coverage. If however, an Participant(s) has Major Medical Benefit coverage, it shall be subject to its respective benefit limitations.

 

1.19 Any treatment directly or indirectly arising from exposure to radioactive, explosive or hazardous nature of nuclear fuel materials or property contaminated by nuclear fuel materials, or accident arising from such nature.

 

1.20 War, direct or indirect participation in riots, rebellions, insurrection or military, civil commotion, explosion of war weapons, revolution, act of foreign enemy or hostilities.

 

1.21 Services of a non-medical nature provided by a Hospital such as television, telephone, fax, radio or similar facilities. Charges for these services must be paid by the Participant(s) prior to discharge from Hospital or daycare center unless otherwise specified.

 

1.22 Out-Patient physical therapy or physiotherapy is not covered. If however, a Participant(s) has Outpatient Rehabilitation Therapy Benefit coverage, it shall be subject to its respective benefit limitations and only be covered when referred by a Specialist and treatment must be provided by a registered physiotherapist.

 

1.23 Outpatient rehabilitation therapy, chemotherapy, radiation therapy, immunotherapy, photodynamic therapy, kidney dialysis and other selected treatment protocols (e.g antiviral / interferon therapy for hepatitis / multiple sclerosis, Lucrin injections for endometriosis, intra articular injections, etc.), unless a Participant(s) has the Chemotherapy, Radiation Therapy coverage, subject to its respective benefit limitations.

 

1.24 Expenses incurred for donation of any body organ by a Participant(s) and costs of acquisition of the organ including all costs incurred by the donor during organ transplant. Otherwise, Participant(s) must have organ transplant coverage subject to its limitations.

 

1.25 Illness or injury sustained during air travel except as a fare paying passenger on a recognized airline operating on scheduled air routes and air travel by any chartered aircraft duly licensed as a recognized air carrier and flown by professional crews between properly established and maintained airports.

 

1.26 Any dental treatment or surgery except when required due to an injury sustained in an accident under Basic Group Health Plan coverage, subject to its limitations. Otherwise a Participant(s) must have Dental Benefit coverage, subject to its limitations.

 

1.27 Allergy testing - blood / topical including patch test.

 

1.28 Preventive vaccinations except for the following those are applicable to eligible children only (subject to Outpatient benefit limit, if any)

        1.28.1 BCG (booster);

        1.28.2 Hepatitis B (infants up to 1 year old);

        1.28.3 Triple Antigen & Hib (infants up to 1 year old);

        1.28.4 Double Antigen (booster), including Oral Polio;

        1.28.5 MMR

        1.28.6 Rubella

 

1.29 Expenses incurred for contact lens, use of cosmetic topically / orally / surgical procedures and any complications arising there from.

 

1.30 Outpatient surgical procedures which are part of any Hospitalisation Takaful or Insurance plan are not covered for Participant(s) and his/ her Dependents within this Certificate.

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