(a) Expenses incurred for Medical Services provided as a result of Pre-existing Conditions and any special exclusion(s) set out under the Policy, except for Disability which has been fully disclosed in the Application and Cigna Healthcare agrees not to classify as an exclusion under the Policy.
(b) Expenses incurred for treatments, procedures, medications, tests or services which are not Medically Necessary.
(c) Expenses incurred for the whole or part of the Confinement solely for the purpose of diagnostic procedures or allied health services, including but not limited to physiotherapy, occupational therapy and speech therapy, unless such procedure or service is recommended by a Registered Medical Practitioner for Medically Necessary investigation or treatment of a Disability which cannot be effectively performed in a setting for providing Medical Services to a Day Patient.
(d) Expenses incurred for treatment for Human Immunodeficiency Virus (“HIV”) and its related Disability, except such occurrences are covered under HIV/ AIDS treatment, “HIV Infection due to Blood Transfusion” under Optional Pharmacy Benefit (if applicable), or “Occupationally acquired HIV” under Optional Pharmacy Benefit (if applicable).
(e) Expenses incurred for Medical Services as a result of Disability arising from or consequential upon the dependence, overdose or influence of drugs, alcohol, narcotics or similar drugs or agents, self-inflicted injuries or attempted suicide, illegal activity, or venereal and sexually transmitted Disease or its sequelae (except for HIV and its related Disability, where the above (d) exclusion applies).
(f) Expenses incurred for – services for
- beautification or cosmetic purposes, except for breast reconstruction surgery covered by breast reconstructive surgery benefit; or
- correcting visual acuity or refractive errors that can be corrected by fitting of spectacles or contact lenses, including but not limited to eye refractive therapy, LASIK and any related tests, procedures and services.
(g) Expenses incurred for prophylactic treatment or preventive care, including but not limited to general check-ups, routine tests or screening procedures for asymptomatic conditions, screening or surveillance procedures based on the health history of the Insured Person and/or his family members, Hair Mineral Analysis (HMA), immunization or health supplements.
(h) Expenses incurred for dental treatment and oral and maxillofacial procedures performed by a Registered Dentist except for Emergency Treatment and surgery during Confinement arising from an Accident or to the extent covered by the Accidental Emergency dental treatment. Follow-up dental treatment or oral surgery after discharge from Confinement shall not be covered. For the avoidance of doubt, this exclusion shall not apply to Optional Dental Benefits (if applicable).
(i) Expenses incurred for Medical Services and counselling services relating to maternity conditions and its complications, including but not limited to diagnostic tests for pregnancy or resulting childbirth, abortion or miscarriage; birth control or reversal of birth control; sterilization or sex reassignment of either sex; infertility including in-vitro fertilization or any other artificial method of inducing pregnancy; or sexual dysfunction including but not limited to impotence, erectile dysfunction or pre-mature ejaculation, regardless of cause, except such occurrences of maternity conditions and its complications are covered under pregnancy complications.
(j) Expenses incurred for the purchase of durable medical equipment or appliances including but not limited to wheelchairs, beds and furniture, airway pressure machines and masks, portable oxygen and oxygen therapy devices, dialysis machines, exercise equipment, spectacles, hearing aids, special braces, walking aids, over-the-counter drugs, air purifiers or conditioners and heat appliances for home use, except such expenses are covered by home facility enhancement benefit for Stroke. For the avoidance of doubt, this exclusion shall not apply to rental of medical equipment or appliances during Confinement or on the day of the Day Case Procedure.
(k) Expenses incurred for traditional Chinese medicine treatment, including but not limited to herbal treatment, bone-setting, acupuncture, acupressure and tui na, and other forms of alternative treatment including but not limited to hypnotism, qigong, massage therapy, aromatherapy, naturopathy, hydropathy, homeotherapy and other similar treatments, except to the extent covered by the traditional Chinese medicine treatment and three Critical Illnesses auxiliary benefit. For the avoidance of doubt, this exclusion shall not apply to Optional Outpatient Benefits (if applicable).
(l) Expenses incurred for experimental or unproven medical technology or procedure in accordance with the common standard, or not approved by the recognised authority, in the locality where the treatment, procedure, test or service is received.
(m) Expenses incurred for Medical Services provided as a result of birth defect(s), Congenital Condition(s), Hereditary Condition(s), or any related Disability, except such occurrences of birth defect(s), Congenital Condition(s), Hereditary Condition(s), or any related Disability are covered under “Medullary Cystic Disease” under Optional Pharmacy Benefit (if applicable).
(n) Expenses which have been reimbursed under any law, or medical program or insurance policy provided by any government, company or other third party.
(o) Expenses incurred for treatment for Disability arising from War, civil war, invasion, acts of foreign enemies, hostilities, rebellion, revolution, insurrection, military or usurped power, or Terrorism.
(p) Expenses incurred for treatment for developmental conditions including but not limited to learning difficulties such as dyslexia, behavioral problems such as autism or attention deficit disorder (ADHD); or physical development problems such as short height.
(q) Expenses incurred for treatment for obesity, or which is necessary because of obesity, which includes but not limited to slimming class, aids and drugs. Cigna Healthcare shall only pay for gastric banding or gastric bypass surgery if the Insured Person has a body mass index (BMI) of fourty (40) or over and had been diagnosed as being morbidly obese; and can provide documented evidence of other methods of weight loss which have been tried over the past twenty-four (24) Calendar Months.
(r) Expenses incurred for artificial life maintenance including mechanical ventilation where such treatment will not or is not expected to result in the Insured Person’s recovery, or restore the Insured Person to his/her previous state of health, except such expenses are covered under “Vegetative State” under Optional Pharmacy Benefit (if applicable).
(s) Expenses incurred for fetal surgery or treatment.
(t) Expenses incurred for treatment for a related condition resulting from addictive conditions and disorders, including but not limited to smoking cessation.
(u) Expenses arising from sleeping disorders except for –
- sleep test (subject to a limit of one (1) sleep test per Policy Year) if there is a diagnosis of sleep apnea of the Insured Person; and
- treatment in relation to sleep apnea and as recommended in writing by a Specialist.
(v) Expenses incurred for or in connection with speech therapy that is not restorative in nature; or if such therapy is used to improve speech skills that have not fully developed, can be considered custodial or educational or intended to maintain speech communication.
(w) Expenses incurred for sex change operations or any treatment needed to prepare for or recover from these operations including complication arising out of such treatment.
(x) Expenses incurred for gene therapy and cell therapy.
(y) Expenses incurred for non-medical services, including but not limited to guest meals, radio, telephone, photocopy, taxes (apart from VAT and GST charged on Eligible Expenses), medical report charges, fax and the like.
(z) Expenses incurred for mental, psychiatric or nervous illness, personality disorder and character disorders, except such occurrences are covered under psychiatric treatments, post-Confinement/ Day Case Procedure auxiliary treatment, psychiatric outpatient treatment or psychological outpatient treatment, or “Alzheimer’s Disease/Dementia“ under Optional Pharmacy Benefit (if applicable).
(aa) Expenses incurred for organ transplantation, except such occurrences are covered under organ transplantation benefit or “Major Organ Transplantation” under Optional Pharmacy Benefit (if applicable).
(bb) Expenses arising from the Insured Person’s engagement and participation in:
- naval, military or air force service or operations, armed force or service with the police of any nation;
- professional sports or hazardous activities such as but not limited to rock climbing or mountaineering, parachuting, hang-gliding (whether powered or not), para-gliding, bungee-jumping or any kind of race other than by foot;
- cave, wreck or free diving, professional diving, diving without holding the correct diving certification such as a Professional Association of Diving Instructors (PADI) and diving at depths more than forty (40) meters;
- professional, semiprofessional or competitive winter sports, cross country skiing or snowboarding, ski or snowboard jumping, heli-skiing, off-piste skiing or snowboarding, speed skiing;
- working at height (over twenty (20) feet);
- operating heavy machinery;
- aviation or aerial activities, except air travel as a fare-paying passenger in or as a member of the aircrew of a properly licensed, fixed-wing multi-engined aircraft constructed to carry passengers and operated by a licensed commercial air carrier, or in a helicopter owned and operated by a commercial concern which is licensed for the regular transportation of fare-paying passengers provided such helicopter is operating only between commercial airports and/or licensed commercial heliports, and provided further that in either event such travel is not for the purpose of any trade or technical operation in or on the aircraft; or
- manufacture, storage, filling, breakdown, handling and transport of any explosive (including but not limited to firework or firecracker) or chemical material.
(cc) In respect of any Optional Dental Benefits (if applicable), in addition to the above (a) to (bb) exclusions, Cigna Healthcare shall not pay expenses incurred for the following:
- Appliances or restoration necessary to increase vertical dimension or restore an occlusion;
- Dental implants or transplants;
- Cosmetic dentistry procedures such as bleaching and veneers;
- Orthodontic services;
- Repair or replacement of orthodontic appliances;
- Placement of bone grafts or extra-oral substances in the treatment of periodontal disorders;
- Procedures or appliances to correct congenital malformations;
- Treatment of malignancies, cysts, or neoplasms;
- Replacement of lost or stolen dentures;
- Services or treatment for, or associated with, temporomandibular joint (TMJ) dysfunction or disorder, or for orthognathic surgery;
- Services or supplies intended to diagnose or treat any condition that is occupational Injury or Disease; or
- Replacement or additions to existing dentures or bridgework.
(dd) In respect of the Optional Pharmacy Benefit (if applicable), in addition to the above (a) to (bb) exclusions, Cigna Healthcare shall not pay expenses incurred for the following:
- Any drugs that are experimental or investigational; or
- Replacement of claimed Western Medications due to loss, theft, damaged, spoiled or expired.
In addition to the above (a) to (dd) exclusions, Cigna Healthcare shall not pay any Accidental Death Benefit in relation to or arising from the following:
(ee) Illness, Disease, bacterial or viral infection, even if contracted by an Accident. This does not exclude bacterial infection that is the direct result of an Accidental cut or wound or Accidental food poisoning.
(ff) Medical or surgical treatment, except where such treatment is rendered necessary by Injury within the scope of the Accidental Death Benefit.
(gg) Pregnancy, childbirth, miscarriage, abortion or complications arising from any of them even though such loss may have been accelerated or induced by Injury.
(hh) Any illegal act of the Insured Person in the country or territory where Injury occurs.
(ii) Being in a state of insanity or psychiatric or psychological disturbance.
(jj) Being under the influence of alcohol or drugs unless the drugs are properly prescribed by a Registered Medical Practitioner and were not taken for the treatment of drug addiction.
(kk) Driving any kind of vehicle while the alcohol level in the Insured Person’s breath, blood or urine is higher than the legal limit in the country or territory where Injury occurs.
(ll) Service in any armed force while: i) in the time of War; ii) under orders for warlike operations; or iii) restoration of public order. For the avoidance of doubt, armed force shall include any police force of a country or territory.
(mm) War or any act of War, invasion, act of foreign enemy, hostilities (whether War be declared or not), strike, riot and/or Civil Commotion, civil war, rebellion, revolution, insurrection, military or usurped power, or Terrorism.
(nn) Taking part in any air sport, air travel or any other kind of aviation activities, other than travelling as a fare-paying passenger on regular scheduled commercial aircraft which is provided and operated by an airline or air charter company which is properly licensed to do so.
(oo) Suicide, attempted suicide, suicide pact or deliberate self-inflicted Injury, while sane or insane.
(pp) Workers involved in the manufacture, storage, filling, breakdown, handling and transport of any explosive (including but not limited to firework or firecracker).
(qq) The Insured Person participating in or conducting training for any of the following activities:
- underwater swimming or diving and use any type of equipment to aid breathing;
- any kind of climbing, or mountaineering using rope or guides;
- pot-holing;
- parachuting, any kind of gliding, ballooning, bungee-jumping or micro-lighting;
- cave, wreck or free diving, professional diving, diving without holding the correct diving certification such as a Professional Association of Diving Instructors (PADI) and diving at depths more than forty (40) meters;
- professional, semiprofessional or competitive winter sports, cross country skiing or snowboarding, ski or snowboard jumping, heli-skiing, off-piste skiing or snowboarding, speed skiing;
- hunting;
- driving or riding in any kind of race; or
- professional sports.
The above insurance plan is underwritten by Cigna Worldwide General Insurance Company Limited.
The above information is for reference only and does not constitute any contract or any part thereof between Cigna Healthcare and any other parties. Please read the product brochure for details. For details of full terms, conditions and exclusions, please refer to the policy provisions. Cigna Healthcare will be happy to provide a specimen of policy upon your request.
