I. Exclusions – what you are not covered for
1. There is no cover under any of the benefits for costs that exceed the reasonable charges for the applicable treatment, procedure, consultation, test, diagnostic imaging, support or care. 2. There is no cover under any of the benefits for costs arising from, or related in any way to, any of the exclusions listed below. 3. There is no cover under the Waiver of Premium on Death, Public Hospital Credit, Public Hospital Cash Grant or Medical Misadventure benefits arising from, or related in any way to, any of the exclusions listed below.
EXCLUSION NAME
EXCLUSION WORDING
Accommodation, Flights and/or Transport costs
Any accommodation, flight and/or transport, except where expressly covered by a benefit in this policy.
Acute care
Care provided for a sign, symptom, condition or disease that requires immediate or same day hospital admission for treatment or monitoring.
Additional surgery
Any additional surgery performed during an operation, which is not directly related to the cancer for which cover is claimed under the terms of this policy.
Allied health
Any treatment by a physiotherapist, chiropractor, osteopath, naturopath, homeopath, acupuncturist, podiatrist, dietitian, counsellor or speech therapist except where expressly covered by a benefit in this policy.
Breast reduction surgery and gynaecomastia
Breast reduction surgery (except where expressly covered under a benefit in this policy) and gynaecomastia.
Congenital conditions
A health anomaly or defect which is present at birth and for which the life assured either had signs or symptoms prior to becoming a life assured or signs or symptoms within 3 months of birth.
Condition other than cancer
Any treatment, specialist consultations, diagnostic tests or medical services that are not directly related to cancer except where expressly covered under a benefit in this policy.
Cosmetic
Any elective or cosmetic procedure or any surgery, procedure or treatment that improves, alters or enhances appearance, whether or not undertaken for medical, physical, functional, psychological or emotional reasons except where expressly covered under a benefit in this policy.
Criminal activities
Any injury or condition arising from participation in a criminal activity.
Dental/oral surgery
Dental repair or implants, orthodontic treatment, orthognathic, periodontal, or endodontic procedures, implants and related surgery of any kind except where expressly covered under a benefit in this policy.
Drugs
The misuse of prescribed or non-prescribed drugs, including where they have not been taken in accordance with the manufacturer’s or registered medical practitioner’s directions.
Any appliances, aids, implants or equipment including but not limited to implantable defibrillators, nerve appliances, hearing aids, cochlear implants, braces, crutches, mouth- guards, orthotics, insulin pumps, CPAP machines and any other appliances or equipment (surgical, medical or dental).
Equipment/appliances
Illness arising from drugs/alcohol
Any, illness or condition arising from, caused or contributed by, drug taking, intoxication or misuse of alcohol.
1304 ACC – UMB version 4 Effective 08 March 2024
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