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, Bereavement Grant, 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. Care provided for a sign, symptom, condition or disease that requires immediate or same day hospital admission for treatment or monitoring. Any additional surgery performed during an operation, which is not directly related to the medical condition or treatment for which cover is claimed under the terms of this policy. 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. Bariatric surgery for any condition including but not limited to obesity, diabetes and sleep apnoea, except where expressly covered by a benefit in this policy. Breast reduction surgery (except where expressly covered under a benefit in this policy) and gynaecomastia.
Acute care
Additional surgery
Allied health
Bariatric surgery
Breast reduction surgery and gynaecomastia
Circumcision
Circumcision except where medically necessary.
Congenital conditions
Any congenital condition except where expressly covered under the Congenital Condition Surgery Benefit in this policy.
Contraception
Contraception of any type.
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.
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. 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) except cardiac pacemakers, implantable loop recorders or where expressly covered under a benefit in this policy.
Drugs
Equipment/appliances
Illness arising from drugs/alcohol
Any injury, illness, condition or disability arising from, caused or contributed by, drug taking, intoxication or misuse of alcohol.
1300 APH-UMB version 6 Effective 17 April 2025
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