• Accommodation fees in a Private Hospital . • Prescription drugs including: − Drugs listed on the PHARMAC Pharmaceutical Schedule and/or − Non PHARMAC subsidised Medsafe indicated chemotherapy medicines for the treatment of cancer administered to You while You are in a Private Hospital . The drugs must be listed on the PHARMAC Pharmaceutical Schedule as being approved for the condition being treated and/or must be Medsafe indicated for the condition being treated, taking into account any restrictions where applicable. • Diagnostic Procedures and Specialist consultations provided they relate to the condition being treated and that they occur within the six (6) month period prior to or after admission to a Private Hospital and they have been recommended by a Specialist . Any applicable excess is payable by You to the treatment provider. 3 We will reimburse You for the cost of the following specific Diagnostic Procedures if they have been recommended by a Specialist or General Practitioner , even if they do not lead to treatment in a Private Hospital , up to $125,000 per Life Assured per Policy Year for: • CT scan • MRI scan • Angiogram • Colposcopy (if carried out under a general anaesthetic) • Cystoscopy (if carried out under a general anaesthetic) • Myelogram (if carried out under a general anaesthetic) • Gastroscopy • Colonoscopy • Hysteroscopy • Laparoscopy Changes in technology in the future may see other major Diagnostic Procedures being introduced which involve significant expense. We may from time to time and at Our discretion, consider reimbursing the cost of such procedures. Any applicable excess is payable by You to the treatment provider. 4 We will cover the costs of the surgical removal of wisdom teeth carried out on You by an Oral Surgeon or Oral and Maxillofacial Surgeon after You have been referred by a General Practitioner or Dentist , up to $200,000 per Policy Year . The wisdom teeth must be totally impacted and totally unerupted, or totally impacted and partially unerupted. Any applicable excess is payable by You to the treatment provider. We do not cover any other dental treatments including, but not limited to, periodontal surgery, orthodontal, endodontal or prosthodontal surgery, or implant prosthesis, check-ups, fillings, caps, repair of broken teeth, cost of gold, titanium or other exotic materials.
SPECIFIC DIAGNOSTICS
BENEFIT
ORAL SURGERY
Page 7 of 22
PC-S3HC-04/2022
[AIA – INTERNAL]
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