EXCESS WAIVER LOYALTY BENEFIT
16 This benefit is included with the optional Specialists Visits and Diagnostics Procedures benefit. The $100 excess per Life Assured per claim form submitted will no longer apply after You have had continuous cover in place for two (2) years from the Policy Commencement Date.
STERILISATION LOYALTY BENEFIT
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This benefit is included with the optional Specialists Visits and Diagnostics Procedures benefit. The Sterilisation Loyalty Benefit applies after You have had continuous cover in place for two (2) years from the Policy Commencement Date . It specifically covers vasectomies and tubal ligation procedures, excluding reversals. Vasectomies carried out by a General Practitioner will be covered. Prior approval must be obtained in writing from Us prior to incurring any costs. We will provide a combined Allowance of up to $7,500 per Life Assured over the lifetime of the Policy after three (3) years of continuous cover towards the costs of:
BILATERAL BREAST REDUCTION / BARIATRIC SURGERY ALLOWANCE
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Bilateral Breast Reduction Surgery Bilateral breast reduction surgery including the costs of the related consultations, tests and diagnostic imaging for the Life Assured .
•
Excludes any surgery to correct any traumatic or post-surgical asymmetry, or to remove breast implants.
Bariatric Surgery Medically necessary sleeve gastrectomy, gastric banding or bypass surgery including the costs of related consultations, tests and diagnostic imaging, where surgery is recommended by a specialist because the Life Assured has all of the following:
•
a BMI of: a.
o
40 or more, or
b. 35 or higher and at least one of the following obesity- related diseases that is expected to be improved: - coronary heart disease; - type 2 diabetes; - obstructive sleep apnoea; - osteoarthritis in a weight bearing joint (radiological evidence required); or - blood pressure greater than 140/90 that cannot be effectively controlled via medication; and
completed physical growth; and
o
previously failed attempts to lose weight.
o
Excludes any other type of bariatric surgery, such as banded gastroplasty (stomach stapling).
You must seek prior approval before this Allowance is payable. The maximum amount payable under this Allowance is $7,500 per Life Assured over the lifetime of the Policy across both bilateral breast reduction surgery and bariatric surgery combined. Once this amount has been exhausted no further Allowance is payable.
An Annual Excess applies.
PC-SHC-04/2022
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