c) Pre Admission & Post Discharge From An Approved Private Hospital Or Day Stay Clinic Specialist Cover: Specialist consultations and diagnostic procedures are covered, on the recommendation of the Specialist , for up to three months before the private hospital or day stay clinic admission, and for up to three months after discharge, from a private hospital or day stay clinic , provided that they relate specifically to the medical condition, which resulted in the private hospital or day stay clinic admission occurring. Physiotherapy and prescription costs directly relating to the approved surgery performed within three months after surgery. NOTE: If you have selected the optional Specialist and Tests benefit, please refer to Section 3 of this MajorCare benefits sheet . d) Dental Evaluation and Treatment Prior To Qualifying Treatment Benefit MajorCare pays a maximum of all reasonable charges up to $1,500 per life assured per policy year. No excess is payable for any claims under this benefit. Covers dental evaluation and treatment performed by an oral surgeon or a dental practitioner , on the recommendation of the treating registered medical specialist as a precursor to the following treatments where those treatments are covered by your policy: > Chemotherapy using antiresorptive drugs. > Radiotherapy treatment (head and neck). > Heart valve replacement surgery. Prior approval must be obtained before any dental evaluation or treatment takes place. procedures performed on a life assured during a surgical or non-surgical admission to a private hospital or day stay clinic . This benefit includes but is not restricted to CT and MRI scans and angiograms. This benefit also applies to costs relating to pre admission and post discharge costs as described in Section 2c above. MajorCare pays a maximum of all reasonable charges up to $100,000 per life assured , per annum. e) Special Diagnostic Procedures Benefit MajorCare covers costs for specialised diagnostic f) Breast Reduction Benefit Sovereign will pay for breast reductions after a life assured has had or you have had cover in place for a minimum continuous period of 3 years from the risk commencement date of you r policy where: > a Specialist provides a medical report which states that surgery for breast reduction is medically necessary and that it is not being done for cosmetic reasons; and
> Oral surgery: MajorCare covers the removal of impacted wisdom teeth, the removal of unerupted teeth, and the treatment of cysts, soft tissue swellings and enlargements. In all cases oral surgery must be performed by an Oral Surgeon or Dentist suitably qualified to perform oral surgery, after referral by a Dentist or Registered Medical Practitioner . MajorCare does not cover root canal treatment, dental repair or implants. The MajorCare benefit includes; > Oral Surgeon ’s or Dentist ’s Fees > Anaesthetist Fees > X-rays > Private hospital or day stay clinic charges (if applicable) > Ancillary Charges / Supplies: including but not limited to; dressings, medication prescribed immediately post surgery, anaesthetic supplies. b) Private hospital – non-surgical benefit MajorCare covers all reasonable charges for admissions to a private hospital on referral by a Specialist or Physician for medical treatment of a condition, which does not require surgery. Non-surgical admissions are commonly referred to as medical admissions and include but are not limited to asthma, diabetes, stroke, cancer and oncology - radiology/chemotherapy treatment, lithotripsy or any other acute or chronic illness. For cancer chemotherapy treatment, this includes targeted therapy, immunotherapy medicines, oral, intravenous infusion, instilled, and intraoperative chemotherapy provided by or under the direction of a specialist in a Sovereign approved facility . This covers the cost of Pharmac and non-Pharmac subsidised MedSafe indicated cancer chemotherapy drugs, subject to Sovereign criteria . Prior approval of any claim should be sought or obtained from Sovereign before seeking medical treatment. MajorCare pays a maximum of all reasonable charges up to $300,000 per life assured , per annum, plus an additional diagnostic benefit of $100,000, as specified in Section 2d of this MajorCare benefits sheet . This benefit entitlement is limited to overnight admissions to a private hospital . This includes: > Physician / Specialist Fees > Diagnostic Fees (As specified in Section 2e) > Accommodation Fees > Ancillary Charges / Supplies: including but not limited to; materials and medication - prescribed while in hospital, physiotherapist fees.
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126 MAJAP-TC version 8 Effective 5 December 2016
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