> Exercise ECG > Laboratory tests > Holter monitoring > Mammography > Ultrasound > Urodynamic assessments > X-rays
g) Suicide, self-inflicted injuries or illness, or, accident, illness, condition or disability arising from, or, caused or contributed to by; drug taking, intoxication or misuse of alcohol, or, nuclear contamination; h) HIV related disorders, including AIDS; i) Pregnancy, childbirth or abortion, or, any conditions or complications arising from any of the foregoing; j) Contraception of any type; k) Sterilisation, except when you have the optional Specialist and Tests Benefit. Refer to Section 3c above as special conditions apply; l) Diagnosis, management and treatment of infertility; m) Circumcision, except where a Specialist provides a medical report that states the surgery is medically necessary; n) Diagnosis, management and treatment of snoring, except where a medical Specialist confirms diagnosis of sleep apnoea and confirms surgical treatment is medically necessary. (Pre-approval of any claim for treatment must be sought or obtained from Sovereign before any costs are incurred); o) Any geriatric or dementia conditions, including disability support services; p) New medical treatments, procedures or technologies that have not been approved by Sovereign ; q) Treatment requiring periodontal, orthodontic, endodontal or cosmetic procedures, including but not limited to, conditions arising out of neglect of dental services except where expressly covered under a benefit in this policy.; r) Any surgery for the correction of refractive visual errors; s) Elective or cosmetic surgery and associated treatments – including surgery or treatment, which a life assured chooses to undergo for cosmetic reasons (e.g. surgery for; breast enlargements or reductions, facelifts, varicose veins), where not having the surgery would not be detrimental to the life assured ’s health except where expressly covered under a benefit in this policy); t) Preventative treatment, or, treatment, or, investigation of any condition not detrimental to health; u) Treatment for obesity, including surgery, or, complications arising from any treatment for obesity; v) Mole mapping; w) Renal dialysis; x) Routine screening ; and y) Psychology, including any counselling services.
> CT Scan > MRI Scan
Routine screening is specifically excluded.
c) Sterilisation Benefit This benefit is included with the Optional Specialist and Tests Benefit. The benefit applies after you have had continuous cover in place for two or more years from your risk commencement date . It specifically covers vasectomies and tubal-ligation procedures. Vasectomies carried out by a General Practitioner will be covered. Prior approval should be sought or obtained from Sovereign before any costs are incurred. 4. Exclusions - Sovereign will not pay any benefit provided under MajorCare if the insured event is caused by or results from (either directly or indirectly) any of the following: a) Any medical condition, including chronic conditions, which existed at the time of your risk commencement date that you or the life assured was aware of, or, ought reasonably to have been aware. This includes the development or presence of underlying symptoms whether you have consulted a medical provider or not, unless the symptom or condition was disclosed at the time of your application and accepted in writing by Sovereign ; b) Any congenital conditions; c) Reconstructive, reparative procedures or surgery, which results from, or, which is traceable to, or, is medically related to, any surgery performed prior to your risk commencement date , or, which relates to cosmetic procedures carried out at any time; d) Injuries of war or resulting from any terrorist act (whether war is declared or not); e) The misuse of prescribed or non-prescribed drugs, where they have not been taken in accordance with the manufacturer’s, or, a Registered Medical Practitioner ’s, directions. f) Certifiable mental disease, psychiatric illness, or, any charges relating to services resulting from a referral to, or, provided by a psychiatrist;
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126 MAJAP-TC version 8 Effective 5 December 2016
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