Benefit
Benefit entitlement
Maximum cover
Private Health Cover and Private Health Plus
Provides a contribution towards the cost, up to the maximum cover for this benefit, of medically necessary sleeve gastrectomy, gastric banding or bypass surgery including the costs of the related consultations, tests and diagnostics imaging for the life assured , where surgery is recommended by a registered medical specialist because the life assured has all of the following,
a BMI of:
a. 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;
BARIATRIC SURGERY
– osteoarthritis in a weight bearing joint (radiological evidence required); or – blood pressure greater than 140/90 that cannot be effectively controlled via medication; and
$7,500 per life assured, per lifetime for the Bariatric Surgery and Bilateral Breast Reduction benefits combined
completed physical growth; and
previously failed attempts to lose weight.
Excludes any other type of bariatric surgery, such as banded gastroplasty (stomach stapling).
Prior approval must be obtained prior to the treatment or procedure taking place.
Cover under this benefit is only available to a life assured after three years of continuous cover under this policy.
The excess applies to any claims under this benefit.
Provides a contribution towards the cost, up to the maximum cover for this benefit, of bilateral breast reduction surgery including the costs of the related consultations, tests and diagnostics imaging for the life assured .
Excludes any surgery to correct any traumatic or post- surgical asymmetry, or to remove breast implants.
BILATERAL BREAST REDUCTION
Prior approval must be obtained prior to the treatment or procedure taking place.
Cover under this benefit is only available to a life assured after three years of continuous cover under this policy.
The excess applies to any claims under this benefit.
712 PH-UMB version 9 Effective 8 April 2022
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