Illness arising from drugs/alcohol
Any injury, illness, condition or disability arising from, caused or contributed by, drug taking, intoxication or misuse of alcohol.
Infertility
Diagnosis, management and treatment of infertility except as specifically provided by the Pregnancy, Maternity and Infertility Allowance benefit under Private Health Plus.
Mental illness
Psychiatric, psychological and/or neurodevelopment disorders including treatment or counselling for but not limited to pre-senile dementia, senile illness or dementia, geriatric care including geriatric in-patient care and disability support services, intellectual disability (intellectual development disorder), autism spectrum disorder, attention deficit/hyperactivity disorder, specific learning disorders, motor disorders (including but not limited to Tourette’s disorder) or dyslexia. New medical treatments and procedures including any prescription drugs, medical devices, treatment techniques and/or procedures, tests and/or other healthcare services that have not been approved by Sovereign in its sole discretion.
New treatments and techniques
Non-Pharmac subsidised drugs
Drugs required for your particular treatment that are not subsidised by Pharmac, except for the drugs required for the chemotherapy benefit under Cancer Care in Private Health Cover.
Nuclear contamination
Any injury, illness, condition or disability arising from nuclear contamination.
Nursing
Nursing care, except where expressly covered under a benefit in this policy.
Obesity
Treatment of obesity (including treatment of complications arising from any treatment for obesity; any disease or disorder of the skin or psychological treatment), except where expressly covered by a benefit in this policy. Obstetric visits, pregnancy, childbirth or any associated conditions or complications except as specifically provided by the Obstetric Care Allowance or, Pregnancy, Maternity and Infertility Allowance benefit under Private Health Plus.
Obstetrics
Organ donation
Organ donation and receipt.
Out of scope treatment
Treatments or procedures not provided by a registered medical practitioner practising within his or her scope of practice except where expressly covered under a benefit in this policy.
Palliative care
Palliative care, except where expressly covered by a benefit in this policy.
Pre-existing conditions
Any pre-existing condition , unless the symptom or condition was disclosed to Sovereign at the time of your application and accepted as covered by Sovereign in writing.
Prescriptions
Prescriptions, except where expressly covered by a benefit in this policy.
Preventative treatment and routine screening
Preventative treatment, health surveillance screening or treatment or investigation (including as a result of family history) where the life assured has no medical symptoms or where the condition will not cause significant problems for the health of the life assured if medical treatment is not received, except as provided under the Health Screening benefit under Private Health Plus.
Public hospital treatment
Treatment provided in a public hospital , except where expressly covered by a benefit in this policy or approved by Sovereign prior to receipt of the treatment.
Reconstructive surgery relating to previous surgery
Reconstructive or reparative treatment associated with a surgical procedure performed before the risk commencement date .
Refractive visual errors
Correction of refractive visual errors or astigmatism by surgery, surgically implanted intraocular lens(es), or laser treatment.
Renal dialysis
Renal dialysis.
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712 PH-UMB Version 9 Effective 8 April 2022
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