special exclusions will be shown on your certificate of insurance.
cover set out in the provision and your certificate of insurance.
If the policy does not meet your needs, or has not been issued in accordance with your intention, you may ask us to cancel it within ten (10) days upon your receipt of your certificate of insurance. If no claims have been made, and no guarantees of payment or prior approvals have been put in place, we will refund any premium which has been paid and without accrued interest. Words and phrases in bold have the meanings given to them in 'Definitions'.
deductibles, coinsurances, and limits of cover may apply..
date will fall on this date each year.
This policy is an annual contract. This means that, unless it is terminated earlier or renewed, the cover will end on the end day.
terminate the policy are explained in provision 13.
are received on or after the date on which the cover ends.
payment or prior approvals have been put in place during the period of cover.
If you choose to renew, you do not need to do anything, and your cover will be renewed automatically for another 12 months. Renewal is subject to the definitions, benefits and terms of the provision in force at the time of renewal. If we are unable to renew your cover, we will give you notice as described in paragraph 13.6. If you do not want to renew your cover, you must let us know at least seven days before your policy end date.
policy, beneficiary is the same person as the insured person.
be payable, and special exclusions may be applied in relation to them.
beneficiary with effect from 1 January the following year.
conditions or exclusions and any additional premium which would apply.
confirm that the new beneficiary has been added.
confirming that the new beneficiary has been added.
date of birth, the newborn will be subject to medical underwriting.
and exclusions) are set out in 'list of benefits' in the provision.
before the annual renewal date.
on the new coverage options.
upon the end of the 60th day after the due date, this policy will be terminated.
you should tell us so in your application.
No deductible applies to 'Inpatient Cash Benefits' or 'Newborn Care Benefits'.
the out of pocket maximumyou have chosen for any one period of cover.
available under the terms of this policy.
to the out of pocket maximum.
beneficiary and each period of cover.
to apply a coinsurance, you should tell us so in your application.
apply new special restrictions or exclusions.
written notice if we are going to terminate the policy for this reason.
rate, we have the right to terminate the policy.
the termination of the policy, but shall refund the unearned net premium.
learnt of the reason for termination.
residence as one necessary factor.
place during the period of cover.
will be considered delivered .
the terms of the policy.
take effect from the annual renewal date.
exclusion(s) will be removed on review.
covered under this policy to use our complaints process).
the People's Court in accordance with legal regulations.
psychiatric treatment on an inpatient, outpatient and day-patient basis.
standard single room with a private bathroom (or equivalent).
hospital is covered under this policy.
beneficiary's family or come from a verified and legitimate source.
are given on an inpatient basis.
this part of this policy if the transplants form part of cancer treatment.
other parts of this policy.
under any other insurance policy or from any other source.
organ if the intended recipient is also a beneficiary under this policy.
limitations to coverage which are explained elsewhere in this policy.
a day-patient basis. We will not pay travel costs.
not the primary treatment which they are in hospital to receive).
provides non-medical care or personal assistance.
condition which requires rehabilitation treatment.
recommended by the treating specialist.
part of the recuperation process on a short-termbasis.
over per period of cover.
to the relevant section of this provision for details of that option.
treatment is covered under this policy.
(but is not the primary treatment which the beneficiary is in hospital to receive).
next three consecutive years of cover.
a formal outpatient course or programme of addiction treatment.
was the direct result of alcoholism or addiction.
staying in a hospital overnight or receiving treatment as a day-patient or outpatient.
be covered by the policy when they are 90 days old.
outpatient visits and much more.
to practice in the country where the treatment is received.
specialist in order to support the beneficiary's treatment.
effect of a disease, illness or injury.
accident and is completed within 30 days of the date of the accident.
treatment are sound natural tooth/teeth.
beneficiary to take control and manage their health the way they want.
by either an ophthalmologist or optometrist.
in hospital is covered under this policy.
amount we have paid from them, as appropriate.
treatments or other benefits which are available under those options.
to all of the extra coverage options.
but which was not disclosed to us.
social or domestic reasons e.g. washing, dressing and bathing.
Costs of hospital accommodation for a deluxe, executive or VIP suite.
includes, but is not limited to, slimming classes, aids and drugs.
cover under this policy commenced.
the pregnancy endangers a beneficiary's life or mental stability.
conditions will apply, other than for cancer.
(whether or not treatment was the main or sole purpose of the visit).
disease, illness or injury (such as cataracts or a detached retina).
been sought, so that we can confirm whether subsequent treatment will be covered.
prior approval (within the terms of this policy).
best use of the cover.
practitioner or clinic to continue treatment, once it is medically appropriate to do so.
we will pay will be reduced accordingly.
the amount which we will pay will be reduced accordingly.
network, we will reduce any amount which we pay by 20%.
cases, we will not apply any reduction to the payments we will make.
learnt or ought to have learnt of the occurrence of the insured event.
the treatment to complete the PAC, which should then be sent to CareAllies.
transfer him or her to CareAllies for an admission certificate.
the original hard copy document must also be sent to us by post.
to address on yourmembership ID card.
policy to that hospital, medical practitioner or clinic directly.
of the cost of the treatment which is covered.
details may be found on your membership ID card.
payment of insurance benefits nor return the insurance premium.
years, 3 years, 4 years, 5 years and 6 years.
Certificate of insurance if selected.
the country in which the treatment is provided.
that commences within 24 hours of the emergency event will be covered.
give to a beneficiary or a hospital, clinic or medical practitioner.
daily care or supervision of a medical practitioner or qualified nurse.
means our clinical team and/or the medical assistance service.
any procedure described as an operation in the schedule of surgical procedures.
the out of pocket maximum.
and is not admitted as a day-patient or an inpatient.
a reasonable degree of medical probability, there can be no recovery.
USA, on the suitability of inpatient treatment or day-patient treatment for a patient.
before the initial start time.
is this document including appended list of benefits, and forms part of the policy.
the treatment which is being recommended.
excluding USA worldwide, with the exception of the USA.
• Treatment room fees for outpatient surgery.
• have not been charged for your room, board and treatment costs.
• treatment of mental health conditions and disorders.
Caesarean sections are only covered when these are required by medical necessity.
congenital condition manifested itself before the patient's 18th birthday.
Coinsurance is the percentage of your claim not covered by your plan.
have to pay in a period of cover.
The coinsurance amount is calculated after the deductible is taken into account.
coinsurance amount is calculated after the deductible is taken into account.
We will pay for routine physical examinations for persons aged 18 or older.
• a mammogram every year for women aged 50 and over.
• Available 24 hours a day, 7 days a week, 365 days a year.
• Up to 5 face-to-face sessions with a professional counsellor.
• Convenient online counselling via E-counselling.
• SMS texting text the support you need and receive a call back.
months, 50% reimbursement will apply.