√ indicates services which are covered
x indicates services not covered under the specific plan
The following are excluded from all plans: –
- Overseas treatment and transplant surgery
- Plastic/cosmetic surgeries
- Investigations and treatment for problems relating to infertility e.g. hydrotubation, hysterosalpingogram, I.V.F,
G.I.F.T and artificial insemination
- Virility enhancing drugs
- Herbal drugs, non-prescription drugs, food supplements and experimental drugs and treatment
- Dental care not listed in the covered services
- Joint replacements and prosthetic limbs
- Long term psychiatric illness (Longer than 3 months)
- Comprehensive health screening/well persons check outside the scope of the benefits covered by the selective health screening
- All maternity and family planning services
- Immunizations not listed in covered services.
- Neonatal Intensive Care services.
- Congenital abnormalities
- Interstate referral services.
- Self-inflicted injuries
- Treatment of obesity
- Speech disorders
- Room upgrades beyond that specified in the plan benefits
- Learning difficulties, behavioral and developmental problems
- Consultations with unrecognized consultants, hospitals, family doctors, therapists, dental practitioners or complementary medicines practitioners
- Any other treatment, service, procedure or investigation not listed in the schedule of covered medical services
- Only persons between the ages of 51-85 years are eligible on this plan.
- The following benefits will not be covered or provided in the first 2 months of the commencement of the scheme: Monthly Drug refills for Chronic Illnesses
- The following benefits will not be covered or provided in the first 3 months of the commencement of the scheme: Optical Care, Dental Care.
- The following benefits will not be covered or provided in the first year of the commencement of the scheme: Surgeries, Cancer Care, Intensive Care Services and Psychiatric Care. This period otherwise known as waiting period shall commence on the date of entry to the date of renewal. On renewal, this benefit will be accessible provided the enrollee has been enrolled for one year with the HMO.
- Enrollees will enjoy a 5% discount on premium paid upon renewal where there is no utilization in the previous year.