Senior Premium Plan

indicates services which are covered
indicates services not covered under the specific plan

D.  EXCLUSIONS:

The following are excluded from all plans: –

  1. All maternity and family planning services
  2. Comprehensive health screening/well persons check outside the scope of the benefits covered by the selective health screening
  3. Congenital abnormalities
  4. Consultations with unrecognized consultants, hospitals, family doctors, therapists, dental practitioners or complementary medicines practitioners
  5. Dental care not listed in the covered services
  6. Herbal drugs, non-prescription drugs, food supplements and experimental drugs and treatment
  7. HIV/AIDS Care & Treatment
  8. Home care and domiciliary services
  9. Immunizations not listed in covered services
  10. Interstate referral services.
  11. Investigations and treatment for problems relating to infertility e.g. hydrotubation, hysterosalpingogram, I.V.F, G.I.F.T and artificial insemination
  12. Joint replacements and prosthetic limbs
  13. Learning difficulties, behavioral and developmental problems
  14. Long term psychiatric illness (Longer than 3 months)
  15. Neonatal Intensive Care Services
  16. Overseas treatment and transplant surgery
  17. Plastic/cosmetic surgeries
  18. Room upgrades beyond that specified in the plan benefits
  19. Self-inflicted injuries
  20. Speech disorders
  21. Treatment of obesity
  22. Virility enhancing drugs
  23. Any other treatment, service, procedure or investigation not listed in the schedule of covered medical services

 

E.  NOTE

 

  1. Only persons between the ages of 51-85 years are eligible on this plan.
  2. 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
  3. All benefits are subject to their respective sectional limits which is described as: Inpatient Limit, Outpatient Limit and Pharmacy Benefit Limit. However, within the respective sectional limit, there are specific benefit limits as well. Consequently, in the event that any specific benefit limit under the sectional limit is exhausted, the remaining limit in that section will only cover other benefits within the section apart from the one that the specific benefit limit has been exhausted.
  4. The following benefits will not be covered or provided in the first 3 months of the commencement of the scheme: Optical Care, Dental Care.
  5. 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.
  6. Enrollees will enjoy a 5% discount on premium paid upon renewal where there is no utilization in the first 12 months.