√ indicates services that are covered
x indicates services not covered under the specific plan
The following are excluded from all plans: –
- Overseas treatment and transplant surgery
- All maternity, neonatal and family planning services
- Plastic/cosmetic surgeries
- Advanced and complex investigations not stated in schedule of covered services
- 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
- HIV/AIDS Care & Treatment
- Herbal drugs, non-prescription drugs, and experimental drugs and treatment
- Other laboratory investigations not listed in the schedule of covered services
- Dental care not listed in the schedule of covered services
- Home care and domiciliary services
- Joint replacements and prosthetic limbs
- Psychiatric Illness and Treatment
- Immunizations not listed in covered services
- Interstate referral services
- Comprehensive health screening/well persons check outside the scope of the benefits covered by the health checks.
- Self-inflicted injuries
- Treatment of obesity
- Covid-19 testing and treatment
- Speech disorders
- Room upgrades beyond that specified in the plan benefits
- Management of severe burns (Burns covering more than 10% body surface area)
- 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.
- There will be a waiting period of 2 weeks after registration. Plans purchased becomes active 2 weeks after purchase date.
- All benefits are subject to their respective sectional limits which is described as: Inpatient Limit and Outpatient 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.
- The following benefits will not be covered or provided in the first 2 months of the commencement of the scheme: Chronic Disease Medication
- 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 6 months of the commencement of the scheme: Death and Funeral Expenses.
- The following benefits will not be covered or provided in the first year of the commencement of the scheme: Surgeries, Cancer Care and Intensive Care Services. This period otherwise known as the 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.