Things we don’t cover

You don’t have cover for accidents or injuries arising from:

• travelling in a motorised vehicle as a driver or passenger, if the driver does not have a valid license and insurance; and
• failure to wear the relevant safety equipment.

You don’t have cover for the accidental death benefit when your death results from:

• military action, revolution, insurrection, any acts of terrorism, murder, attempted murder, kidnap, or assault of any kind, anywhere in the world;
• any illness or disease;
• food poisoning or bacterial infections;
• suicide, or the consequences of attempted suicide;
• intentionally self-inflicted injuries, whether sane or insane;
• intentional inhalation of gas, or intentional ingestion of poisons or drugs;
• intentionally contracted infection by bacteria or virus;
• being under the influence of alcohol or drugs; or
• an accident whilst participating in a hazardous activity.

You don’t have cover for treatment related to:

• addictions or substance abuse;
• any illness or injury caused as a result of any such abuse or addiction; or
• any illness or injury caused as a result of being under the influence of any substance.

You don’t have cover for treatment related to:

• allergy testing by hair analysis; or
• allergy desensitisation or food neutralising injections.

You don’t have cover for alternative treatments and therapies, including aqua physiotherapy, bone-setting, colonic irrigation, hydrotherapy, Intervertebral Differential Dynamics (IDD), kinesiology, naturotherapy, Ayurveda, and massage therapy.

You don’t have cover for artificial life maintenance.*

*Except any cover you’re eligible for under the lifetime care benefits of your plan’s table of benefits.

You don’t have cover for treatment arising from or connected with:

• contraception or sterilisation;
• sexual problems; or
• gender reassignment.

We won’t pay for the fees and charges listed below and you will be responsible for them:

• fees for the completion or providing of claim forms or any other medical reports or forms such as medical referral letters, even if we have requested them;
• bank charges incurred as a result of us transferring money;
• losses you may incur due to fluctuations in exchange rates;
• charges incurred as the result of payment errors that arise as the result of you having provided us with incorrect information;
• administration, registration, or cancellation fees charged by hospitals, doctors, or other providers of medical services; and
• any charges made by your bank or credit card company.

You don’t have cover for investigations or treatment related to any medical conditions arising from chemical contamination, radioactivity or any nuclear material whatsoever, including the combustion of nuclear fuel.

You don’t have cover for treatment related to circumcision, unless it is required for treatment of an acute medical condition covered by your plan.

You don’t have cover for commercially available substances that can be purchased without prescription, including vitamins, minerals, organic substances, moisturisers, oils, creams, or other pharmaceutical products.*

*Except any cover you’re eligible for under the maternity care benefits of your plan’s table of benefits.

You don’t have cover for:

• hospital accommodation if the reason you are hospitalised is for the purpose of convalescence, rehabilitation or supervision;
• relaxation or rest treatments, or treatments in nature cure clinics, health spas and health hydros; or
• private beds registered as nursing homes attached to such establishments or a hospital where the hospital has effectively become your home or permanent abode.*

*Except any cover you’re eligible for under the rehabilitation benefit of your plan’s table of benefits.

You don’t have cover for investigations or treatment, even when medically prescribed, that are related to:

• cosmetic or aesthetic treatment to enhance your appearance;
• the removal of healthy tissue, including fat, skin or breast tissue;
• breast enlargement or reduction;
• sclerotherapy for spider veins, treatment of superficial varicose veins; or
• Botox, dermal fillers, or treatment of vitiligo or any skin pigmentation disorder.*

*Except any cover you’re eligible for under the reconstructive surgery benefit of your plan’s table of benefits.

You don’t have cover for treatment arising from or related to injuries sustained while you are engaged in a criminal, illegal or unlawful act.

You don’t have cover for treatment or advice by a dietitian or nutritionist.*

*Except any cover you’re eligible for under the dietitian benefit in the cancer treatment section of your plan’s table of benefits.

You don’t have cover for treatment or medicine which in our reasonable opinion is experimental or unproven based on generally accepted current clinical evidence and generally accepted medical practice.

You don’t have cover for:

• LASIK eye surgery or any other surgical correction of short-sightedness (myopia), long-sightedness (hyperopia) or irregular-shaped cornea (astigmatism);
• any lens other than a standard mono-focal replacement lens as part of an eye operation, such as cataract surgery;
• spectacles, and other visual aids, treatment of strabismus (squint) or amblyopia (lazy eye); or
• sight tests.*

*Except any cover you’re eligible for under the well-being benefits of your plan’s table of benefits.

You don’t have cover for:

• treatment arising from or related to your unreasonable failure to seek or follow medical advice and/or prescribed treatment, or your unreasonable delay in seeking or following such medical advice and/or prescribed treatment; or
• complications arising from ignoring such advice.

You don’t have cover for surgery undertaken on a child while it is in its mother’s womb.

You don’t have cover for genetic testing or genetic engineering.*

*Except any cover you’re eligible for under the cancer benefits of your plan’s table of benefits.

You don’t have cover for:

• treatment for or arising from deafness caused by maturing or ageing;
• treatment for or arising from deafness caused by a congenital condition if either the abnormality was diagnosed, or you were showing signs or symptoms of the abnormality, before your policy starts;
• hearing aids; or
• hearing tests.*

*Except any cover you’re eligible for under the welll-being benefits of your plan’s table of benefits.

You don’t have cover for:

• testing or diagnosis related to infertility; or
• infertility treatment, assisted reproduction (e.g., IVF treatment), including establishing pregnancy.

You don’t have cover for learning and educational difficulties, including dyslexia and speech disorders.

You don’t have cover for:

• treatment to relieve the symptoms commonly associated with physiological or natural changes as a result of ageing (e.g., menopause or puberty);
• bone densitometry;* or
• reproductive hormone testing, reproductive hormone therapy or hormone replacement therapy.*

*Except any cover you’re eligible for under the well-being benefits or outpatient treatment benefits of your plan’s table of benefits.

You don’t have cover for palliative care.*

*Except any cover you’re eligible for under the lifetime care benefits of your plan’s table of benefits.

You don’t have cover for treatment received after:

• you have been in a vegetative state for a period of eight weeks; or
• you have sustained permanent neurological damage and remained in hospital for a period of eight weeks.*

*Except any cover you’re eligible for under the lifetime care benefits of your plan’s table of benefits.

You don’t have cover for any consultations, tests required to diagnose or exclude a diagnosis, or treatment of or related to:

• developmental delays;
• learning and education difficulties, including dyslexia and speech disorders;
• behavioural problems, including attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and Tourette’s syndrome;
• physical development of any kind;
• teething; or
• bed wetting.

You don’t have cover for surgery when no physical signs or symptoms are shown, or no diagnosis has been made.*

*Except any cover you’re eligible for under the cancer benefits of your plan’s table of benefits.

You don’t have cover for treatment for an illness or injury related to:

• participation in any kind of professional sport or professional racing; or
• participation in any kind of racing which involves the use of a motorised vehicle.

You don’t have cover for:

• treatment specifically related to scalp conditions, including alopecia; or
• wigs.*

*Except any cover you’re eligible for under the cancer benefits of your plan’s table of benefits.

You don’t have cover for:

• search and/or rescue operations, including mountain rescue, rescue from ski slopes or pistes, underground rescue, or underwater rescue; or
• evacuations from offshore installations such as oil rigs, or from any type of sea going vessel such as a ship, ferry or yacht.

You don’t have cover for treatment of self-inflicted injuries or treatment of any injury or illness caused by self-inflicted injuries.

You don’t have cover for treatment related to sexually-transmitted infections including genital/anal warts.

You don’t have cover for imaging tests for or treatment of any sleep related disorder, including insomnia, snoring, and sleep apnoea.

You don’t have cover for stem cell harvesting other than prior to a stem cell transplant, or any treatment undertaken for such harvesting.

You don’t have cover for non-prescribed items such as hot and cold packs and support bandages, unless these are required as a result of treatment received during a medical emergency.

You don’t have cover for treatment of disorders of the Temporomandibular joint (TMJ) including any related condition.

You don’t have cover for travel costs including airfares and hotel accommodation.*

*Except any cover you’re eligible for under the expat benefits of your plan’s table of benefits.

You don’t have cover for treatment provided by and/or under the control of and/or on referral from:

• any family member, including a spouse, partner, parent, brother, sister, child, grand-parent, grand-child, uncle or aunt; or
• any medical services provider, medical practitioner or specialist where the member has a financial interest and/or a professional interest, including employees, employers, consultants and owners.

You don’t have cover for treatment arising from war, foreign enemy hostility, terrorism, rebellion, civil war, revolution, military coup, riot, strike, martial law, state of siege or attempted overthrow of a government, unless you are an innocent bystander.

You don’t have cover for investigations or treatment related to:

• obesity, or which is necessary because of obesity;
• weight monitoring or control, such as slimming classes, aids and drugs;
• bariatric surgery, or complications resulting from bariatric surgery; or
• eating disorders of any kind, such as anorexia nervosa or bulimia.

You don’t have cover for treatment of any conditions arising from your gross negligence and/or your wilful exposure to needless danger except in an attempt to save a human life.