t’azur Company B.S.C

Summary of General Exclusions:

Unless specifically included in the table of benefits, this Plan does not cover expenses arising directly or indirectly for any tests or treatments for the following:

  • Pre-existing conditions (other than acute presentation of a pre-existing condition), as specified under Article 3.11 of this Plan, if not included in the Plan schedule, table of benefits and membership cards.
  • Unless pre-existing condition is covered, maintenance treatment of chronic conditions, except for necessary investigations until a diagnosis for the condition is confirmed
  • Home visits
  • Services or treatment in any rest home, spa, hydro-clinic, health resorts, massage centers, sanatorium or long-term care facility that is not a hospital, unless covered in the table of benefits
  • Admissions for rehabilitation and isolation purposes, unless covered in the table of benefits
  • Routine medical examinations or regular check-ups, unless covered in the table of benefits
  • Medical certificates and examinations for residence, employment or travel
  • Provider registration fees, and medical report charges unless requested by the Company
  • Vaccinations, unless covered in the table of benefits
  • Circumcision, unless covered in the table of benefits
  • Cosmetic, plastic, reconstructive or restorative treatments, unless pre-authorized by the Company
  • Cosmetic products such as shampoos, soaps, hair stimulants, hair removers, moisturizers, creams or other similar products
  • Alternative treatments including but not limited to ayurvedic (such as herbal medicine), holistic medicine, hypnosis, yoga, acupuncture, homeopathy, chiropractic and other similar treatments, unless covered in the table of benefits.
  • Any illness caused by, or resulting from sexually transmitted illnesses, and any treatment or test for acquired immune deficiency syndrome (AIDS) and any AIDS / HIV related conditions.
  • Organ transplantation and its related expenses not covering the acquisition or search costs of an organ, treatment incurred as a result of the removal of a donor organ from a donor, or treatment for removal of an organ from a Participant Member for the purposes of transplantation into another person and any complications arising thereafter. However, heart, heart / valve, heart / lung, liver, pancreas, kidney, bone marrow transplantation are covered, but organ-donor related charges and organ acquisition charges are not covered
  • Prosthesis (including stents) and medical appliances including but not limited to knee brace, collar brace, lumbar support, heel pads, arch support and hearing aids, unless covered in the table of benefits.
  • Long term kidney dialysis in the case of chronic kidney failure. The Company does pay for dialysis for up to three (3) months during preparation for kidney transplant.
  • Medical treatment of obesity (including morbid obesity), and any other weight control programs, services or supplies.
  • Psychiatric disorders, unless covered in the table of benefits.
  • Vitamins, mineral supplements, hormones replacement therapy, steroids and organic preparation, unless covered in the table of benefits
  • Skin disorders like warts, skin tags, keloid, acne (unless infected) , and molluscum,contagiosum, sebaceous cyst (unless infected), epidermal cyst, lipoma.
  • Maternity care, as specified under Article 3.8 of this Plan, if not included in the Plan schedule, table of benefits and membership cards.
  • Dental related services, as specified under Article 3.9 of this Plan, if not included in the Plan schedule, table of benefits and membership cards, except in cases of accidental injury, where damage has occurred to sound natural teeth. Services are covered for initial pain relief and for any treatment necessary to preserve the dental structure for future permanent restoration for damages done to sound natural teeth.
  • Optometry / optical treatment and surgeries for correction of refraction errors, as specified under Article 3.10 of this Plan, if not included in the Plan schedule, table of benefits and membership cards.
  • Infertility, impotency, sexual dysfunction, contraception, sterilization or other similar conditions
  • Children under 15 days unless covered in table of benefits
  • Birth defects, congenital Illness, hereditary conditions, developmental disorders and behavioural problems unless covered in the table of benefits.
  • All transportation costs occurring during trips specifically made for the purpose of obtaining treatment
  • Corrective treatment for hearing defects
  • Injuries arising from professional and hazardous sports including but not limited to scuba diving, sky diving, parachuting, paragliding, mountaineering and martial arts.
  • Treatments and medical costs resulting from work related accidents and / or illnesses that are eligible under any workers’ compensation scheme.
  • Injury or Illness caused by, contributed to, or resulting from self-infliction, suicide, use of alcohol, intoxicants, hallucinogenic, illegal drugs or any drugs and medicines that are not taken in the dosage or for the purpose as prescribed by the physician
  • Treatments resulting from participating in war (declared or not), acts of terrorism, riot, civil commotion, or any illegal act, including resultant imprisonment and any accident or illness incurred while serving as a full-time member of a police or military unit
  • Injury caused by nuclear fission, nuclear fusion or radioactive contamination, chemical or biological warfare.
  • All exclusions specifically mentioned under Article 3 of this Plan
  • Health Service, which are not medically necessary
  • Personal comfort and convenience items or services such as television, telephone, barber, gust service and similar incidental services and supplies.
  • Health Services and associated expenses for experimental, investigational or unproven services
  • Services and supplies for smoking cessation programs and the treatment of nicotine addiction are excluded.
  • Growth hormone therapy, unless medically necessary
  • Treatment directly or indirectly associated with gender change and any consequence thereof.
  • Treatment for learning difficulties, hyperactivity, attention deficit disorder, speech therapy, developmental and behavioural problems in children. Unless covered in the Table of benefits
  • Treatment for sleep related breathing disorders, including snoring and sleep apnoea, fatigue, jet lag or work related stress or any related conditions
  • Air ambulance transportation in general and terrestrial transportation in non-emergency cases or by non-licensed providers
  • All cases related to maternity in respect of unmarried females.
  • All cases requiring emergency in-hospital treatment / services, which have not been notified to the Company within twenty-four (24) hours from admission.
  • Complications directly arising from services not covered.
  • Officially (WHO and / or national law) recognized epidemics/pandemics.
  • Any Health Services and associated expenses for alopecia, baldness, hair falling, dandruff, wigs, or toupees.
  • Natural perils, such as but not limited to avalanches, earthquake, volcanic eruptions, tsunamis, hurricanes, tornados or any other kind of natural hazard;
  • All preventative cares , including vaccinations, immunizations, hyaluronic acid injection, allergy testing & desensitization; any physical, psychiatric or psychological examinations or testing during these examinations, unless covered in the table of benefits
  • Nasal septum deviation and/or nasal concha resection for cosmetic purpose.
  • All cases requiring non-emergency In-Hospital treatment / services, which have not been approved by the Company prior to admission.
  • Any test and / or treatment not required by a medical Physician.
  • Any In-Hospital treatment, tests and other procedures, which can be carried out on Out-of-Hospital basis without jeopardizing the Participant Member’s health.

Any pharmaceutical products, which are not considered as specific treatment for a particular disease and / or not prescribed by an approved Physician