Maximum limit that can be claimed during any one policy year

Including follow-up out-patient treatment (up to maximum of 90 days following discharge from hospital for covered persons with a Bronze plan).
Important note: You must obtain pre-authorisation for all benefits included in this section.

Donor's costs are not covered.

Medical costs associated with the donor as an in-patient.

A surgical operation required to restore a covered person’s appearance after an accident, or after surgery for breast cancer, provided the original treatment for the accident or breast cancer surgery was covered by the policy and the surgery takes place within two years of the accident or the original breast cancer surgery.

Fitted immediately following in-patient or emergency ward treatment.

For accidental injury to natural teeth (within 15 days of the accident).

For one parent (who is a covered person) to stay with the child, who is under 18 and insured, at the hospital.

Payable for each night spent in a hospital when a covered person receives treatment, up to a maximum of 60 nights.

Treatment, aimed at restoring form and/or function to the state it was in immediately before suffering an acute illness or injury, received immediately following in-patient treatment in a rehabilitation hospital or unit.

A specialist’s referral letter for the rehabilitation treatment is required.

The cost of test(s) to sequence the genes of cancer cells.

Cancers such as breast cancer, bowel cancer, lung cancer, bowel cancer & cancers of the blood (also known as leukaemia). The following are not covered:

• Non-melanoma skin cancer unless it has spread to lymph nodes or organs.
• Prostate cancer.

There is a lifetime limit of one claim per covered person.

Treatment, excluding any prescribed drugs, received by a registered psychologist or counsellor when the covered person is first diagnosed with cancer (up to a maximum of 10 consultations).

Up to a maximum of 2 consultations.

Including all treatment & care received after the covered person has been in a persistent vegetative state for a period of eight consecutive weeks due to an illness or injury.

Kidney dialysis of up to 4 weeks if this is needed immediately before or after a kidney transplant operation covered by the policy or if this is needed temporarily for sudden kidney failure resulting from a disease or injury, covered by the policy.

A waiting period of 24 months applies.

Up to 30 days in a recognised psychiatric unit of a hospital.

Up to a maximum of 10 consultations.

Includes cover for one consultation regarding the results.

When they relate to any surgery or in-patient treatment that the company is paying for under the terms of this policy.

For an acute condition, up to a maximum of 10 sessions. A doctor's referral letter is required if more sessions are required after the initial 10 sessions.

Cover is limited to the maximum number of sessions shown per policy year.

Hormone replacement therapy (HRT) received when the covered person is diagnosed with premature ovarian failure i.e. loss of ovarian function, before the age of 40 and where the HRT has been prescribed by a medical doctor. Treatment is only covered for a maximum of 12 months from the date of diagnosis.

Cover is limited to the maximum number of sessions shown opposite per policy year.

Monitoring and maintenance by a medical doctor only.

Up to 12 weeks per medical condition.

A waiting period of 6 months applies.

Routine vaccinations and developmental check-ups. The 12 month waiting period does not apply to children born to a person covered by the Gold plan for at least 12 months, provided they are added to the same policy within the first 28 days of life.

For accidental injury to natural teeth, provided treatment is received within 72 hours of the accident. This benefit excludes cover for injuries arising from biting.

Screening twice per year (e.g. the assessment of diseased, missing & filled teeth, including x-rays where necessary) preventative scaling, polishing & sealing twice per year, fillings (standard amalgam or composite fillings only), extractions and root canal treatment. A waiting period of 6 months applies.

Virus must have been contracted after the date of entry to the plan. Cover is limited to 5 years & a waiting period of 24 months applies.

Includes cover for congenital conditions whether that condition has been diagnosed as chronic or not, palliative treatment and care for a congenital condition that is diagnosed as terminal, and treatment for any related medical conditions, provided that the covered person had no signs or symptoms of the congenital condition prior to his or her date of entry, and that the congenital abnormality was diagnosed after his or her date of entry.

This benefit excludes all childbirth costs. A waiting period of 280 days applies.

Surgeons' fees, anaesthetists' fees, theatre fees, and any necessary additional nights of accommodation. A waiting period of 280 days applies.

A waiting period of 280 days applies.

Cover for the first 90 days of life. The limit shown opposite applies per pregnancy, not per child. A waiting period of 280 days applies.

If a covered person (or any child covered by the newborn benefit within its first 90 days of life) has a life-threatening or limb-threatening condition covered by the policy, which requires immediate treatment that cannot be adequately provided locally, the assistance service will arrange for the covered person to be moved by air and/or by surface transportation, to the nearest hospital within the covered person's area of cover where appropriate medical treatment is available.

The company will pay for the reasonable and customary cost of the evacuation. Other costs, such as hotel accommodation, are not covered under this benefit. Emergency evacuation or repatriation to the USA is not covered.

The assistance service retains the absolute right to decide whether the covered person's medical condition is eligible for evacuation, where the covered person shall be evacuated to, and the means and method of the evacuation.

The cost of an economy return airfare to the covered person's country of residence following his or her emergency evacuation.

If it is not possible for a companion to accompany the covered person on the evacuation flight, the company will pay for the companion's economy airfare on a scheduled flight (if the companion is required to stay with the covered person while he or she receives in-patient treatment, the company will pay towards the companion's hotel accommodation).

If your companion is staying with you while you are hospitalised following your evacuation, we will pay towards the costs of their hotel accommodation up to 15 nights.

If a close family member dies during the policy year, the company will pay for a covered person's return economy airfare to attend the funeral, provided that the travel takes place within 28 days of the death of the close family member (the waiting period for this benefit is 12 months, and there is a lifetime limit of one claim per covered person).

The cost of repatriation of mortal remains, transported to the covered person's home country or country of residence, if he or she dies if outside his or her home country (unless a claim is made under the 'Burial or cremation' benefit).

The cost of burial or cremation at the place where the covered person has died (unless a claim is made under the 'Repatriation of mortal remains' benefit).

Please see the 'Personal accident benefit' section of this document (pp. 12-14) for full information of the benefit and percentage benefit payments for each type of injury.

Please see the 'Personal accident benefit' section of this document (pp. 12-14) for full information of the benefit and percentage benefit payments for each type of injury.