1 We do not pay for the following: (the letters next to each limitation are related to your company’s Agreement with us).
(d) Any surgical procedure which is not listed in the schedule of procedures, unless we have agreed, in writing, beforehand;
(e) Any treatment which only offers tfemporary relief of symptoms rather than dealing with the underlying medical condition;
(f) We will not pay for maternity complications during the pregnancy if the pregnancy was a result of any form of assisted conception including artificial insemination. However, if the pregnancy is a result of assisted conception including artificial insemination, we will pay for the normal pregnancy and for the delivery whether by vaginal delivery or by caesarean section up to the limit shown under the benefits table under the Normal Pregnancy and Delivery benefit.
(g) Treatment begun, or for which the need had arisen, during the first 90 days after birth for any child conceived by artificial means or any form of assisted conception including artificial insemination;
(h) Termination of pregnancy or any consequences of it;
(i) Investigations into and treatment of infertility, contraception, assisted reproduction, sterilization (or its reversal) or any consequence of any of them or of any treatment for them;
(j) Treatment of impotence or any consequence of it;
(k) Treatment of sexually transmitted diseases;
(l) Treatment which arises from or is directly or indirectly made necessary by a sex change;
(m) Treatment of any medical condition which arises in any way from HIV infection;
(n) The removal of fat or surplus tissue from any part of the body whether or not it is needed for medical or psychological reasons;
(o) The costs of collecting donor organs for transplant surgery or any administration costs involved even if such transplants are allowed by the terms of this plan. Where both the donor and the receiver of an organ transplant are covered under this policy we will pay for the costs of the surgery performed for the removal of the organ from the donor and the costs of the surgery performed for the implant of the organ to the recipient.
(p) Treatment which arises from or is directly or indirectly caused by a deliberately self-inflicted injury or an attempt at suicide;
(q) Treatment which arises from or is in any way connected with alcohol abuse or drug or substance abuse;
(r) Any treatment to correct long or shortsightedness;
(s) Treatment directed towards developmental delay in children whether physical or psychological or learning difficulties;
(t) Preventative (i.e.: prophylactic) treatment;
(u) Vaccinations and routine or preventative medical examinations including routine follow-up consultations; we will pay for the listed vaccinations (as shown in the ‘vaccinations benefit’ in the benefits table) for children up to 6 years old.
(v) The costs of providing or fitting any external prosthesis or appliance;
(w) Out-patient drugs or dressings except those defined in 2.1(i), ‘prescriptions’;
(y) Claims in respect of treatment received outside the area of cover or if the member travelled against medical advice even inside the area of cover;
(z) Treatment of injuries sustained from playing professional sport or from base jumping, cliff diving, flying in an unlicensed aircraft or as a learner, martial arts, free climbing, mountaineering with or without ropes, scuba diving to a depth of more than 10 meters, trekking to a height of over 2,500 meters, bunjee jumping, canyoning, hangliding, paragliding, or microlighting, parachuting, potholing, skiing off piste or any other winter sports activity carried out off pist;
(aa) Any treatment specifically excluded by the terms shown on the schedules forming part of your Company’s contract with us;
(bb) Any charges which are incurred for social or domestic reasons or for reasons which are not directly connected with treatment; we will pay for circumcision of new born baby boys when the procedure is performed on the day of birth.
(cc) Any charges from health hydros, spas, nature cure clinics (or practitioners) or any similar place, even if it is registered as a hospital;
(dd) Any claim or part of a claim in respect of which you have to pay an excess (or deductible or co-insurance). In this case we will only pay the balance of the claim after we have deducted the excess (or deductible or co-insurance) amount;
(ff) Charges for any hospital or medical practitioner which are unreasonable or excessive;
(gg) We will pay for the correction of a congenital defect and complications thereof when such treatment is to prevent either immediate hospitalization or immediate termination of life. This benefit applies to congenital defects of vision, hearing, digestive system, respiratory system and other major internal organs. Exclusions 3.g, 3. l and 3.r will apply in any event.