Al Koot Insurance and Reinsurance Co. - Qatar

(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.

(a)     Cosmetic (aesthetic) surgery or treatment or for any treatment which relates to or is needed because of previous cosmetic treatment. However we will pay for reconstructive surgery if:

(i) it is carried out to restore function after an accident or following surgery for a medical condition, and

(ii) it is done at a medically appropriate stage after the accident or surgery; and

iii) we agree the cost of the treatment in writing before it is done. Please note that in the event that the accident or surgery happened before policy inception we will not pay if a recovery from a third party could have been made at any time, whether or not such a recovery was made. Al Koot will determine whether or not a recovery would have been possible and the AXA medical panel reserves the right to determine whether the treatment is to restore function or is only cosmetic in nature. Due and serious consideration will be given to the advice of the QP Medical panel in making such a determination

(b)     Any dental procedure unless provided for by your group plan. However, we will pay for some surgical procedures which need to be carried out by an oral and maxillofacial surgeon. We will send you a list of these procedures if you ask us.

(c)     Special nursing in hospital and/or any nursing at home unless we have agreed in writing beforehand that it is necessary and appropriate.

(d)     Hormone replacement therapy, except when it is medically indicated (rather than for the relief of physiological symptoms), when we will pay for the consultations and for the cost of the implants or patches (but not tablets). We will only pay benefits for a maximum of eighteen months from the date of the first consultation.

(e)     In-patient rehabilitation except when:

• it is an integral part of treatment; and
• it is carried out by a medical practitioner specialising in rehabilitation; and
• it is carried out in a rehabilitation hospital or unit which is recognised by us; and
• the costs have been agreed, in writing, by us before the rehabilitation begins. We will not pay for in-patient rehabilitation for more than 28 days except in cases such as in severe central nervous system damage caused by external trauma

(f) Treatment which has not been established as being effective or which is experimental. However we will pay if, before the treatment begins, it is established that the treatment is recognised as appropriate by an authoritative medical body and we have agreed in writing, with the medical practitioner what the fees will be