Gap Cover Exclusions

The Product Provider shall not be liable for costs incurred for hospitalisation, bodily injury, sickness, or related disease directly or indirectly because of or in consequence of:

• Exposure to discharged nuclear weaponry fallout or by ionising radiation or contamination by radioactivity from any nuclear matter or from any nuclear waste from the combustion of nuclear fuel. For this exception, combustion shall include any self-sustaining process of nuclear fission;

• Suicide, attempted suicide, or intentional self-injury;

• Consuming any drug or narcotic unless prescribed by and taken in accordance with the instructions of a registered medical practitioner (other than the insured person) or drug addiction;

• An event directly attributable to the insured person having a blood alcohol concentration exceeding the legal permitted level, or the insured person presenting with alcoholism or an illness resulting from alcohol abuse.

• Drug Addiction;

• Participation in

1.  Active military duty, police duty, police reservist duty, (only applicable to Gap Cover and short-term products), civil commotion, labour disturbances, riot, strike, or the activities of locked out workers);
2. Aviation other than as a passenger (excluding commercial pilots);
3. Any form of race or speed test (other than on foot or involving any non-mechanically propelled vehicle, vessel, craft or aircraft);

• Any procedure not covered or declined by the medical scheme;

• No benefits shall be payable for an insured event for which the insured person received treatment or advice 12 months prior to becoming an insured person. This exclusion applies to the first 12 months of cover only;

• No benefits shall be payable for pregnancy or childbirth for a period of 9-months from inception of the policy;

• Investigations, treatment or surgery for artificial insemination or hormone treatment for infertility;

• Depression, insanity or mental stress or psychotic/psychoneurotic disorders;

• No benefits shall be payable in the event of fraudulent claim submission;

• No benefits shall be payable which includes split billing

• No benefits shall be payable for consultations in the rooms of a medical practitioner (GP);

• No benefits shall be payable for any external appliances;

The table of benefits do not apply to any territory outside of the borders of the Republic of South Africa, Botswana, Lesotho, Swaziland, and Namibia.