NON-PMB SURGERY SUPPORT

CURA NON-PMB SUGERY SUPPORT EXCLUSIONS

We shall not be liable for Hospitalisation, bodily Injury, sickness or disease directly or indirectly caused by or related to or in consequence of:

• Nuclear weapons or nuclear material or by ionising radiation or contamination by radioactivity from any nuclear fuel or any nuclear waste from the combustion of nuclear fuel. For this exception, combustion shall include any self-sustaining process of nuclear fission.
• Any claim arising directly or indirectly from active involvement in a war, invasion, act of a foreign enemy, hostilities (whether war be declared or not), civil war,
  rebellion, revolution, insurrection or political risk of any kind, or any act of any person acting on behalf of or in connection with any organisation, group or activity aimed at verthrowing any government by force or any deliberate act of terrorism or violence.
• Any participation in riot, strike, or public disorder (including civil commotion, labour disturbances or lock-out) or any act or activity resulting in or calculated to bring about riot, strike, or such disorder.
• Active military duty, police duty, police reservist duty, civil commotion, labour disturbances, riots, strikes, or the activities of locked-out workers.
• The act of any lawfully established authority, police force, security force or any other local, provincial, or national body, in controlling, preventing, suppressing or in any other way dealing with any event referred to in the clauses above.
• Compensation in terms of the War Damage Insurance Act 85 of 1976.
• Any loss arising from any contractual liability.
• Any consequential loss or damage whatsoever.
• Any attempt by an Insured Person to commit an unlawful act.
• Any claim payable in terms of alternate proclaimed legislation, such as the Compensation for Occupational Injuries Act 90 of 1993, and the Road Accident Fund Act 56 of 1996.
• An event not covered by this Policy and/or falling outside of the Policy’s intention.
• Investigations, Treatment, Surgery for obesity, its sequelae or Cosmetic Surgery or Surgery directly or indirectly caused by or related to or in consequence of Cosmetic Surgery, other than as a result of an Insured Incident otherwise insured.
• Cosmetic Surgery shall include Surgery for breast reduction or reconstruction unless necessitated as a result of Treatment for Cancer.
• Any routine physical or any procedure of a purely Diagnostic nature or any other examination where there is no objective indication of impairment in normal health and laboratory diagnostic or X-ray examinations, except in the course of a disability established by prior call or attendance of a physician.
• An event where pre-authorisation was not obtained or approved from the Medical Scheme or where Medical Scheme Rules were not adhered to.
• Any dependent not registered on the Policy at the time of
  the Incident.
• Any benefit not covered by the selected Cura Plan Option.
• Suicide, attempted suicide or any intentional or deliberate self-injury and/or self-exposure to danger or risk except to save a human life.
• Any Illness, Injury or consequence from alcohol, drug or substance intoxication, use, abuse, or addiction, directly or indirectly traceable to the Insured Person being affected, permanently or temporarily. Claims may be considered where registered drugs are administered and prescribed by a Registered Medical Professional.
• Drug addiction.
• An event directly attributable to the Insured Person where the alcohol content in the blood exceeds the legal level permitted by law.
• Any Psychiatric or Psychological Condition or emotional or nervous conditions, including, but not limited to, depression, insanity, psychosis, stress-related and affective disorders.
• Participation in:
  1. Active military duty, police duty, police reservist duty, civil commotion, labour disturbances, riots, strikes 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).
• No benefits are payable that should be provided by the Medical Scheme.
• No benefits shall be payable due to the Insured person’s failure to comply with the Medical Scheme Rules regarding the failure to make use of a Hospital that is a Designated Service Provider, Preferred Service Provider, Associated Hospital or Network Hospital. This exclusion does not apply to traditional Cancer Treatment if such Designated Service Provider is a Public Hospital, Public Clinics, or otherwise indicated under the table of benefits.
• No benefits are payable for ward fees, theatre fees, medicines, and other Hospital expenses. Excluding shortfalls on consumables, private rooms and TTO medication as stated to be included in the selected Plan Option.
• No benefits shall be payable for an Insured Incident for which the Insured Person received Treatment or advice 12 (twelve) months before becoming an Insured Person. This exclusion only applies to the first 12 (twelve) months of an Insured Person’s cover.
• No benefit shall be payable for the severe Illness benefit if the Insured Person was diagnosed with Cancer (as defined) before the Inception Date of this Policy, not with standing the 12 (twelve) month Waiting Period.
• Investigations, Treatment, or Surgery related to infertility, artificial insemination, hormone Treatment for infertility, or any other form of assisted reproduction.
• No benefits shall be payable in the event of fraudulent submission by the claimant.
• Sub-Limitations imposed by a Medical Scheme as a result of an agreement between a member and a Medical Scheme will not qualify for benefits in terms of this Policy.
• A Co-Payment or deductible as a result of an agreement between a member and a Medical Scheme will not qualify for benefits in terms of this Policy.
• Split Billing.
• Consultations in the rooms of a general medical practitioner (GP).

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