General Exclusions

What is not covered for Health Insurance

General Exclusions

Although you will be covered for the major costs of treatment, there are certain things that BUPA Health Insurance has to exclude including medical check ups. Full details of these including the conditions applied to each of the member in your policy can be found in your policy document. Some of the key conditions which we cannot pay for are shown below:-

1. Pre-existing conditions. This means any disease, illness or injury or symptoms and complications thereof for which the covered person was treated or knew about (or a prudent person should have been aware existed), within 5 years before joining BUPA Health Insurance or it is medically proven that the member has such sickness or conditions prior to joining the BUPA Health Insurance health scheme.
2. Congenital abnormalities.
3. Kidney dialysis or organ transplant.
4. Outpatient physical therapy.
5. Any treatment, drugs or medical supplies which are not related to the diagnosis; health check ups; and convalescent care including rest cures and rehabilitation and rehabilitation and any treatment that such treatment is unnecessary or inappropriate
6. Genetic disorders; sexually transmitted diseases; drug abuse; alcoholism; treatment to stop snoring; behaviour modification therapy; weight loss programs and treatment; acute or chronic mental and nervous disorders including eating and sleeping disorders, disease or symptoms of stop breathing while sleeping, anxiety, stress, prolonged or regular headaches
7. Symptoms or diseases resulted from alcohol i.e. Alcoholic Gastritis, Alcoholic Hepatitis
8. Human Immuno-deficiency Virus (HIV) and Acquired Immuno-deficiency Syndrome (AIDS) including any condition which is related to, or results from AIDS and HIV.
9. Medical services or surgery in connection with an injury or sickness arising out of fraudulent intention.
10. Suicide or self inflicted injury including drug overdose; dangerous sports or activities including hunting for animals, racing of all kinds including car, boat and horse racing, water and snow ski-ing, and skateboarding, boxing, parachuting, boarding or traveling in a hot air balloon, gliding, bungy jumping, mountain climbing with equipment; diving with oxygen tank and breathing equipment under water
11. Any loss or injury arising from the action of the covered person whilst under the influence of alcohol, addictive drugs, narcotic drugs to the extent of being unable to control one’s mind. The term “under the influence of alcohol” in case of having a blood test refers to a blood/alcohol level of 150 mg and over.
12. War (whether declared or not), invasion, acts of foreign enemies, civil war, revolution, insurrection. Civil commotion, popular rising against the government, riot, strike and terrorism.
13. Nuclear weapons, radiation or radioactivity from any nuclear fuel or nuclear refuse arising from the combustion of nuclear fuel and any process of self-sustaining nuclear fission/fusion.
14. While the covered person is boarding or traveling in an aircraft which has no licence for carrying passengers of does not operate as a commercial aircraft; or whilst piloting or working on board as an employee of an airline
15. While the covered person serves as a soldier, police, or a volunteer and participates in war or crime suppression.
16. While the covered person is taking part in a brawl or taking part in inciting a brawl; or while the covered person is committing a felony or while the covered person is being arrested, arrest or escaping the arrest.
17. Any cosmetic surgery or beautification treatment including lasik surgery, the treatment of acne, freckles, dandruff, weight reduction and weight gain hair loss. Reconstructive surgery is also excluded unless injury is sustained as a result of an accident and reconstructive surgery is necessary to restore functionality. Precocious puberty is also not covered
18. Any expenses not related to medical treatment such as telephone, radio, television, newspaper, extra meals.
19. Any medical treatment given by a medical practitioner who is the parent, spouse or child of the covered person. The covered person who is a registered medical practitioner may not be reimbursed for any self-administered treatment.
20. Investigation or treatment for sexual dysfunction or sex change.
21. Treatment related to pregnancy, miscarriage and the treatment for the new born baby.
22. Investigation or treatment of male or female infertility or sterilization and reversal of sterilization of either sex or birth control.
23. Treatment to relieve symptoms commonly associated with ageing, menopause or precocious puberty, learning difficulties, behavioral problems or development problems.
24. Any inoculations and vaccinations.
25. Treatment or surgical operation which has not been recommended by a physician or a surgeon including the medical service which is not necessary or appropriate
26. Any drugs, therapeutic treatments or diagnostic tests which are not related to the diagnosis, symptoms or conditions stated on the medical certificate.
27. Alternative treatment including hypnosis, acupuncture, chiropractic, homeopathy.
28. Special nursing.
29. Eye examination and eyesight corrective surgery, refraction, hearing tests.
30. Artificial aids, wheelchairs, crutches, glasses, hearing aids, speech device, heart pacemaker, cardio defibrillators, diabetic infusion pumps and similar devices
31. Prostheses except heart valve, skull plates, hip and knee prostheses.
32. Any dental treatment except emergency dental treatment resulting from an accident. The Company will not reimburse the cost of dental reconstructive treatment, orthodontist, crowns, dentures, polishing, and fillings. (unless the dental benefit is purchased)