HOSPITALIZATION EXCLUSIONS

1. Pre-existing conditions where the costs are incurred within the Waiting Period on Pre-existing Conditions as specified in the Summary of the Policy;
2. Any ailment, disease, disorder, condition or disability which existed at the admission date on which the Beneficiary should have disclosed to the Policy when making application for admission or registration as a Beneficiary;
3. Any treatment or condition which may be determined from time to time by the Scheme which will be duly notified to the Principal Insured Person at the expiration of the policy and prior to the Renewal Date;
4. Nuclear weapons or nuclear material or by ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception combustion shall include any self-sustaining process of nuclear fission;
5. Investigations, treatment, surgery for obesity and its sequellae;
6. Cosmetic surgery or surgery directly or indirectly caused by or related to or in consequence of cosmetic surgery;
7. Treatment for infertility including but not limited to artificial insemination and invitro fertilisation; Hormone replacement treatment;
8. Any procedure of a purely diagnostic nature or any examination where there are no objective indications of impairment in normal health;
9. Suicide, attempted suicide or intentional self-injury;
10. The taking of any drug or narcotic substance that was not prescribed by and / or not taken in accordance with the instructions of a registered Medical Practitioner;
11. Substance abuse including drug addiction;
12. An event attributable to the Beneficiary having an alcohol content exceeding eighty milligrams per one hundred millilitres of blood or an event attributable to the Beneficiary suffering from alcoholism;
13. Participation in:
    • Active military duty, police duty, police reservist duty, military reservist duty, civil commotion labour, disturbances, riot strike or the activities of locked out workers;
    • Aviation other than as a passenger or member of a crew on a scheduled commercial flight;
    • Any form of race or speed contest (other than on foot or involving any non-mechanically propelled vehicle);
    • Excluded activities;
    • Professional Sports;
    • Any other activity where the Beneficiary deliberately exposes himself to danger;
14. Purchase or hire of external /internal medical appliances except for crutches, braces and / or elastic stockings provided on discharge from hospital;
15. Services by persons not registered as medical personnel with the relevant medical authorities within Ghana, except when specifically provided for as a benefit in the Policy;
16. The purchase of:
    • medicines other than TTO.s;
    • bandages, aids, syringes and instruments other than for in-hospital use or during an evacuation;
    • patent medicines and proprietary preparations, patent foods such as baby foods; tonics, slimming preparations, appetite suppressants and stop-smoking aids;
    • domestic and herbal remedies, homeopathic remedies, except when specifically provided for as a benefit in the Policy.
    • vitamins, tonics and mineral supplements not prescribed in conjunction with an antibiotic;
    • contraceptives;
17. Medical Examinations for insurance, school camp, visa, employment, annual medical checks or similar services;
18. Admission and/or treatment in convalescent or old age homes or similar institutions catering for the aged or chronically ill including private nursing costs; as well as Rehabilitation facilities, nursing homes, hospice, private nursing and similar facilities, unless approved by the Scheme as an alternative to hospitalisation;
19. Any treatment or advise for Services rendered in respect of a condition that in the opinion of the Scheme, is directly attributable to irregular or immoral behaviour, activities involving an unacceptable risk of injury or of a particular hazardous nature, negligence or contributory negligence, breach of the law or failure to carry out the instructions of the Medical Practitioner;
20. Martial law or state of siege or any events or causes which determine the proclamation or maintenance or martial law or state or siege;
21. Dental and ear treatments that include but are not limited to:
    • the provision of false teeth or dentures; orthodontics; advanced and specialised dentistry;
    • the provision of hearing aids, unless as a result of a covered injury or cancer;
22. Confinements other than routine confinements and medically necessary caesarean sections. Included in the exclusion are treatment relating to birth defects and congenital illnesses as well as foetal treatment. All abortions are also excluded from the benefit except where there is an immediate threat to the life of the mother;
23. Voluntary Caesarean section costs;
24. Congenital abnormalities;
25. Mental Health and/or psychiatric conditions;
26. All treatments of hepatitis with the exception of surface antigen screening.
27. Renal dialysis other than short-term acute dialysis for reversible renal conditions;
28. Organ transplants and organ donation;
29. Brain surgeries, cardiovascular surgeries unless as a result of accidents occurring within the currency of the policy year.
30. Auxiliary services and preparations provided by and including but not limited to psychologists, podiatrists, chiropodists, chiropractors, homeopaths, naturopaths, osteopaths, acupuncturists, speech therapists; herbalists, spiritualists; traditional medicines and occupational therapists;
31. All costs relating to treatment covered by any other insurance policy.
32. Treatment by a Medical Practitioner who is a relative of the Insured;
33. Costs either indirectly or directly relating to a sex change;
34. Costs relating to corrective treatments for medical procedures that are not covered by the Policy;
35. Cryopreservation, implantation or re-implantation of living cells or living tissue.
36. Any claims in excess of the benefit limits indicated in the Benefit Schedule
37. All costs relating to treatment of cancer of any kind
38. Cost relating to Neuro Surgeries, Cardio thoracic surgeries and Colorectal surgeries