Policy Exclusions - GHS
Exclusions Inpatient:
i) Cosmetic surgery or treatment including (but not limited to) eg. Double eyelids, acne, hair loss or treatment of their complications except as medically necessitated by accidental injuries.
ii) Any corrective treatment including glasses or contact lenses for refractive errors, except mono-focal intraocular lenses up to a maximum reimbursement amount of One Thousand Ringgit Malaysia in cataract surgery.
iii) Use or acquisition of all appliances (e g artificial limbs, pacemakers, hearing aids, aero chambers).
iv) Equipment for nebulizer, Continuous positive airway pressure (CPAP), Continuous ambulatory peritoneal dialysis (CAPD), orthopedic pads and the rental of such devices except during hospital confinement.
v) Dental treatment or oral surgery except as necessitated by an accidental injuries to sound natural teeth occurring wholly during the period of Takaful.
vi) Private nursing care or house calls engaged by Person Covered or services for rest cure provided by nursing home purely for recuperative purposes.
vii) Conditions related to sexually transmitted diseases, AIDS and AIDS Related Complex or its sequelae, and any communicable diseases requiring quarantine by Malaysian Law.
viii) Treatment arising from injuries sustained while committing a crime or felony, or while under the influence of alcohol, narcotics, or mind altering substance or injuries which are self- inflicted while sane or insane.
ix) Any treatment or surgical operation for congenital abnormalities or deformities including hereditary and developmental conditions.
x) Hyperhidrosis.
xi) Contraceptive medications and devices, sterilization procedures or treatment for its complications, reversal of such procedures and the work up or treatment of sexual dysfunction or infertility, sex transformation surgery and sex hormone therapy.
xii) Allergy testing blood /topical including patch test.
xiii) Investigation and treatment relating to pregnancy including childbirth, Ectopic Pregnancy and Vesicular Mole and all complications arising therefrom.
xiv) Care and treatment that is experimental, investigative or diagnostic /examination which are non-medically necessary or incidental to treatment or diagnosis of a covered Disability.
xv) Stem Cell Therapy except hamoepoietic blood disorders.
xvi) Vitamins, Food Supplements, Herbal Cures and Anti- Obesity / Weight Reducing Agents including any of the counter medications.
xvii) Any circumcision unless medically indicated.
xviii) War, direct or indirect participation in riots, rebellions. Insurrection or military, civil commotion, explosion of war weapons, revolution, act of foreign enemy or hostilities.
xix) Any treatment directly or indirectly arising from exposure to radioactive, explosive or hazardous nature of nuclear fuel materials or property contaminated by nuclear fuel materials or accident arising from such nature.
xx) Expenses incurred for donation of any body organ by a Person Covered and costs of acquisition of the organ including all costs incurred by the donor during organ transplant.
xxi) Investigation and treatment of sleep and snoring disorders and alternative therapy such as (but not limited to) to chiropractic services, acupuncture, acupressure, reflexology, bone-setting, herbalist treatment, Osteopathy, Podiatic, Dietetic consultation.
xxii) Psychotic, mental or nervous disorders and behavioral conditions including any neuroses and their physiological or psychosomatic manifestations and sleep disorder.
xxiii) Services of a non-medical nature provided by the Hospital such as television, telephones, telex services, radios or similar facilities.
xxiv) Illnesses or injury sustained during air travel except as a fare paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes.
This contract does not cover any hospitalization, surgery or charges cause directly or indirectly, wholly or partly, by any one (1) of the following occurrences:
1. Plastic/Cosmetic surgery, circumcision, eye examination, glasses and refraction or surgical correction of nearsightedness (Radial Keratotomy or Lasik) and the use or acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions thereof.
2. Dental conditions including dental treatment or oral surgery except as necessitated by Accidental injuries to sound natural teeth occurring wholly during the Period of Insurance.
3. Private nursing, rest cures or sanitaria care, illegal drugs, intoxication, sterilization, venereal disease and its sequelae, AIDS (Acquired immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV related diseases, and any communicable diseases required quarantine by law.
4. Pregnancy, child birth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care and surgical, mechanical or chemical contraceptive methods or birth control or treatment pertaining to infertility. Erectile dysfunction and tests or treatment related to impotence or sterilization.
5. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
6. Hospitalization primarily for investigatory purposes, diagnosis, X-ray examination, general physical or medical examinations, not Incidental to treatment or diagnosis of a covered Disability or any treatment which is not Medically Necessary and any preventive treatments, preventive medicines or examinations carried out by a Physician, and treatments specifically for weight reduction or gain.
7. War or any act of war, declare or undeclared, criminal or terrorist activities, active duty in any armed forces, direct participation in strikes, riots and civil commotion or insurrection.
8. Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material.
9. Expenses incurred for donation of any body organ by an Insured Person and costs of acquisition of the organ including all costs incurred by the donor during organ transplant and its complications.
10. Investigation and treatment of sleep and snoring disorders, hormone replacement therapy and alternative therapy such as treatment, medical service or supplies, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, Bone setting, herbalist treatment, massage or aroma therapy or other alternative treatment.
11. Care or treatment or which payment is not required or to the extent which is payable by any other insurance or indemnity covering the insured and Disabilities arising out of duties of employment or profession that is covered under a Workman’s Compensation Takaful Contract.
12. Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations).
13. Costs/expenses of services of a non-medical nature, such as television, telephones, telex services, radios or similar facilities, admission kit/pack and other ineligible non-medical items.
14. Sickness or injury arising from racing of any kind (except foot racing), hazardous sports such as but not limited to skydiving, water skiing, underwater activities requiring breathing apparatus, winter sports, professional sports and illegal activities.
15. Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes.
16. Expenses incurred for sex changes.
17. Hereditary Disease
18. Terrorism.
19. Any treatment arising from alcoholic or drug addiction.
20. Any breach of the civil or Syariah Law by the members.
For detail description of the covered benefits, please refer to the Policy Contract/ Policy Information Statement.
