1. EXCLUSIONS:

The following are excluded from all plans: –

1. Overseas treatment and transplant surgery
2. Plastic/cosmetic surgeries
3. Management of Chronic Diseases on the HyStarter Plan including but not limited to consultation, prescription drugs and laboratory tests
4. Advanced and complex investigations including but not limited to CT Scan, MRI Scan and Echocardiography
5. Investigations and treatment for problems relating to infertility e.g. hydrotubation, hysterosalpingogram, I.V.F, G.I.F.T and artificial insemination
6. Virility enhancing drugs
7. Maternity services including but not limited to antenatal care, delivery services, postnatal care services
8. Renal Dialysis
9. Treatment of Congenital abnormalities
10. Herbal drugs, non-prescription drugs and experimental drugs and treatment
11. Other laboratory investigations not listed in the schedule of covered services
12. Dental care not listed in the schedule of covered services
13. Optical care not listed in the schedule of covered services including Frames and Lenses
14. Neonatal care services including but not limited to male circumcision, ear piercing, treatment of mild or moderate neonatal sepsis, phototherapy, NICU and SBCU services.
15. Optical Care: Lenses, Frames & Contact, Lenses
16. Other advanced immunizations not specified in the plan benefits.
17. HIV/AIDS Care & Treatment
18. Home care and domiciliary services
19. Intensive care treatment
20. Interstate travel for services not available in State
21. Joint replacements and prosthetic limbs
22. Psychiatric Treatment and illness
23. Comprehensive health screening/well persons’ check
24. Pre – School Health examinations
25. Self-inflicted injuries
26. Treatment of obesity
27. All Covid-19 testing and treatment
28. Speech disorders
29. Room upgrades beyond that specified in the plan benefits
30. Management of severe burns (Burns covering more than 10% body surface area)
31. Learning difficulties, behavioral and developmental problems
32. Consultations with unrecognized consultants, hospitals, family doctors, therapists, dental practitioners, or complementary medicines practitioners
33. Any other treatment, service, procedure, or investigation not listed in the schedule of covered medical services.NOTE
34. 1. Only persons below the age of 60 years are eligible for this plan.
    2. There will be a waiting period of 2 weeks after registration. Plans purchased become active 2 weeks after the purchase date.
    3. All benefits are subject to their respective sectional limits which are described as Inpatient Limit and Outpatient Limit. However, within the respective sectional limit, there are specific benefit limits as well. Consequently, in the event that any specific benefit limit under the sectional limit is exhausted, the remaining limit in that section will only cover other benefits within the section apart from the one that the specific benefit limit has been exhausted.
    4. The following benefits will not be covered or provided in the first year of the commencement of the scheme: Surgeries and Critical Illness + Death Cover. This period otherwise known as the waiting period shall commence on the date of entry to the date of renewal. On renewal, this benefit will be accessible provided the enrollee has been enrolled for one year with the HMO.
    5. The following benefits will not be covered or provided in the first 3 months of the commencement of the scheme: Optical Care, Dental Care, and Chronic Disease Medication.