Health Plan - Exclusions from Cover
1. No claim shall be payable for any condition pre-existing at the time of commencement of a member's membership of the Health Plan unless disclosed and specifically accepted by the Company on the member's entry to the Health Plan.
2. No claim shall be payable for examinations and reports for disengagement or discharge from the NZ Police, or in respect of any other insurance claim.
3. No claim shall be payable if any treatment or operation is claimed for outside the scope of the Benefits, or subject to an exclusion, no claims for related charges such as anaesthetist, hospital and x-ray will be met by Health Plan limited.
4. No claim shall be payable for:
4.1 Any diagnosed condition, or signs/symptoms of a condition, pre-existing at the time of commencement of a member’s membership of Police Health Plan unless disclosed and specifically accepted by Police Health Plan Limited on the member’s entry to the Health Plan.
4.2 Maintenance examinations or medical check-ups including mole mapping or dermatological surveillance, health screening, physicals for life insurance, driving licence or any other third party requirements.
4.3 Acute hospital admissions – “Acute” means an unplanned admission or a planned admission if the admission date is less than 48 hours after the date on which the decision to admit was made.
4.4 Treatment where a condition detrimental to health is not evident, including preventative medicine, Prophylactic Healthcare and/or Unapproved Healthcare services and vaccinations, unless otherwise authorised in writing by Police Health Plan limited.
4.5 Mental disorders as defined in the mental Health (Compulsory Assessment and Treatment) Act 1992.
4.6 Geriatric care including geriatric hospitalisation and pre-senile dementia.
4.7 Aids or HIV infection or any condition arising from the presence of Aids or HIV infection as well as other sexually transmitted disease.
4.8 Congenital conditions other than those existing in children who become a member of Police Health Plan within three months from their date of birth.
4.9 Expenses recoverable from a third party or under any contract of indemnity or insurance.
4.10 Any costs for Cosmetic Treatment, however, remedial treatment may be considered by Police Health Plan Limited, at its sole discretion, if such treatment relates to correction of previously qualifying treatment under Police Health Plan.
4.11 Sterilisation reversal.
4.12 Contraceptives, whether prescribed or non-prescribed.
4.13 Any treatment required due to an accident.
4.14 Pregnancy, childbirth or consequences, except for those costs covered under the Prenatal/Antenatal Loyalty Benefit.
4.15 Homeopathy, naturopathy, herbal medicine or any other alternative medicinal treatment.
4.16 Cardiac pacemakers, implantable defibrillations, nerve appliances, hearing aids, cochlear implants and any other appliances (surgical, medical or dental) other than surgically implanted prostheses which have been approved by Police Health Plan limited.
4.17 The extraction of teeth, implantation of teeth or costs of implants with the exception of impacted wisdom teeth or those costs covered under the Surgical Loyalty Benefit.
4.18 Chelation therapy or similar treatment as defined by Police Health Plan Limited.
4.19 Refractive Surgery for the correction of short sight or long sight including Astigmatism.
4.20 Treatment for obesity.
4.21 War injury or disability.
4.22 Self-inflicted injuries or illness including disability or illness arising from the use of alcohol or drugs, including prescription medication.
4.23 Any costs not referred to under a particular Plan option in the Police Health Plan Brochure.
4.24 Management and treatment of snoring.
4.25 Surgery designed to assist or allow the implementation of orthodontic services.
4.26 Breast reduction procedures performed for any reason.
4.27 Sexual dysfunction.
4.28 Treatment provided by any person outside New Zealand except as agreed by Police Health Plan limited.
5. No claim shall be payable for technologies, pharmaceuticals, or medical procedures that have not been approved by Police Health Plan limited.
6. No claim shall be payable for cost in excess of Usual Reasonable and Customary charges (see definition under Terms & Conditions).