Healthnet healthcare insurance

GROUP MEDICAL INSURANCE POLICY CONDITIONS
In recognition of the payment of the PREMIUM WE undertake to reimburse MEDICAL
TREATMENT CHARGES for MEDICAL TREATMENT incurred during the POLICY
YEAR.
YOUR cover is governed by the following documents all of which must be read together.
The Application Form and any associated declarations.
The Policy Conditions when YOUR POLICY begins or is renewed.
The Schedule of Benefits when YOUR POLICY begins or is renewed.
The Endorsements.
The Certificate of Insurance.
The Premium Table.
Any word explained in the definitions section will have the same meaning throughout.
Such words are shown in capital letters for ease of recognition.
A Certificate of Insurance will be issued only when YOU have completed an Application
Form, this has been accepted by US and the PREMIUM has been paid. Any Certificate of
Insurance replaces any other Certificate previously issued to cover the same Insurance.
Any Cover not shown on the Schedule of Benefits is not provided.

DEFINITIONS

Accident
Any sudden and unforeseen event occurring during the POLICY YEAR, resulting in
bodily injury, the cause or one of the causes of which is external to the victim’s own
body and occurs beyond the victim’s control.
Acupuncture
Therapy of a MEDICAL CONDITION by needles or laser provided by or ordered by a
licensed PHYSICIAN.

Active Service
An EMPLOYEE will be considered in Active Service on any day if they are performing
in the customary manner all the regular duties of their employment as performed, or where capable of being performed, on the last regularly scheduled work day. 1 Healthnet Group Medical Policy Wordings 2008//01
Benefit/s
A benefit that WE will pay under this POLICY for MEDICAL TREATMENT
CHARGES incurred during the POLICY YEAR. Only those Benefits stated on the
Schedule of Benefits are covered.

Compulsory Plan
A plan where all eligible persons must be included.

Day Patient
A patient who occupies a HOSPITAL bed or is charged for HOSPITAL accommodation
in the course of MEDICAL TREATMENT but does not remain overnight.
Dependant
The spouse of the INSURED PERSON (but excluding those legally separated), and/or
unmarried children, step-children, foster children and legally adopted children, who are
dependent on the INSURED PERSON for support. Provided that such children are not
less than 15 days and not more than 18 years old at the date of enrolment in the Plan, (or
24 years old provided it can be proved that the child is dependent upon the parents for
financial support, and in full time education within the United Arab Emirates.
The DEPENDANTS of the INSURED PERSON must be recognised as such in the
records of the EMPLOYER.
Deductible
The contribution that YOU must pay towards MEDICAL TREATMENT CHARGES.
Due Date
The date of commencement or renewal of cover as shown on the Certificate of Insurance,
or the date on which any subsequent installment of premium falls due.
Emergency Dental Treatment
Emergency MEDICAL TREATMENT necessary to restore or replace sound natural teeth
lost or damaged in an ACCIDENT and for which MEDICAL TREATMENT is provided
within 48 hours following the ACCIDENT.
Emergency Medical Evacuation
The medically necessary expense of emergency transportation and medical care en route
to move an INSURED PERSON who has a critical MEDICAL CONDITION to the
nearest HOSPITAL where appropriate care and facilities are available.
Reasonable transportation costs only of one other person accompanying the patient on an
EMERGENCY MEDICAL EVACUATION when this is deemed necessary.
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In the event of an approved EMERGENCY MEDICAL EVACUATION WE will pay the
cost of an economy air ticket back to the United Arab emirates.
This BENEFIT does not apply within the United Arab Emirates or in the event of
maternity.

Emergency Medical Repatriation
Evacuation costs of an INSURED PERSON (including one other person necessarily
having to travel, remain with or escort the INSURED PERSON) in the event of in-patient
treatment not being readily available in the Country of Residence or country of incident
(if different) to an appropriate facility in the home country of the insured person on the
certified instructions of a Medical Practitioner or Specialist and only upon receipt of
written agreement from the appointed assistance provider prior to travel.
The appointed assistance provider will decide whether such evacuation requires an air
ambulance or whether a commercial flight is appropriate.
Emergency Ward Services following Accident
Services performed in a HOSPITAL casualty ward or emergency room immediately
following an ACCIDENT.

Employee
An INSURED PERSON who is in ACTIVE SERVICE on a full-time basis with the
EMPLOYER under a written contract of employment. Persons in casual employment
with the EMPLOYER are not included. Sole Proprietors, Partners or Directors of the
EMPLOYER can be included.

Employer
The EMPLOYER of the INSURED PERSON or, in the case of non employee groups
accepted by US, the Sponsoring organisation through which the plan is offered, effected
or administered and to whom the MASTER POLICY is issued.
General Outpatient Services
OUTPATIENT SERVICES provided by or ordered by a PHYSICIAN who is licensed as
a General Practitioner.

Geographical Area
The Geographical Area stated in the POLICY for which the appropriate premium has
been paid. MEDICAL TREATMENT for a MEDICAL CONDITION will only be
reimbursed under this POLICY if the MEDICAL TREATMENT was performed in a
country specified under the Geographical Area in the POLICY.
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Group
Membership of a Group Plan accepted by US. It comprises a group of EMPLOYEES
employed by an EMPLOYER or Members of a Trade Union or Members of any
Association and their Dependants or Members of any other Institution accepted by US
and considered to be a group for the purposes of this contract.

Hospital Cash Benefit
The cash payment by us of the amount mentioned in the Schedule of Benefits
when the INSURED PERSON is admitted in one of the hospitals stated in
Schedule of Benefits for inpatient treatment.

Healthnet Network
Is the group of Medical Service Providers including hospitals which have contracted with
US to provide MEDICAL TREATMENT to YOU.

Hospital
Any institution which is legally licensed as a medical or surgical Hospital in the country
in which it is located and whose main activities are not those of a rehabilitation centre,
spa, hydroclinic, sanatorium, nursing home, or home for the aged. It must be under the
constant supervision of a resident PHYSICIAN.

Hospital Services
Accommodation, nursing, operating theatres, drugs, dressings, diagnostic procedures and
any other necessary services rendered by the HOSPITAL for MEDICAL TREATMENT
as an IN-PATIENT.

In-Patient
A patient who occupies a HOSPITAL bed for more than 24 hours for MEDICAL
TREATMENT.

Insured Person
(You/Your)
Any person listed as an insured person on any Certificate of Insurance or Schedule.

Laboratory and X-ray Services
Laboratory testing, radiographic and nuclear medicine procedures used to diagnose and
treat MEDICAL CONDITIONS. Laboratory and X-ray Services must be provided by or
ordered by a PHYSICIAN.

Local Ambulance Services
The necessary medical transportation by road ambulance to a local HOSPITAL.

Master Policy
The Contract of Insurance which is issued to the EMPLOYER or the Sponsoring
organisation as defined.
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Maternity Care
Maternity Care, where included, shall mean pre-natal, childbirth and post-natal treatment
for YOU up to the limit specified and subject to any co-insurance per pregnancy. Where
this benefit is included, it will only apply to pregnancies beginning at least 10 calendar
months after the date of enrollment of the Insured Person.

Medical Condition
Any illness, disease or injury not excluded under this POLICY.
Medical Emergency
Any Medical Condition or serious accident which require urgent and immediate
Medical Treatment and which cannot be delayed.
Medical Treatment
Medical or Surgical procedures performed with the sole purpose to cure or relieve a
MEDICAL CONDITION.

Medical Treatment Charges
Reasonable, customary and necessary charges for:
1) HOSPITAL SERVICES
2) OUT PATIENT SERVICES
3) POST HOSPITALISATION TREATMENT
4) EMERGENCY WARD SERVICES
5) NURSING AT HOME
6) SPECIALIST HERBAL TREATMENT
7) ACUPUNCTURE
8) MATERNITY CARE
9) GENERAL OUTPATIENT SERVICES
10)SPECIALIST OUTPATIENT SERVICES

Nursing at Home
Medical services of a government licensed nurse in YOUR home when prescribed by a
PHYSICIAN and related directly to a MEDICAL CONDITION for which YOU have
received or are receiving treatment covered under the terms and conditions of this
POLICY.

Organ Transplantation
MEDICAL TREATMENT costs incurred in respect of kidney, heart and liver transplants.
This BENEFIT does not cover the cost of acquiring the organ or any expenses
whatsoever incurred by the donor.
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Overall Limits
Are the total aggregate BENEFITS that may be claimed in any one POLICY YEAR by
an INSURED PERSON. Such limits will be shown in the Schedule of Benefits on the
Certificate.

Out Patient Services
MEDICAL TREATMENT provided to an INSURED PERSON when not a DAY
PATIENT or IN PATIENT. These may include:
GENERAL OUTPATIENT SERVICES
SPECIALIST OUTPATIENT SERVICES
LABORATORY AND X-RAY SERVICES
PRESCRIBED DRUGS
SPECIALIST HERBAL TREATMENT
ACUPUNCTURE

Parent Accompanying Child
Charges made by a HOSPITAL for one parent to accompany a child aged 15 years or
under when treated as an IN-PATIENT

Physician
Is a legally licensed medical practitioner recognised by the law of the country where
treatment is provided and who, in rendering such treatment, is practising within the scope
of his licensing and training.

Physiotherapy and Chiropractic
Consultation and procedures conduct by physiotherapist physician subject to prior
referral of specialist orthopedician or Neurosurgeon only.

Policy
YOUR application forms, declaration, definitions, conditions, exclusions, including the
table of benefits, certificate of insurance and any endorsements and the premium table.
Policy Year
The annual period of insurance from one Due Date to the next anniversary of the Due
Date as specified in the Certificate of Insurance.

Post Hospitalisation Treatment
Is all MEDICAL TREATMENT provided within three months immediately following
discharge from HOSPITAL provided by or ordered by a PHYSICIAN which directly
results from a MEDICAL CONDITION for which the INSURED PERSON has been
treated as an INPATIENT. Such treatment may include:
GENERAL OUTPATIENT SERVICES
SPECIALIST OUTPATIENT SERVICES
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LABORATORY AND X-RAY SERVICES
PRESCRIBED DRUGS
SPECIALIST HERBAL TREATMENT
ACUPUNCTURE
Pre-Authorised
Planned IN-PATIENT or DAY PATIENT treatment or SPECIALIST OUTPATIENT
SERVICES that YOU have informed US about prior to admission or treatment that WE
have checked against YOUR POLICY cover and agreed.

Pre-authorisation Code
Is a code number issued by US to YOU or directly to a PHYSICIAN or
HOSPITAL prior to certain types of MEDICAL TREATMENT taking place.

Prescribed Drugs
Medications whose sale and use are legally restricted to the order of a PHYSICIAN and
do not include items that may be purchased without a PHYSICIAN’S prescription.
Reasonable and customary charges
The average amount charged in respect of a valid services or Treatment costs, as
determined by Our experience in any particular country, area or region and
substantiated by an independent third party, being a practicing
Surgeon/Specialist or Government Health Department.
Repatriation of Mortal Remains from outside U.A.E. or Local Burial
The expense of preparation and the air transportation of the mortal remains of an
INSURED PERSON from the place of death either to the United Arab Emirates or to the
HOME COUNTRY, or the preparation and Local Burial of the mortal remains of an
INSURED PERSON. This BENEFIT is excluded where death occurs in the HOME
COUNTRY.

Repatriation of Mortal Remains from within the U.A.E.
The expense of preparation and the air transportation of the mortal remains of an
INSURED PERSON from the U.A.E. to the HOME COUNTRY where death occurs
within the U.A.E.

Specialist Herbal Treatment
Means internal and/or external application of herbs provided or ordered by a specialist.

Specialist Outpatient Services
Outpatient Services provided by or ordered by a specialist or consultant to whom the
Insured Person has been referred by another PHYSICIAN.
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The Insurer is
NATIONAL GENERAL INSURANCE Co. (P.S.C.)

Utilisation Review
OUR right, in consultation with your treating PHYSICIAN, to review any course of
MEDICAL TREATMENT and to recommend alternatives.
WE/US/OUR
NATIONAL GENERAL INSURANCE Co. (P.S.C.)
Work Related Accident/Illness
Any ACCIDENT or MEDICAL CONDITION incurred as a result of an EMPLOYEES
occupation.

YOU/YOUR INSURED PERSONS
Any person listed as an INSURED PERSON on any Certificate of Insurance or Schedule
or listed in Staff census which YOU have given to US and which has been accepted by
US.

Additions/Deletions
Additions/ Deletions will be on a pro-rata premium basis.
For new additions passport copies showing stamped visa page, photograph, addition &
deletions form and duly filled in application forms if applicable should be submitted.
The company reserves the right to vary the premium rates, if there is a change in the total
number of insured members above or below 25% during the policy year.
Application
All policies are subject to the completion of the appropriate application form and medical
underwriting. WE retain the right to decline any application.
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Arbitration
Any differences in respect of medical opinion will be settled between two medical
experts one appointed by each of the two parties to the dispute in writing. Any
differences of opinion between the two medical experts shall be referred to an umpire
who shall have been appointed in writing at the outset by the two medical experts.

Cancellation
WE may cancel this MASTER POLICY if:
• The premium has not been paid.
• The EMPLOYER fails to observe the terms of the POLICY or fails to act with

Cancellation of the MASTER POLICY will automatically cancel all cover for all
persons insured under the MASTER POLICY.

Cessation of Coverage
Cover will cease automatically at the first DUE DATE following the 65th birthday of
any INSURED PERSON covered hereunder or if any INSURED PERSON ceases to
fulfil the requirements for ELIGIBILITY.

Claims
In the event of a claim under the policy we will only pay BENEFIT if:
1. YOU have contacted US and received PRE-AUTHORISATION of any costs to be incurred as either a DAY-PATIENT or an IN-PATIENT or as a result of SPECIALIST OUTPATIENT SERVICES (other than Gynaecological or Paediatric Consultations). In an emergency when WE can not be contacted in advance then the admission to HOSPITAL must be reported as soon as possible and in any event not later than 2 working days after admission and. 2. Premiums have been paid for the POLICY YEAR and MEDICAL TREATMENT 3. WE can ask for medical information including pre-admission certification and concurrent review reports, from any PHYSICIAN as often as WE require and if necessary examine YOU and 4. WE are told of any circumstances that may lead to a claim against a third party or 5. MEDICAL TREATMENT is carried out within the “HEALTHNET” NETWORK. Treatment received outside of the “HEALTHNET” NETWORK will be subject to 20% coinsurance after deductible and treatment will be on a reimbursement basis and reasonable and customary charges will prevail. 9 Healthnet Group Medical Policy Wordings 2008//01
6. Where MEDICAL TREATMENT is carried out outside of the “HEALTHNET” NETWORK written details of the claim have been sent to US as soon as possible and in any event not later than 90 days from the start of MEDICAL TREATMENT. All documentation relating to the claim must be originals and not copies.
Eligibility
This Insurance is available only to United Arab Emirates Nationals and persons holding a
valid current full residence status visa for the United Arab Emirates and who are
ordinarily resident in the United Arab Emirates. Only EMPLOYEES aged under 65
currently in ACTIVE SERVICE of the EMPLOYER and their DEPENDANTS aged
under 65 at the date of entry into the coverage are eligible. Newly born children shall be
eligible for insurance 15 days after the date of birth or 15 days after discharge from the
HOSPITAL where the birth took place, whichever is the later.
Emergency Medical Evacuation
In the event of EMERGENCY MEDICAL EVACUATION WE retain the right to decide
where YOU are transported to. Any portion of YOUR travel ticket which is unused after
the provision of EMERGENCY MEDICAL EVACUATION SERVICES shall be
surrendered to US.

Fraud
If any claim shall in any respect be false or fraudulent or if fraudulent means or devices
are used by the INSURED PERSON or anyone acting on his behalf to obtain BENEFIT
hereunder then the coverage in respect of such person and insured dependants shall be
cancelled immediately and all BENEFITS and premium forfeited.
Legal Proceedings
No Legal proceedings shall be commenced until 60 days after a claim has been correctly
submitted with all documentation required by US and no such action shall be brought
unless commenced within 6 years from the first date of treatment.
This POLICY is governed by the Law of the United Arab Emirates and any dispute arising out this POLICY shall be settled in the Courts of Dubai.
Lost Card
For Lost or stolen cards a cost of Dhs. 25 will be levied.

Material Changes
WE must be advised as soon as possible of any material change effecting any INSURED
PERSONS. WE retain the right to alter the terms of the POLICY or cancel the POLICY
in the event of material change.
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Other Insurance
WE will not pay for MEDICAL TREATMENT CHARGES if there is or may be any
other insurance or indemnity that may cover those charges. If the other insurance or
indemnity does not cover all MEDICAL TREATMENT CHARGES. WE will pay the
balance subject to the limitations of this policy.

Payment of Benefits
We will make payment directly to a provider of MEDICAL TREATMENT which is a
member of the HEALTHNET NETWORK subject to receiving satisfactory proof of the
MEDICAL TREATMENT provided. WE will make payment to YOU for MEDICAL
TREATMENT received outside the HEALTHNET NETWORK subject to receiving
satisfactory proof of the MEDICAL TREATMENT received.

Payment of Deductible
YOU must make payment directly to any provider of MEDICAL TREATMENT for the
amount of any DEDUCTIBLE applicable as specified in the Certificate of Insurance.

Payment of Premium
Premiums are payable in advance of the DUE DATE. If payment is not made on or
before the DUE DATE the insurance will be cancelled from the DUE DATE.

Renewal
This plan is an annual contract and YOUR cover ends on the last day of the POLICY
YEAR. It may be renewed if renewal is invited by us and the premium has been paid.

WE will not pay for the following treatments, conditions, activities, items or their
consequences or any related expenses.
Acne and Hirsutism
Acne and Primary Hirsutism or related medical conditions.

Aids
Acquired Immune Deficiency Syndrome (AIDS), AIDS-related Complex Syndrome
(ARCS) and all diseases caused by and/or related to the virus HIV positive including
any treatment for the purpose of preventing or retarding the development of the
virus HIV positive.
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Alcohol, Drug or Substance Abuse
MEDICAL TREATMENT for alcoholism; alcohol, drug or substance abuse or addictions
or conditions that may be attributed to alcoholism; alcohol, drug or substance abuse or
addictions.

Appliances
Prostheses, corrective devices and medical appliances which are not required intra-
operatively including glasses, contact lenses, hearing aids, dentures or dental appliances.

Auto therapy
MEDICAL TREATMENT by a family member and any auto therapy including
prescription of drugs.

Birth Control
MEDICAL TREATMENT for contraceptive measures whether procedures or medicines
and related conditions.

Birth Defects
MEDICAL TREATMENT relating to birth defects and congenital illnesses. Birth
defects are deemed to include hereditary conditions, manifested at any age.
Care of the Aged
MEDICAL TREATMENT in any establishment for care of the aged.

Circumcision
Circumcision for any reason

Cosmetic Treatment
Elective cosmetic surgical or non-surgical procedures, whether or not for
psychological reasons including non-complicated varicose veins either
symptomatic or not, deviated nasal septum, uvuloplasty for any reason and any
treatment or procedure of navi which are not proved malignant.

Cryo preservation
All expenses of any cryo preservation and implantation or re-implantation of living cells.

Deductible
The amount of the deductible stated in the Certificate of Insurance.
Dental
All dental treatment which is not EMERGENCY DENTAL TREATMENT unless
ROUTINE DENTAL TREATMENT is specifically included in the coverage.
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Dietician Consultation
Consulting a Dietician for any reason.

Dialysis
Regular or long-term kidney dialysis in chronic or end-stage kidney failure.

Emergency Medical Evacuation/ Emergency Medical Repatriation (Refer
Schedule of benefits)
All EMERGENCY MEDICAL EVACUATION/ EMERGENCY MEDICAL
REPATRIATION benefits are excluded unless specifically included in the
coverage.

All EMERGENCY MEDICAL EVACUATION/ EMERGENCY MEDICAL
REPATRIATION costs not approved in advance by the appointed Assistance
Center and Emergency Medical Evacuation/ Emergency Medical Repatriation
costs where :
1. YOU were under MEDICAL TREATMENT at the time of commencing a journey and the costs incurred were relevant to that treatment, or if the journey was undertaken against a PHYSICIAN’S orders or advice. 2. A journey was specifically undertaken with the intention of obtaining 3. YOU were exercising any form of hazardous work in connection with any 4. YOU were engaging in any form of aerial flight except as a fare paying passenger on a regular scheduled airline or licensed charter aircraft over an established route. 5. YOU were engaging in any potentially hazardous sports including Winter 6. Any expenses incurred as result of pre-existing conditions. 7. More than one emergency evacuation and/or repatriation for any single medical condition of a INSURED PERSON during the term of the insurance policy, subject to a maximum of one year. 8. Any expenses for medical evacuation or repatriation if the INSURED PERSON is not suffering from a serious Medical Condition, and/or in the opinion of the SOS physician, the INSURED PERSON can be adequately treated locally, or treatment can be reasonably delayed until the INSURED PERSON return to the United Arab Emirates.
9. Any expenses for medical evacuation or repatriation where the INSURED
PERSON, in the opinion of the SOS physician, can travel as an ordinary 13 Healthnet Group Medical Policy Wordings 2008//01

10. Any expenses related to accident or injury occurring while the INSURED
PERSON is engaged in caving, mountaineering or rock climbing necessitating the use of guides or ropes potholing, skydiving, parachuting, bungee-jumping, ballooning, hang gliding, deep sea diving utilizing hard helmet with air hose attachments, martial arts, rallying, racing of any kind other than on foot, and any organized sports undertaken on a professional or sponsored basis. 11. Any expenses incurred for emotional, mental or psychiatric illness. 12. Any expenses incurred as result of a self- inflicted injury, suicide, drug addiction or abuse, alcohol abuse, sexually transmitted diseases. 13. Any expenses incurred as a result of Acquired Immune Deficiency Syndrome (AIDS) or any AIDS related conditions or disease. 14. Any expenses related to the INSURED PERSON engaging in any form of aerial flight except as a passenger on a scheduled airline flight or licensed charter aircraft over any established route. 15. Any expenses related to the INSURED PERSON engaging in the commission of, or the attempt to commit, an unlawful act. 16. Any expenses related to treatment performed or ordered by a non-registered practitioner not in accordance with the standard medical practice as defined in the country of treatment. 17. Any expenses incurred as a result of the INSURED PERSON engaging in active service in the armed forces or police of any nation; active participation in war (whether declared or not), invasion, act of foreign enemy, hostilities, civil war, rebellion, riot, revolution or insurrection. 18. Any expenses which is a direct result of nuclear reaction or radiation. 19. Any expenses incurred for or as a result of any activity required from or on a ship or oil-rig platform, or at a similar off-shore location. 14 Healthnet Group Medical Policy Wordings 2008//01

Flight Risks
Any form of ariel flight except as a fare paying passenger on a regular, scheduled
airline or licensed charter aircraft over an established route.

Growth and development disorder:
All illness of developmental and constitutional nature either of physical or non-
physical origin.

Hazardous/Professional Sports
MEDICAL CONDITIONS arising from:
• ANY PROFESSIONAL SPORTS.
• MOTOR CYCLING APART FROM ON ROADWAYS DESIGNED FOR MOTOR TRAFFIC. • ABSAILING, CLIMBING AND MOUNTAINEERING NORMALLY REQUIRING THE USE OF ROPES • RACING OF ANY KIND OTHER THAN ON FOOT. • DIVING INVOLVING THE USE OF BREATHING APPARATUS • DESERT SAFARI SPORTS
Hormonal replacement therapy
All kinds of treatment which are needed to replace any hormonal deficiency of
the body.

Hospital Costs and Specialist Outpatient Services
Costs incurred as a DAY-PATIENT or IN-PATIENT unless PRE-AUTHORISED by US
in advance except in the case of a medical emergency.
Impotence
Medical treatment for impotence whether physical or psychological in origin
Infertility
Cost of tests or treatment relating to infertility or the inability to conceive,
assisted reproduction and invitro fertilisation.
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Maternity
1. All maternity care unless specifically included in the coverage.
2. Cost of tests or treatment relating to infertility or the inability to conceive.
3. Assisted reproduction including invitro fertilisation.
4. Termination of pregnancy for any reason unless medically necessary due to a life

5. Any EMERGENCY MEDICAL EVACUATION costs.
6. Any illegal pregnancy.
Medicine
General items, Cosmetic items and supplementary vitamins either prescribed by
physician or not as well as the following specific medicine: Interferon injections,
Viagra and all weight reducing medicine and regime.
Menopause
Cost of tests or treatment relating to menopause and Peri-menopausal symptoms include
hormonal replacement therapy
Mental or Psychiatric
MEDICAL TREATMENT of mental illness, psychiatric and psychological disorders.
Ophthalmology
Medical Treatment and measurements for the correction of error of refraction.
Organ Transplantation
All Organ, any tissue or cells Transplantations except heart, kidneys and liver.
Acquisition of the Organ itself and expenses incurred by the donor.
Costs for acquisition and implantation of artificial heart and mono or bi-ventricular
devices.
Outside Geographical Area
Any costs incurred outside the selected GEOGRAPHICAL AREA.
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Outside Policy Period
Any costs incurred outside of YOUR POLICY YEAR or during any period for which the
appropriate premium has not been paid.
Palliative therapy: Any treatment or procedure which is not curative but is
palliating the medical condition of the insured.
Polycystic ovarian syndrome and related conditions.
Prophylactic Medicine
Medical treatment and tests include vaccination (therapeutic, prophylactic),
allergy skin patch tests, RAST test and desensitization therapy.
Pre Existing Conditions
MEDICAL TREATMENT of any MEDICAL CONDITION including its
consequences from which YOU were already suffering or which was foreseeable
at the time YOUR Coverage under the POLICY began unless such MEDICAL
condition was declared to and accepted by US. This includes any previous
MEDICAL CONDITION or its consequences which recurs. “Foreseeable” means
that YOU knew or reasonably should have known that the MEDICAL
CONDITION existed, whether or not any PHYSICIAN had been consulted. Or
any MEDICAL CONDITION which is in context of natural course of this
condition should be manifested or symptomatic at the time of the insurance and
this is decided by the opinion of Medicine and independent medical consultant.
Radioactivity
MEDICAL CONDITIONS caused by, or attributed to radioactive contamination.
Rehabilitation
Services or treatment in any long term care facility, rehabilitation centre, spa,
hydroclinic, sanatorium, nursing home or home for the aged, including all
physiotherapeutic procedures which exceed one month after commencement of the
treatment.

Routine Examinations
Routine medical examination, including ear and eye examination, vaccinations, the issue
of medical certificates and attestations, and examinations as to suitability for employment
or travel.
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Self-inflicted
Costs resulting from wilfully self inflicted MEDICAL CONDITIONS.

Sexually transmitted diseases
Any MEDICAL TREATMENT of sexually transmitted diseases.
Terrorism Exclusion
Notwithstanding any provision to the contrary within this policy or any endorsement
thereto it is agreed that this policy excludes, loss, damage, cost or expense of whatsoever
nature directly or indirectly caused by, resulting from or in connection with any act of
terrorism regardless of any other cause or event contributing concurrently or in any other
sequence to the loss.
For the purpose of this exclusion an act of terrorism means an act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organisation(s) or government(s), committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.
This policy also excludes loss, damage, cost or expense of whatsoever nature directly or
indirectly caused by, resulting from or in connection with any action taken in controlling,
preventing, suppressing or in any way relating to any act of terrorism.
If WE allege that by reason of this exclusion any loss, damage, cost or expense is not
covered by this policy the burden of proving the contrary shall be upon YOU.
In the event any portion of this endorsement is found to be invalid or unenforceable, the
remainder shall remain in full force and effect.
Transportation Costs
All transportation costs except as defined under LOCAL AMBULANCE SERVICES .
Treatment outside the Healthnet Network
20% of the cost incurred (after deductible) of any MEDICAL TREATMENT outside the
HEALTHNET Network even when PRE-AUTHORISED by US in advance.
Unconventional Medical Treatment
Unconventional alternatives of surgical or non-surgical procedures, except if
approved by NGI on case by case basis.
Unproven Treatment
MEDICAL TREATMENT that is not Scientifically proven or recognised.
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War
Treatment of MEDICAL CONDITIONS resulting from participation in war, riot, civil
commotion the commission of or the attempt to commit any criminal act, including
resultant imprisonment.

Work Related Accident/Illness
Any ACCIDENT or MEDICAL CONDITION incurred as a result of an EMPLOYEES
occupation.
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Source: http://www.ngi.ae/ngi/assets/pdf/POLICYWORDINGS-Healthnet.pdf