Turnberry shall not be liable for hospitalisation, bodily injury, sickness or disease directly or indirectly caused by, related to or in consequence of:
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;
LASIK or Lasik (laser-assisted in situkeratomileusis) surgery or any type of refractive surgery for correcting myopia,
hyperopia, and astigmatism;
Investigations, treatment or surgery for obesity its sequela or cosmetic surgery or surgery directly or indirectly caused
by or related to or in consequence of cosmetic surgery other than as a result of an insured event otherwise insured.
For the purpose of this exception cosmetic surgery shall include surgery for breast reduction or reconstruction unless
necessitated as a result of treatment for cancer;
Routine physical or any procedure of a purely diagnostic nature or any other examination where there are no objective
indications of impairment in normal health and laboratory diagnostic or X-ray examinations except in the course of a
disability established by prior call or attendance of a Medical practitioner;
Suicide, attempted suicide or intentional self-injury;
The taking of any drug or narcotic unless prescribed by and taken in accordance with the instructions of a Medical
practitioner (other than the Insured person) or drug addiction;
An event directly attributable to the Insured person having an alcohol content exceeding the legal limit or the Insured
person suffering from alcoholism or any illness caused by the use of alcohol;
8. Participation in:
a. Active military duty police duty police reservist duty civil commotion labour disturbances riot strike or the activities
of locked-out workers
b. Aviation other than as a passenger
c. Any form of race or speed test (other than on foot or involving any non-mechanically propelled vehicle vessel craft or aircraft);
9. Investigations, treatment or surgery for artificial insemination or hormone treatment for infertility;
10. No benefits are payable which should be provided by the Medical Aid scheme (such as Prescribed Minimum Benefits),
this exception includes ward fees, theatre fees, medicines, appliances and other hospital expenses;
11. No benefits shall be payable in the event of fraudulent submission by the claimant;
12. No benefits shall be payable in the event the insured did not pre-authorise, make use of a Designated Service Provider (DSP) or any condition set by the Insured’s Medical Aid scheme;
13. No benefits shall be payable in the event there is no benefit for the treatment and/or the condition or if it is excluded and/or declined by the Insured’s Medical Aid scheme or if the Medical Aid scheme pays less than tariff for benefits associated with costs incurred above Medical Scheme tariff;
14. No benefit shall be payable in respect of any medical or surgical treatment unless such treatment occurred during the period of hospital confinement as an in-patient or as an out-patient (as defined);
15. The table of benefits applies in the territory of the RSA and no benefits are payable for expenses incurred for transport charges or for services rendered whilst being transported in any emergency vehicle vessel or aircraft;
16. No ward fee benefits shall be payable in respect of any additional costs incurred as a result of confinement to a private ward if such confinement to a private ward was requested by the Insured person.
17. Treatment resulting from failure to carry out the instructions of a Medical Practitioner
ADDITIONAL EXCEPTIONS APPLICABLE ONLY TO THE PREMIER, ENHANCE, OPTIMAL, SYNERGY AND VITAL OPTIONS
18. Any condition for which the insured person received treatment or advice prior to the date of inception, or any medical conditions that resulted from an injury that occurred prior to the date of inception for the emergency casualty benefit.
19. Any costs associated with a hip or knee replacement for the emergency casualty benefit.
20. Injuries arising from professional sport or any other recreational activity which is not commonly recognised as a sport and/or involves uncontrolled competition, unusual skill or violent activity and is generally considered to be inherently dangerous for the emergency casualty benefit (as defined in the policy document) provided in a hospital out-patient emergency facility.
ADDITIONAL EXCEPTIONS APPLICABLE ONLY TO PREMIER, ENHANCE AND OPTIMAL OPTIONS
21. No benefits shall be payable for any pre-existing condition, meaning any form of cancer occurring or manifesting itself prior to the Commencement Date for any cancer specific benefits, unless the Insured person is in complete remission (as defined) for a period of 5 years or more as determined from the Commencement Date of the policy.
ADDITIONAL EXCEPTIONS APPLICABLE ONLY TO PREMIER, ENHANCE, OPTIMAL, SYNERGY AND SENIOR OPTIONS
22. Psychiatric conditions including but not limited to depression, insanity, mental and or stress related conditions for co-payment, sub-limit and stated benefits;
23. Investigations, treatment or surgery for dental implants or any surgical implant of an artificial tooth root used in dentistry to support restorations that resemble a tooth or group of teeth for co-payments and sub-limits;
24. All dental procedures, unless due to reconstructive surgery as a result of an accident or impacted wisdom teeth for all benefits other than co-payments and sub-limits. A 12 (twelve) month waiting period shall apply to investigations, treatment or surgery for impacted wisdom teeth.