الاستشفاء

Company: Fidelity
TPA: Nextcare

List of Exclusions

If insured after 2 months from policy inception (3 months waiting period)

• Ligament and meniscus disease or surgery (unless mandated by a covered accidental injury), thyroglossal cyst, hernia, disc, endometriosis, carpal tunnel, hemorrhoids, gall bladder, ulcer, tonsillectomy, infant paralysis, kidney and urinary tract diseases (except for Fidelity baby who shall be covered as from Day One as per POLICY terms and conditions), retinal surgery, vitrectomy, prostate, cataract, synovectomy, hysterectomy, Women genital organ diseases except for Ovarian Cyst that is not congenital and Uterine Fibroma, Polysomnography.
• Nasal septal deviation and any nose related surgery unless due to a covered accident during the contractual period of this POLICY.

Applicant benefiting from one year or more of uninterrupted insurance coverage is not subject to the above exclusions.

Lifetime Exclusions:

• All routine medical check-ups, and all Out-Patient healthcare services not specifically covered under an applicable healthcare plan, defined as healthcare services (e.g., diagnostic tests, treatments) that do not require hospital confinement, such as those delivered at a physician office, clinic, medical center or OutPatient hospital facility.
• Any hospitalizations not medically mandatory, like abortion that is not medically mandated, treatment of chronic allergy, and eye examination, contact lenses and all other optical devices as well as conditions that no longer require hospital confinement.
• Sleep disorders including snoring and sleep apnea except for polysomnography.
• All genetic and/or hereditary cases including the complications arising thereof under Inpatient, genetic engineering and cloning.
• Dynamic light treatment (e.g., Verteporfin).
• Cost of transplanted Organ as well as any cost related to the Donor.
• In-Vitro, Ex-Vitro, Intracytoplasmic sperm injection and any other artificial insemination procedures and related consequences remain excluded.
• All birth control procedures.
• Cost and Treatment of Parkinson Diseases and related consequences.
• Peritoneal Dialysis, Hemodialysis and the arterio-venous shunt related thereto shall be excluded except for the first three sessions of Hemodialysis for acute renal failure delivered during the initial hospital admission and till discharge.
• Cosmetic or plastic surgery unless mandated by a covered accidental injury.
• Dental and gum medical or surgical treatment (temporomandibular joint disorders) unless mandated by a covered accidental injury.
• Mental or psychiatric disorders, Nervous breakdowns, attention deficit disorders, senility related conditions including but not limited to Alzheimer’s disease, learning difficulties as well as all treatments related to speech therapy including but not limited to Orthophony sessions and all consequences arising thereto.
• Suicide, self-destruction or intentional self-inflicted injury or any attempt, while sane or insane.
• Air Ambulance and Road Ambulance Expenses.
• Sexually transmitted diseases including but not limited to Acquired Immune Deficiency Syndrome (AIDS), Human Immunodeficiency Viruses (HIV), Hepatitis other than A.
• Special diets and weight control procedures and all consequences arising thereto.
• Rest Cures, sanitarium, custodial care and periods of quarantine, costs related to convalescence even when initial hospitalization was covered under the policy.
• Abuse of alcohol, drugs and alike substance, the addiction to and abuse of medication without medical supervision and all consequences arising thereto.
• Alternative medicine including Chiropraxy, Osteopathy, Acupuncture, Ayurvedic and Homeopathy.
• Procedures related to change of gender, sexual fortifying products, treatments and procedures.
• Any treatment underwent by a physician not licensed to operate in the country where treatment is being delivered or by family member.
• Unusual tests or treatments that in the sole discretion of THE COMPANY and/ or THE ADMINISTRATOR is deemed to be experimental. As a special exception to the latter, Ligasure and endopouch are covered subject to medical necessity and in major surgeries.
• Any injury affecting an insured serving or attached in any armed force during war activities, and claims arising from the insured taking an active part in any of the following events: war, warlike activities, civil strike and commotion, crime and misdemeanors, assassination, personal assault, aggression and terrorism and any other similar acts.
• Hazardous sports for professionals.
• Claims arising from the use of motorcycles as mean of transportation.
• Claims arising from ionization, polluting chemicals or nuclear contamination or infiltration of toxic wastes.
• Artificial Limbs and Orthesis.

Exclusions to Ambulatory Out:

• All exclusions applicable to the In-hospital plan are applicable to the Out-patient plan.
• Diagnostic tests for the purposes of health check-ups and/or routine examinations.
• Diagnostic tests for the purposes of employment or travel.
• Tests related to error of refraction, nearsightedness (myopia), farsightedness, astigmatism
• Allergy tests except IGE total which is covered.
• Prescribed Medicines
• Doctor Visits

For  any inquiries, please send an email to insurance@scsl.org.lb