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Insular Health Care Inc Makati Office Clinic

Permanent Exclusions (examples of) for Individual and Family


  1. Care by non-accredited Physician and/or in a non-preferred hospital/clinic except in emergencies wherein the emergency provision of the agreement will apply
  2. All pregnancy related conditions requiring medical/surgical care and screen tests related thereto
  3. All dental related services not expressly stipulated in the dental rider
  4. Sterilization of either sex or reversal of such, artificial insemination, sex transformations or diagnosis and treatment of infertility, and circumcision
  5. Rest cures, custodial, domiciliary or convalescent care
  6. Cosmetic surgery, dental/oral surgery, and dermatological procedures for the purpose of beautification except reconstructive surgery to treat a dysfunctional defect due to disease or accident
  7. Psychiatric disorders, psychosomatic illnesses, hyperventilation syndrome, adjustment disorders, alcoholism and its complications or conditions related to substance or drug abuse, addiction and intoxication
  8. Sexually transmitted diseases
  9. Medical and surgical procedures which are not generally accepted as standard treatment by the medical profession
  10. Procurement or use of corrective appliances, artificial aids, durable equipment, and orthopedic prosthesis and implants
  11. Surcharges resulting from additional personal (luxuries/accommodation) request or service including special nursing services
  12. Physical examination required for obtaining employment, medical certification, insurance or a government license, and procedures for purely diagnostic/screening purposes
  13. Injuries or illnesses due to military, paramilitary, police service, high risk activities, or suffered under conditions of war
  14. Reimbursement of procedures obtained through government programs
  15. Injuries or illnesses, which are self-inflicted, caused by attempt at suicide or incurred as a result of or while participating in a crime or acts involving the violation of laws or ordinances
  16. Out-patient/take-home medicines
  17. Cardiovalvular Heart Disease and Rheumatic Heart Disease
  18. Medico-legal consultations
  19. When a member is discharged against medical advice or acts, and all subsequent benefits/services related thereto
  20. Blood / Organ Donor screening / other screening procedure that are purely diagnostic or for screening purposes including, among others, Purified Protein Derivative (PPD), and procedures conducted prior to hormonal replacement therapy
  21. All hospital charges and professional fees after the day and time hospital discharge has been duly authorized
  22. Professional fees of Assistant Surgeons
  23. All confirmatory tests used to document health conditions not covered under the plan
  24. Conditions excluded by medical underwriting
  25. Concealment cases
  26. Hypersensitivity / Allergy test
  27. Hospital Admission Kits
  28. Diseases declared by the Department of Health (DOH) as Epidemic
  29. Use of Emergency room facilities on non-emergency cases or by reason of conditions / injuries not falling under the term “Emergency” as defined under the Agreement (“Emergency” shall mean the sudden, unexpected onset of illnes or injury having the potential of causing immediate disability or death, or requiring the immediate alleviation of severe pain or discomfort.) For the purpose of implementation, the final diagnosis shall be the basis for a member’s eligibility to emergency care benefits under the plan.