The Amended Unified Cooperative Health Insurance Policy Section (3) – Limitations & Exclusions

A - This Policy does not cover claims arising from the following:

(01) Intentional self-inflicted injury. (02) Ailments arising out of abuse certain medicine, stimulants or depressants or by the use of alcohol, narcotics and the like. (03) Cosmetic surgery or treatment unless necessitated by an accidental bodily injury not otherwise excluded in this Section. (04) General health examinations, vaccinations, drugs or prophylactics which are not required for medical treatment of an ailment provided for herein (excluding the preventive measures specified by the Ministry of Health such as vaccinations, maternity care and child care). (05) Pregnancy and maternity treatment for a woman who is contracted on the basis of “unmarried status”. (06) Treatment, which the Insured Person receives without charge. (07) Convalescence and general physical health programs and treatment at social care centers. (08) Any ailment or injury arising as a direct result of the Insured Person’s occupation. (09) The treatment of any venereal or sexually transmitted disease that are medically recognized. (10) Medical expenses for the treatment period following the diagnosis of the HIV (Human Immune Deficiency Virus) and/ or HIV related ailment including AIDS (Acquired Immune Deficiency Syndrome) and or any mutant, derivative or variation thereof. (11) All services and treatments related to dental implants or prosthesis or orthodontics or bridges fixed or moving, unless occasioned by violent external means. (12) All tests for sight and hearing correction and audiovisual aids, unless ordered by a licensed physician. (13) Transportation of the Insured Person other than by local ambulance service licensed by or belonging to the Saudi Red Crescent Society. (14) Hair loss, alopecia or wigs. (15) Any psychiatric treatment or nervous or mental disorder, except for acute cases. (16) Allergy testing of any nature, other than those relating to the medicine or diagnosis or treatment. (17) Devices, medicines, procedures and/ or hormone treatment related to birth control, contraception or conception, sterility, impotency or infertility, and in-vitro fertilization or any other artificial insemination procedures. (18) Any congenital weakness or deformity existing prior to the Policy effective date and is not considered life threatening. (19) Any additional costs or expenses incurred by the companion of the Insured Person during his in-patient or stay at the hospital, except room and board in a hospital for one companion, such as the mother accompanying her child up to 12 years of age or as required by medical necessity at the sole discretion of the treating physician. (20) Acne treatment or obesity or overweight related treatment. (21) Any cases of organ and bone marrow transplantation or implantation of any prosthetic devices replacing an organ. (22) Personal Endangerment acts mentioned and defined in the Definition Section of the Policy. (23) Medications and Treatment Modules of Alternative Medicine. (24) Artificial Limbs or Aiding Limbs unless ordered by a specialist from an accredited Healthcare Provider. (25) Normal Post Menopausal Changes of the insured female including menstruation irregularities.

B - This Policy does not cover the health benefits and repatriation of mortal remains to home country in case of claims arising directly from:

(1) War, invasion, acts of foreign enemy, hostilities (whether war be declared or not), civil war. (2) Ionizing radiation by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. (3) The radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof. (4) The Insured Person engaging in or taking part in armed forces or police service or operation. (5) Riots, strikes, terrorism or any similar acts.