Cigna Global | Exclusions

Please see below a summary of the most common exclusions on the Cigna Medical Insurance plan:

  1. Cigna will not pay claims where it is illegal for them. Examples include OFAC countries, or countries that have an Embargo.
  2. Claims will not be paid if they’re fraudulent.
  3. Cigna is not responsible for malpractice.
  4. Cigna will not pay for medical expenses not covered under the individuals plan, or specifically excluded under the individual policy.
  5. Life support, unless it is expected that the member will recover, or be restored to the previous state of health.
  6. Pre-existing conditions, or anything directly or indirectly related to a pre-existing condition, that was not disclosed on the application.
  7. Non-medical admissions to the hospital or stays, including things that could have been covered on an outpatient basis, or admission for domestic reasons.
  8. Cost of a Deluxe, Executive, or VIP Suite in a hospital.
  9. mechanical or animal organs, except where a mechanical appliance is temporarily used to maintain bodily function whilst awaiting transplant;
  10. purchase of a donor organ from any source;
  11. harvesting and storage of stem cells, when a preventative measure against possible future disease.
  12. Foetal surgery, i.e. treatment or surgery undertaken in the womb before birth, unless this is resulting from complications arising through maternity and shall be subject to the limits detailed in the ‘Complicated Maternity’ section of your policy, where covered.
  13. Footcare by a Chiropodist or Podiatrist.
  14. Sleep disorders unless there are indications that the beneficiary is suffering from severe sleep apnoea. In these circumstances, we will only pay for:
    1. one (1) sleep study;
    2. the hire of equipment such as a Continuous Positive Airway Pressure (CPAP) machine (only if the beneficiary has cover under the International Outpatient option).
    3. If it is medically necessary, we will pay for surgery.
  15. Treatment that is provided by a medical practitioner who is not recognised by the relevant authorities in the country where the treatment is received as having specialist knowledge of, or expertise in, the treatment of the disease, illness or injury being treated;
    1. a medical practitioner, therapist, hospital, clinic, or facility to whom we have given written notice that we no longer recognise them as a treatment provider.
    2. a medical practitioner, therapist, hospital, clinic, or facility which, in our reasonable opinion, is either not properly qualified or authorised to provide treatment, or is not competent to provide treatment.
  16. Treatment which is provided by anyone who lives at the same address as the beneficiary, or who is a member of the beneficiary’s family.
  17. Treatment for, or in connection with, smoking cessation.
  18. Treatment which is necessary as a result of conflict or disaster including but not limited to:
    1. nuclear or chemical contamination;
    2. war, invasion, acts of terrorism, rebellion (whether or not war is declared), civil war, commotion, military coup or other usurpation of power, martial law, riot, or the act of any unlawfully constituted authority;
    3. any other conflict or disaster events;
    4. where the beneficiary has: put him or herself in danger by entering a known area of conflict (as identified by a Government in your Country of nationality, for example the British Foreign and Commonwealth Office);
    5. actively participated in the conflict; or
    6. displayed a blatant disregard for their own safety.
  19. Treatment that arises from, or is in any way connected with attempted suicide, or any injury or illness that the beneficiary inflicts upon him or herself.
  20. Treatment for or in connection with speech therapy that is not restorative in nature, or if such therapy is:
    1. used to improve speech skills that have not fully developed;
    2. can be considered educational; or
    3. is intended to maintain speech communication.
  21. Developmental problems including:
    1. learning difficulties such as dyslexia;
    2. autism or attention deficit disorder (ADHD);
    3. physical development problems such as short height.
  22. Disorders of the temporomandibular joint (TMJ).
  23. Treatment for obesity, or which is necessary because of obesity. This includes, but is not limited to, slimming classes, aids and drugs. We will only pay for gastric banding or gastric bypass surgery if a beneficiary:
    1. has a body mass index (BMI) of forty (40) or over and has been diagnosed as being morbidly obese;
    2. can provide documented evidence of other methods of weight loss which have been tried over the past twenty-four (24) months; and
    3. has been through a psychological assessment which has confirmed that it is appropriate for them to undergo the procedure.
  24. Treatment in nature cure clinics, health spas, nursing homes, or other facilities which are not hospitals or recognised medical treatment providers.
  25. Charges for residential stays in hospitals which are arranged wholly or partly for domestic reasons or where treatment is not required or where the hospital has effectively become the place of domicile or permanent abode.
  26. Treatment for a related condition resulting from addictive conditions and disorders.
  27. Treatment for a related condition resulting from any kind of substance or alcohol use or misuse.
  28. Treatment needed because of, or relating to, male or female birth control, including but not limited to:
    1. surgical contraception, namely:
      1. vasectomy, sterilisation or implants;
    2. non surgical contraception, namely:
      1. pills or condoms;
    3. family planning, namely:
      1. meeting a doctor to discuss becoming pregnant or contraception.
  29. Treatment relating to infertility (other than investigation to the point of diagnosis), fertility treatment of any sort, or treatment of complications arising as a result of such treatment. This includes, but is not limited to: IVF, GIFT, ZIFT, AI, drug treatment, embryo transportation.
    1. We will pay for investigations into the cause of infertility if:
      1. the specialist wishes to rule out any medical cause;
      2. the beneficiary has been covered under this policy for two (2) consecutive years before the investigations have commenced; and
      3. the beneficiary was unaware of the existence of any infertility problem, and had not suffered any symptoms, when their cover under this policy commenced.
  30. Treatment by way of the intentional termination of pregnancy, unless the pregnancy endangers a beneficiary’s life or mental stability
  31. Treatment directly related to surrogacy. We will not pay maternity benefits:
    1. to a beneficiary who acts as a surrogate; or
    2. to anyone else acting as a surrogate for a beneficiary.
  32. ‘Newborn Care Benefits’ for children born as a result of fertility treatment, such as IVF, or for children born to a surrogate, or who have been adopted. These children can only join once they are ninety (90) days old, and will be subject to medical underwriting.
  33. Nursery care for a newborn in hospital, unless the mother is required to remain in hospital due to medical necessity for treatment that is covered by this policy.
  34. Treatment for more than ninety (90) continuous days for a beneficiary who has suffered permanent neurological damage and/or is in a persistent vegetative state (PVS).
  35. Treatment for personality and/or character disorders, including but not limited to:
    1. affective personality disorder;
    2. schizoid personality disorder; or
    3. histrionic personality disorder.
  36. Preventative treatment, including but not limited to health screening, routine health checks and vaccinations (unless that treatment is available under one of the options for which a beneficiary has cover).
    1. We will pay for preventative surgery when a beneficiary:
      1. has a significant family history of a disease which is part of a hereditary cancer syndrome (such as ovarian cancer); and
      2. has undergone genetic testing which has established the presence of a hereditary cancer syndrome. (Please note that we will not pay for the genetic testing).
    2. Under the International Medical Insurance plan, the limits of cover for preventative surgery in respect of congenital conditions will apply, other than for cancer.
  37. Treatment for sexual dysfunction disorders (such as impotence) or other sexual problems regardless of the underlying cause.
  38. Treatment in the USA, unless the beneficiary has purchased Worldwide including USA cover under this policy, or the treatment can be covered under the Out of Area Emergency cover conditions.
  39. Treatment in the USA (where the Worldwide including USA cover was purchased) if we know or reasonably suspect that the cover was purchased and the beneficiary travelled to the USA for the purpose of receiving treatment.
  40. Treatment which is intended to change the refraction of one or both eyes, including but not limited to laser treatment, refractive keratotomy and photorefractive keratectomy. We will pay for treatment to correct or restore eyesight if it is needed as a result of a disease, illness or injury (such as cataracts or a detached retina).
  41. Any treatment outside your selected area of coverage, unless the treatment can be covered under the Out of Area Emergency cover conditions.
  42. Travel costs for treatment including any fares such as taxis or buses, unless otherwise specified, and expenses such as petrol or parking fees.
  43. Any expenses for international emergency services which were not approved in advance by the medical assistance service, where applicable.
  44. International services expenses for emergency evacuation, medical repatriation and transportation costs for third parties where the treatment needed is not covered under this policy.
  45. Any expenses for ship-to-shore evacuations.
  46. Gender reassignment surgery, including elective procedures and any medical or psychological counselling in preparation for, or subsequent to, any such surgery.
  47. Treatment which is necessary because of, or is any way connected with, any injury or sickness suffered by a beneficiary as a result of:
    1. taking part in a sporting activity on a professional basis;
    2. solo scuba-diving; or
    3. scuba-diving at a depth of more than thirty (30) metres unless the beneficiary is appropriately qualified (namely PADI or equivalent) to scuba-dive at that depth.
  48. Treatment which (in our reasonable opinion) is experimental, is not orthodox, or has not been proven to be effective.
  49. Any form of plastic, cosmetic or reconstructive treatment, the purpose of which is to alter or improve appearance even for psychological reasons, unless that treatment is medically necessary and is a direct result of an illness or an injury suffered by the beneficiary, or as a result of surgery.
    1. We will only pay for plastic, cosmetic or reconstructive treatment if the illness, injury or surgery as a result of which the treatment is required took place during the beneficiary’s current continuous period of cover and is itself covered under the policy
  50. Appliances, including but not limited to hearing aids and spectacles (unless the International Vision & Dental option is selected) which do not fall within our definition of surgical appliances and/or medical appliances.
  51. Incidental costs including newspapers, taxi fares, telephone calls, guests’ meals and hotel accommodation.
  52. Costs or fees for filling in a claim form or other administration charges.
  53. Costs that have been or can be paid by another insurance company, person, organisation or public programme. If a beneficiary is covered by other insurance, we may only pay part of the cost of treatment. If another person, organisation or public programme is responsible for paying the costs of treatment, we may claim back any of the costs we have paid.
  54. Treatment that is in any way caused by, or necessary because of, a beneficiary carrying out an illegal act.

The exclusions listed here are a summary of the plan exclusions/ limitations and are for informational purposes only. Please refer to the certificate of insurance for a full list of plan exclusions and limitations. You can view the certificates for the Silver, Gold, and Platinum levels here.

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