The insurer has no obligation to pay for treatments of :
1. Pre-existing conditions: as pre-existing conditions count all illnesses and complaints existing and known to the insured person at the time of conclusion of contract, or of conclusion of a follow-up contract, and their foreseeable consequences, as well as all foreseeable consequences of illnesses and accidents of the insured person treated or diagnosed within the period of 12 months prior to the conclusion of contract which have or would have had required hospitalization and / or medical treatment and / or medications. The above definition of pre-existing conditions applies also in particular to any kind of chronic illnesses as well as existing dental defects and defective vision.
2. birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions.
3. disturbances and defects of reproductive organs; including infertility, artificial insemination and connected preventive medical examination and follow-up treatment.
4. mental illnesses, psychiatric and psychological disorders, all elimination examinations and all diseases caused by and/or related to mental diseases as well as all psychoanalytic and psychotherapeutic treatments.
5. Tuberculosis, AIDS and all diseases caused by and/or related to HIV, sexually transmitted diseases, all tropical diseases including but not limited to malaria, yellow fever, cholera, dysentery, leprosy.
6. diseases, actions and accidents including their consequences resulting from willful intent (e.g.: self-inflicted injury, suicide, abuse of alcohol, drug addiction or abuse) as well as for withdrawal treatment including withdrawal cures.
7. Loss of self-government or in case of necessary safe custody of the insured person, the stay and / or non-medical care which is provided at home, in a recreation or nursing home, in a psychiatric care facility or an similar institution.
8. diseases including their consequences as well as for the consequences of accidents and for deaths that are caused by nuclear, biological or chemical contamination, active participation in war, warlike events, riots or criminal activity.
Following types of treatment are excluded from the cover:
1. Prostheses, glasses, contact lenses, hearing aids, bandages and all aids.
2. Electric and physical medical treatment: physiotherapy, therapeutic exercises, massages, hydrotherapy and packs, thermotherapy, electrotherapy and phototherapy.
3. Alternative medicine (osteopathy, chiropractic, etc.).
4. Transplants and all related costs.
5. for cure and sanatorium treatment as well as measures of rehabilitation, unless otherwise agreed in 5.4.
6. Immunization measures.
7. Elective and/or cosmetic treatments (e.g. removal of warts).
8. Treatments or surgical procedures for visual corrections, e.g. laser surgery, refractive keratotomy (RK) and photorefractive keratotomy (PRK). Visual corrections are reimbursable if the treatment becomes necessary due to a disturbance, illness or injury (e.g. cataract or retinal detachment).
9. Maternity care, abortions and child birth, any contraceptives (pill, spiral, etc.) and all consequences thereof.
10. Prophylaxis (e.g. cancer) and routine medical examinations (including vaccinations).
11. Operative and hormonal adjustment of the biological sexual characteristics to the opposite sex.
12. Reports, attestations, estimates, insofar these are to be provided by the insured person or policy holder.
13. Treatment by a family member and any auto therapy including prescription of drugs.
14. All emergency medical evacuations and repatriation costs.
15. Any benefit, treatment and expenses not particularly covered and specified in the general and special terms.
16. If a medical or any other treatment, which services were agreed upon exceeds the medically necessary extent, the insurer may reduce his payment to an appropriate amount.
