Please read them carefully before agreeing to proceed as you will be bound by these terms and the terms contained in the policy document after a successful purchase.
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General Conditions: Applies to All Plans
All AXA Mansard Health Plans
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The maximum age limit for Principal and Dependant is 65 years and 25 years respectively.
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Chronic ailments and pre-existing conditions as well as the following conditions: Diabetes, Hypertension, Arthritis, Sickle Cell Anaemia; pregnancy and maternity care have a one year waiting period and will not be covered or provided in the first year of the commencement of any of the plans. On renewal, these conditions will be covered subject to the health insurance plan limits provided the Enrollee remains enrolled with AXA Mansard Health for a period of one consecutive year.
Exclusions:
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Cosmetic Surgery or treatment
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Teeth Whitening
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Dental Prosthesis
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Domiciliary/Hospice Care
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Alternative /Unorthodox medicine
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Neonatal care not listed under neonatal services
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Self-inflicted injuries
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Congenital abnormalities
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Conditions caused by an act of war, an epidemic or enrollee participating in a riot
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Services primarily for weight reduction or treatment of obesity
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Treatment of substance abuse
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Infertility- All investigations and treatment
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Orthodontics
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Advanced radiological investigations (e.g. C.T. scan, Myelogram, EEG)
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Advanced and Complex investigations (e.g. Marrow biopsy, skeletal survey)
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Prosthetic devices such as cardiac pacemaker, orthopedic implants
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Management of Chronic Renal Failure (Dialysis and Transplant Surgery)
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Induced Abortion
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Laser Treatments
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Transplants
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Complex major Surgeries (e.g. Heart, Brain and Great blood vessels).
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Neurological surgeries.
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Management of Cancers
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Professional Sports and wilful exposure to needless danger
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Infectious and contagious diseases in an epidemic
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All procedures, management and investigations not covered by the plans
Cover Limit: : The overall cover limit refers to the maximum annual reimbursement by AXA Mansard Health to cater
for the care and treatment of an Enrolee. These limits are plan and provider category specific. Specific monetary or benefit
limits may apply for specific services such as optical, dental and surgical procedures. In addition, some services are capped
or restricted based on length of stay or number of procedures dispensed.
Waiting period The standard waiting period is 14 days and during this period, you will have no access to the covered
services and the plan purchased will only become active 14 days after completion of registration.
Right to cancel Policy: AXA Mansard Health is at liberty to cancel the cover of an Enrolee who has misled it or breached any
term of the health insurance policy, given incorrect, incomplete or misleading information, failed to provide any reasonable information which
AXA Mansard Health has requested for, conspired with a third party to obtain undue benefit from this Policy, or submitted a claim which is
in any respect fraudulent or unfounded. In any of these circumstances, AXA Mansard Health shall have the right to cancel the Enrolee’s
cover from the date of commencement (without refund of any portion of the unused premium) and shall recover from the Enrolee any benefit
it might have paid in relation to such claim
Cancellation/Termination by an Enrolee is only possible within the first 30 days of the commencement of the policy.
An Enrolee that decides to cancel/terminate this Health Insurance Policy must notify AXA Mansard Health in writing and the Enrolee shall
be entitled to a refund of the premium paid less (1) any amounts incurred on their behalf as medical and other expenses (2) an administrative
charge of 20% of the premium paid. No refund shall apply in case of termination/cancellation made by an Enrollee after 30 days of the commencement of the policy.
Cancellation/Termination by AXA Mansard: AXA Mansard Health may terminate the Policy by sending 30 days' notice by registered letter
to an Enrolee at their last known address or to their known e-mail address. In such event, AXA Mansard Health will refund to the Enrolee an amount equal
to the pro-rata value of their unused premium. Unused premium refers to the difference between the premium paid and the medical cost incurred as at the
effective date of termination which includes amounts reported and amounts yet to be reported but which were incurred prior to the date of termination.
Treatment prior to Date of Commencement: AXA Mansard Health will not cover or pay for any treatment that was given before
an Enrolee’s commencement date of cover or after cancellation/termination of cover or during any period for which AXA Mansard Health is yet to receive premiums.
Treatment that is not covered under the Benefit Schedule: AXA Mansard Health will not cover or pay for any treatment
that is not specifically covered under the Benefit Schedule of the Policy. Similarly, all plans do not cover Consultations with
unrecognized/un-orthodox consultants, hospitals, family doctors, therapists, dental practitioners or complementary medicines practitioners.
In the same vein, complications from such unrecognized/un-orthodox places are not covered under any of the plans.
Transferability: The plans are person specific and non-transferable.
Confidentiality: AXA Mansard Health is committed to protecting the information of its Enrolees and it is bound by law and regulatory
standards to maintain the privacy of its Enrolees’ medical information and records. AXA Mansard Health also holds its employees, providers and consultants
and business associates to strict policies and procedures protecting Enrolee’s information. The Information collected from an Enrolee at enrolment and
other transactions would include an Enrolee’s biodata as well as an Enrolee’s medical information through claims and utilization data submitted from
healthcare providers. AXA Mansard Health can also access an Enrolee’s medical records in furtherance of its role under the health plans and you hereby
consent to our access of your medical records and information accordingly.
Categorization of Healthcare facilities: Healthcare Providers are categorized by AXA Mansard Health for the benefit of ease of
access to care by its Enrolees. AXA Mansard Health reserves the right to review this categorization from time to time without prior recourse to an Enrolee.
This could include (but not limited to) the addition and deletion of healthcare providers from the general list and/or from a specific plan provider list.
At the point of filling your proposal form, you shall be required to select your preferred hospital(s) from the list of in-network hospitals accessible on your plan.
PLEASE NOTE that we will not be liable to pay for care accessed from an in-network hospital that is not available on the list of hospitals associated with your plan.
In the event we choose to make payment for care received from an in-network hospital not on your plan, our payment shall be limited only to what it would have
cost us to pay if you had accessed the services from an in-network hospital accessible on your plan.
Liability: AXA Mansard Health shall not be liable for any damages or losses that may arise from an Enrollee’s failure to pay premiums as and when due.
Refunds: Enrollees are required to access care within AXA Mansard Health’s network of Providers and not pay out of pocket for
covered services. Reimbursement may only apply for extreme cases of emergency requiring enrollee to access care in a non-network Hospital,
AXA Mansard Health should be notified of such emergencies within 72hrs of occurrence for approval through its contact centre. refund will
be made by AXA Mansard Health upon the Enrollee providing the following documents within 30 days of encounter:
(1) copy of medical report from
the Healthcare practitioner indicating history of the medical condition, diagnosis and treatment administered
(2) Original Receipt for having made
payment indicating the costs separately for consultation, each investigation, each procedure and each Drug and the quantity dispensed.
(3)Pre-authorisation
number received from AXA Mansard Health.
All refunds will be made only into the principal Enrollees designated account based only on medical emergency as might be reviewed by AXA Mansard Health's
in-house medical practitioners and only at AXA Mansard Health's designated/customary rate irrespective of the cost of care. Also, refunds are only applicable
where same is processed and paid before receipt by AXA Mansard Health of the notice to terminate or expiration of a plan.
Supply of drugs & medication: all Enrolees are covered for drugs recommended during their treatment for covered services except for excluded items.
Notices or Demands: . Any notices or demands required to be given under this Agreement, or given in connection with it, shall be in writing
and shall be given by electronic means. Should the Enrollee require or where AXA Mansard Health deems same expedient, such notice can also be issued in hard
copy and delivered by personal delivery or courier service delivery to the last known address of the other party. Changes in address has to be communicated
to the other party otherwise, notifications will continue to be delivered to the last known address and remain legally enforceable. AXA Mansard Health can be
contacted at any time through its Call Centre: 0700 AXAMANSARD (07002926267273); or send an email to HealthCare@axamansard.com
