Common use of Benefits Clarifications Clause in Contracts

Benefits Clarifications. Pre and post-hospitalization treatment In-patient rehabilitation This benefit pays for in-patient rehabilitation when: a) it is carried out by a medical practitioner specialising in rehabilitation; and b) it is carried out in a rehabilitation hospital or unit which is recognised by us; and c) the treatment could not be carried out on an out-patient basis, and d) the costs have been agreed, in writing by us before the rehabilitation begins. We will not pay for in-patient rehabilitation for more than twenty-eight (28) days except in cases such as in severe central nervous system damage caused by external trauma. For cases such as in severe central nervous system damage caused by external trauma, we will not pay for in-patient rehabilitation for more than one hundred eighty (180) days Pre-hospitalization treatment We will pay for consultation, prescribed investigations and essential medications by a medical practitioner received as an out-patient within ninety (90) days prior to a hospitalization, where such hospitalization is eligible for cover under member’s plan and where the need for such hospitalization has arisen as a direct result of the medical examination and investigation findings drawn from that consultation. Post-hospitalization treatment We will pay for follow-up out-patient consultation and treatment following an eligible in-patient treatment or daycare surgery when such consultation is carried out by the in-patient treating medical practitioner or a referred medical practitioner and provided such consultation or treatment occurs within ninety (90) days immediately following the date of discharge from hospital for which the member was confined as an in-patient or the date of the daycare surgery. Out-patient treatment – general information Out-patient treatment is treatment given by a medical practitioner at an out-patient clinic, a medical practitioner’s consulting room or in a hospital where the member is not admitted to a bed. A member is covered, subject to the limits shown, for: • medical practitioner charges for consultations; • diagnostic procedures; • prescriptions (note any prescribed drug or other medication required for more than 30 days should be pre-authorized by us); • hormone replacement therapy (pre-authorization is recommended) • physiotherapy, occupational therapy and/or speech therapy for an eligible medical condition received as an out-patient (pre-authorization is recommended); • computerized tomography, magnetic resonance imaging, positron emission tomography and gait scans received as an out-patient (pre-authorization is recommended); • radiotherapy and chemotherapy received as an out-patient; • kidney dialysis received as an out-patient; • surgical procedures received as an out-patient; • consultation and treatment provided and prescribed by a qualified and registered chiropractor, podiatrist, dietitian, naturopath, acupuncturist, homeopath, osteopath, physiotherapist and traditional Chinese medicine practitioner; • emergency treatment due to accident;

Benefits Clarifications. Pre Primary and post-hospitalization treatment In-patient rehabilitation This benefit pays for in-patient rehabilitation when: aspecialist care (Plan A and B only) it A consultation is carried out by a visit to any medical practitioner specialising in rehabilitation; and b) it is carried out in a rehabilitation hospital or unit which is recognised by us; and c) for the treatment could not be carried out on of an eligible medical condition. We will pay for the medical practitioner charges for consultations, prescriptions and diagnostic procedures. Diagnostic tests include and are limited to laboratory, X-ray and ultrasound. Second opinion for the same medical condition: • pre-authorization is recommended Thereafter subsequent opinions and referrals for the same condition: • written pre-authorization is required Surgical procedures We will pay for any surgical procedure received as part of an out-patient basis, and d) the costs have been agreed, in writing by us before the rehabilitation beginstreatment. We will not pay for inThis include one post-patient rehabilitation for more than twenty-eight surgery consultation within ninety (2890) days except in cases such as in severe central nervous system damage caused by external traumafrom the date of the surgical procedure. For cases such as in severe central nervous system damage caused by external trauma, we will not pay for in-patient rehabilitation for more than one hundred eighty (180) days Pre-hospitalization Emergency treatment due to accident We will pay for consultationout-patient treatment due to accident required immediately (within twenty-four (24) hours) following bodily injury arising from an accident, prescribed investigations provided the member has been continuously covered under the policy since before the accident happened. Follow up treatment for the same bodily injury will be covered up to thirty (30) days from the date of the accident. Radiotherapy and essential medications by a medical practitioner chemotherapy We will pay for radiotherapy and chemotherapy received as an out-patient within ninety (90) days prior to a hospitalization, where such hospitalization is eligible for cover under member’s plan and where the need for such hospitalization has arisen as a direct result of the medical examination and investigation findings drawn from that consultation. Post-hospitalization treatment We will pay for follow-up out-patient consultation and treatment following an eligible in-patient treatment or daycare surgery when such consultation is carried out by the in-patient treating medical practitioner or a referred medical practitioner and provided such consultation or treatment occurs within ninety (90) days immediately following the date of discharge from hospital for which the member was confined as an in-patient or the date of the daycare surgery. Out-patient treatment – general information Out-patient treatment is treatment given by a medical practitioner at an out-patient clinic, a medical practitioner’s consulting room or in a hospital where the member is not admitted to a bed. A member is covered, subject to the limits shown, for: • medical practitioner charges for consultations; • diagnostic procedures; • prescriptions (note any prescribed drug or other medication required for more than 30 days should be pre-authorized by us); • hormone replacement therapy (pre-authorization is recommended) • physiotherapy, occupational therapy and/or speech therapy for an eligible medical condition at a registered medical facility recognised by us. Kidney dialysis We will pay for kidney dialysis received as an out-patient (pre-authorization is recommended); • for an eligible medical condition at a registered medical facility recognised by us. Computerized tomography, magnetic resonance imaging, positron emission tomography and gait scans We will pay for computerized tomography, magnetic resonance imaging, positron emission tomography and gait scans received as part of an eligible out-patient (pretreatment. Hormone replacement therapy We will pay for the consultations and the cost of the implants, injections, patches or tablets when it is medically necessary and resulting from a medical intervention rather than for the relief of physiological symptoms. Where hormone replacement therapy is only required for the relief of menopausal symptoms, this benefit will pay for consultation and prescribed implants, patches or tablets up to the limit shown in the benefits table applicable to the member’s plan. Benefits Clarifications Physiotherapy, occupational therapy and speech therapy Such treatment must be given by a qualified practitioner who is recognised by us and registered to practice this where the eligible treatment is given. Benefit is payable only following in-authorization patient treatment for an eligible medical condition, provided that the member has been continuously covered under the policy since before the in-patient treatment commenced. Treatment given by any of these practitioners must be under the medical supervision of a medical practitioner. Medical supervision means that the reason for referral, where applicable, has been initiated by the medical practitioner who has defined a diagnosis. There must be a clear treatment plan from the practitioner with an end point and expected outcome. Other benefits – general information These are the additional features of your plan. Please note that all deductibles, limitations and terms apply to these benefits exactly as for the main in-patient/daycare and out-patient benefits depending on whether treatment is recommended); • radiotherapy and chemotherapy received as part of an out-patient; • kidney dialysis received as an out, in-patient; • surgical procedures received as an out-patient; • consultation patient or daycare treatment. Please refer to the benefits table on Section 10 for further information on the availability, benefit levels and treatment provided and prescribed by a qualified and registered chiropractor, podiatrist, dietitian, naturopath, acupuncturist, homeopath, osteopath, physiotherapist and traditional Chinese medicine practitioner; • emergency treatment due to accident;waiting periods of your plan.

Benefits Clarifications. Pre Primary and post-hospitalization treatment In-patient rehabilitation This benefit pays for in-patient rehabilitation when: aspecialist care (Plan A and B only) it A consultation is carried out by a visit to any medical practitioner specialising in rehabilitation; and b) it is carried out in a rehabilitation hospital or unit which is recognised by us; and c) for the treatment could not be carried out on of an eligible medical condition. We will pay for the medical practitioner charges for consultations, prescriptions and diagnostic procedures. Diagnostic tests include and are limited to laboratory, X-ray and ultrasound. Second opinion for the same medical condition: • pre-authorization is recommended Thereafter subsequent opinions and referrals for the same condition: • written pre-authorization is required Surgical procedures We will pay for any surgical procedure received as part of an out-patient basis, and d) the costs have been agreed, in writing by us before the rehabilitation beginstreatment. We will not pay for inThis include one post-patient rehabilitation for more than twenty-eight surgery consultation within ninety (2890) days except in cases such as in severe central nervous system damage caused by external traumafrom the date of the surgical procedure. For cases such as in severe central nervous system damage caused by external trauma, we will not pay for in-patient rehabilitation for more than one hundred eighty (180) days Pre-hospitalization Emergency treatment due to accident We will pay for consultationout-patient treatment due to accident required immediately (within twenty-four (24) hours) following bodily injury arising from an accident, prescribed investigations provided the member has been continuously covered under the policy since before the accident happened. Follow up treatment for the same bodily injury will be covered up to thirty (30) days from the date of the accident. Radiotherapy and essential medications by a medical practitioner chemotherapy We will pay for radiotherapy and chemotherapy received as an out-patient within ninety (90) days prior to a hospitalization, where such hospitalization is eligible for cover under member’s plan and where the need for such hospitalization has arisen as a direct result of the medical examination and investigation findings drawn from that consultation. Post-hospitalization treatment We will pay for follow-up out-patient consultation and treatment following an eligible in-patient treatment or daycare surgery when such consultation is carried out by the in-patient treating medical practitioner or a referred medical practitioner and provided such consultation or treatment occurs within ninety (90) days immediately following the date of discharge from hospital for which the member was confined as an in-patient or the date of the daycare surgery. Out-patient treatment – general information Out-patient treatment is treatment given by a medical practitioner at an out-patient clinic, a medical practitioner’s consulting room or in a hospital where the member is not admitted to a bed. A member is covered, subject to the limits shown, for: • medical practitioner charges for consultations; • diagnostic procedures; • prescriptions (note any prescribed drug or other medication required for more than 30 days should be pre-authorized by us); • hormone replacement therapy (pre-authorization is recommended) • physiotherapy, occupational therapy and/or speech therapy for an eligible medical condition at a registered medical facility recognised by us. Kidney dialysis We will pay for kidney dialysis received as an out-patient (pre-authorization is recommended); • for an eligible medical condition at a registered medical facility recognised by us. Computerized tomography, magnetic resonance imaging, positron emission tomography and gait scans We will pay for computerized tomography, magnetic resonance imaging, positron emission tomography and gait scans received as part of an eligible out-patient (pretreatment. Hormone replacement therapy We will pay for the consultations and the cost of the implants, injections, patches or tablets when it is medically necessary and resulting from a medical intervention rather than for the relief of physiological symptoms. Where hormone replacement therapy is only required for the relief of menopausal symptoms, this benefit will pay for consultation and prescribed implants, patches or tablets up to the limit shown in the benefits table applicable to the member’s plan. Benefits Clarifications Physiotherapy, occupational therapy and speech therapy Such treatment must be given by a qualified practitioner who is recognised by us and registered to practice this where the eligible treatment is given. Benefit is payable only following in-authorization patient treatment for an eligible medical condition, provided that the member has been continuously covered under the policy since before the in-patient treatment commenced. Treatment given by any of these practitioners must be under the medical supervision of a medical practitioner. Medical supervision means that the reason for referral, where applicable, has been initiated by the medical practitioner who has defined a diagnosis. There must be a clear treatment plan from the practitioner with an end point and expected outcome. Other benefits – general information These are the additional features of your plan. Please note that all deductibles, limitations and terms apply to these benefits exactly as for the main in-patient/daycare and out-patient benefits depending on whether treatment is recommended); • radiotherapy and chemotherapy received as part of an out-patient; • kidney dialysis received as an out, in-patient; • surgical procedures received as an out-patient; • consultation patient or daycare treatment. Please refer to the benefits table on Section 11 for further information on the availability, benefit levels and treatment provided and prescribed by a qualified and registered chiropractor, podiatrist, dietitian, naturopath, acupuncturist, homeopath, osteopath, physiotherapist and traditional Chinese medicine practitioner; • emergency treatment due to accident;waiting periods of your plan.

Benefits Clarifications. Pre and post-hospitalization hospitalisation treatment In-patient rehabilitation This benefit pays for in-patient rehabilitation when: a) it is carried out by a medical practitioner specialising in rehabilitation; and b) it is carried out in a rehabilitation hospital or unit which is recognised by us; and c) the treatment could not be carried out on an out-patient basis, and d) the costs have been agreed, in writing by us before the rehabilitation begins. We will not pay for in-patient rehabilitation for more than twenty-eight (28) days except in cases such as in severe central nervous system damage caused by external trauma. For cases such as in severe central nervous system damage caused by external trauma, we will not pay for in-patient rehabilitation for more than one hundred eighty (180) days Pre-hospitalization hospitalisation treatment We will pay for consultation, prescribed investigations and essential medications by a medical practitioner received as an out-patient within ninety (90) days prior to a hospitalizationhospitalisation, where such hospitalization hospitalisation is eligible for cover under member’s plan and where the need for such hospitalization hospitalisation has arisen as a direct result of the medical examination and investigation findings drawn from that consultation. Post-hospitalization hospitalisation treatment We will pay for follow-up out-patient consultation and treatment following an eligible in-patient treatment or daycare surgery when such consultation is carried out by the in-patient treating medical practitioner or a referred medical practitioner and provided such consultation or treatment occurs within ninety (90) days immediately following the date of discharge from hospital for which the member was confined as an in-patient or the date of the daycare surgery. Out-patient treatment – general information Out-patient treatment is treatment given by a medical practitioner at an out-patient clinic, a medical practitioner’s consulting room or in a hospital where the member is not admitted to a bed. A member is covered, subject to the limits shown, for: • medical practitioner charges for consultations; • diagnostic procedures; • prescriptions (note any prescribed drug or other medication required for more than 30 days should be pre-authorized authorised by us); • hormone replacement therapy (pre-authorization authorisation is recommended) • physiotherapy, occupational therapy and/or speech therapy for an eligible medical condition received as an out-patient (pre-authorization authorisation is recommended); • computerized computerised tomography, magnetic resonance imaging, positron emission tomography and gait scans received as an out-patient (pre-authorization authorisation is recommended); • radiotherapy and chemotherapy received as an out-patient; • kidney dialysis received as an out-patient; • surgical procedures received as an out-patient; • consultation and treatment provided and prescribed by a qualified and registered chiropractor, podiatrist, dietitian, naturopath, acupuncturist, homeopath, osteopath, physiotherapist and traditional Chinese medicine practitioner; • emergency treatment due to accident;

Benefits Clarifications. Pre and post-hospitalization treatment In-patient rehabilitation This benefit pays for in-patient rehabilitation when: a) it is carried out by a medical practitioner specialising in rehabilitation; and b) it is carried out in a rehabilitation hospital or unit which is recognised by us; and c) the treatment could not be carried out on an out-patient basis, and d) the costs have been agreed, in writing by us before the rehabilitation begins. We will not pay for in-patient rehabilitation for more than twenty-eight (28) days except in cases such as in severe central nervous system damage caused by external trauma. For cases such as in severe central nervous system damage caused by external trauma, we will not pay for in-patient rehabilitation for more than one hundred eighty (180) days Pre-hospitalization treatment We will pay for consultationforconsultation, prescribed investigations and essential medications by a medical practitioner received as an out-patient within ninety (90) days prior to a hospitalization, where such hospitalization is eligible for cover under member’s plan and where the need for such hospitalization has arisen as a direct result of the medical examination and investigation findings drawn from that consultation. Post-hospitalization treatment We will pay for followwillpayforfollow-up outupout-patient consultation and treatment following an eligible in-patient treatment or daycare surgery when such consultation is carried out by the in-patient treating medical practitioner or a referred medical practitioner and provided such consultation or treatment occurs within ninety (90) days immediately following the date of discharge from hospital for which the member was confined as an in-patient or the date of the daycare surgery. Out-patient treatment – general information Out-patient treatment is treatment given by a medical practitioner at an out-patient clinic, a medical practitioner’s consulting room or in a hospital where the member is not admitted to a bed. A member is covered, subject to the limits shown, for: • medical practitioner charges for consultations; • diagnostic procedures; • prescriptions (note any prescribed drug or other medication required for more than 30 days should be pre-authorized by us); • hormone replacement therapy (pre-authorization is recommended) • physiotherapy, occupational therapy and/or speech therapy for an eligible medical condition received as an out-patient (pre-authorization is recommended); • computerized tomography, magnetic resonance imaging, positron emission tomography and gait scans received as an out-patient out -patient (pre-authorization is recommended); • radiotherapy and chemotherapy received as an out-patient; • kidney dialysis received as an out-patient; • surgical procedures received as an out-patient; • consultation and treatment provided and prescribed by a qualified and registered chiropractor, podiatrist, dietitian, naturopath, acupuncturist, homeopath, osteopath, physiotherapist and traditional Chinese medicine practitioner; • emergency treatment due to accident;