Tag Archives: PRUhealth conditions

What are the medical coverage under PRUhealth Malaysia?

what are the medical coverage under pruhealth - What are the medical coverage under PRUhealth Malaysia?

What are the medical coverage under PRUhealth Malaysia?

It is simple to list down the exclusion of the coverage.

PRUhealth does not cover any hospitalisation, surgery or charges caused directly or indirectly,
wholly or partly, by any one (1) of the following occurrences:
1. Pre-existing illness.
2. Specified Illnesses occurring during the first 120 days of continuous cover for:

  • a. Hypertension, diabetes mellitus and cardiovascular disease
  • b. All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and
  • biliary system
  • c. All ear, nose (including sinuses) and throat conditions
  • d. Hernias, haemorrhoids, fistulae, hydrocele, varicocele
  • e. Endometriosis including disease of the reproduction system
  • f. Vertebro-spinal disorders (including disc) and knee conditions

3. Any medical or physical conditions arising within the first 30 days of the Insured Person’s
cover or date of reinstatement whichever is latest except for accidental injuries.
4. Plastic / Cosmetic surgery, circumcision, eye examination, glasses and refraction or
surgical correction of nearsightedness (Radial Keratotomy) and the use or acquisition of
external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted
pacemakers and prescriptions thereof.
5. Dental conditions including dental treatment or oral surgery except as necessitated
by Accidental Injuries to sound natural teeth occurring wholly during the Period of
6. Private nursing (save and except for Home Nursing Care Benefit), rest cures or sanitaria
care, illegal drugs, intoxication, sterilisation, venereal disease and its sequelae, AIDS
(Acquired Immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV
related diseases, and any communicable diseases required quarantine by law.
7. Any treatment or surgical operation for congenital abnormalities or deformities including
hereditary conditions.
8. Pregnancy, child birth (including surgical delivery), miscarriage, abortion and prenatal
or postnatal care and surgical, mechanical or chemical contraceptive methods of birth
control or treatment pertaining to infertility. Erectile dysfunction and tests or treatment
related to impotence or sterilisation.
9. Hospitalisation primarily for investigatory purposes, diagnosis, X-ray examination,
general physical or medical examinations, not incidental to treatment or diagnosis
of a covered Disability or any treatment which is not Medically Necessary and any
preventive treatments, preventive medicines or examinations carried out by a Physician,
and treatments specifically for weight reduction or gain.

10. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
11. War or any act of war, declared or undeclared, criminal or terrorist activities, active
duty in any armed forces, direct participation in strikes, riots and civil commotion or
12. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear
waste from process of nuclear fission or from any nuclear weapons material.
13. Expenses incurred for donation of any body organ by an Insured Person and costs of
acquisition of the organ including all costs incurred by the donor during organ transplant
and its complications.

14. Investigation and treatment of sleep and snoring disorders, hormone replacement
therapy and alternative therapy such as treatment, medical service or supplies, including
but not limited to chiropractic services, acupuncture, acupressure, reflexology, bone
setting, herbalist treatment, massage or aroma therapy or other alternative treatment.
15. Care or treatment for which payment is not required or to the extent which is payable
by any other insurance or indemnity covering the Insured and Disabilities arising out of
duties of employment or profession that is covered under a Workman’s Compensation
Insurance Contract.
16. Psychotic, mental or nervous disorders (including any neuroses and their physiological or
psychosomatic manifestations).
17. Costs / expenses of services of a non-medical nature, such as television, telephones,
telex services, radios or similar facilities, admission kit / pack and other ineligible nonmedical
18. Sickness or Injury arising from racing of any kind (except foot racing), hazardous sports
such as but not limited to skydiving, water skiing, underwater activities requiring breathing
apparatus, winter sports, professional sports and illegal activities.

19. Private flying other than as a fare-paying passenger in any commercial scheduled airlines
licensed to carry passengers over established routes.
20. Expenses incurred for sex changes.