CUSTOMER GUIDE

Cigna Global Health Options

COVER

POLICY RULES
Terms, General Exclusions and Definitions
relating to your plan

®
 CONTENTS
Please read these Policy Rules along with your Certificate of Insurance and your Customer Guide as
they all form part of your contract between you and us. If necessary seek expert advice should you
need to determine if this policy is appropriate for you.
Words and phrases in italics have the meanings given to them in Section 3, ‘Definitions’.

Please see below where to find all of the important information in relation to your
Cigna Global Health Options plan.

Legal and regulatory information Page 3

Complaints Page 3

How to contact us Page 3

Section 1: General terms and conditions Page 4

Clause 1. Scope of cover and policy eligibility.......................................................................Page 4

Clause 2. When does cover begin and end.............................................................................Page 4
Clause 3. The information you give us......................................................................................Page 5
Clause 4. Free look period.............................................................................................................Page 5
Clause 5. Premium and other charges......................................................................................Page 5
Clause 6. Termination.......................................................................................................................Page 6
Clause 7. Fraud....................................................................................................................................Page 7
Clause 8. Coverage options...........................................................................................................Page 8
Clause 9. Deductible and Cost Share........................................................................................Page 8
Clause 10. Adding or removing beneficiaries.........................................................................Page 8
Clause 11. Changes to country of habitual residence, address and/or nationality........ Page 9
Clause 12. How we will communicate with you.....................................................................Page 10
Clause 13. Policy renewal.................................................................................................................Page 10
Clause 14. Data protection.............................................................................................................Page 11
Clause 15. Who can enforce this policy.....................................................................................Page 11
Clause 16. Our right to recovery from third parties.............................................................Page 11
Clause 17. Other insurance..............................................................................................................Page 11
Clause 18. Changes to this policy................................................................................................Page 11

Section 2: General exclusions Page 12

Section 3: Definitions Page 15

 LEGAL AND REGULATORY INFORMATION

For the purpose of this policy:

Cigna Insurance Management Services (DIFC) Limited which is regulated by the Dubai Financial
Services Authority is acting as an underwriting agent on behalf of Cigna Global Insurance Company
Limited.
This insurance is provided by:
Cigna Global Insurance Company Limited
PO Box 155, Mill court
La Charroterie, St Peter Port
Guernsey
GY1 4ET
Channel Islands
Cigna Global Insurance Company Limited is authorised and regulated in Guernsey by the Guernsey
Financial Services Commission for the conduct of insurance business.
This policy does not replace any state health insurance scheme. You may wish to take appropriate
advice before stopping contributions to any state health insurance scheme of which you are a
member.

COMPLAINTS

Any complaint should in the first instance be sent to us at the address in the ‘How to contact us’
section below.
If the complaint is not resolved, the complaint may be referred to the Financial Ombudsman at:

The Channel Islands Financial Ombudsman (CIFO) Telephone: +44 (0)1534 748610
PO Box 114 Fax: +44 (0)1534 747629
Jersey, Channel Islands Email: [email protected]
JE4 9QG

The Financial Ombudsman Service can adjudicate most (but not all) complaints. Its decision is
binding on us but the person making the complaint may reject it without affecting their legal rights
(including their right to bring court proceedings).
Unless specifically agreed to the contrary, this policy is governed by, and will be interpreted in
accordance with, the law of England and Wales.
Any disputes about this policy, including disputes about its validity, formation and termination, will be
determined exclusively in the courts of England and Wales.

HOW TO CONTACT US

To cancel this policy, please email us at: [email protected].

For full details, please see clause 6.5 of these Policy Rules. You will need to provide your policy
number, full name and email address used in the application form.
You can also write to us at the following address:
Cigna Global Health Options
Customer Care Team
1 Knowe Road
Greenock
Scotland
PA15 4RJ
In other circumstances you can call our Customer Care Team 24/7 on:
+44 (0) 1475 788 182 or from inside the USA on 800 835 7677.

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 SECTION 1: GENERAL TERMS
AND CONDITIONS

1. Scope of cover and policy eligibility Guernsey Financial Services Commission or

their successors):
1.1
This policy is only offered to beneficiaries who 1.4.1
are expatriates. Therefore, the policy will only Until we receive the requested know your
cover the costs of treatment in a beneficiary’s customer documentation outlined in 1.4 we
country of nationality in circumstances where will not approve any treatment under this
the beneficiary is temporarily resident in their policy, we will not issue any guarantee of
country of nationality. Such circumstances payment or settle any claims for treatment
may not exceed one hundred and eighty (180) costs in relation to any beneficiary; and
days in aggregate per period of cover, and
1.4.2
the country of nationality must be within the
A failure to provide us with the requisite
selected area of coverage (see clause 11 for full
know your customer documentation
details).
within thirty (30) days of the start date will
1.2 give rise to a right, exercisable by us, to
Subject to the terms, conditions, limits, terminate this policy with immediate effect
exclusions (and special exclusions as detailed or on such longer period of notice as we in
in your Certificate of Insurance, if applicable) our absolute discretion may determine.
of this policy, Cigna will cover you for medical
1.5
and related expenses relating to medically
If there are any changes that occur between
necessary treatment which is recommended
your application and the initial start date of
by a medical practitioner, and provided within
your policy and any information that you
the selected area of coverage for injury and
provided to us in your application changes
sickness. The treatment must occur during
during this period, you must let us know.
the period of cover and deductibles, cost
We reserve the right to cancel the policy or
shares and limits of cover may apply. In
apply any additional premiums or exclusions
some circumstances we may, at our absolute
as a result of any change to your state of
discretion, agree to remove an exclusion if you
health which you have notified us of before
pay an additional premium. This will be agreed
the initial start date of the policy. If you fail
at the time you purchase your policy.
to inform us of any change to your state of
1.3 health during this period, we may treat this as
You must be eighteen (18) years old or over at misrepresentation, which could affect coverage
the time of purchase in order to purchase this under your policy or payment of claims.
policy.
1.6
1.4 This policy will not cover any costs relating to
You must provide us with all of the necessary treatment received before the cover starts, or
customer identification documentation or after the cover ends (even if that treatment
know your customer documentation (for was approved by us before the cover ends).
example a copy of your passport and proof of
address dated within the last 3 months) that 2. When does cover begin and end
we may request in relation to any beneficiary
2.1
to satisfy applicable anti-money laundering
This policy is an annual contract. This means
regulations from time to time (including but
that, unless it is terminated earlier, the cover
not limited to, any regulations issued by the
will end one (1) year after the start date.
Dubai Financial Services Authority and the
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2.2 > amend the terms of your insurance. We
If this policy ends before the normal end date, may apply these amended terms as if they
any premium which has been paid in relation were already in place if a claim has been
to the period after cover has ended will be adversely impacted by your carelessness;
refunded on a pro rata basis, so long as no or
claims have been made and no guarantees of
payment have been put in place during the > terminate in accordance with 6.2.
period of cover.
We will notify you in writing if any of the above
If the policy ends before the normal end date circumstances occur.
and you have made claims under it, you will
be liable for the remainder of any premium in If you become aware that information you have
respect of the policy which are unpaid. given us is inaccurate, you must inform us as
soon as possible using one of the options in
2.3 the ‘How to contact us’ section on page 3 of
If you die, cover will end for all beneficiaries these Policy Rules.
unless a beneficiary contacts us within thirty
(30) days of the date of death as shown in the 4. Free look period
Death Certificate. If any of the beneficiaries
would like to continue coverage by becoming You have a statutory right to cancel your policy
the policyholder, and subject to our policy within fourteen (14) days from the date you
terms, they must inform us within thirty (30) receive this policy. If you wish to cancel this
days and must provide us with a copy of the policy and we have not paid a claim or issued
Death Certificate. If a beneficiary does not a guarantee of payment, you will receive a
wish to continue coverage as the policyholder, full refund of your premium. Alternatively, if
all cover will end, and we will not make any we have paid a claim, or issued a guarantee
payments in relation to treatment or services of payment, we will not refund any premium
which are received on or after the date on which has been paid. To cancel this policy,
which the cover ends. please contact us using one of the options in
the ‘How to contact us’ section on page 3 of
3. The information you give us these Policy Rules.

If you do not exercise your right to cancel this

In deciding whether to accept this policy and
policy, it will continue in force and you will be
in setting the terms and premium, we have
required to make any premium payments that
relied on the information that you have given
are due to us.
to us. You must take care when answering
any questions that we ask by ensuring that all For your cancellation rights outside of the
information is accurate and complete. fourteen (14) day statutory cooling off period,
please refer to clause 6 of this policy.
If we determine on reasonable grounds that
you deliberately or recklessly provided us 5. Premium and other charges
with false or misleading information, it could
adversely affect this policy and any claim. For 5.1
example, we may: Your Certificate of Insurance sets out the
premium and any other charges (such as
> treat this policy as if it had never existed, taxes) which are payable, and states when and
refuse to pay all claims and return the how they must be paid.
premium paid. We will only do this if we
provided you with insurance cover which Payments must be made in the currency and
we would not otherwise have offered; in the manner detailed in your Certificate of
Insurance.

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 5.2 6.1.1
If you, or any beneficiaries, do not seek prior any premium or other charge (including any
approval for treatment or receive treatment relevant tax) is not paid in full within thirty
in the USA at a hospital, clinic or medical (30) days of the date on which it is due. We
practitioner which is not part of the Cigna will give you written notice if we are going
network, we may not pay for all of your to terminate the policy for this reason;
treatment. Please see ‘Your Guide to Getting
Treatment’ on page 10 of the Customer Guide 6.1.2
for the details of how we will calculate any it becomes unlawful for us to provide any
reduction in the value of your claim. A list of the cover available under this policy or
of Cigna’s network of hospitals, clinics and we are required to terminate the policy in
medical practitioners is available in your secure any particular jurisdiction or territory at the
online Customer Area. direction of a regulator or authority with
competent jurisdiction;
5.3
If you do not pay premium and/or any other 6.1.3
charges when they are due, we will notify you any beneficiary is identified on any list
by email immediately and suspend your policy imposing financial sanctions on targeted
i.e. cover for all beneficiaries will be suspended. individuals or entities maintained by the
If payment is made, the policy will be United Nations Security Council, the
reinstated. We will not approve treatment while European Union, the United States Office
the policy is suspended. We will not settle any of Foreign Assets Control or any other
claim while any payment to us is outstanding applicable jurisdiction. Furthermore, we
until the outstanding amount is paid. will not pay claims for services received
in sanctioned countries if doing so would
If after thirty (30) days the amount is still violate the requirements of the United
outstanding, we will write to you informing you Nations Security Council, the European
that the policy is cancelled. The cancellation Union or the United States Department of
date shall take effect on the date when the first Treasury’s Office of Foreign Assets Control;
outstanding payment was due. or

If you settle the outstanding amount within 6.1.4

thirty (30) days of when the first outstanding you have failed to provide us with the
payment was due, we will reinstate your cover requisite know your customer
back to that date. documentation requested pursuant to
clause 1.4 within thirty (30) days of the
5.4 start date (or such longer period of time
Subject to clause 13, we will inform you of the that we may have notified you in writing),
premium and any other charges which will termination in accordance with this clause
apply during the next period of cover. 6.1.4 shall have immediate effect although
we will refund any premiums you have paid.
The premium and/or other charges will change
each period of cover. 6.2
Subject to clause 3, we will terminate this
6. Termination policy with immediate effect if, we, at our sole
discretion determine, on reasonable grounds,
6.1 that you have, in the course of applying for
Subject to any conflicting legal or regulatory the policy or when making any claim under it,
requirements we will terminate this policy for withheld information or knowingly or recklessly
all beneficiaries immediately if: provided information which you know or

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believe to be untrue or inaccurate or failed to provided cover, so long as we have not paid
provide information which we have asked for, any claim, or issued any guarantee of payment
including medical information. during the period of cover.

6.3 6.7
Subject to clause 11, we may terminate this If treatment has been authorised, we will not
policy if any beneficiary ceases to be an be held responsible for any treatment costs
expatriate whether as a result of a change to a if the policy ends or a beneficiary leaves the
beneficiary’s country of nationality or country policy before treatment has taken place.
of habitual residence.
7. Fraud
6.4
If we are no longer in the market to sell 7.1
the policy or suitable alternative in your If a beneficiary makes a fraudulent claim under
geographical area, we will notify you at least this policy, we:
one (1) month before the end date to advise i. are not liable to pay the claim;
you that the policy will be terminated (and ii. may recover from the beneficiary any sums
therefore unable to be renewed) with effect paid by us in respect of the claim; and
from the end date.
iii. may give notice to the beneficiary and treat
the contract as having been terminated
6.5
with effect from the time of the fraudulent
If you want to terminate this policy and end
act.
cover for all beneficiaries, you may do so at
any time by giving us at least seven (7) days’
notice in writing. Please write to us using
7.2
If we exercise our right under clause 7.1 (iii)
one of the options in the ‘How to contact us’
above:
section on page 3 of these Policy Rules.
i. we shall not be liable to the beneficiary in
respect of a relevant event occurring after
6.5.1
the time of the fraudulent act. A relevant
If the policy is terminated in accordance
event is whatever gives rise to our liability
with clause 6.5, before the end date, and
under this policy (such as the occurrence
we have paid a claim or issued a guarantee
of a loss, the submission of a claim, or the
of payment during the period of cover,
notification of a potential claim); and
you will be liable for the remainder of any
premiums in respect of the policy which ii. we do not need to return any of the
are unpaid. If your annual premium is premium paid.
collected at intervals throughout the policy
year, you will be responsible for making 7.3
these payments for the remainder of the If this policy provides cover for any beneficiary
period of cover or alternatively, settle the other than you, and a fraudulent claim is made
outstanding premium amount. under this policy on behalf of a beneficiary
other than you, we may exercise the right
6.6 set out in clause 7.1 above as if there were
In relation to the period after your cover has an individual insurance contract between us
ended, unless your policy is terminated in and that beneficiary. However, the exercise of
accordance with clause 6.2 and/or clause 7, any of those rights shall not affect the cover
then any premium which has been paid in provided under the contract for any other
relation to the period after cover has ended beneficiary.
will be refunded to the extent that it does not
relate to a period of time in which we have

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 Nothing in this clause 7 is intended to vary the we will reduce the amount we pay towards
position under the Insurance Act 2015. the cost of treatment by that cost share
percentage. You will be responsible for paying
8. Coverage options the cost share directly to the hospital, clinic or
medical practitioner. The amounts you pay are
8.1 subject to the capping effect of the applicable
If a beneficiary does not have cover under out of pocket maximum.
the International Outpatient, International
Evacuation & Crisis Assistance Plus™, 9.3
International Health and Wellbeing or Only amounts you pay related to the cost
International Vision and Dental options, we will share on the International Medical Insurance
not pay for any of the treatments which are and/or International Outpatient option are
available under those options. subject to the capping effect of the out of
pocket maximum. The following are not
8.2 subject to the out of pocket maximum:
Coverage options cannot be changed at your
request during the period of cover and can > Any amounts you pay due to a deductible;
only be made upon renewal. If you want to > Due to exceeding limits of cover;
add or remove coverage options, or reduce > For treatment not covered by the
your deductible, cost share or out of pocket International Medical Insurance plan or
maximum, we may ask you to complete a new International Outpatient option; or
medical history questionnaire, and we may > Due to penalties for not obtaining prior
apply new special restrictions or exclusions on approval or using out of network providers
the new coverage options. You should let us in the USA.
know in writing at least seven (7) days before
the annual renewal date. Any amounts you pay to the deductible,
cost share and out of pocket maximum
9. Deductible and Cost Share where applicable, apply separately to each
beneficiary, each coverage option and each
9.1 period of cover.
If you have selected a deductible on the
International Medical Insurance plan and/or 9.4
International Outpatient option (if applicable), No deductible applies to ‘Inpatient cash
you will be responsible for paying the benefit’ or ‘Newborn Care’ benefit.
deductible amount directly to the hospital,
clinic or medical practitioner. We will let you 10. Adding or removing beneficiaries
know what this amount is.
10.1
We will reduce the amount which we will Unless there has been a relevant qualifying life
pay towards the cost of treatment in respect event, you cannot add or remove a beneficiary
of each claim which is made under the during the policy year. A beneficiary can only
International Medical Insurance or International be added or removed if you are renewing the
Outpatient option (if applicable) by the cover at the end of an annual period of cover.
amount of any deductible until the deductible
for the period of cover is reached. 10.2
If you would like to add a new beneficiary
9.2 on this basis, you must send us a completed
If you have selected a cost share on the application for that person. Acceptance of any
International Medical Insurance plan and/or new beneficiary is at our sole discretion. We
International Outpatient option (if applicable), will advise you of any special conditions or

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exclusions and any additional premium that 11. Changes to country of habitual
will apply to the offer of cover. Cover for any residence, address and/or nationality
new beneficiary will begin from the date on
which you confirm your acceptance. We will 11.1
send you an updated Certificate of Insurance If any beneficiary changes their country of
confirming that the new beneficiary has been habitual residence you must inform us as soon
added. as practicable and in any event within thirty
(30) days. We reserve the right to ask you for
10.3 further information about a change in your
If a beneficiary gives birth, you may apply or any other beneficiary’s country of habitual
to add the newborn as a beneficiary to your residence from time to time. Note that any
existing plan. change to your or any other beneficiary’s
country of habitual residence may result in an
10.3.1 increase to your premium or additional tax
If at least one (1) parent has been covered becoming payable, meaning you may have
by the policy for a continuous period to make an additional payment of premium
of twelve (12) months or more prior to or your monthly or quarterly payments may
the newborns birth, we will not require increase. If the premium increases, we will
information about the newborn’s health give you the right to cancel the policy, in
or a medical examination if an application accordance with clause 6.5, in which case
is received by us to add the newborn to clauses 6.5.1, 6.6 and 6.7 will apply. Please note
the policy within thirty (30) days of the that the insurance may be provided by another
newborn’s date of birth. However, if an Cigna group company.
application is received by us more than
thirty (30) days after the newborn’s date 11.2
of birth, the newborn will be subject to If a beneficiary returns to their country of
medical underwriting. nationality then the treatment which they
can obtain will be limited to one hundred and
10.3.2 eighty days (180) days in aggregate during the
If neither parent has been covered by policy year.
the policy for a period of twelve (12)
consecutive months or more prior to
11.2.1
the newborn’s birth, the newborn will
We reserve the right to review all claims
be subject to medical underwriting, and
submitted by beneficiaries in their country
you can submit an application to add the
of nationality and in circumstances
newborn.
where we know or reasonably believe the
beneficiary is or intends to be resident in
10.4
their country of nationality in excess of one
If medical underwriting is required for the
hundred and eighty (180) days in aggregate
newborn, we will then tell you whether we
per period of cover. In such circumstances
will offer cover to the newborn and, if so, any
we may no longer consider that beneficiary
special conditions and exclusions which would
to be an expatriate as they have returned to
apply. Cover will begin no sooner than the date
their country of nationality for a sustained
you accept our offered terms.
period and we may refuse payment of
any claim or issuance of a guarantee of
We will send you an updated Certificate of
payment.
Insurance confirming that the new beneficiary
has been added. Please refer to the ‘Newborn
Care’ benefit in your Customer Guide for 11.3
further details. We reserve the right to terminate this policy in
accordance with 6.3.

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 11.4 history or any illness, injury or condition
If any beneficiary ceases to be an expatriate suffered by any beneficiaries.
whether as a result of a change to a
beneficiary’s country of nationality or country 13.2
of habitual residence, then you can either: If you accept the invitation to renew, please
ensure you have read and understood the
11.4.1 policy documents for the forthcoming period
leave the policy in force for the remainder of cover. Your cover will be renewed for
of the period of cover. You must inform another twelve (12) months.
us upon renewal if you cease to be an
expatriate and we will determine if we 13.3
can offer you an alternative health plan If you do not want to renew your cover, you
provided by another Cigna group company; must let us know in writing at least seven (7)
or days before your policy end date.

11.4.2 13.3.1
terminate the policy by giving written If you do not renew your cover, any
notice with the effect that cover will end beneficiaries who have been covered under
for all beneficiaries. Any premium which the policy can apply for their own cover. We
has been paid in relation to the period after will consider their applications individually,
termination will be refunded to the extent and inform them whether, and on what
that it does not relate to a period of time terms, we are willing to offer them such
in which we have provided cover, so long cover.
as we have not paid claims or issued any
guarantees of payment during the period of 13.4
cover. If you would like to add or remove coverage
options, you must let us know in writing
12. How we will communicate with you at least seven (7) days before your annual
renewal date. We may apply new special
We will send any communication and notices restrictions, exclusions and/or adjust premium.
in relation to this policy electronically to the If we do so we will send you an updated
email address you have provided, and we will Certificate of Insurance.
place your policy documents in your secure
online Customer Area. 13.5
If any special exclusion(s) have been applied
13. Policy renewal to any beneficiary there may be occasions
when we can review them at a future annual
13.1 renewal date, to consider whether we are
If we determine to renew, we will write to you willing to remove the exclusion. If this is the
at least one (1) calendar month before the end case, we will show the exclusions review date
date to invite you to renew on the terms we in the Certificate of Insurance. At such date,
offer you. We will inform you of any changes we will also review the additional premium (if
to the policy and premium for the forthcoming any) which we may have applied to cover a
period of cover. If local law and/or regulation condition.
dictates, we may be required to offer you an
alternative health plan. You should contact us upon receipt of the
renewal notification, and at least fourteen (14)
Subject to clause 7, any decision by Cigna not days before the annual renewal date if there
to renew shall not be based on your claims is an exclusion which is due for review at that
date.

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We will then advise you of changes (if any) party is at fault, we (or any person or company
we have made and, where appropriate, we nominate) will take on that beneficiary’s
issue an amended Certificate of Insurance. right to recover the cost of that treatment
Amendments will be effective from the from the third party at fault (or their insurance
relevant annual renewal date. We do not company). If we ask a beneficiary to do so,
guarantee that any special exclusion(s) or he or she must take all steps to include the
additional premium will be removed on amount of benefit claimed from us under this
renewal. policy in any claim against the person at fault
(or their insurance company).
14. Data protection
The beneficiary will need to sign and deliver all
14.1 documents or papers and take any other steps
In assessing your application, and we require to secure our rights. The beneficiary
administering the policy and the insurance must not take any action which could damage
provided to you, we will collect, process and or affect these rights. We can take over and
share certain personal information about defend or settle any claim, or prosecute any
you. We take your privacy very seriously and claim, in a beneficiary’s name for our own
we will always process your information in benefit. We will decide how to carry out any
accordance with applicable data protection proceedings and settlement.
legislation, including the General Data
Protection Regulation (EU 2016/679) and any 17. Other Insurance
other applicable legislation and any guidance
or codes of practice issued in respect of If another insurer also provides cover, we will
protection of personal data from time to time. negotiate with them as regards to who pays
For more information please see our Data what proportion of any claim. If a beneficiary
Protection Notice, which we may update from is covered by other insurance, we may only
time to time. pay part of the cost of treatment. If another
person, organisation or public programme is
14.2 responsible for paying the costs of treatment,
Cigna will for the purposes of administering we may claim back any of the costs we have
any claim, ask a beneficiary to provide special paid.
category data relating to his or her medical
condition, previous conditions, state of health 18. Changes to this policy
and treatments.
18.1
15. Who can enforce this policy No person other than an executive officer of
Cigna has authority to change this policy or to
Only we and you have legal rights in waive any of its provisions on our behalf, for
connection with this policy. A person who is example, sales representatives, brokers and
not a party to this policy has no right under the other intermediaries cannot vary or extend the
Contracts (Rights of Third Parties) Act 1999 to terms of the policy.
enforce any term of this contract but this does
not affect any right or remedy of a third party 18.2
which exists or is available apart from that Act. We reserve the right to make any changes to
this policy that are necessary to comply with
16. Our right to recovery from third any changes to relevant laws and regulations. If
parties this happens, we will write to you and tell you
of the change.
If a beneficiary requires treatment as a result of
an accident or deliberate act for which a third

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 SECTION 2: GENERAL EXCLUSIONS

We will not offer cover or pay claims when be obtained by calling our Customer Care
it is illegal for us to do so under applicable Team; or
laws. Examples include but are not limited to, c) a medical practitioner, therapist, hospital,
exchange controls, local licensing regulations clinic, or facility which, in our reasonable
or trade embargo. opinion, is either not properly qualified or
authorised to provide treatment, or is not
We will not cover any beneficiaries or pay competent to provide treatment.
claims in jurisdictions when doing so would
violate applicable trade restrictions, including 2. Treatment for:
but not limited to: restrictions imposed by the
a) a pre-existing condition; or
United States Department of Treasury’s Office
b) any condition or symptoms which result
of Foreign Assets Control; the European Union
from, or are related to, a pre-existing
Commission, or; the United Nations Security
condition.
Council Sanctions Committees.

We will not pay for treatment for a

We cannot be held responsible for any loss,
pre-existing condition of which the
damage, illness and/or injury that may occur
policyholder was (or should reasonably have
as a result of receiving medical treatment at a
been) aware at the date cover commenced,
hospital or from a medical practitioner, even
and in respect of which we have not expressly
when we have approved the treatment as
agreed to provide cover.
being covered.

3. Preventative treatment, including but

The following exclusions apply to the
not limited to health screening, routine
International Medical Insurance plan and to all
health checks and vaccinations (unless that
of the extra coverage options. Please also refer
treatment is available under the International
to the list of benefits detailed in the Customer
Medical Insurance plan or one of the options
Guide, including the notes section for any
for which a beneficiary has cover).
further restrictions and exclusions that apply,
in addition to the General Exclusions. Please
Under the International Medical Insurance
also refer to your Certificate of Insurance for
plan, the limits of cover for preventative
any special exclusions that may apply.
surgery in respect of congenital conditions will
apply, other than for cancer.
1. Treatment which is provided by:

a) a medical practitioner who is not 4. Treatment which is provided by anyone who

recognised by the relevant authorities lives at the same address as the beneficiary, or
in the country where the treatment is who is a member of the beneficiary’s family.
received as having specialist knowledge
of, or expertise in, the treatment of the 5. Treatment which is necessary as a result of
disease, illness or injury being treated; conflict or disaster including but not limited
b) a medical practitioner, therapist, hospital, to:
clinic, or facility to whom we have given
a) nuclear or chemical contamination;
written notice that we no longer recognise
b) war, invasion, acts of terrorism, rebellion
them as a treatment provider. Details of
(whether or not war is declared), civil
individuals, institutions and organisations
war, commotion, military coup or other
to whom we have given such notice may
usurpation of power, martial law, riot,

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 or the act of any unlawfully constituted 14. Costs or fees for filling in a claim form or
authority; other administration charges.
c) any other conflict or disaster events; where
the beneficiary has: 15. Non-medical admissions or stays in
i) put him or herself in danger by entering hospital which include:
a known area of conflict (as identified
a) treatment that could take place on a
by a Government in your country of
daypatient or outpatient basis;
nationality, for example the British
b) convalescence;
Foreign and Commonwealth Office);
c) admissions and stays for social or
ii) actively participated in the conflict; or
domestic reasons e.g. washing, dressing
iii) displayed a blatant disregard for their
and bathing.
own safety.

16. Life support treatment (such as

6. Any treatment outside your selected area
mechanical ventilation) unless such treatment
of coverage, unless the treatment can be
has a reasonable prospect of resulting in
covered under the ‘Out of Area Emergency
the beneficiary’s recovery, or restoring the
Hospitalisation Cover’ conditions.
beneficiary to his or her previous state of
health.
7. Travel costs for treatment including any
fares such as taxis or buses, unless otherwise
17. Foetal surgery, i.e. treatment or surgery
specified, and expenses such as petrol or
undertaken in the womb before birth, unless
parking fees.
this is resulting from complications arising
through maternity and shall be subject to
8. Any expenses for ship to shore evacuations.
the limits detailed in the Complications from
Maternity benefit under the International
9. Treatment in nature cure clinics, health spas,
Medical Insurance plan.
nursing homes, or other facilities which are
not hospitals or recognised medical treatment
18. Footcare by a Chiropodist or Podiatrist.
providers.

19. Treatment for, or in connection with,

10. Charges for residential stays in hospital
smoking cessation.
which are arranged wholly or partly for
domestic reasons or where treatment is not
20. Treatment that arises from, or is in any
required or where the hospital has effectively
way connected with attempted suicide, or
become the place of domicile or permanent
any injury or illness that the beneficiary inflicts
abode.
upon him or herself.

11. Costs of hospital accommodation for a

21. Developmental problems, treatment
deluxe, executive or VIP suite.
for personality and/or character disorders,
including but not limited to:
12. Any prosthetic device or appliance,
including but not limited to hearing aids and a) learning difficulties such as dyslexia;
spectacles (unless the International Vision b) physical development problems such as
& Dental module is selected) which is not short height;
medically necessary and/or does not fall c) affective personality disorder;
within our definition of prosthetic device(s). d) schizoid personality disorder; or
e) histronic personality disorder.
13. Incidental costs including newspapers,
telephone calls, guests’ meals and hotel 22. Disorders of the temporomandibular joint
accommodation. (TMJ).

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 23. Treatment for a related condition resulting c) solo scuba-diving; or
from addictive conditions and disorders.
d) scuba-diving at a depth of more than
thirty (30) metres unless the beneficiary
24. Treatment for a related condition resulting
is appropriately qualified (namely PADI or
from any kind of substance or alcohol use or
equivalent) to scuba-dive at that depth.
misuse.
31. Treatment which (in our reasonable
25. Treatment needed because of or relating
opinion) is experimental, or has not been
to male or female birth control, including but
proven to be effective. This includes but is not
not limited to:
limited to:
a) surgical contraception namely:
a) treatment which is provided as part of a
> vasectomy, sterilisation or implants;
clinical trial;
b) non-surgical contraception, namely:
> pills or condoms; b) treatment which has not been approved by
c) family planning namely: the relevant public health authority in the
> meeting a doctor to discuss becoming country in which it is received; or
pregnant or contraception. c) any drug or medicine which is prescribed
for a purpose for which it has not been
26. Treatment by way of the intentional licensed or approved in the country in
termination of pregnancy, unless the which it is prescribed.
pregnancy endangers a beneficiary’s life or
mental stability. 32. Any form of cosmetic or reconstructive
treatment, the purpose of which is to alter or
27. Treatment for sexual dysfunction disorders improve appearance even for psychological
(such as impotence) or other sexual problems reasons, unless that treatment is medically
regardless of the underlying cause. necessary and is a direct result of an illness or
an injury suffered by the beneficiary, or as a
28. Treatment which is intended to change result of surgery.
the refraction of one or both eyes, including
but not limited to laser treatment, refractive 33. Treatment that is in any way caused by, or
keratotomy and photorefractive keratectomy. necessary because of, a beneficiary carrying
Note that we will pay for treatment to correct out an illegal act.
or restore eyesight if it is needed as a result of
a disease, illness or injury (such as cataracts or
a detached retina).

29. Gender reassignment surgery, including

elective procedures and any medical or
psychological counselling in preparation for, or
subsequent to, any such surgery.

30. Treatment which is necessary because of,

or is any way connected with, any injury or
sickness suffered by a beneficiary as a result
of:

a) taking part in a sporting activity at a

professional level;
b) taking part in a dangerous sporting activity
or hobby;
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 SECTION 3: DEFINITIONS

The words and phrases set out below have the meanings specified. Where those words and
phrases are used with those meanings, they will appear in italics in these Policy Rules, and in the
Customer Guide, including the list of benefits.

Unless otherwise provided, the singular includes the plural and the masculine includes the
feminine and vice versa.

Annual renewal date - the anniversary of Clinic(s) - a health care facility which is
the start date. registered or licensed in the country in which
it is located, primarily to provide care for
Application - the policyholder’s application outpatients and where care or supervision is
(whether they have sent in a form directly by a medical practitioner.
to us or through a broker or applied online
or through our telemarketers), and any Congenital condition(s) - any abnormality,
declarations that they made during their deformity, disease, illness or injury present at
enrolment for them and any beneficiaries birth, whether diagnosed or not.
included in the application.
Cosmetic - services, procedures or items that
Appropriate age intervals - child are supplied primarily for aesthetic purposes
and adolescence age schedule up to age and which are not necessary in order to
seventeen years old as set out by the maintain an acceptable standard of health.
American Academy of Pediatrics (AAP).
Country of habitual residence -
Beneficiaries, beneficiary - anybody the country where a beneficiary habitually
named in your Certificate of Insurance as being resides, as stated in your application.
covered under this policy, including newborn
children. Country of nationality - any country of
which a beneficiary is a citizen, national or
Certificate of Insurance - the certificate subject, as stated in your application.
issued to the policyholder. This shows the
policy number, the annual premium, the start Daypatient - a patient who is admitted to a
date, the deductible amount (if selected), the hospital or daypatient unit or other medical
cost share amount (if selected), the out of facility for treatment or because they need a
pocket maximum (if applicable), details of who period of medically supervised recovery, but
is covered, any special exclusions or exclusions who does not occupy a bed overnight. This
that have been removed at an additional also includes surgical procedures carried out in
premium and the health plan and selected a doctor’s surgery.
options (if applicable) which apply.
Dentist - dental surgeon or dental
Cigna, we, us, our, the insurer - see page practitioner who is registered or licensed as
3 of these Policy Rules for details of the Cigna such under the laws of the country, state or
insurer providing your policy. other regulated area in which the treatment is
provided.

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 Doctor - a medical professional who is Inpatient - a patient who is admitted to
registered and licensed under the laws hospital and who occupies a bed overnight or
of the country, state or regulated area to longer, for medical reasons.
practice medicine in the country in which the
treatment is provided. Medical assistance service - a service
which provides medical advice, evacuation,
Emergency treatment - treatment which is assistance and repatriation in accordance with
medically necessary to prevent the immediate International Clinical Guidelines. This service
and significant effects of illnesses, injuries can be multi-lingual and assistance is available
or conditions which, if left untreated, could twenty four (24) hours per day.
result in a significant deterioration in health.
Only medical treatment through a physician, Medically necessary/ medical necessity
medical practitioner and hospitalisation that - medically necessary covered services and
commences within twenty four (24) hours of supplies are those determined in accordance
the emergency event will be covered. with International Clinical Guidelines by the
medical team to be:
End date - the date on which cover under > required to diagnose or treat an illness,
this policy ends, as shown in the Certificate of injury, disease or its symptoms;
Insurance. > orthodox, and in accordance with generally
accepted standards of medical practice;
Evidence-based treatment - treatment > clinically appropriate in terms of type,
which has been researched, reviewed and
frequency, extent, site and duration;
recognised by:
> not primarily for the convenience of the
> the National Institute for Health and Clinical beneficiary, physician or other hospital,
Excellence; or clinic or medical practitioner; and
> International Clinical Guidelines. > rendered in the least intensive setting
that is appropriate for the delivery of the
Expatriate - means a beneficiary residing services and supplies.
outside of their country of nationality.
Where applicable, the medical team
Guarantee of payment - a binding may compare the cost effectiveness of
guarantee made by us to pay a provider the alternative services, settings or supplies when
agreed costs associated with a particular determining what the least intensive setting is.
treatment which we may give to a beneficiary
or a hospital, clinic or medical practitioner. Medical practitioner - a doctor or specialist
who is registered or licensed to practice
Hospital - any organisation or institution
medicine under the laws of the country, state
which is registered or licensed as a medical
or other regulated area in which the treatment
or surgical hospital in the country in which it
is provided, and who is not covered under
is located and where the beneficiary is under
this policy, or a family member of someone
the daily care or supervision of a medical
covered under this policy.
practitioner or qualified nurse.

Initial start date - the first day the Outpatient - a patient who attends a
beneficiary’s cover commenced on the hospital, consulting room, or outpatient
International Medical Insurance plan. clinic for treatment and is not admitted as a
daypatient or an inpatient.
Injury - a physical injury.

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Period of cover - the twelve (12) months Qualified nurse - a nurse who is registered
continuous period during which the or licensed as such under the laws of the
beneficiaries are covered under this policy, country, state or other regulated area in which
being the period from the start date to the treatment is provided.
the end date as noted in the Certificate
of Insurance or earlier if terminated in Qualifying life event means:
accordance with the Policy Rules.
> marriage or civil partnership;
> commencing cohabitation with a partner;
Personal Data - any information relating to > divorce or separation;
an identified or identifiable natural person.
> birth of a child;
> legal adoption of a child; or
Policy - the policy comprising these Policy
> death of a spouse, partner or child.
Rules, the Customer Guide (which contains
the list of benefits and claiming information), We may require evidence of the above event.
and your Certificate of Insurance.
Rehabilitation - physical, speech and
Policy documents - the documentation occupational therapy for the purpose of
relating to the policy, comprising of these treatment aimed at restoring the beneficiary
Policy Rules, the Customer Guide, your to their previous state of health after an event.
Certificate of Insurance and your Cigna ID
Card. Selected area of coverage - means either:
> Worldwide, including USA; or
Policyholder - a person who is aged 18 years > Worldwide, excluding USA.
or older who has made an application to us
which has been accepted in writing by us, and Special category data - personal data
who pays the premium under the policy. revealing racial or ethnic origin, political
opinions, religious or philosophical beliefs or
Policy Rules - the terms and conditions, trade union membership, genetic
general exclusions and defined terms that data, biometric data for the purpose of
govern this policy. uniquely identifying a natural person, data
concerning health and data concerning a
Pre-existing condition - any disease, illness person’s sex life or sexual orientation.
or injury, or symptoms present before the
initial start date linked to such disease, illness Spouse - a beneficiary’s legal husband or
or injury for which: wife, or unmarried or civil partner who we
> medical advice or treatment has been have accepted for cover under this policy.
sought or received; or
> the beneficiary knew about and did not Start date - the date on which coverage
seek medical advice or treatment. under this policy starts, as shown in the
Certificate of Insurance.
Prosthetic device(s) - an artificial limb or
tool which is required for the purpose of or Surgery - the branch of medicine that treats
in connection with surgery; or is a necessary diseases, injuries, and deformities by operative
part of the treatment immediately following methods which involves an incision into the
surgery for as long as required by medical body.
necessity; or which is medically necessary and
is part of the recuperation process on a Therapist - a speech therapist, dietician or
short-term basis. orthoptist who is suitably qualified and holds
the appropriate license to practice in the
country where treatment is received.
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 Treatment - any surgical or medical
treatment controlled by a medical practitioner
that is medically necessary to diagnose, cure
or substantially relieve disease, illness or injury.

USA - the United States of America and US

territories.

Worldwide including USA - every country

throughout the world, excluding any country
with whom, at the date of commencement
of treatment, the Federal Government of the
USA has prohibited trade to the extent that
payments are illegal under applicable law.

Worldwide excluding USA - worldwide,

with the exception of the USA.

You, your - the policyholder.

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 ®
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products and services are provided by or through such operating subsidiaries, and not by Cigna Corporation. Such operating subsidiaries include Cigna Global Insurance
Company Limited, Cigna Life Insurance Company of Europe S.A.–N.V, Cigna Europe Insurance Company S.A.-N.V. and Cigna Worldwide General Insurance Company Limited.
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CGHO Policy Rules CGIC EN 09/2020