25th July 2008

Exclusions for Dive Injury Insurance

No benefits will be paid under any plan for charges in connection with:

  1. Services or supplies for which a Member is not required to pay.
  2. Charges made only because Insurance exists.
  3. An Injury for which benefits are paid or payable under Workers’ Compensation or any Occupational Disease or similar law whether such benefits are insured or self-insured.
  4. Any act of war, if declared or not.
  5. Custodial Care.
  6. Drugs and medicines that may be obtained without written prescription and/or not furnished by and administered during a Hospital confinement as an Inpatient.
  7. Charges that are more than the Reasonable and Customary Charges for the services and supplies furnished.
  8. Hospital services and supplies when confinement is solely for diagnostic testing purposes; or costs incurred after 12 months from the date of accident.
  9. A dive, or one or more dives as part of a Repetitive Dive Series which exceeds the maximum depth specified under the policy taken out by the Member.
  10. Any medical charges incurred later than 12 months immediately following the date of the illness or injury.
  11. Nervous, emotional or mental disorders.
  12. An Injury or Illness that occurs after drug and alcohol use except those prescribed by a physician.
  13. Medical exams not required for treatment of any Injury or Illness.
  14. Routine eye or hearing exams, eye refractions, eye glasses contact lens, hearing aids or any type of external appliances used to improve visual or hearing acuity and their fittings.
  15. Cosmetic or reconstructive procedures, and any related services or supplies, which alter appearance but do not restore or improve impaired physical function.
  16. Care, treatment, services or supplies: (a) not prescribed by a Physician; or (b) not Medically Necessary; or (c) resulting from a Predisposing Medical Condition that was not declared in writing to DAN at the time of application for the insurance or communicated to DAN in writing if the condition arose during the period of the policy; or (d) mainly for the purpose of medical or other research; or (e) received from a Nurse which do not require the skill and training of a Nurse; or (f) to the extent that benefits are payable under other provisions of this Group Policy; or (g) provided or paid for by any government’s civilian employees and their dependents; or (h) reordered by a family member.
  17. Any act of Nuclear, Biological or Chemical Terrorism.
  18. Undertaking a dive, a Repetitive Dive Series, a scuba diving activity or snorkelling activity against the advice of a physician.
  19. Flying within a Surface Interval shorter than the required interval specified in the most recent Divers Alert Network Flying After Diving Guidelines
  20. Flying within at 72 hours of Recompression Treatment or within a longer period if so specified by the treating physician.
  21. Undertaking a dive, a Repetitive Dive Series, a scuba diving activity within a minimum period of six weeks after the completion of Recompression Treatment.
  22. Undertaking a dive, a Repetitive Dive Series, a scuba diving activity without first obtaining a clearance to return to diving from the treating physician after undergoing Recompression Treatment.
  23. Undertaking a dive, a Repetitive Dive Series, a scuba diving activity or snorkelling or  breathhold diving activity as part of, or preparation for, a contest, competition, record attempt, trial or experiment related to achieving depth or endurance records on compressed gas or breathhold.
  24. Undertaking a dive, a Repetitive Dive Series, a scuba diving activity or snorkelling or breathhold diving activity in a manner which the Member knew, or reasonably should have known would expose them to an obvious risk of suffering an injury or illness.

No benefits will be paid under specific plans for charges in connection with:

Standard Insurance Plan:

Services and supplies for any Injury or Illness other than DCI;

Master/Preferred Insurance Plans:

  1. Service and supplies for an Injury or Illness not due to:
    (a) Decompression Sickness (DCS), Arterial Gas Embolism (AGE), or Pulmonary Barotrauma caused by a scuba diving or snorkeling activity;
    (b) Any accidental Injury that occurs in the water and is a direct result of a scuba diving or snorkeling activity;
    (c) Diving within the depth, training and breathing gas requirements of the particular policy.

    No benefit payment shall be made for charges incurred after the date the Group Policy is terminated except as provided under any extended benefits provision of this Group Policy.

IMPORTANT: By virtue of the National Health Act, 1953, the Medical Insurance cover referred to in the DAN Diving Insurance plans is not available to Australian Members in respect to hospital treatment, medical and health services, medical, surgical and prosthetic equipment and appliances, drugs and medicines or ambulance services provided in Australia.

Additional Exclusions For Death & Disability Cover

For the Accidental Death and Dismemberment Indemnity, Permanent Total Disability Indemnity, the Group Policy does not cover any loss, fatal or non-fatal; caused by or resulting from:

  1. Traveling against the advice of a physician;
  2. Intentionally self-inflicted injury;
  3. Suicide or attempted suicide; while sane or insane;
  4. War or any act of war; declared or undeclared;
  5. Service in the military, naval, or air service of any country;
  6. Illness, disease, pregnancy, childbirth, miscarriage or any bacterial infection other than bacterial infection occurring from an accidental cut or wound;
  7. Piloting or acting as a crew member or riding in any aircraft; except as a fare-paying passenger on a scheduled airline.
  8. Diving with a Predisposing Medical Condition that was known by the Insured and not declared in writing to Divers Alert Network.
  9. Any act of Nuclear, Biological or Chemical Terrorism.

IMPORTANT NOTICE
Availability of services and benefits for evacuation or injury commences on acceptance of an application for membership of DAN Asia-Pacific. The applicant is required to complete the application fully and in good faith and with appropriate and full disclosure of any predisposing medical condition, pre-existing condition or previous decompression illness. No cover is provided for any evacuation, medical, paramedical or other injury benefits resulting from or materially contributed to, directly or indirectly by any diving or other activity in which the applicant engaged prior to and up to the time of acceptance of the application by DAN Asia-Pacific, regardless of the date on which any claim for cover is made by or on behalf of the applicant.

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