AIA health insurance — what's not covered

29 exclusions from wording effective 2026-05-16 · source PDF ↗

• Any accommodation, flight and/or transport, except where expressly covered by a benefit in this policy.
• Care provided for a sign, symptom, condition or disease that requires immediate or same day hospital admission for treatment or monitoring.
• Any additional surgery performed during an operation, which is not directly related to the medical condition or treatment for which cover is claimed under the terms of this policy.
• Any treatment by a physiotherapist, chiropractor, osteopath, naturopath, homeopath, acupuncturist, podiatrist, dietitian, counsellor or speech therapist except where expressly covered by a benefit in this policy.
• Bariatric surgery for any condition including but not limited to obesity, diabetes and sleep apnoea, except where expressly covered by a benefit in this policy.
• Breast reduction surgery (except where expressly covered under a benefit in this policy) and gynaecomastia.
• Circumcision except where medically necessary.
• Any congenital condition except where expressly covered under the Congenital Condition Surgery Benefit in this policy.
• Contraception of any type.
• Any elective or cosmetic procedure or any surgery, procedure or treatment that improves, alters or enhances appearance, whether or not undertaken for medical, physical, functional, psychological or emotional reasons.
• Any injury or condition arising from participation in a criminal activity.
• Dental repair or implants, orthodontic treatment, orthognathic, periodontal, or endodontic procedures, implants and related surgery of any kind except where expressly covered under a benefit in this policy.
• The misuse of prescribed or non-prescribed drugs, including where they have not been taken in accordance with the manufacturer's or registered medical practitioner's directions.
• Any appliances, aids, implants or equipment including but not limited to implantable defibrillators, nerve appliances, hearing aids, cochlear implants, braces, crutches, mouth-guards, orthotics, insulin pumps, CPAP machines and any other appliances or equipment (surgical, medical or dental) except cardiac pacemakers, implantable loop recorders or where expressly covered under a benefit in this policy.
• Any injury, illness, condition or disability arising from, caused or contributed by, drug taking, intoxication or misuse of alcohol.
• Diagnosis, management and treatment of infertility except as specifically provided by the pregnancy, maternity and infertility benefit under AIA Private Health Plus.
• Psychiatric, psychological and/or neurodevelopment disorders including treatment or counselling for but not limited to pre-senile dementia, senile illness or dementia, geriatric care including geriatric in-patient care and disability support services, intellectual disability (intellectual development disorder), autism spectrum disorder, attention deficit/hyperactivity disorder, specific learning disorders, motor disorders (including but not limited to Tourette's disorder) or dyslexia.
• New medical treatments and procedures including any prescription drugs, medical devices, treatment techniques and/or procedures, tests and/or other healthcare services that have not been approved by AIA in its sole discretion.
• Drugs required for your particular treatment that are not subsidised by Pharmac, except for the drugs required for the chemotherapy benefit under Cancer Care in AIA Private Health Cover.
• Any injury, illness, condition or disability arising from nuclear contamination.
• Nursing care, except where expressly covered under a benefit in this policy.
• Treatment of obesity (including treatment of complications arising from any treatment for obesity; any disease or disorder of the skin or psychological treatment), except where expressly covered by a benefit in this policy.
• Obstetric visits, pregnancy, childbirth or any associated conditions or complications except as specifically provided by the obstetric care allowance or, the pregnancy, maternity and infertility benefit under AIA Private Health Plus.
• Organ donation and receipt.
• Treatments or procedures not provided by a registered medical practitioner practising within his or her scope of practice except where expressly covered under a benefit in this policy.
• Palliative care, except where expressly covered by a benefit in this policy.
• Any pre-existing condition, unless the symptom or condition was disclosed to AIA at the time of your application and accepted as covered by AIA in writing.
• Prescriptions, except where expressly covered by a benefit in this policy.
• Preventative treatment, health surveillance screening or treatment or investigation (including as a result of family history) where the life assured has no medical symptoms or where the condition will not cause significant problems for the health of the life assured.