Exhibit_E_-__List_of_Exclusions.pdf

LES Health Insurance Services

STC10014R0001

Exhibit E

List of Exclusions

This schedule sets out the non-basic (excluded) healthcare services:

1. Healthcare services, which are not medically necessary.

2. Services which do not require continued administration by trained medical personnel.

3. Healthcare Services that are not performed by Authorized Healthcare Service

Providers, apart from Healthcare Services rendered in a Medical Emergency.

4. Fees of persons who are not licensed physicians or nurses.

5. Non-medical hospital charges – for personal comfort and convenience items

(television, telephone, barber or beauty services, home help, family help, guest services and/or similar household assistance, incidental services and supplies).

6. Custodial care includes:

(1) Non-medical treatment services; or

(2) Health-related services which do not seek to cure or which do not result in a change in the medical condition of the patient.

7. Healthcare services and associated expenses for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitation therapy and; replacement of an existing breast implant. Elective cosmetic procedures are those procedures which improve physical appearance and which are not incidental to an injury, sickness or congenital anomaly when the primary purpose is to improve physiological functioning of the involved part of the body.

Breast reconstruction following a mastectomy for cancer is covered.

8. Surgical and non-surgical treatment for obesity (including morbid obesity), and any other weight control programs, services, or supplies.

9. Medically non-approved experimental, research, investigational healthcare services, treatments, devices and pharmacological regimens.

10. Healthcare services, treatments and associated expenses for baldness, hair falling, hair transplant, dandruff or wigs.

11. Non-medically necessary Amniocentesis.

12. Treatment, services and surgeries for sex transformation.

13. Prosthetic devices and durable medical equipment, unless approved by the insurance company.

14. Treatments and services arising as a result of an unlawful action on the part of the patient, the practice of a dangerous sport, hazardous activities, including but not limited to, any form of aerial flight, any kind of power-vehicle race, water sports, horse riding activities, mountaineering activities, violent sports such as judo, boxing, wrestling, bungee jumping, any professional sports activities, self-inflicted wounds, or service in the armed forces of any country.

LES Health Insurance Services

STC10014R0001

15. Growth hormone therapy.

16. Costs associated with eyeglass frames, nonprescription lenses, or tinting.

17. Services rendered by any medical provider relevant of an Insured Person or who is a member of an Insured Person's family, including spouse, brother, sister, parent or child.

18. Healthcare services and treatments by acupuncture; acupressure, hypnotism, Rolfing, massage therapy, aromatherapy, homeopathic treatments, and other forms of alternative treatment.

19. All Healthcare services and treatments for in-vitro fertilization (IVF), embryo transport; ovum and male sperms transport.

20. Birth defects, congenital disease and/or deformities unless life-threatening.

21. Terrestrial or air transportation in cases other than medical emergencies or unauthorized transportation services.

22. Transportation for out of country treatment.

23. Circumcision healthcare services.

24. Inpatient treatment received without prior approval from the insurance company which were not notified within 24 hours from the date of admission.

25. Any test or treatment, which is not related to a specific symptom and/or disease, examinations required for employment, travel, licensing or insurance purposes.

26. All supplies which are not considered as medical treatments including but not limited to: mouthwash, toothpaste, lozenges, antiseptics, milk formulas, food supplements, skin care products, shampoos and multivitamins (unless prescribed as replacement therapy for known vitamin deficiency conditions) and all equipment not primarily intended to improve a medical condition or injury, including but not limited to air conditioners or air purifying systems, arch supports, convenience items/ options, exercise equipment and sanitary supplies.

27. More than one consultation or follow up with a medical specialist for same ailment in a single day unless referred by a physician.

28. Health services and associated expenses for organ and tissue transplants, irrespective of whether the insured person is a donor or recipient.

29. All kinds of education programs and/or learning disabilities treatments.

30. Injuries resulting from criminal acts or resisting authority by the insured person.

31. All cases resulting from the use of alcohol, non-prescribed narcotic drugs and hallucinatory substances by the insured person.

32. Any examination, treatment, services or supplies not prescribed by a physician or nurse.

33. Injuries resulting from attempted suicide or self-inflicted injuries.