Are consultations performed by you or a family member typically excluded from cover?

What this exclusion usually means

Insurers generally want consultations and treatment to be provided by an independent clinician so that the diagnosis, recommendation, and claim pathway are properly documented and free from conflicts of interest.

That means even if the person giving advice is medically qualified, the claim may still be excluded if the provider is the insured person or a close relative.

What may be excluded

• Consultations performed by the insured person
• Treatment provided by a spouse, parent, child, sibling, or other close relative
• Prescriptions or certificates issued without an independent clinical relationship
• Charges where the insurer believes the provider relationship is not sufficiently independent

What may still be covered

Treatment may still be covered where it is carried out by an independent recognised medical practitioner or facility in line with the policy rules. The issue is usually not the type of treatment, but who provided it and whether the clinical relationship is independent.

What to check in your policy

• How does the policy define family member or relative?
• Does it exclude both consultations and treatment, or only one of them?
• Does it require treatment to be provided by an independent recognised practitioner?
• Would prescriptions, referrals, or certificates from a family member also be excluded?
• Are there any emergency exceptions?

Why this matters

This exclusion is about independence and proper claim control. It is common even where the family member is a qualified clinician, because insurers want a clear external professional judgement and properly documented care pathway.