Friday, 13 May 2016

Exclusions That the Health Insurance Policy Does not Cover

 Exclusions That the Health Insurance Policy Does not Cover

  1. All diseases / injuries which are pre-existing when the cover incepts for the first time.
  2. Any disease other than those stated in clause (c) below, contracted by the insured person during the first 30 days from the commencement date of the policy. This exclusion shall not, however, apply if in the opinion of Panel of Medical Practitioners constituted by the company for the purpose, the insured person could not have known of the existence of the disease or any symptoms or complaints thereof at the time of making the proposal for insurance to the company. This condition shall not however apply in case of the insured person have been covered under this scheme or group insurance scheme with any of the Indian Insurance Companies for a continuous period of preceding 12 months without any break.
  3. During the first or more years of the operation of the policy the expenses on treatment of diseases such as Cataract, Benign Prostates Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele,Congenital Internal Disease, Fistula in anus. Piles, Sinusitis and related disorders. If these diseases are preexisting at the time of proposal they will not be covered even during subsequent period of renewal.
  4. Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
  5. Cost of spectacles and contact lenses, hearing aids. (These may be termed as normal maintenance expenses.)
  6. Dental treatment or surgery of any kind unless requiring
  7. hospitalisation.
  8. Convalescence, general debility, run down condition or rest cure, congenital external disease, or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs / alcohol.
  9. Various conditions commonly referred to as AIDS.
  10. Charges incurred at hospital or nursing home primarily for diagnostic. X-Ray or laboratory examinations or other diagnostic studies not consistent with the positive existence or presence of any ailment, sickness or injury for which confinement is required at a Hospital / Nursing Home or at Home under Domiciliary Hospitalisation as defined.
  11. Expenses on vitamins and tonics unless forming part of treatment.
  12. Treatment arising from childbirth including Caesarean section (can be deleted, if maternity benefit is covered).
  13. Voluntary medical termination of pregnancy (abortion) during the first 12 weeks from the date of conception.
  14. Naturopathy treatment.

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