Pre-existing health condition or disease or ailment / injuries
Any ailment / disease / injuries / health condition which are pre-existing (treated / untreated, declared / not declared in the proposal form), in case of any of the insured person of the family, when the cover incepts for the first time, are excluded for such insured person upto 4 years of this policy being in force continuously.
For the purpose of applying this condition, the date of inception of the policy taken from the Company, for each insured person of the family, shall be considered, provided the renewals have been continuous and without any break in period.
This exclusion will also apply to any complications arising from pre existing ailments / diseases / injuries. Such complications shall be considered as a part of the pre existing health condition or disease. To illustrate if a person is suffering from hypertension or diabetes or both hypertension
and diabetes at the time of taking the policy, then policy shall be subject to following exclusions.
Diabetes
Hypertension
Diabetes & Hypertension
Diabetic Retinopathy
Cerebro Vascular accident
Diabetic Retinopathy
Diabetic Nephropathy
Hypertensive Nephropathy
Diabetic Nephropathy
Diabetic Foot /wound
Internal Bleed/ Haemorrhages
Diabetic Foot
Diabetic Angiopathy
Coronary Artery Disease
Diabetic Angiopathy
Diabetic Neuropathy
Diabetic Neuropathy
Hyper / Hypoglycaemic shocks
Hyper / Hypoglycaemic shocks
Coronary Artery Disease
Cerebro Vascular accident
Hypertension Nephropathy
Internal Bleeds/ Haemorrhages
Expenses incurred on any disease, except as specified under the following table, contracted by the Insured person during the first 30 days from the commencement date of the policy except treatment for accidental external injuries.
The expenses on treatment of following ailment / diseases / surgeries for the specified periods are not payable if contracted and / or manifested during the currency of the policy.
If these diseases are pre-existing at the time of proposal the exclusion for preexisting condition SHALL be applicable in such cases.
Benign ENT disorders and surgeries i.e. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty etc.
1 year
Polycystic ovarian diseases
1 year
Surgery of hernia
2 year
Surgery of hydrocele
2 year
Non infective Arthritis
2 year
Undescendent Testes.
2 year
Cataract.
2 year
Surgery of benign prostatic hypertrophy
2 year
Hysterectomy for menorrhagia or fibromyoma or myomectomy or prolapse of uterus
2 year
Fissure / Fistula in anus
2 year
Piles
2 year
Sinusitis and related disorders
2 year
Surgery of gallbladder and bile duct excluding malignancy
2 year
Surgery of genito- urinary system excluding malignancy
2 year
Pilonidal Sinus
2 year
Gout and Rheumatism
2 year
Hypertension
2 year
Diabetes
2 year
Calculus diseases
2 year
Surgery for prolapsed inter vertebral disk unless arising from accident
2 year
Surgery of varicose veins and varicose ulcers
2 year
Joint Replacement due to Degenerative condition.
4 year
Age related osteoarthritis and Osteoporosis
4 year
Injury or disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, War like operations (whether war be declared or not) or by nuclear weapons / materials.
Circumcision (unless necessary for treatment of a disease not excluded under the policy or as may be necessitated due to any accident), vaccination, inoculation, 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.
Surgery for correction of eye sight, cost of spectacles, contact lenses, hearing aids etc.
Any dental treatment or surgery, unless arising from injury and which requires hospitalisation, which is corrective, cosmetic or of aesthetic in nature, filling of cavity, root canal treatment including treatment for wear and tear etc
Convalescence, general debility, "run down" condition or rest cure, congenital external and internal diseases or defects or anomalies, sterility, any fertility, sub-fertility or assisted conception procedure, venereal diseases, intentional self-injury/suicide, all psychiatric and psychosomatic disorders and diseases / accident due to and / or use, misuse or abuse of drugs / alcohol or use of intoxicating substances or such abuse or addiction etc.
Any treatment received in convalescent home, convalescent hospital, health hydro, nature care clinic or similar establishments.
All expenses arising out of any condition directly or indirectly caused by, or associated with Human T-cell Lymphotropic Virus Type III (HTLD - III) or Lymohadinopathy Associated Virus (LAV) or the Mutants Derivative or Variations Deficiency Syndrome or any Syndrome or condition of similar kind commonly referred to as AIDS, HIV and its complications including sexually transmitted diseases.
Expenses incurred at Hospital or Nursing Home primarily for evaluation / diagnostic purposes which is not followed by active treatment for the ailment during the hospitalised period OR expenses incurred for investigation or treatment irrelevant to the diseases diagnosed during hospitalisation or primary reasons for admission, referral fee to family doctors, out station consultants / Surgeons fees, Doctor's home visit charges/ Attendant /
Nursing charges during pre and post hospitalisation period. etc.
Expenses incurred on vitamins and tonics etc unless forming part of treatment for injury or disease as certified by the attending physician and / or all non medical expenses including personal comfort and convenience items or services.
Any Treatment arising from or traceable to pregnancy, childbirth, miscarriage, caesarean section, abortion or complications of any of these including changes in chronic condition as a result of pregnancy.
Naturopathy treatment, unproven procedure or treatment, experimental or alternative medicine and related treatment including acupressure, acupuncture, magnetic and such other therapies etc.
Genetic disorders and stem cell implantation / surgery.
Cost of external and or durable Medical / Non medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Infusion pump etc., Ambulatory devices i.e. walker , Crutches, Belts ,Collars ,Caps , splints, slings, braces ,Stockings etc. of any kind, Diabetic foot wear, Glucometer / Thermometer and similar related items etc. and also any medical / non medical equipment which is subsequently used at home.
Treatment of obesity or condition arising therefrom (including morbid obesity) and any other weight control programme, services or supplies etc...
Change of treatment from one system to another system of medicine unless being agreed / allowed and recommended by the consultant under whom the treatment is taken.
Any treatment arising from Insured's participation in any hazardous activity including but not limited to scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing etc unless specifically agreed by the Insurance Company.
Out patient Diagnostic, Medical or Surgical procedures or treatments, non-prescribed drugs and medical supplies, Hormone replacement therapy, Sex change or treatment which results from or is in any way related to sex change.
Massages, Steam bathing, Shirodhara and like treatment under Ayurvedic treatment.
Any kind of Service charges/Surcharges, unless payable to the Govt. Authority, levied by the hospital.
Compulsory Co-Payment: Under the SILVER plan the insured has to bear 10% of admissible claim amount in each and every claim.
