|
Policy Exclusions |
 |
| 1. |
Pre-Existing Illness
shall mean :-
Disabilities that existed before the
Effective date of Insurance that the
Insured Person has reasonable knowledge
of. An Insured Person may be considered
to have reasonable knowledge of a
pre-existing condition where the
condition is one for which :-
| a) |
the Insured Person had
received or is receiving treatment; |
| b) |
medical advice,
diagnosis, care or treatment has been
recommended; |
| c) |
clear and distinct
symptoms are or were evident; or |
| d) |
its existence would have
been apparent to a reasonable person in
the circumstances. |
|
| 2. |
SPECIFIED ILLNESSES
shall mean the following disabilities
and its related complications occurring
within the first 120 days of Insurance
of the Insured Person :-
| i. |
Hypertension, diabetes
mellitus and Cardiovascular Disease |
| ii. |
All tumours, cancers,
cysts, nodules, polyps, stones of any
kind |
| iii. |
All ear, nose (including
sinuses) and throat conditions |
| iv. |
Hernias, haemorrhoids,
fistulae, hydrocele, varicocele |
| v. |
Endometriosis including
disease of the female Reproduction
System |
| vi. |
Vertebro-spinal
disorders (including disc) and knee
conditions |
|
| 3. |
WAITING PERIOD
Eligibility for benefits starts 30
days after the Insured has been included
in the Policy, except for a covered
Accident occurring after the effective
date of coverage. |
Exclusions
This Policy shall not cover: -
| 1. |
Pre-existing illness.
|
| 2. |
Specified Illnesses
occurring during the first 120 days of
continuous cover.
|
| 3. |
Any medical or physical
conditions arising within the first 30
days of the Insured Person’s cover or
date reinstatement whichever is latest
except for accidental injuries.
|
| 4. |
Care/treatment for which
payment is not required or to the extent
which is payable by any other
insurance/indemnity covering the Insured
and disabilities arising out of duties
of employment or profession that is
covered under a Workman’s Compensation
Ins Contract.
|
| 5. |
Plastic/Cosmetic
surgery, circumcision, eye examination,
glasses and refraction or surgical
correction of nearsightedness (Radial
Keratotomy or Lasik) and the use or
acquisition of external prosthetic
appliances or devices such as artificial
limbs, hearing aids, implanted
pacemakers and prescription thereof.
|
| 6. |
Dental conditions
including dental treatment or oral
surgery except as necessitated by
Accidental Injuries to sound natural
teeth occurring wholly during the Period
of Insurance.
|
| 7. |
Private nursing, rest
cures or sanitaria care, illegal drugs,
intoxication, sterilization, venereal
disease and its sequelae, AIDS or ARC
and HIV related diseases, any
communicable diseases required
quarantine by law.
|
| 8. |
Any treatment or
surgical operation for congenital
abnormalities / deformities including
hereditary conditions.
|
| 9. |
Pregnancy, child birth
(including surgical delivery),
miscarriage, abortion and prenatal or
postnatal care and surgical, mechanical
or chemical contraceptive methods of
birth control or treatment pertaining to
infertility. Erectile dysfunction and
tests or treatment related to impotence
or sterilization.
|
| 10. |
Psychotic , mental and
nervous disorders (including any
neuroses and their physiological or
psychosomatic manifestations).
|
| 11. |
Hospitalization
primarily for investigatory purposes,
diagnosis, x-ray examination, general
physical or medical examinations not
incidental to treatment or diagnosis of
a Covered Disability or any treatment
which is not Medically Necessary and any
preventive treatments, preventive
medicines or examinations carried out by
a Physician, and treatments specifically
for weight reduction or gain.
|
| 12. |
Costs/expenses of
services of a non-medical nature such as
television, telephones, telex services,
radios or similar facilities, admission
kit/pack and other ineligible
non-medical items.
|
| 13. |
Sickness or injury
arising from racing of any kind (except
foot racing), hazardous sports such as
but not limited to skydiving,
water-skiing, underwater activities
requiring breathing apparatus, winter
sports, professional sports and illegal
activities.
|
| 14. |
Suicide, attempted
suicide or intentionally self-inflicted
injury while sane or insane.
|
| 15. |
Private flying other
than as a fare-paying passenger in any
commercial scheduled airlines licensed
to carry passengers over established
routes.
|
| 16. |
War or act of war,
declared or undeclared, criminal or
terrorist activities, active duty in any
armed forces, direct participation in
strikes, riots and civil commotion or
insurrection.
|
| 17. |
Ionising radiation or
contamination by radioactivity from any
nuclear fuel or nuclear waste from
process of nuclear fussion or from any
nuclear weapons material.
|
| 18. |
Expenses incurred for
donation of any body organ by an Insured
Person and costs of acquisition of the
organ including all costs incurred by
the donor during organ transplant and
its complications.
|
| 19. |
Expenses incurred for
sex changes.
|
| 20. |
Investigation and
treatment of sleep and snoring
disorders, and hormone replacement
therapy and alternative therapy such as
treatment, medical service or supplies,
including but not limited to
chiropractic services, acupuncture,
acupressure, reflexology, bonesetting,
herbalist treatment, massage or aroma
therapy or other alternative treatment. |
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