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B.Health Major
This provides you with an extensive coverage over
acute medical conditions that might otherwise be
excluded from other basic insurance policies due to
the following reasons :
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Basic Health Insurance
policies do not provide coverage against major
illnesses, diseases and critical medical
conditions
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Insurance policies that are
not upgraded as they gradually mature increase
the probability of the holder not getting the
essential coverage he or she needs |
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Even with a high coverage,
escalating medical costs can restrict your
present benefits coverage, especially in the
event of a critical medical condition requiring
major surgery.
With these factors in mind, B-Health Major
provides you with the protection and assurance
you need by covering medical expenses that are
not payable or insufficient under existing basic
policies. |
Special Features
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24-hour Worldwide Cover
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Full Reimbursement without Surgical Schedule
up to Overall Annual & Lifetime Limit |
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A choice of deductible limits - as a
policyholder, you have the freedom of
determining the amount you want the basic policy
to cover. You can also choose a plan that will
cover expenses over and above your deductible
limit, in the event that you decide to pay for
medical fees personally |
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Extensive coverage of major medical
conditions as opposed to the limited list of
medical benefits typically provided by employers |
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Outpatient Treatments - Actual charges are
reimbursed subject to benefit limits for
outpatient cancer or kidney dialysis and
emergency accidental injuries at clinics
including dental treatment |
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Guaranteed Renewal - The renewal of the
policy is guaranteed up to the age of 70 years
or upon expiration of the lifetime limit up to
its policy term to ensure you enjoy continuous
coverage. However, please note that the premium
rates are not guaranteed and will increase with
age on the published premium rate applicable. |
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Policy Exclusions |
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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 :-
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a) |
the Insured Person had
received or is receiving treatment;
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b) |
medical advice, diagnosis,
care or treatment has been recommended;
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c) |
clear and distinct symptoms
are or were evident; or
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d) |
its existence would have
been apparent to a reasonable person in the
circumstances.
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SPECIFIED ILLNESSES
shall mean the following disabilities and
its related complications occurring within
the first 120 days of Insurance of the
Insured Person :-
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i) |
Hypertension, diabetes
mellitus and Cardiovascular Disease
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ii) |
All tumours, cancers, cysts,
nodules, polyps, stones of any kind
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iii) |
All ear, nose (including
sinuses) and throat conditions
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iv) |
Hernias, haemorrhoids,
fistulae, hydrocele, varicocele
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v) |
Endometriosis including
disease of the female Reproduction System
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vi) |
Vertebro-spinal disorders
(including disc) and knee conditions
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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: -
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1. |
Pre-existing illness.
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2. |
Specified Illnesses
occurring during the first 120 days of
continuous cover.
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3. |
Any medical or physical
conditions arising within the first 30 days
of the Insured Persons cover or date
reinstatement whichever is latest except for
accidental injuries.
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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 Workmans Compensation Ins Contract.
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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.
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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.
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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.
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Any treatment or surgical
operation for congenital abnormalities /
deformities including hereditary conditions.
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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.
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10. |
Psychotic , mental and
nervous disorders (including any neuroses
and their physiological or psychosomatic
manifestations).
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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.
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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.
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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.
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14. |
Suicide, attempted suicide
or intentionally self-inflicted injury while
sane or insane.
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15. |
Private flying other than as
a fare-paying passenger in any commercial
scheduled airlines licensed to carry
passengers over established routes.
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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.
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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.
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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.
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19. |
Expenses incurred for sex
changes.
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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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