Health Insurance Policies - Fine Prints - First 30 days Policy Exclusions

First 30 days Policy Exclusions

Any disease other than those stated in clause 4.3 below, contracted by the Insured person during the first 30 days from the commencement date of the policy. This condition 4.2, shall not however, apply in the case of the Insured person having 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.

Under this clause, the following ailments mentioned in clause 4.3 are not payable as follows:

• Cataract and age related eye ailments
• Benign Prostate Hypertrophy
• Hysterectomy for Menorrhagia, Fibromyoma, Myomectomy or Prolapse of Uterus
• Hernia
• Hydrocele
• Congenital internal disease
• Fistula in anus
• Fissures

• Piles
• Pilonidal Sinus, Sinusitis and related disorders
• Gall Bladder and Bile Duct Calculus
• Gout and Rheumatism
• Calculus Diseases (Stones in Urinary system)
• Joint Diseases
• Any Skin Disorder
• All internal and external benign tumors, cysts, polyps of any kind, including benign breast lumps
• Benign Ear, Nose, Throat disorders
• Gastric or Duodenal Ulcer
• Non-infective arthritis
• PIVD (Prolapse of Inter-vertebral Disc) unless arising from accident
• Varicose veins and varicose ulcers
• Age related Osteoporosis and Osteoarthritis
• Joint Replacement due to Degenerative Condition

In cases wherein, a customer avails of health insurance cover and contracts an ailment (mentioned in the above list) during the first 30 days i.e. first month since the commencement of the policy cover, then such ailments (in the above list) are not payable by Insurance Companies. Only the ailments that are not mentioned in the aforesaid list for example Road Traffic Accident (RTA) etc may be payable, but that depends on individual case study.

There are numerous circumstances wherein the policyholder changes/alters his policy cover to suit his personal needs and/or individual requirements. It is also possible that the policyholder may switch over from one insurance company to another insurance company based on different factors which may be difficult to elaborate here and is out of the scope of this article. There are possibilities that the customer is holding a policy cover with the same insurance company or with some other Indian insurance company without any break in the policy for a minimal period of one year and subsequently, avails a fresh policy cover to suit/meet his requirements. Upon availing the new policy product, suppose if that particular individual contracts a disease or an ailment (soon after the inception of a new policy cover) mentioned in the above list, then this clause does not become applicable i.e. it becomes null and void. In other words, this clause does not hold good and the policyholder can go ahead to claim for the medical expenses incurred on account of the ailment, since he has been covered by insurance cover that he previously held. Thus, in the aforesaid case the freshly availed policy is not treated as a new policy cover, but a continuation of the previous policy cover.

Reference

1. Best Health Insurance Policy in India - (https://www.apnapaisa.com/insurance/health-insurance-india/index.html)

Disclaimer: The contents of the article are in tune with the regulations in Insurance and TPAs (Third Party Administrators) since the past 2 years. The same rules are likely to prevail and be in force for the year 2009-10, unless changes/modifications/alterations/deletions/additions in existing regulations are made by the Insurance Companies, in tune with the guidelines issued by IRDA (Insurance Regulatory Development Authority). The author of this article does not take responsibility for changes made in the existing health insurance policy coverage which would occur with passage of time.

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