First Two years / Four years Exclusions
During the first two years of the operation of this policy, the expenses on treatment of diseases such as Cataract, Benign Prostate Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Disease, Fistula in Anus, Piles, Sinusitus and other related disorders, Gall Bladder Stone Removal, Gout and Rheumatism, Calculus Diseases, Joint Replacement due to Degenerative Condition and age-related Osteoarthritis and Osteoporosis are not payable. These diseases (other than congenital internal disease) if pre-existing at the time of the proposal, will not be covered even during the subsequent period of renewal. If the insured is aware of the existence of congenital internal disease before commencement of policy, the same will be treated as pre-existing.
Under this clause, the following ailments are excluded for a period of the first 2 years which are listed below:
- 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
In certain Insurance companies, certain ailments are not payable for the first 4 years since inception of the policy enlisted below:
- Age related Osteoporosis and Osteoarthritis
- Joint Replacement due to Degenerative Condition
This is on account of the pathology or etiology involved in such ailments.
Joint Replacement surgeries such as Knee Replacement or Hip Replacement conducted on account of degenerative changes in the body are excluded for first four years since the inception of the policy cover, without a break in the policy cover. In case, if the joint replacement surgery is conducted on an individual other than the stated reason, then such a surgery can be reimbursed – but a final decision regarding this can be taken based on analysis of case-history of that particular patient.
In cases of Congenital Internal Ailment, suppose if the patient is aware/unaware about the existence of the ailment, then this ailment or disease is not reimbursable by Insurance and such a disease is treated as Pre-existing disease or ailment. Examples include Thalassemia, Sickle Cell Anemia, etc.
