Waiting Periods of Health Insurance Policy

Ways-to-avoid-Health-Insurance-Claim-rejection

WAITING PERIODS

We shall not be liable to make any payment under this Policy directly or indirectly caused by, based on, arising out of or howsoever attributable to any of the following. All the waiting period shall be applicable individually for each Insured Person and claims shall be assessed accordingly.

V.1. Pre-existing Disease Waiting Period

All Pre-existing Diseases / Illness / Injury / conditions as defined in the Policy, until 24/ 36/ 48 (as specified in the Schedule) months of continuous covers have elapsed since inception of the first Policy with Us. This exclusion doesn’t apply for Insured Person having any health insurance indemnity policy in India at least for a period of 12/24/36/48 months as applicable, prior to taking this Policy and accepted under portability cover, as well as for subsequent Renewals with Us without a break.

V.2. 30 days Waiting Period

Any disease contracted and/or Medical Expenses incurred in respect of any Disease/Illness by the Insured/Insured Person during the first 30 days from the inception date of the Policy will not be covered.

This exclusion doesn’t apply for Insured Person having any health insurance indemnity policy in India at least for a period of 30 days prior to taking this Policy and accepted under portability cover, as well as for subsequent Renewals with Us without a break.

V.3. Two year waiting period

A waiting period of 24 months shall apply to the treatment, of the following, whether medical or surgical for all Medical Expenses along with their complications on treatment towards:

  1. Cataract,
  1. Hysterectomy for Menorrhagia or Fibromyoma or prolapse of Uterus unless necessitated by malignancy myomectomy for fibroids,
  1. Knee Replacement Surgery (other than caused by an Accident),
Non-infectiousArthritis,  Gout,  Rheumatism,Oestoarthritis  and
Osteoposrosis,Joint  Replacement  Surgery  (other  than  caused
byAccident),Prolapse  ofIntervertibral  discs(otherthan  caused
byAccident), all VertibraeDisorders, includingbutnot limited to

Spondylitis, Spondylosis, Spondylolisthesis, Congenital Internal,

  1. Varicose Veins and Varicose Ulcers,
  • Stones in the urinary uro-genital and biliary systems including calculus diseases,
  • Benign Prostate Hypertrophy, all types of Hydrocele,
  • Fissure, Fistula in anus, Piles, all types of Hernia, Pilonidal sinus, Hemorrhoids and any abscess related to the anal region.
  • Chronic Suppurative Otitis Media (CSOM), Deviated Nasal Septum,

Sinusitis and related disorders, Surgery on tonsils/Adenoids, Tympanoplasty and any other benign ear, nose and throat disorder or surgery.

  1. Gastric and duodenal ulcer, any type of Cysts/Nodules/Polyps/internal tumors/skin tumors, and any type of Breast lumps(unless malignant),

Polycystic Ovarian Diseases,

  • Any surgery of the genito-urinary system unless necessitated by malignancy.

If these diseases are pre-existing at the time of proposal or subsequently found to be pre-existing the pre-existing waiting periods as mentioned in the Schedule to this Policy shall apply.

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