| 3- Apollo Munich Optima Plus Top Up Health Insurance Policy |
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10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002 |
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iii) If the Insured person renews with Us or transfers from any other insurer and increases the Sum Insured or changes his Deductible, then this exclusion shall only apply in relation to the amount by which the Sum Insured has been increased or Deductible has been changed.
d)SpecificWaiting Periods - The Illnesses and treatments listed below will be covered subject to a waiting period of 2 years as long as in the third Policy Year the Insured Person has been insured under an Optima Plus Policy continuously and without any break:
i) Illnesses: arthritis if non infective; calculus diseases of gall bladder and urogenital system; cataract; fissure/fistulain anus, hemorrhoids, pilonidal sinus, gastric and duodenal ulcers; gout and rheumatism; internal tumors, cysts, nodules, polyps including breast lumps (each of any kind unless malignant); osteoarthritis and osteoporosis if age related; polycystic ovarian diseases; sinusitis and related disorders and skin tumors unless malignant.
ii) Treatments: benign ear, nose and throat (ENT) disorders and surgeries (including but not limited to adenoidectomy, mastoidectomy, tonsillectomy and tympanoplasty); dilatation and curettage (D&C); hysterectomy for menorrhagia or fibromyomaor prolapse of uterus unless necessitated by malignancy; joint replacement; myomectomy
for fibroids;surgery of gallbladder and bile duct unless necessitated by malignancy; surgery of genito urinary system unless necessitated by malignancy; surgery of
benign prostatic hypertrophy; surgery of hernia; surgery of hydrocele; surgery for prolapsed inter vertebral disk; surgery of varicose veins and varicose ulcers; surgery on tonsils and sinuses; surgery for nasal septum deviation.
iii) However, a waiting period of 2 years will not apply if the Insured Person was insured continuously and without interruption for at least 2 years under any other individual health insurance policy (top-up policy with high Deductible) for the reimbursement of medical costs for in-patient treatment in a Hospital, and he establishes to Our satisfaction that he was unaware of and had not taken any advice or medication for such Illness or treatment.
iv) If the Insured Person renews with Us or transfers from any other insurer and increases the Sum Insured or changes his Deductible, then this exclusion shall only apply
f)Pre-existing Conditions will not be covered until 48 months of continuous coverage have elapsed, since inception of the firstOptima Plus Policy with Us; but a waiting period of 1 year will apply, if the Insured Person:
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was insured continuously and without interruption for at least 3 years under any other individual health insurance policy (top-up policy with high Deductible) for the reimbursement of medical costs for in-patient treatment in a Hospital, and
ii) establishes to Our satisfaction that he was unaware of and had not taken any advice or medication for such Illness or treatment.
iii) If the Insured Person renews with Us or transfers from any other insurer and increases the Sum Insured or changes his Deductible, then this exclusion shall only apply in relation to the amount by which the Sum Insured has been increased or Deductible has been changed.
g)We will not make any payment for any claim in respect of any Insured Person directly or indirectly for, caused by, arising from or in any way attributable to any of the following unless expressly stated to the contrary in this Policy: |
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- War or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or not or caused during service in the armed forces of any country),
civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, radiation of any kind.
- Any Insured Person committing or attempting to commit a breach of law with criminal intent, or intentional self injury or attempted suicide while sane or insane.
- Any Insured Person’s participation or involvement in naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing.
- The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies.
- Treatment of obesity and any weight control program.
- Psychiatric, mental disorders (including mental health treatments); Parkinson and Alzheimer’s disease; general debility or exhaustion (“run-down condition”); congenital internal or external diseases, defects or anomalies; genetic disorders; stem cell implantation or surgery; or growth hormone therapy; sleep-apnoea.
- Venereal disease, sexually transmitted disease or Illness; “AIDS” (Acquired Immune DeficiencySyndrome) and/or infection with HIV (Human ImmunodeficiencyVirus) including but not limited to conditions related to or arising out of HIV/AIDS such as ARC (AIDS related complex), Lymphomas in brain, Kaposi’s sarcoma, tuberculosis.
- Pregnancy (including voluntary termination), miscarriage (except as a result of an Accident or Illness), maternity or birth (including caesarean section) except in the case of ectopic pregnancy in relation to 1)a) in-patient treatment only.
- Sterility, treatment whether to effect or to treat infertility; any fertility, sub-fertility or assisted conception procedure; surrogate or vicarious pregnancy; birth control, contraceptive supplies or services including complications arising due to supplying services.
- Dental treatment and surgery of any kind, unless requiring Hospitalisation.
- Expenses for donor screening, or, save as and to the extent provided for in 1)e) organ donor, the treatment of the donor (including surgery to remove organs from a donor in the case of transplant surgery).
- Treatment and supplies for analysis and adjustments of spinal subluxation; diagnosis and treatment by manipulation of the skeletal structure; muscle stimulation by any means except for treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities.
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