7- Family Floater Coverage - Easy Health Family Floater Insurance Plan from Apollo Munich |
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Source : Website of Apollo Munich Insurance Company Limited |
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Section. 6 Exclusions |
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- Waiting Periods
- We are not liable for any treatment which begins during waiting periods except if any Insured Person suffers an Accident.
- 30 days Waiting Period
- A waiting period of 30 days (or longer if specified in any benefit) will apply to all claims unless:
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1. The Insured Person has been insured under Easy Health Individual Health Insurance Plan or Easy Health Family Floater Insurance Plan continuously and without any break in the previous Policy Year, or |
2. If the Insured person renews with Us or transfers from any other insurer and increases the Sum Insured (other than as a result of the application of Benefit 5a) upon renewal with Us), then this exclusion shall only apply in relation to the amount by which the Sum Insured has been increased. |
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Specific Waiting 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 Easy Health Individual Health Insurance Plan or Easy Health Family Floater Insurance Plan continuously and without any break: |
- Illnesses: arthritis if non infective; calculus diseases of gall bladder and urogenital system; cataract; fissure/fistula in 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.
- 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 fibromyoma or 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 begnin 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.
- 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 another Indian insurer’s individual health insurance policy for the reimbursement of medical costs for inpatient 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.
- If the Insured person renews with Us or transfers from any other insurer and increases the Sum Insured (other than as a result of the application of Benefit 5a) upon renewal with Us), then this exclusion shall only apply in relation to the amount by which the Sum Insured has been increased.
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Pre-existing Conditions which the Insured Person has declared in the Proposal or of which he was unaware at the inception of the Policy will be covered subject to a waiting period of 3 years as long as in the fourth Policy Year the Insured Person has been insured under an Easy Health Individual Health Insurance Plan or Easy Health Family Floater Insurance Plan continuously and without any break, but a waiting period of 1 year will apply, if the Insured Person: |
- was insured continuously and without interruption for at least 2 years under another Indian insurer’s individual health insurance policy for the reimbursement of medical costs for inpatient treatment in a Hospital, and<
- establishes to Our satisfaction that he was unaware of and had not taken any advice or medication for such Illness or treatment.
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