| 4- Coverage & Exclusion Under Critical Illness Insurance Policies |
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| Exclusions in Critical Illness- Silver Plan of HDFC Ergo General Insurance Company Limited |
| We will not make any payment for any claim in respect of the 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 |
- A waiting period of 90 days will apply to all claims unless the Insured Person has been insured under this policy continuously and without any break in the previous Policy Year.
- 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.
- Insured Person committing or attempting any breach of the law with criminal intent or arising out of or as a result of any act of self-destruction or self inflicted injury, attempted suicide or suicide.
- 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 drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies.
- Venereal disease, sexually transmitted disease or illness; “AIDS” (Acquired Immune Deficiency Syndrome) and/or infection with HIV (Human immunodeficiency virus) 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.
- Any treatment arising from pregnancy (including voluntary termination), miscarriage, maternity or birth (including caesarean section), congenital internal and external diseases, defects or anomalies.
- Any exclusion mentioned in the Schedule or the breach of any specific condition mentioned in the Schedule.
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| Exclusion in Critical Care (Secure Mind) of ICICI Lombard General Insurance Company Limited |
| EXCLUSIONS APPLICABLE TO SECTION I |
| The Company shall not be liable to make any payment directly or indirectly arising out of the following events: |
- Any Pre-Existing Illness Any Insured Event arising on account of or in connection with any Pre-Existing Illness
- If the Insured does not submit a medical certificate from the Doctor evidencing diagnosis of Illness or Injury or occurrence of the medical event or the undergoing of the medical/ surgical procedure.
- The Company shall not be liable to make any payment under this Policy in connection with or in respect of any Insured Event, as stated in this Section, occurred or suffered before the commencement of Period of Insurance or arising within the first 90 days of the commencement of the Period of Insurance.
- Any congenital Illness or condition;
- Any medical procedure or treatment, which is not medically necessary or not performed by a Doctor.
- Any physical, medical or mental condition or treatment or service that is specifically excluded in the Policy in Part I of the Schedule under Special Conditions.
- Treatment relating to birth defects and external congenital Illnesses.
- Birth control procedures and hormone replacement therapy.
- Any treatment/surgery for change of sex or any cosmetic surgery or treatment/ surgery/complications/ illness arising as a consequence thereof.
- Treatment by a family member and self-medication or any treatment that is NOT scientifically recognized
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