| 6- Senior Citizens Mediclaim Policies - The New India Assurance Co. Ltd. |
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| 4.0 EXCLUSIONS: |
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The Company shall not be liable to make any payment under this policy in respect of:
4.1 Pre-existing diseases/condition: All diseases/ injuries, which are pre-existing when the cover incepts for the first time. However, they will be covered on completion of 18 claim free months of insurance.
Dialysis, Chemotherapy & Radiotherapy for diseases, including Critical Illnesses, existing prior to commencement of this policy are excluded even after two- claim free years.
Pre-existing conditions of Diabetes mellitus and Hypertension are covered from inception of the policy but only on payment of additional premium. However, any ailment attributable to Diabetes mellitus or Hypertension, which has already manifested at the time of inception of insurance, will not be covered even on payment of additional premium for covering Diabetes mellitus and / or Hypertension.
4.2 30-day Exclusion: No claim will be payable in respect of any disease contracted by the Insured person during first 30 days from the commencement date of the policy. This exclusion will not apply if the policy is renewed without any break. The exclusion does not apply to treatment for accidental injuries.
4.3 Writing period for specified diseases/ ailments/ conditions: No claim will be payable in respect of the following Diseases/Conditions contracted during the ‘waiting periods’ specified below, starting from the first day of inception of the cover for the first time. |
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| Sr. No |
Name of Disease/Ailment/Surgery not covered for |
|
| 1 |
Any skin disorder |
18 months |
| 2 |
All internal & external benign tumors, cysts, polyps of any kind, including benign breast lumps |
18 months |
| 3 |
Benign Ear, Nose, Throat disorders |
18 months |
| 4 |
Benign Prostate Hypertrophy |
18 months |
| 5 |
Cataract & age related eye ailments |
18 months |
| 6 |
Diabetes melitus |
18 months |
| 7 |
Gastric/ Duodenal Ulcer |
18 months |
| 8 |
Gout & Rheumatism |
18 months |
| 9 |
Hernia of all types |
18 months |
| 10 |
Hydrocele |
18 months |
| 11 |
Hypertension |
18 months |
| 12 |
Hysterectomy for Menorrhagia/ Fibromyoma, Myomectomy and Prolapse of uterus |
18 months |
| 13 |
Non Infective Arthritis |
18 months |
| 14 |
Piles, Fissure and Fistula in Anus |
18 months |
| 15 |
Pilonidal Sinus, Sinusitis and related disorders |
18 months |
| 16 |
Prolapse Inter Vertebral Disc unless arising from accident |
18 months |
| 17 |
Stone in Gall Bladder & Bile duct |
18 months |
| 18 |
Stones in Urinary Systems |
18 months |
| 19 |
Unknown Congenital internal disease/defects |
18 months |
| 20 |
Varicose Veins and Varicose Ulcers |
18 months |
| 21 |
Age related Osteoarthritis & Osteoporosis |
48 months |
| 22 |
Joint Replacements due to Degenerative Condition |
48 months |
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These diseases/conditions are covered on expiry of the duration shown against each, provided the policy is continuously renewed with the Company without any break.
4.4 Permanent Exclusions:
Any medical expenses incurred for or arising out of:
4.4.1 War, Invasion, Act of foreign enemy, War like operations, Nuclear weapons, Ionising Radiation, contamination by Radioactive material nuclear fuel or nuclear waste.
4.4.2 Circumcision, cosmetic or aesthetic treatment, plastic surgery unless required to treat any injury or illness.
4.4.3 Vaccination & Inoculation.
4.4.4 Cost of braces, equipment or external prosthetic devices, non-durable implants, eyeglasses, Cost of spectacles and contact lenses, hearing aids including cochlear implants and durable medical equipments.
4.4.5 All types of Dental treatments except arising out of an accident.
4.4.6 Convalescence, general debility. ‘Run-down’ condition or rest cure. Obesity treatment and its complications, congenital external disease/ defects or anomalies, treatment relating to all psychiatric and psychosomatic disorders, dementia, Alzheimer’s disease, infertility, sterility, use of intoxicating drugs/alcohol, use of tobacco leading to cancer. |
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