What is not cover in Mediclaim Policy

Every article about mediclaim related article you find out what is cover under this policy, but I am trying to tell us what is  Exclusions in your health insurance policy



Waiting Period & Exclusion 

Claims for the following are not covered:



Pre-Existing Conditions: Benefits will not be available for Pre-existing Conditions until  48 months(4 years) of continuous coverage have elapsed since the inception of the first Policy.


Waiting Period: Any illness contracted within 30 days of the inception date of the Policy, except those that are incurred as a result of an accident. This clause is not applicable on the subsequent renewals


Exclusions valid for the first 2 Years

Treatment of the following diseases/illness/ailments:

• Cataract
• Benign Prostatic Hypertrophy
• Myomectomy, Hysterectomy unless because of malignancy
• Hernia, Hydrocele
• Fistula in Anus, Piles
• Arthritis, Gout, Rheumatism
• Joint replacement, unless due to accident
• Sinusitis and related disorders
• Stone in the urinary and biliary systems
• Dilatation & Curettage
• Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast lumps, unless malignant / adenoids and hemorrhoids
• Dialysis required for chronic renal failure
• Surgery on tonsils, adenoids and sinuses
• Gastric and duodenal ulcers

If the Policy is renewed with us for two consecutive years, the above diseases / illness / ailments will be covered from the third year. If these are pre-existing diseases at the time of inception of the policy, the same will be covered after the fourth year onwards, subject to continuous renewal of the policy .
The list of diseases for which treatment is not cover during the 2 year of your policy may vary from one health policy to another.

Permanent Exclusions:

• Any illness/ disease/ injury/ pre-existing disease before the inception of the policy. However, this exclusion ceases to apply if the policy is renewed with the Company for 4 consecutive years
• Non-allopathic treatment, pregnancy and childbirth related complications, cosmetic, aesthetic and obesity related treatment
• Expenses arising from HIV or AIDS and related diseases, use or misuse of liquor, intoxicating substances or drugs as well as intentional self injury
• War, riots, strike, nuclear weapon, induced treatment
• Cost of spectacles and contact lenses, hearing aids
• Any dental treatment or surgery which is a corrective, cosmetic or aesthetic procedure, including wear and tear, unless arising from disease or injury & which requires hospitalization for treatment.
• Expesnses on vitamins or tonics unless forming part of treatment for injury or disease as certified by the attending physician.
• Naturopathy treatment

Please contact your Insurance agent/ company for details on Specific exclusions along with your policy copy