Page 213 - DCOM309_INSURANCE_LAWS_AND_PRACTICES

Insurance Laws and Practices

Notes 4. Expenses on hospitalisation for minimum period of 24 hours are admissible. However,
this time limit is not applied to specific treatment i.e. Dialysis, Chemotherapy,
Radiotherapy, Eye Surgery, Dental Surgery, Lithography Kidney stone removal), D&C,
Tonsillectomy taken in the hospital/nursing home and the insured is discharged on the
same day; the treatment will be considered to be taken under hospitalisation benefit.

Notes Relevant medical expenses incurred prior to up to certain period, say 30 days and
after hospitalization up to certain period, say 60 days, are treated as part of the claim.

5. Any one illness means continuous period of illness and it includes relapse within 105 days
from the day of last consultation with the Hospital/Nursing Home where treatment may
have been taken. Occurrence of same illness after a lapse of 105 days will be considered as
fresh illness for the purpose of this policy.
6. The policy does not cover some disease i.e. Asthma, Bronchitis, Chronic Nephritis Diarrhoea
and all type of Dysenteries including Gastroenteritis, Diabetes Mellitus and Insipid us,
Epilepsy, Hypertension, Influenza, Cough and cold, All psychiatric or Psychosomatic
Disorders Pyrexia of unknown origin for less than 10 days, Tonsillitis and upper respiratory
Tract infection including Laryngitis and Pharyngitis, Arthritis, Gout and Rheumatism.
Exclusions that the Health Insurance Policy does not cover the following:

1. All diseases/injuries which are pre-existing when the cover incepts for the first time.
2. Any disease other than those stated in clause (c) below, contracted by the insured person
during the first 30 days from the commencement date of the policy. This exclusion shall
not, however, apply if in the opinion of Panel of Medical Practitioners constituted by the
company for the purpose, the insured person could not have known of the existence of the
disease or any symptoms or complaints thereof at the time of making the proposal for
insurance to the company. This condition shall not however apply in case of the insured
person have been covered under this scheme or group insurance scheme with any of the
Indian Insurance Companies for a continuous period of preceding 12 months without any
break.

3. During the first or more years of the operation of the policy the expenses on treatment of
diseases such as Cataract, Benign Prostates Hypertrophy, Hysterectomy for Menorrhagia
or Fibromyoma, Hernia, Hydrocele, Congenital Internal Disease, Fistula in anus. Piles,
Sinusitis and related disorders. If these diseases are pre-existing at the time of proposal
they will not be covered even during subsequent period of renewal.
4. Circumcision unless necessary for treatment of a disease not excluded hereunder or as
may be necessitated due to an accident, vaccination or inoculation or change of life or
cosmetic or aesthetic treatment of any description, plastic surgery other than as may be
necessitated due to an accident or as a part of any illness.
5. Cost of spectacles and contact lenses, hearing aids. (These may be termed as normal
maintenance expenses.)
6. Dental treatment or surgery of any kind unless requiring hospitalisation.

7. Convalescence, general debility, run down condition or rest cure, congenital external
disease, or defects or anomalies, sterility, venereal disease, intentional self-injury and use
of intoxicating drugs/alcohol.

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