Mediclaim Policy Exclusions in General Insurance

Most Important Exceptions In Health Insurance (Mediclaim Policy) of General Insurance...
Mediclaim Policy covers reimbursement of Hospitalization/Domiciliary hospitalization expenses for diseases or injury or illness in General Insurance Sector.

The Insurance company will pay to the insured person the amount of hospitalization expenses when claim is genuine and the claim is admissible.  But the claim is not covered under Insurance conditions at that time the claim is dismissible and the insurance company can not be liable to pay the any amount for the claim.

The Insurance company cannot be liable to pay the any claim or any payment under the mediclaim policy in respect of below exclusions.

• Dental treatment or any dental surgery is not covered in mediclaim policy features. But in any accident the dental treatment is necessary at that time the insurance company liable to pay the compensation to the insured person.
• The first 30 days from the commencement of the insurance any hospitalization/ Domiciliary expenses are not covered in general insurance conditions but except in case of injury arising out of accident.
• The pre- existing diseases are not covered in the mediclaim insurance policy.  Pre-existing disease means which is existed disease before the insurance period. Any symptoms or any sickness before the insurance that is called as pre-existing disease.
• In the first of the insurance policy some diseases not covered for treatment such as cataract, prostatic hyperthrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal disease, Fistula in anus, plies, Sinusitis and related disorders. At the time of the insurance, if the diseases are pre-existing they will not covered.
• War and kindred perils and nuclear weapons materials not covered. but in necessity for treatment of a disease not excluded due to an accident. Vaccination or inoculation or changed of life or cosmetic or aesthetic treatment of any description, plastic surgery not covered but other than as any be necessitated due to an accident or as a part of any illness.
• Circumcision, vaccination, change of life(also known as menopause) are not diseases.  Some of these conditions are covered only if associated with disease or illness or accident, which falls within the scope of policy.
• The cost of spectacles and contact lenses, hearing aids or not covered. These are termed as normal maintenance expenses.
• In mediclaim insurance the Convalescence, general debility, run down condition or rest cure, congenital external disease, defects or anomolies sterility, veneral disease, intentional self injury and use of intoxicating drugs/alcohol were not covered.
• The Convalescence etc are not diseases, congenital(i.e existing at birth) disease etc are pre-existing and hence excluded, veneral disease or use of drugs/alcohol are excluded on grounds of public policy.
• The AIDS is new disease and it has no known treatment.
• Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending doctor is not covered under this mediclaim policy.
• Treatment is not covered arising from or traceable to pregnancy, childbirth including Caesarean section.  If maternity benefit is included at the time of insurance these are covered.
• Naturopathy treatment is not covered in the mediclaim policy in general insurance.
• Voluntary medical termination of pregnancy during the first 12 weeks from the date of conception is not covered.

The above exclusions of Mediclaim Policy will applicable to only for General Insurance Sector.