Health Insurance Policies - Fine Prints - First Two years / Four years Exclusions

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First Two years / Four years Exclusions

During the first two years of the operation of this policy, the expenses on treatment of diseases such as Cataract, Benign Prostate Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Disease, Fistula in Anus, Piles, Sinusitus and other related disorders, Gall Bladder Stone Removal, Gout and Rheumatism, Calculus Diseases, Joint Replacement due to Degenerative Condition and age-related Osteoarthritis and Osteoporosis are not payable. These diseases (other than congenital internal disease) if pre-existing at the time of the proposal, will not be covered even during the subsequent period of renewal. If the insured is aware of the existence of congenital internal disease before commencement of policy, the same will be treated as pre-existing.

Under this clause, the following ailments are excluded for a period of the first 2 years which are listed below:-

► Cataract and age related eye ailments

► Benign Prostate Hypertrophy

► Hysterectomy for Menorrhagia, Fibromyoma, Myomectomy or Prolapse of Uterus

► Hernia

► Hydrocele

► Congenital internal disease

► Fistula in anus

► Fissures

► Piles

► Pilonidal Sinus, Sinusitis and related disorders

► Gall Bladder and Bile Duct Calculus

► Gout and Rheumatism

► Calculus Diseases (Stones in Urinary system)

► Joint Diseases

► Any Skin Disorder

► All internal and external benign tumors, cysts, polyps of any kind, including benign breast lumps

► Benign Ear, Nose, Throat disorders

► Gastric or Duodenal Ulcer

► Non-infective arthritis

► PIVD (Prolapse of Inter-vertebral Disc) unless arising from accident

► Varicose veins and varicose ulcers

In certain Insurance companies, certain ailments are not payable for the first 4 years since inception of the policy enlisted below:-

► Age related Osteoporosis and Osteoarthritis

► Joint Replacement due to Degenerative Condition

This is on account of the pathology or etiology involved in such ailments.

Joint Replacement surgeries such as Knee Replacement or Hip Replacement conducted on account of degenerative changes in the body are excluded for first four years since the inception of the policy cover, without a break in the policy cover. In case, if the joint replacement surgery is conducted on an individual other than the stated reason, then such a surgery can be reimbursed – but a final decision regarding this can be taken based on analysis of case-history of that particular patient.

In cases of Congenital Internal Ailment, suppose if the patient is aware/unaware about the existence of the ailment, then this ailment or disease is not reimbursable by Insurance and such a disease is treated as Pre-existing disease or ailment. Examples include Thalassemia, Sickle Cell Anemia, etc.

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what are ENT daycare procedures?


Hi, My father [Age-62yr] underwent Cardiac by-pass surgery in 2006 and after that he undergoes annual cardiac check-up every year. He is in good health now. I want to take a Mediclaim policy for him which covers him for any possible future hospitalization (for all generally covered diseases including his pre-existing condition). Please recommend me good options which is also not very expensive.

Hi, I reside in a Metro city and my child is admitted in a Child Care Centre / Nursing Home last night due to illness last night. However the Nursing Home is a small one and has 5-6 beds only. But it is registered one under the regulatory authorities. I seek clarification on below: "HOSPITAL/NURSING HOME: means any institution in India established for indoor care and treatment of sickness and injuries and which either Is duly licensed and registered as a Hospital or Nursing Home with the appropriate authorities and is under the supervision of a registered and qualified Medical Practitioner. OR In areas where licensing and registration facilities with appropriate authorities are not available, the institution must be one recognised in locality as Hospital / Nursing Home andshould comply with minimum criteria as under: [1] It should have at least 15 in-patient medical beds in case of Metro cities, A Class cities......................." Will I be able to claim for reimbursement? Regards, Sameer

My Wife was Pregnant and was in 9th month. All was normal but one night we finish our dinner and went to our bed. But suddenly at midnight my wife found Heavy Bleeding. We immediately run for our Doctor treating her. She refer us to one of the Big n Best Hospital of our city. The problem raised is called Ante partrue Hemarhage [APH] according to Doctor. As due to heavy bleeding my wife was almost in shock. And to save the life of both (Baby n Mother) a Emergency LSCS was done. A baby born via Cesarean. So, I submit a file for claim against my Medical Policy with United India Insurance Co. but that was rejected by saying "Treatment arising from or traceable to Pregnancy (including Caesarean) not covored. But as per me, as My Wife have no Labour Pain nor the whole process was done because of or for Delivery. So, kindly guide me for the same. Should I go to Insurance Ombudsman???


I am 26 years old and I would like to undergo Lasik Operation. My sight is -7 in both eyes. Can I get free operation in Hospitals?

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