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Critcal Illness Plan Exclusions

There are a few exclusions applicable in case of a critical illness health insurance plan. Find out more about these exclusion, read onn.

Apnainsurance.com Research Bureau

03 Dec 2007

Some of the exclusions applicable to the critical illness health insurance plan are:

  • Any illnesses and procedures within 90 days to 120 days from start date of policy will not be covered. This clause is not applicable for policy renewal (without a break)
  • Death within 30 days following the diagnosis of a critical illness
  • Any pre-existing illness
  • Lack of doctor's medical certificate confirming the diagnosis of illness/injury or medical/surgical procedure undergone
  • Any congenital illness or condition
  • Any medical procedure or treatment that is not medically necessary or not performed by a doctor; treatment by family member and self-medication or any treatment that is not scientifically recognized
  • Treatment relating to birth defects and external congenital illnesses
  • Birth control procedures and hormone replacement therapy
  • Any treatment/surgery for change of sex or any cosmetic surgery or treatment
  • Presence of HIV/AIDS infection
  • Naval or military operations of the armed forces or air force and participation in operations requiring the use of arms
  • Consequential losses of any kind, be they by way of loss of profit, loss of opportunity, loss of gain, business interruption etc.

Some exclusions to the personal accident rider on the critical illness plan for insurance are:

  • Compensation/claim under more than one of the categories specified in the policy with respect to disablement
  • Claims arising out of sickness/illness
  • Death, injury or disablement of insured:

o From intentional self-injury, suicide, or attempted suicide

o Whilst under the influence of intoxicating liquor or drugs

o Directly or indirectly caused by venereal disease or AIDS

o Any condition associated with childbirth or pregnancy or as a consequence of the same

o Engagement in dangerous activities

o Traveling in any aircraft other than as a fare paying passenger on a scheduled flight

o Mental disorder or psychosomatic dysfunction

o Permanent total disablement prior to commencement of the policy.

See also:

Miscellaneous health insurance FAQs

health insurance FAQs about Coverage

Health Insurance FAQs about Claims

Health Insurance FAQs about Premiums

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