Certain conditions such as glasses, dental treatment, treatment outside India and cosmetic surgery are definitely excluded from almost all of the MEDICLAIM policies.
Then there are certain conditions which are excluded only from new policies which has been explained under “ waiting periods “.
Congenital diseases, which are conditions with which some is born with are both external and internal .
Webbed fingers or an extra finger is an example of a external congenital disease. Internal congenital anomalies are more difficult to understand.
Some one might have a umbilical hernia which existed since birth but causes a discomfort later on in life.
Some persons have a narrowing in the heart vessel called the “coarctation of the aorta” and might land up with high blood pressure which is different when measured in the arm and different when measured in the leg.
This condition requires a surgery to correct it. Many polices exclude such conditions.
Genetic conditions are in the list of exclusions in most policies. Anemia such as Thallassemia which have a genetic basis might be excluded. However, on this ground Insurance companies have been known to exclude even diabetes saying it is a condition with a genetic basis , an argument which was rejected by the court.
Macular degeneration which requires treatment with expensive injections is often excluded and is a common cause of dispute.
Vaccination is generally excluded but some policies specify that vaccination in case of injury is accepted. The only such condition is that when there is a severe injury with dog bite which requires hospitalisation, then the cost of anti Rabies vaccination will be accepted.
Weight reduction surgery is generally in the exclusion list but then it has been allowed after court cases in selected claims.
Admission for 24 hours only for diagnostic purpose is in the exclusion list .It is again is a frequent cause of dispute .
Please go through the exclusion list of your policy so that you are not caught off guard in case of a claim.