Page 131 - Ebook health insurance IC27

Exclusions Sashi Publications
Cancellation clause
Till fouryears no amount is covered butifthepolicy
is continuously renewed from the same insurer,
pre- existing diseases are also covered.

Every policy excludes certain diseases/expenses from
the policy which is not payable.
This is to prevent fraudulent claims, moral hazard, to
keep costs of claim low.
Some of the common exclusions
l Pre-existing illness
l Disease contracted during initial waiting period
l Injury or disease due to war, war like scenarios
l Cosmetic surgery, plastic surgery
l Dental treatment
l Abuse of drugs/alcohol usage
l Naturopathy treatment
l Non-medical expenses like television, telephone

Insurer incorporates this class so that they may cancel
the policy during midterm if they find any instances of
l Fraud
l Moral hazard
l Misrepresentation by the insured
Similarly customer may also cancel the policy during
midterm and insurer must refund the premium on the
basis of short period scales.
Companies are liable to pay any claim arising prior to
date of cancellation.

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