Page 142 - Ebook health insurance IC27

The Insurance Times

(vi) Sum Insured/ Plan opted for.
(vii) Address & Telephone Number.
(viii) PAN details.
(ix) Details of past hospitalization/illness/disease or at present.
(x) For family floater policy, details of members with their relationship.

(B) Declaration by applicant
This comprises of Self declaration of Health Status by the applicant. This includes
specific questions about the various systems of the human body. The following is
an indicative list, which may vary from company to company :
(i) Neurological diseases
(ii) Mental diseases
(iii) Paralysis
(iv) Fainting episodes/blackouts
(v) High Blood Pressure
(vi) Heart diseases including ischemic heart disease
(vii) Circulatory disorders
(viii) Diseases pertaining to uterus, ovaries etc
(ix) Fistula, Piles
(x) Opthalmological diseases like Cataract
(xi) Respiratory diseases
(xii) Allergic diseases
(xiii) Diabetes
(xiv) Cancer
(xv) Cerebral diseases like Paralytic Strokes etc
(xvi) Tuberculosis, AIDS/HIV etc.

146 Guide for Health Insurance