Page 157 - Ebook health insurance IC27

Sashi Publications

(ix) General Waiting Period - Normally all the products have a waiting period of 30
days , wherein a customer cannot make a claim , except for accidental cases, and
in case of renewals. This is basically to avoid someone taking a policy to get
coverage for impending treatment/hospitalization.

(x) Pre- existing illness - This exclusion of pre-existing illnesses have been the subject
of many legal interpretations, a lot of consumer grievances and considerable media
attention. In recent years many insurers have started covering pre-existing diseases
after the completion of standard number of years (usually 4 year).

(xi) Exclusions - Insurers normally do not entertain all claims by customers and impose
some restrictions. The rationale behind this is to avoid staged or fraudulent claims,
misuse of insurance for profits, and to keep claim costs lower, and thus indirectly
keep the premium costs lower. However, customers usually do not fully understand
the conditions and many such trust issues arise. Some of the common exclusions
are :
(1) pre-existing illness
(2) Diseases contracted during initial waiting period
(3) Expenses on treatment of Hernis, Hydrocele, Fistula, Cataract etc , which
require time to reach operational stage
(4) Injury/disease due to war, and war like operations
(5) Cosmetic/ plastic surgery without accidental/surgical requirement
(6) Dental treatment
(7) Drug abuse/Alcohol usage
(8) Naturopathy treatment and
(9) Non medical expenses for personal comfort like TV, telephone, toiletry items
etc.

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