What does Chola MS Family Health Insurance not cover?
1. Right after the commencement of the policy, the insured needs to wait for 30 days to make any claim, except for injuries caused due to an accident. This exclusion is not applicable for subsequent renewals of the policy with the company.
2. The treatment of the following health issues aren’t covered during the first year of the policy:
- Benign Prostatic Hypertrophy
- Hysterectomy or for Menorrhagia or Fibromyoma
- Fistula in anus, Piles
- Congenital Internal Anomaly
- Sinusitis and related disorders
3. Coverage for pre-existing diseases won’t be offered until you have been insured for 48 months continuously, with an Indian insurer.
4. The insured won’t be covered if they are involved in a war or in an act of war, invasion, acts of foreign enemies, and hostilities, whether war be declared or not.
5. We are not responsible to indemnify the cost in case the policyholder commits or attempts any breach of law, or attempts suicide.
6. The use of misuse of tobacco, alcohol, any banned substances, narcotic drugs (prescribed or not).
7. Any travel charges except ambulance.
8. The medical expenses incurred due to ionising radiation or contamination by radioactivity from nuclear waste or nuclear fuel.
9. Experimental or unproven treatment.
10. We are not liable to cover the policyholder if they participate in any hazardous activity such as scuba diving, motorcycling, parachuting, rock or mountain climbing, etc. Also, members of the armed forces, paramilitary, security forces, fire or ambulance services, lifeboat services, police service, etc. are not covered under this policy.
11. Treatment for reducing weight, debility, convalescence, run-down conditions, rest cure, and treatment for sleep apnoea.
12.Treatments to affect or treat infertility and any fertility and sub-fertility procedures. Surrogacy, birth control, contraceptives, or any complications caused by supplying these services. Also, treatments to cure impotency or improve potency are not covered under family health insurance.
13. Circumcisions, unless necessary due to an illness or injury.
14. Any sex transformation operation or any procedures to improve physical appearance.
15. Cosmetic procedures and any complications caused due to cosmetic procedure, unless it is done after a traumatic injury, burn, or cancer.
16. Vaccination or inoculation, unless required as a post-animal-bite treatment.
17. Treatment for psychiatric or mental sickness.
18. Covering the cost of medical equipment, unless it is needed after a treatment or an injury.
19. Treatment for external congenital diseases, defects, or anomalies and genetic disorders.
20. The expenses included in buying hearing aids or eyeglasses or lens.
21. Expenses incurred primarily during the diagnosis stage, such as X-ray, MRI, blood test, etc. that are not incidental to the diagnosis or treatment for which the policyholder was hospitalised.
22. Costs that include all personal comfort services such as TV, barber, guest service, etc., unless they are already included in the room charges.
23. The treatment extended by an unauthorised doctor, or a doctor who lacks specialisation in the required field of treatment, or any medical help provided by a doctor who is also a family member.
24. Any medication that’s not supported by a prescription.
25. Any non-medical expenses incurred during the treatment.
Family Health Insurance Claim Process
1. First, the insured needs to pay from their own pocket.
2. Then, they should submit the required forms, hospital and medicine bills, reports, etc. to the insurer. We are not liable to cover the insured unless they have fulfilled all the requirements.
3. The claim will be validated and then processed as per the company’s terms and conditions.
Documents required to make a Family Health Insurance Claim
1. Our reimbursement form duly filled and signed by the insured.
2. Discharge card.
3. Written consultation from the doctor along with receipts.
4. Hospital bills stamped and signed by the hospital authorities.
5. X-ray films and all the other tests conducted like urine tests, MRIs, blood tests, etc.
6. Medicine bills and other documents related to the treatment of the policyholder’s ailment.
Note: The above is a partial listing of the policy exclusions. Please refer to the policy clauses for the full listing