Partner - Risk Management
Asso.prof.(commerce & Management) Pg
How will an outsider who does not have access to the polcy or know it's terms be able to say whether the surgery will be covered ?
Either check the policy IR go and speak to the HR department of your company.
14th September 2014 From India, Mumbai
Of course there are certain restrictions. Soon after the Policy document containing the terms & conditions are received every one should go thru' the contents very carefully to understand fully what are all the restrictions/curtailment etc. To highlight some such restrictions & Exclusiions I indicate/quote from one such Policy Provider with whom I interacted for your ready ref. -
" 3.12 GRACE PERIOD
Grace Period means the specified period of time immediately following the premium due date during which a payment can be made to renew or continue a policy in force without loss of continuity benefits such as "waiting periods" and coverage of pre-existing diseases. Coverage is not available for the period for which no premium is received.
VI Free Look period of 15 days shall be applicable at the inception of the first policy.
All Pre-existing diseases upto 48 months of continuous coverage.
2 Any disease contracted during the first 30 days of inception of policy.
3 Waiting period of 2/4 years for certain specified illness/treatment.
4 Vaccination and Inoculation of any kind unless it is post-animal bite
5 General debility and Run down conditions
6 Circumcision, Cosmetic surgery, Plastic surgery.
8 Psychiatric and psychosomatic disorders
9 Injury arising out of drug/alcohol abuse.
10 Pregnancy, ailments related thereto and child birth
11 War, act of foreign enemy, ionizing radiation and nuclear weapon.
13 Experimental or unproven treatment
14 All external equipments
15 Dental treatments"
You will also have to read the full text of the Terms & Conditions which is in my possession and attached for your guidance.
It is advisable that every one first go thru' the terms & conditions of various Policy Providers, get all the doubts arising clarified, satisfy themselves about them and then decide which terms are more agreeable before the policy premium is paid for. These are only sample conditions and would vary from co. to co. So it's necessary terms & conditions of respective Policy Providers should be taken into consideration. Almost all the Policy Providers have placed their Terms & conditions on their web sites to fecilitate easy reference.
15th September 2014 From India, Bangalore