Specified Diseases

These are listed diseases which are not covered for a certain period, typically 24 months, although IRDAI allows a maximum waiting period of 48 months.

These are specifically mentioned in the policy:

Some examples are:

Cataract, Benign Prostatic Hypertrophy, Hysterectomy, Fistula, Piles, Hernia, Hydrocele, Sinusitis, Knee/Hip joint replacement.

The waiting period for specified diseases is applicable even if disease is contracted after the inception of the policy. Any enhancement in sum insured is will be subject to a fresh waiting period.  And under a ported policy, the waiting period of the fresh policy will be reduced by the waiting period exhausted under the policy.

Scenario 1

Mr. A has cataract and declares it at the time of the proposal. There is a waiting period of 24 month for specified diseases in the policy. So even if Mr. A undergoes a cataract operation within the two year period, the claim amount will not be paid.

Scenario 2

Mr. A is afflicted with Cataract six months after the inception of the policy. His claim is rejected by the insurer as it falls within the waiting period for specified diseases.

Remarks: Specified diseases are generally slow growing diseases which are difficult to detect. Therefore the insurer imposes waiting period in order to protect itself from losses arising out of claims made for such diseases.