Permanent Exclusion specific to policy holder?

POSTED BY Ankur Agrawal ON March 10, 2011 4:17 pm COMMENTS (4)

Hi all…

I recently applied for a family floater from Apollo Munich. In the questionnaire, I mentioned that I have allergy, which has once ( 8 years back ) led to mild asthma. Then they asked me to fill up a \’respiratory disease questionnaire\’, on which all my answers were of the type \”no, never had to do that, etc.\”- basically, I think no one who ever fills that form can have responses milder than mine.

They then came back to me telling me I will need to accept a \’permanent exclusion\’ to asthma. I tried to push back, asked for the rationale, offered to undergo tests etc. but to no avail. The local sales guy at the firm was also very surprised at this, and called it \’stupid\’, but said he was helpless.

Is there anything I can do about this? Is it possible to fight the decision? or is this pretty much final?

I feel really stupid mentioning that asthma in the form: don\’t even know for absolutely sure if I have it… I mean, 8 years back, one minor occurence… would probably not have been relevant in the future any way…



4 replies on this article “Permanent Exclusion specific to policy holder?”

  1. ashalanshu says:

    Dear Sathi, I agree on the thing that there is no standardisation among Insurers but life is also complicated so health insurance is bound to be complicated. the permanent exclusion exist for certain illness like AIDS. Once you are diagnosed with it, life long you w’d have to take medicines for it and that’s why there is a known unlimited risk to Insurer and hence nobody ‘ll cover it. that’s the general meaning of Permanent exclusion.



  2. ashal jauhari says:

    Dear Ankur, The policy with permanent exclusion has been issued or not, it’s not clear from your query. In case you want to escalate the matter, first try to contact grievance cell of the insurer. Try to know the exact reason for permanent exclusion. When your medical tests are not showing any symptoms of Asthma, Insurer can’t deny to include the same.

    Since your policy has not been issued yet, Insurer Ombudsman is not in the picture yet.

    In case, Your Insurer is not co-operating, better to cancel the application & apply with another insurer.



    1. healthinsuranceshoppe says:

      @ ankur and ashal

      Pls note , there is no IRDA regulation for permanent exclusion in health insurance.

      Just change the service provider.. Apply at Icici Lombard or Bajaj Allianz…

    2. sathisp says:

      Hi Ashal,
      I have encountered a similar situation with Apollo Munich guys. I immediately requested for cancellation and it seems to be in process. I also sent an email to grievance on same. They sent me an email with below explanation. I have sent another email back to them asking why it is not listed in the policy wordings documents. I am awaiting for their response. Health insurance is a murky business. Every company i have been interacting have very confusing terms. It is difficult to assess and finalize on one.

      “Pre-existing diseases are covered after a waiting of 3 yrs except those which warrant a permanent policy exclusion due to their increased recurrence rate and more than average complications as per the policy acceptance limit.”

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