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Clarification required on HDFC ERGO Optima Secure
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09 Aug, 2023
by Dhivakar Parandla
I'm looking at the Specific Exclusions section in HDFC Ergo Optima Secure Health Insurance. Request group members to provide more information as to what the below statements mean??
1) Expenses related to external birth diseases, defects or anomalies
2) Treatment related to spinal injuries, skeletal structure, muscle stimulation, except treatment of fractures (excluding hairline fractures)
What are external birth diseases or anamolies that are mentioned here?
Also point 2 talks abt spinal injuries and hairline fractures. Are these not covered by the health Insurance?
Page 17 of the Policy Wordings available in the link below. https://www.hdfcergo.com/docs/default-source/downloads/policy-wordings/health/optima-secure-revision-pw.pdf
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10 Aug, 2023
Dhivakar Parandla
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Dear Dhivakar,
I think you were reading point no. 2 in isolation
Below is the complete extract related to it in full context
Pretty Much self explanatory -
12. Treatment and supplies for analysis and adjustments of spinal subluxation, diagnosis and treatment by manipulation of the skeletal structure; muscle stimulation by any means except treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities.
👆One example for this is : When someone gets a slip disc or a hairline fracture treated by any self appointed expert by some arbitrary/unproven method, then it's excluded, otherwise there is no issue here👍
For the first point
external diseases or defects anomalies are structural or functional anomalies that occur during intrauterine life. Also called birth defects, these congenital anomalies or malformations, develop prenatally and may be identified before or at birth, or later in life.
this is pretty much a generic definition for a generic questions, you will have to bring out the specific case, if any, for more detailed analysis.
hope this explanation helps!
Regards
Rana Sahib
ANTFINKART.