Senior Midi Plan

indicates services which are covered
indicates services not covered under the specific plan

B.    EXCLUSIONS: 

The following are excluded from all plans: –

  1. Overseas treatment and transplant surgery
  2. All maternity, neonatal, and family planning services
  3. Plastic/cosmetic surgeries
  4. Advanced and complex investigations not stated in the schedule of covered services
  5. Investigations and     treatment      for     problems     relating     to infertility   e.g.   hydrotubation, hysterosalpingogram, I.V.F, G.I.F.T, and artificial insemination
  6. Virility enhancing drugs
  7. HIV/AIDS Care & Treatment
  8. Herbal drugs, non-prescription drugs, and experimental drugs and treatment
  9. Other laboratory investigations not listed in the schedule of covered services
  10. Dental care not listed in the schedule of covered services
  11. Home care and domiciliary services
  12. Joint replacements and prosthetic limbs
  13. Long term psychiatric illness (Longer than 3 months)
  14. Immunizations not listed in covered services
  15. Interstate referral services
  16. Comprehensive health screening/well persons check outside the scope of the benefits covered by the health
  17. Self-inflicted injuries
  18. Treatment of obesity
  19. Covid-19 testing and treatment
  20. Speech disorders
  21. Room upgrades beyond that specified in the plan benefits
  22. Management of severe burns (Burns covering more than 10% body surface area)
  23. Learning difficulties, behavioral and developmental problems
  24. Consultations with unrecognized consultants, hospitals, family doctors, therapists, dental practitioners or complementary medicines practitioners
  25. Any other treatment, service, procedure or investigation not listed in the schedule of covered medical services

C.   NOTE

  1. Only persons between the ages of 51-85 years are eligible for this
  2. There will be a waiting period of 2 weeks after Plans purchased becomes active 2 weeks after the purchase date.
  1. All benefits are subject to their respective sectional limits which is described as: Inpatient Limit and Outpatient Limit. However, within the respective sectional limit, there are specific benefit limits as Consequently, in the event that any specific benefit limit under the sectional limit is exhausted, the remaining limit in that section will only cover other benefits within the section apart from the one that the specific benefit limit has been exhausted.
  2. The following benefits will not be covered or provided in the first 2 months of the commencement of the scheme: Chronic Disease Medication
  3. The following benefits will not be covered or provided in the first 3 months of the commencement of the scheme: Optical Care, Dental
  4. The following benefits will not be covered or provided in the first 6 months of the commencement of the scheme: Death and Funeral
  5. The following benefits will not be covered or provided in the first year of the commencement of the scheme: Surgeries, Cancer Care, Intensive Care Services, and Psychiatric Care. This period otherwise known as the waiting period shall commence on the date of entry to the date of renewal. On renewal, this benefit will be accessible provided the enrollee has been enrolled for one year with the