Assure Familio Diamond

No benefit shall be paid under this Contract for expenses or losses resulting from or incurred in connection with or in consequence of the following:

Core Exclusions:

• Waiting period of 30 days from date of registration, for which period no IPD claim shall be entertained except accidental injury
• 24 hours hospital waiting period after admission will be applied for Hospitalization (in-patient service) coverage
• Difference in-between IPD claims shall be at-least 90 days from the previous settled claim
• Waiting period of 60 days from date of registration, for which period no OPD claim shall be entertained except accidental injury
• Maximum 3 days coverage at a stretch will be considered as a single confinement for Hospitalization (in-patient service)
• Life coverage will start immediately after purchase
• Death due to any cause other than Suicide/HIV-AIDS is covered under Life Insurance
• Claim must be made within 30 days of incident
• This is a non-refundable product
• Only MBBS or above qualified doctor's prescriptions will be valid

General Exclusions:                                                 

• Pre-existing Conditions: Any pre-existing conditions shall mean any illness or disability of which the Policyholder is aware, or of which symptoms were evident, or for which the Policyholder received medical advice or treatment within last twenty-four months immediately prior to the date of his policy inception.
• Non-Allopathic and Experimental Treatment: any Non-Allopathic treatment, Treatment provided by a medical practitioner who is not recognized by the Medical Council of Bangladesh, Experimental, investigational or unproven treatment, devices and pharmacological regimens
• Breach of Law: Any Illness or Injury directly or indirectly resulting or arising from or occurring during commission of any breach of any law by the Policyholder with any criminal intent, and/or Participating in any types of illegal activities.
• Conflicts and Disasters: War, or any act of War, invasion, act of foreign enemy, war like operations
• Military Services: Involvement in the naval, military, or air force operations
• Aviation: A direct consequence of participation by the Policyholder in any flying
• Hazardous Activities: Policyholder's participation or involvement in racing, diving, scuba diving, parachuting, hang-gliding, rock or mountain climbing.
• Self-Inflicted injuries or attempted suicide: Treatment for, or arising from, an injury that is intentionally self-inflicted, including attempted suicide while sane or insane.
• Substance Misuse and De-addiction: The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs (not prescribed by Registered Medical Practitioner) and alcohol, including smoking cessation programs and the treatment of nicotine addiction or any other substance
• Rehabilitation and Convalescence: Convalescence, rest cure, sanatorium treatment, rehabilitation measures, private duty nursing, respite care, long-term nursing care or custodial care, general debility or exhaustion ("run-down condition").
• Cosmetic treatments: Aesthetic treatment, cosmetic surgery or plastic surgery or related treatment of any description including any complications attributable to such treatments other than as may be necessitated due to an Accident, cancer or burns. Any medical treatment related with beautification or luxury of patients like laser treatment for hair/skin, spot removal, alopecia, dandruff, skin protectors, skin softeners, skin moisturizers etc. even with valid advice by Physician.
• Sleep and Obesity: Weight management services and treatment, vitamins and tonics related (including morbid obesity) and any treatment related to sleep disorder or sleep apnea syndrome.
• Hormone Replacement Therapy: Medical expenses incurred by Policyholder for any type of hormone replacement therapy.
• Dental treatments: Any dental treatment or surgery unless necessitated due to an Accident.
• Routine Eye(s) and (Ear) ailments: Cost of routine eye and ear examinations, cost of spectacles, laser surgery for correction of refractory errors, contact lenses, hearing aids, dentures and artificial teeth.
• HIV/AIDS: Any treatment for or treatment arising from Human Immunodeficiency
• Sexually transmitted Disease and other Sexual problems: Treatment for any sexually transmitted disease, including Genital Warts, Syphilis, Gonorrhea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis. Treatment of any sexual problem including impotence (irrespective of the cause) and sex changes/ gender reassignments or erectile dysfunction.
• Circumcision: Circumcision unless necessary for the treatment of a disease or necessitated by an Accident.
• Birth Control and Assisted Reproduction /Infertility: a. Any type of contraception, sterilization and family planning; b. Treatment to assist reproduction, including IVF treatment.
• Pregnancy: Any treatment arising from or traceable to pregnancy (including Illness), childbirth, maternity (including caesarean section), abortion or complications of any of these. This exclusion does not apply in case of ectopic pregnancy and emergency arising from rupture ovarian cyst, pregnancy eligible for payment under 'Maternity Benefit' as described in this policy.
• OPD for any sorts of Dental and Optical treatment.
• Pre and post hospitalization expenses: Pre and post Hospitalization expense is not payable.
• Psychological disorders: Any expense incurred on Treatment of mental illness, stress, psychiatric or psychological disorder.
• Congenital Conditions/ Congenital infirmity Treatment of any Congenital Anomaly or illness or defects or anomalies or treatment related to birth defects.
• Preliminary diagnostics materials and Examination: a. Charges incurred primarily for diagnostic, X-ray or laboratory examination not consistent with or not incidental to the diagnosis and treatment of positive existence or presence of any Illness or Injury for which Inpatient hospitalization required. b. Any Hospitalization primarily for investigation, evaluation and /or diagnosis purpose. c. Routine Health Check-ups / Executive health check up
• Expenses of Life Insured as Donor or cost of Donor: Expenses related to donor screening, treatment, including surgery to remove organs from a donor in the case of transplant surgery, where the life insured acts as a donor. This exclusion will not apply where life insured is an organ recipient.
• Failure to take Reasonable Medical Care: The Company’s not obliged to make payment for any claim or that part of any claim that could have been avoided or reduced if the Policyholder had taken reasonable care, or that is brought about or contributed to by the Policyholder failing to follow the directions, advice or guidance provided by a Registered Medical Practitioner.
• Expenses Other than Reasonable and Customary Medically Necessary: a. Any treatment or part of a treatment that is not of a reasonable and customary charge, not medically necessary, drugs or treatments which are not supported by a prescription. b. Charges related to a Hospital stay not expressly mentioned as being covered, including but not limited to charges for admission, discharge, administration, registration, documentation and filing.
• Immunization & Nutritional treatment: All preventive care, vaccination including inoculation and prophylactic immunizations, any physical, psychiatric or psychological examinations or testing, enteral feedings (infusion formulae via a tube into the upper gastrointestinal tract) and other nutritional and electrolyte supplements, unless certified to be required by the attending Registered Medical Physician as a direct consequence of an otherwise covered claim.
• Nuclear Reaction: Injury, destruction or damage caused by nuclear fission, nuclear fusion or irradiation.
• Following conditions and treatments thereof are covered only for Hospicash/IPD (which are Excluded under OPD benefits) after 06 consecutive months of continuous coverage have elapsed since the coverage effective date. In case of revival or reinstatement of the policy, only the remaining part, if any, of the waiting period applies.                                                                  
  • ENT (EAR, NOSE & THROAT): Adenoid and Tonsillar Disorder, Deviated Nasal Septum / Nasal &Paranasal Sinus Disorders, Thyroid surgery for benign conditions, Functional endoscopic sinus surgery
  • GYNECOLOGICAL: Benign breast disorder, Myomectomy, Hysterectomy with or without Bilateral Salphingo- Opherectomy excluding malignancy
  • ORTHOPEDIC: Carpal tunnel syndrome, PIVD-Prolapsed Intervertebral Disk (unless due to accident), Osteoporosis, Gout and Rheumatism, Osteoarthritis and Degenerative joint disorders, Knee / Hip Replacement Surgery (other than caused by an accident). For Knee / Hip replacement actual expenses incurred subject to a maximum of 1 (One) Lac whichever is lower, per Policyholder per joint per annum will be payable after the waiting period is over
  • GASTROINTESTINAL: Surgery of gallbladder and bile duct stones, Gastric/Duodenal Ulcer (Surgical), All types of Hernia, Hydrocele, Hemorrhoids, Anal Fissure / Fistula, Rectal Prolapse, Pilonidal sinus
  • UROGENITAL: Surgery of Urinary Stones, Benign Enlargement of Prostate gland (BEP), Varicocele, Spermatocele, Treatment for Chronic Renal Failure (CRF)
  • OTHERS: Skin conditions, Varicose Veins/Ulcers, Cataract and age related eye conditions, Cataract after the Waiting period, Diabetes and related treatments

Note: After the waiting period, the Policyholder is eligible to get insurance coverage as per terms and conditions of the Contract.

• Others: Apart from the above-mentioned exclusions, we are covering all other scenarios, procedures or conditions.
• One can avail a maximum life coverage of Five Lakh Taka (BDT 500,000)
• One can avail a maximum Hospicash/IPD Coverage of Fifty Thousand Taka (BDT 50,000)
• One can avail a maximum OPD Coverage of Ten Thousand Taka (BDT 10,000)
• "Pre-existing Conditions (PEC)’’ Shall mean any injury, sickness, disease or physical condition which
  • has existed before the date of Commencement in respect of the Assured and
  • has received medical advice or treatment within last twenty-four months immediately prior to the Date of Commencement or
  • has manifested signs or symptoms of which the Assured is aware or should have reasonably been aware of.