Specific illness-I in Mediclaim policy.

What is specific illness ?

Coverage for specific diseases is essential to Mediclaim insurance in order to guarantee complete healthcare protection. they policies usually include a list of illnesses for which the policyholder is eligible to receive benefits; they usually include serious illnesses like cancer, heart problems, strokes, and long-term conditions like diabetes. The policy’s inclusion of particular ailments guarantees financial support for people in medical emergencies, reducing the financial burden of treatment expenses. Furthermore, knowing that they have a safety net in place for the most common and serious health concerns gives policyholders piece of mind. In addition to the base policy, insurers may provide riders or add-ons for coverage of extra specific ailments, enabling customers to customize their coverage to meet their specific healthcare needs. In the end, the inclusion of coverage for particular illnesses amplifies the efficacy and significance of Mediclaim plans in protecting people’s health and financial security.
Also note that this specific illness is covered in Mediclaim policy with a waiting period of 24 months or more as per the company terms and condition.

LIST OF SOME SPECIFIC ILLNESS-I

A waiting period of 24 months or more as per the company terms and condition from the first policy commencement date will be applicable to the medical and surgical treatment of illnesses, disease or surgical procedures mentioned below, unless necessitated due to cancer:

The following Illnesses/diseases would be covered after a waiting period of two years or more as per the company terms and condition irrespective of the treatment undergone, medical or surgical:

1.Tumors, Cysts, polyps including breast lumps (benign)

Tumors – When cells divide more frequently than they should or do not die when they should, an abnormal mass of tissue called a tumor is created. Benign (non-cancerous) or malignant (cancerous) tumors are both possible. Benign tumors often have well-defined borders, develop slowly, and do not spread to other areas of the body. On the other hand, cancerous tumors have the ability to infiltrate adjacent tissues and disperse throughout the body via the lymphatic and circulatory systems. Any area of the body can acquire a tumor, and they differ greatly in behavior, prognosis, and treatment.
Cysts- A cyst is a closed, sac-like growth that can develop inside the body’s tissues. Usually, a liquid, semi-solid, or gaseous material is inside of it. Cysts can form in tissues, organs, and skin, among other parts of the body. Although they are often benign (not malignant), depending on their size and location, they may occasionally produce pain, discomfort, or other symptoms. A number of things, including as infections, blocked ducts, or long-term inflammatory disorders, can result in cysts. While most cysts go away on their own, some may need to be surgically removed or treated with drainage if they start to cause problems.
Polyps – Unusual growths called polyps form on the mucous membranes of different body organs. The colon, stomach, nasal passageways, and uterus are among the places where they can occur. Polyps typically have the appearance of tiny, round lumps or stalks that stick out from the tissue surface. Although the majority of polyps are benign (not cancerous), some, especially colon polyps called adenomatous polyps, have the potential to develop into malignant (cancerous) over time. Although polyps are usually asymptomatic, depending on their size and location, they can occasionally cause symptoms including bleeding, blockage, or discomfort. In general, polyps should be evaluated by a physician and removed, particularly if there is a higher risk of cancer.

2. Polycystic ovarian disease

A frequent hormonal condition affecting women of reproductive age is Polycystic Ovarian Disease (PCOD), commonly referred to as Polycystic Ovary Syndrome (PCOS). Menstrual irregularities, high levels of male hormones (androgens), and several tiny, fluid-filled cysts in the ovaries are its defining features. PCOD in women can cause hirsutism, or excessive hair growth, irregular periods, acne, and obesity, among other symptoms. Infertility, insulin resistance, type 2 diabetes, and a higher risk of cardiovascular disease are among the consequences that PCOD can cause. Although the precise origin of PCOD is unknown, a combination of lifestyle, environmental, and genetic variables are thought to be involved.
The main goal of treatment is usually symptom management; this may involve lifestyle modifications, medicines to control menstrual periods and lower testosterone levels, and fertility therapies if a pregnancy is sought.

3. Fibromyoma

A fibromyoma, sometimes referred to as a leiomyoma or uterine fibroid, is a benign (non-cancerous) tumor that grows inside the uterus and is made of muscle and fibrous tissue. When it comes to benign tumors in women who are fertile, these growths are the most prevalent kind. Fibromyomas range in size from tiny, imperceptible nodules to massive masses that can alter the uterus’s size and form. They may show up in groups or alone.

4. Adenomyosis

In adenomyosis, the endometrial tissue that normally lines the uterus develops into the myometrium, the muscle wall of the uterus. The uterus thickens and enlarges as a result of this aberrant growth, which frequently produces uncomfortable and heavy menstrual cycles. Severe cramps during menstruation, copious bleeding, protracted periods, and pelvic pain are among the symptoms. Although the precise reason is uncertain, hormonal variables and uterine inflammation are thought to play a role. MRIs and ultrasounds are two common imaging methods used to make diagnoses. Options for treatment include hormone treatments, prescription drugs for pain management, and, in extreme circumstances, surgery.

5. Endometriosis

Endometriosis is a long-term medical disorder characterized by the growth of tissue outside the uterine cavity that resembles the endometrium, the lining within the uterus. The uterus’ exterior, the fallopian tubes, the ovaries, and other pelvic organs may all experience this aberrant expansion. Severe menstrual cramps, ongoing pelvic pain, excessive menstrual bleeding, pain during sex, and infertility are common symptoms. Although the precise origin of endometriosis is unknown, immune system, hormonal, and genetic variables are thought to be involved. Diagnostic procedures include pelvic examinations, MRIs and ultrasounds, and occasionally laparoscopies. In order to relieve symptoms and enhance quality of life, treatment options include pain management, hormonal therapy, and surgical procedures to eliminate or limit endometrial tissue growth.

6. Prolapsed Uterus

A prolapsed uterus happens when the pelvic floor muscles and ligaments are weakened or strained, causing the uterus to fall from its usual position into or beyond the vaginal canal. Obesity, aging, childbearing, and other diseases that raise abdominal pressure are common causes of this syndrome. Among the symptoms are discomfort during sexual activity, urine incontinence, trouble passing gas, and a sensation of weight or dragging in the pelvic. A pelvic examination is usually used to make the diagnosis. Treatment options include pessary devices, surgical procedures to realign the uterus, and lifestyle modifications and pelvic floor exercises.

7. Non-infective arthritis

A form of joint inflammation that is not brought on by an infection is called non-infective arthritis, or simply non-infectious arthritis. This illness includes gout, psoriatic arthritis, osteoarthritis, and rheumatoid arthritis, among other types of arthritis. Common symptoms include decreased range of motion, stiffness, edema, and joint pain. The underlying causes are many and may involve metabolic problems, inflammatory reactions, or cartilage deterioration. Laboratory testing, imaging studies, and clinical evaluation are frequently used in the diagnosis process. The goal of treatment is to control symptoms. In severe situations, this may entail surgery to enhance joint function and quality of life in addition to medication, physical therapy, and lifestyle modifications.

8. Gout and Rheumatism

One of the most common symptoms of gout is sudden, intense pain, swelling, and redness in the joints, usually the big toe. Gout is a kind of inflammatory arthritis. It happens as a result of high blood uric acid levels (hyperuricemia), which causes uric acid crystals to accumulate in the joints. Genetics, a diet high in purines, alcohol use, and specific medical problems are all contributing factors. The clinical assessment, uric acid level blood tests, and joint fluid analysis are usually used to make the diagnosis. Treatment options include long-term methods to lower uric acid levels, such as lifestyle changes and medication, as well as pain and inflammation-relieving drugs to help during episodes

9. Osteoporosis

Reduced bone mass and density are the hallmarks of osteoporosis, a chronic bone condition that makes bones brittle and raises the risk of fractures. This disorder results in porous and brittle bones because the formation of new bone is not keeping up with the elimination of old bone. Osteoporosis, which commonly affects the hip, spine, and wrist, is more common in older persons, especially in postmenopausal women because of the drop in estrogenic levels. Age, family history, low body weight, smoking, heavy alcohol use, and a diet deficient in calcium and vitamin D are risk factors. Bone density scans are commonly used for diagnosis (DEXA). The mainstays of treatment include nutritional supplements, drugs to fortify bones, falls prevention techniques, and lifestyle modifications.

10. Ligament, Tendon or Meniscal tear (due to injury or otherwise)

Ligaments are strong, fibrous bands of connective tissue that run between bones, giving joints all over the body support and stability. The long, stringy collagen fibbers that give ligaments their strength and flexibility are their main constituent. They are essential in preserving the skeletal system’s structural integrity because they inhibit overexertion, which can cause injury or dislocation of the joints. Ligaments come in several varieties, including capsular, extracapsular, and intracapsular ligaments, and they all have distinct purposes in different kinds of joints. Sprains and rips are common ligament injuries that frequently come from sports-related activities or accidents. Ligament injuries are usually treated with rest, physical therapy, and in more serious situations, surgery to restore the damaged ligament.

11. Prolapsed Inter Vertebral Disc (due to injury or otherwise)

The soft inner gel-like core of a spinal disc, called the nucleus pulposus, protrudes through the outer fibrous ring, called the annulus fibrosus, resulting in a prolapsed intervertebral disc, often referred to as a herniated or slipped disc. Compression of adjacent spinal nerves due to this condition may result in pain, numbness, or weakness in the affected area. Sciatica, back pain, and discomfort that gets worse with activity are typical symptoms. Age, poor lifting technique, and repetitive strain are risk factors. Usually, an MRI or CT scan along with a physical examination are used to make the diagnosis. Options for treatment include physical therapy, rest, medicines, and, in extreme situations, surgery.

12. Cholelithiasis

The medical name for the development of gallstones inside the gallbladder is cholelithiasis. Solid particles called gallstones form in the gallbladder due to bile cholesterol and bilirubin. They range in size and quantity from the size of a golf ball to as small as a grain of sand. Obesity, high-fat diets, abrupt weight reduction, and specific genetic predispositions are common risk factors. Gallstones sometimes cause no symptoms at all, but if a stone obstructs a bile duct, it can cause symptoms including severe abdominal pain (called biliary colic), nausea, vomiting, and jaundice. Imaging with ultrasonography is usually used for diagnosis. Dietary changes, drugs to dissolve gallstones, and, in symptomatic situations, surgical removal of the gallbladder (cholecystectomy) are available forms of treatment.

13. Pancreatitis

An inflammation of the pancreas, an organ situated behind the stomach and vital to both digestion and blood sugar management, is known as pancreatitis. This illness may be chronic or acute. Acute pancreatitis is a sudden, severe illness that is frequently brought on by gallstones or binge drinking. Severe stomach discomfort, nausea, vomiting, fever, and a fast heartbeat are among the symptoms. A long-term disorder known as chronic pancreatitis can be brought on by extended alcohol misuse, hereditary causes, or other chronic inflammatory diseases. It results in chronic pain, gastrointestinal problems, and may harm the pancreas permanently. Blood tests, imaging studies such as CT scans, and occasionally endoscopic procedures are used in the diagnosis process. The goals of treatment are to support pancreatic function, control symptoms, and treat the underlying cause.

14. Fissure/fistula in anus, haemorrhoids, pilonidal sinus

A little rip in the anal lining that is frequently brought on by passing firm or big feces is called an anal fissure. It causes excruciating pain both during and after bowel movements and, on occasion, bleeding. Sharp pain, a noticeable skin crack around the anus, and blood on the toilet paper or stool are some of the symptoms. An irregular tunnel connecting the skin covering the anus to the inside of the rectum or anus is called an anal fistula. Usually, it starts as an infected, pus-filled cavity called an anal abscess. Pain, enema, repeated abscesses, and pus or blood oozing from a hole close to the anus are among the symptoms. Surgery is frequently used as a kind of treatment to close the fistula or fissure and relieve symptoms.

15. Ulcer & erosion of stomach & duodenum

Lesions in the lining of the stomach and duodenum are referred to as erosions and ulcers in these digestive tract segments. A deep lesion or sore that penetrates the lining is called an ulcer, and it is frequently brought on by a Helicobacter pylori infection or chronic use of nonsteroidal anti-inflammatory medicines (NSAIDs). Erosions are microscopic tears that solely impact the mucosa’s outer layer. Both disorders can cause burning stomach pain, nausea, heartburn, bloating, and, in extreme situations, vomiting blood or black stools. Tests for H. pylori and endoscopy are usually used in diagnosis. Antibiotics for infections, stomach acid-reducing drugs, and lifestyle modifications to encourage recovery and stop recurrence are all part of the treatment.

16. Gastro Esophageal Reflux Disorder (GERD)

The chronic illness known as gastroesophageal reflux disease (GERD) is characterized by recurrent reflux of stomach acid into the esophagus, irritating its lining. Symptoms of acid reflux include regurgitation, heartburn, chest pain, and difficulty swallowing. The lower esophageal sphincter (LES), which typically keeps stomach contents from ascending, might become weaker or more relaxed, which leads to GERD. Obesity, pregnancy, smoking, and specific foods or drugs are risk factors. The diagnosis is frequently made on the basis of the patient’s symptoms, and it may be verified by endoscopy or pH monitoring. Changes in lifestyle, drugs to lower acid production, and, in extreme situations, surgery to reinforce the LES are also part of the treatment plan.

17. Liver Cirrhosis

Liver cirrhosis is a type of advanced liver disease that impairs liver function by causing scarring (fibrosis) to replace healthy liver tissue. This illness is brought on by persistent, long-term liver damage from a variety of sources, such as persistent alcohol misuse, viral hepatitis (particularly hepatitis B and C), nonalcoholic fatty liver disease, and specific hereditary conditions. Cirrhosis can cause jaundice, which is a yellowing of the skin and eyes, ascites, edema, lethargy, easy bruising and bleeding, and confusion, sometimes known as hepatic encephalopathy. Usually, imaging tests, liver biopsies, and blood tests are used to make the diagnosis. Managing symptoms, stopping more liver damage, and treating the underlying cause are the main goals of treatment. A liver transplant may be required in severe situations.

18. Perineal Abscesses

The perineal region, which is the space between the genitalia and the anus, is the site of localized pus collections known as perineal abscesses. They are brought on by bacterial infections, which frequently start from diseased anal fissures or fistulas or clogged glands. In addition to fever and malaise, symptoms include excruciating pain, swelling, redness, and tenderness in the afflicted area. It could be difficult to sit, walk, or urinate because to the abscess. The diagnosis is mainly clinical, with imaging investigations used to corroborate it if needed. In order to treat the abscess, it is usually drained surgically by an incision, and medicines are given to eradicate the infection. Timely medical intervention is essential to avoid problems like infection spread or fistula formation.

19. Perianal / Anal Abscesses

An infection of the anal glands can result in painful collections of pus called perianal and anal abscesses, which occur near the anus or rectum. These abscesses are caused by bacteria that enter the tissue and become infected; they are frequently associated with anal fissures, blocked anal glands, or inflammatory bowel illness. Severe pain, swelling, redness, and soreness around the anus are among the symptoms; fever and malaise are also present. When sitting and having bowel movements, the abscess could hurt. Usually, a clinical examination and, if required, imaging studies, are used to make the diagnosis. Surgical drainage of the abscess is the first step in treatment; medications may also be used to treat the underlying infection. Treatment must be started right away in order to avoid complications like the development of anal fistulas.

20. Calculus diseases of Urogenital system Example: Kidney stone, Urinary bladder stone.

The condition, sometimes referred to as urinary stone disease, or calculus diseases of the urogenital system, are disorders of the urinary tract that cause calculi (stones) to form in the kidneys, ureters, bladder, and urethra. The minerals and salts that make up these stones crystallize and agglomerate. Urinary tract infections, haematuria (blood in the urine), intense discomfort (renal colic), and frequent urination are other symptoms. Dehydration, nutritional considerations, genetic predispositions, and specific medical problems are risk factors. CT or ultrasound scans are common imaging studies used to confirm the diagnosis. Increased fluid intake, dietary modifications, pharmaceuticals, extracorporeal shock wave lithotripsy (ESWL), and surgical excision are all possible forms of treatment.

21. Benign Hyperplasia of prostate

Men are frequently affected with benign hyperplasia of the prostate (BPH), a benign swelling of the prostate gland that occurs with aging. The urethra’s surrounding prostate tissue has the potential to enlarge and compress the urine tube, resulting in symptoms related to the urinary system such as nocturia (nighttime peeing), urgency, weak stream, and trouble initiating or ceasing urination. Although the precise origin of BPH is unknown, aging-related hormonal changes are thought to be a contributing factor. A digital rectal exam, blood tests for prostate-specific antigen (PSA), urine tests, and imaging studies are usually performed in order to make the diagnosis. Depending on the severity of the symptoms, there are a variety of treatment options available to relieve urinary blockage and enhance quality of life, including lifestyle modifications, medication, minimally invasive treatments, and surgery.

22. Varicocele

Similar to varicose veins in the legs, a varicocele is an abnormal expansion of the veins within the scrotum. Blood might pool as a result of the pampiniform plexus, a dilation and engorgement of these veins. The left testicle is more likely to have varicoceles due to anatomical variations. They may result in palpable or apparent swollen veins, a heavy, hurting scrotal pain, and occasionally problems with reproduction as a result of elevated scrotal temperature that affects sperm quality and production. Ultrasonography is typically used to confirm the diagnosis, which is determined after a physical examination. Conservative treatments like wearing supportive undergarments or surgical procedures like varicocelectomy to repair the damaged veins and relieve symptoms are available as treatment options.

23. Cataract

A cataract is a clouding of the eye’s normally clear lens that impairs vision. This is usually an age-related condition, produced by the lens’s normal aging process, but it can also be brought on by diabetes, smoking, long-term UV radiation exposure, certain drugs, and eye traumas. Cataracts can cause impaired or poor vision, night blindness, glare and light sensitivity, and the appearance of “halos” surrounding lights. Additionally, colours may seem faded. The process of diagnosing involves a thorough examination of the eyes. In order to restore clear vision, the clouded lens is surgically removed and replaced with an artificial intraocular lens (IOL).

24. Retinal detachment

A dangerous illness known as retinal detachment occurs when the retina, a small layer of tissue in the back of the eye that processes light and sends visual signals to the brain, separates from the supporting tissue beneath it. If left untreated, this detachment impairs the retina’s ability to function, which can result in blindness. A sudden rise in floaters, light flashes, and a shadow or curtain effect over part of the visual field are other symptoms. Retinal tears, trauma, severe diabetes, and inflammatory eye illnesses are among the causes. Using ophthalmoscopy and imaging methods, a thorough eye examination is used to make the diagnosis. Reattaching the retina and restoring eyesight usually requires surgery, such as vitrectomy or laser surgery.

25. Glaucoma

A class of eye conditions known as glaucoma is defined by harm to the optic nerve and is frequently linked to increased intraocular pressure (IOP). If left untreated, this illness can cause progressive, permanent eyesight loss and blindness. There are other forms of glaucoma, such as angle-closure glaucoma, which can happen quickly and is a medical emergency, and open-angle glaucoma, which progresses gradually over time. A progressive loss of peripheral vision, tunnel vision, eye pain, light-induced halos, and redness of the eyes are possible symptoms. Comprehensive eye exams monitoring IOP and evaluating the health of the optic nerve are necessary for diagnosis. Medication, laser therapy, and surgery are available as treatments to reduce IOP and stop more damage to the optic nerve.

26. Congenital Internal Diseases

Congenital internal diseases are illnesses or anomalies affecting the body’s internal organs or systems that are present from birth. During fatal development, these disorders may arise from a mix of environmental exposures, genetic factors, or both. Examples include gastrointestinal malformations, congenital lung diseases, structural anomalies of the kidneys or urinary tract, and congenital heart defects. While some congenital internal disorders may cause urgent health problems requiring medical attention, others may be asymptomatic at birth and only become apparent later in life. Prenatal screening, genetic testing, and postnatal medical assessment are usually part of the diagnosis process. Depending on the exact ailment, there are a variety of treatment options available, such as medication, surgery, supportive therapy, and lifestyle changes to control symptoms and enhance long-term results.