Pamana Savings Contestability on Illnesses


No benefits shall be payable to any claim made for any conditions considered pre-existing. An illness or condition shall be considered Pre-existing if, during the period prior to the Effective Date of the Member’s coverage or the approval date or its reinstatement in case of lapsation, a) any professional advise or treatment was given for such illness or condition; or b) such illness or condition was in any way evident to the Member; or c) the pathogenesis of such illness or condition has started whether or not the Member is aware of such illness or condition.


The following conditions and their complications, among others, when occurring during the first year of coverage after the Effective Date or reinstatement date, are considered Pre-existing: (a) cancer and tumor of the internal organs, including the brain and the thyroid glands; (b) endometriosis; (c) hemorrhoids; (d) diseased tonsils requiring surgery; (e) pathological abnormalities of nasal septum and turbinates; (f) hyperthyroidism/goiter; (g) cataracts; (h) sinus condition requiring surgery; (i) epilepsy; (j) asthma; (k) cirrhosis of the liver; (l) tuberculosis; (m) anal fistulae; (n) cholecystitis/cholelithiasis; (o) calculi of the urinary system; (p) gastric or duodenal ulcer; (q) hallux vagus; (r) all the tumors of the skin, muscular tissue, breast bone or malignancies of blood or bone marrow; (s) diabetes mellitus; (t) hypertension; (u) collagen disease; (v) cardiovascular disease; (w) hernia; and (x) HIV/AIDS.