All the Waiting Periods shall be applicable individually for each Insured Person and claims shall be assessed accordingly.

A. Permanent Exclusions

 We shall not be liable to make any payment under this Policy directly or indirectly caused by, based on, arising out of, relating to or howsoever attributable to any of the following:

 1.All expenses directly or indirectly, caused by or arising from or attributable to foreign invasion, act of foreign enemies, hostilities, warlike operations (whether war be declared or not or while performing duties in the armed forces of any country), civil war, public defense, rebellion, revolution, insurrection, military or usurped power.

2.All Illness/expenses caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or hazardous form) or from any nuclear waste from the combustion of nuclear fuel nuclear, chemical or biological attack.

3.a) Stem cell implantation/Surgery, harvesting, storage or any kind of Treatment using stem cells; b) growth hormone therapy.

4.External Congenital Anomaly or defects, inherited disorders or any complications or conditions arising therefrom including any developmental conditions of the Insured Person.

5.Treatment for developmental problems including learning difficulties e.g. Dyslexia, behavioural problems including attention deficit hyperactivity disorder (ADHD).

6.Venereal diseases; all sexually transmitted diseases including but not limited to Genital Warts, Syphilis, Gonorrhea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis and any condition directly or indirectly caused by or associated with them.

7.Birth control, Sterility and Infertility: Expenses related to Birth Control, sterility and infertility. This includes:

i.Any type of contraception, sterilization

ii.Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI

iii.Gestational Surrogacy

iv.Reversal of sterilization

8.Circumcision unless necessary for Treatment of an Illness or Injury not excluded hereunder or due to an Accident.

9.Parkinson’s or Alzheimer’s disease even if caused or aggravated by or related to an Accident or Illness.

10.Conditions for which treatment could have been done on an out-patient basis without any Hospitalization.

11.All routine examinations and preventive health check-ups.

12.Any treatment or part of a treatment that is not of a reasonable charge, is not a Medically Necessary Treatment; drugs or treatments which are not supported by a prescription.

13.Charges incurred primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and Treatment even if the same requires confinement at a Hospital.

14.Costs of donor screening or costs incurred in an organ transplant Surgery involving organs not harvested from a human body.

15.Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.

16.Any form of Alternative Treatment:

i.AYUSH Treatment;

ii.Hydrotherapy, Acupuncture, Reflexology, Chiropractic Treatment or any other form of indigenous system of medicine.

17.Dental Treatment, dentures or Surgery of any kind unless necessitated due to an Accident and requiring minimum 24 hours Hospitalisation. Treatment related to gum disease or tooth disease or damage unless related to irreversible bone disease involving the jaw which cannot be treated in any other way.

18.Routine eye examinations, cost of spectacles, multifocal lens, contact lenses; Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 diopters.

19.a) Cost of hearing aids; including optometric therapy; b) cochlear implants unless necessitated by an Accident or required intra-operatively.

20.Vaccinations including inoculation and immunizations except in case of post-bite treatment.

21.Any Treatment and associated expenses for alopecia, baldness, wigs, or toupees and hair fall Treatment and products,

22.Cost incurred for any health check-up or for the purpose of issuance of medical certificates and examinations required for employment or travel or any other such purpose.

23.Any stay in Hospital without undertaking any Treatment or any other purpose other than for receiving eligible Treatment of a type that normally requires a stay in the Hospital.

24.Admission for enteral feedings (infusion formulas via a tube into the upper gastrointestinal tract) and other nutritional and electrolyte supplements unless certified to be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.

25.Dietary supplements and substances which are available naturally and that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of Treatment of Illness or Accident.

26.Artificial life maintenance, including life support machine used to sustain a person, who has been declared brain dead, as demonstrated by:

1.Deep coma and unresponsiveness to all forms of stimulation; or

2.Absent pupillary light reaction; or

3.Absent oculovestibular and corneal reflexes; or

4.Complete apnea.

27.Rest Cure, rehabilitation and respite care: Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:

i.Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.

ii.Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.

28.Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or a Hospital where the Hospital has effectively become the Insured Person’s home or permanent abode or where admission is arranged wholly or partly for domestic reasons

29.Committing or attempting to commit a breach of law with criminal intent, intentional self- Injury or attempted suicide while Insured Person is sane or insane.

30.a) Treatment for general debility, ageing, convalescence, sanatorium Treatment, rehabilitation measures, b) private duty nursing, long-term nursing care or custodial care, respite care, c) run down condition or rest cure

31.Certification / diagnosis / Treatment by a family member, or a person who stays with the Insured Person, save for the proven material costs which are eligible for reimbursement as per the applicable cover, or from persons not registered as Medical Practitioners under the respective Medical Councils, or from a Medical Practitioner who is practicing outside the discipline that he is licensed for.

32.Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof

33.Prostheses, corrective devices and and/or Medical Appliances, which are not required intra- operatively for the Illness/ Injury for which the Insured Person was Hospitalized.

34.Cosmetic or plastic Surgery: Expenses for cosmetic or plastic surgery or any treatment to change appearance unless as a part of medically necessary treatment. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner for reconstruction following an Accident, Burn(s) or Cancer.

35.Change-of-life treatments: Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.

36.Obesity/ Weight Control: Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:

1.Surgery to be conducted is upon the advice of the Doctor

2.The surgery/Procedure conducted should be supported by clinical protocols

3.The member has to be 18 years of age or older and

4.Body Mass Index (BMI);

a.greater than or equal to 40 or

b.greater than or equal to 35 in conjunction with any of the following severe co- morbidities following failure of less invasive methods of weight loss:

i.Obesity-related cardiomyopathy

ii.Coronary heart disease

iii.Severe Sleep Apnea

iv.Uncontrolled Type2 Diabetes

37.Treatment received outside India.

38.Any robotic, remote Surgery or Treatment using cyber knife.

39.a) Instrument used in Treatment of Sleep Apnea Syndrome (C.P.A.P.); b) Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.); c) Oxygen Concentrator for Bronchial Asthmatic condition; d) Infusion pump or any other external devices used during or after Treatment.

40.Dangerous acts including hazardous activities but not limited to the list given below:

a.An Insured Person’s participation or involvement in naval, military or air force operation, racing, diving, bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, scuba diving, parachuting, hang-gliding, rock or mountain climbing, potholing, abseiling, deep sea diving using hard helmet and breathing apparatus, polo, snow and ice sports in a professional or semi-professional nature.

b.Any claim arising out of sporting activities in so far as they involve training or participation in competitions of professional or semi-professional sports persons.

41.Injury caused whilst flying or taking part in aerial activities (including cabin) except as a fare- paying passenger in a regular scheduled airline or air charter company.

42.Treatment arising from or traceable to pregnancy/childbirth including caesarean by section, surrogate or vicarious pregnancy, miscarriage, voluntary termination of pregnancy, abortion or sterilization or birth control procedures/ medicines, contraceptive supplies, hormone replacement therapy, including changes in chronic ectopic pregnancy which may be established by medical reports & complications arising due to any of the above. However, this exclusion does not apply to ectopic pregnancy proved by diagnostic means which is certified to be life threatening by a Medical Practitioner.

43.All non-medical expenses including but not limited to convenience items for personal comfort not consistent with or incidental to the diagnosis and Treatment of the Illness/Injury for which the Insured Person was Hospitalised, such as, ambulatory devices, walker, crutches, belts, collars, splints, slings, braces, stockings of any kind, diabetic footwear, glucometer/thermometer and any medical equipment that is subsequently used at home except when they form part of room expenses. For complete list of non-medical expenses, please refer to the Annexure I “Non-Medical Expenses” and also on Our website.

44.Any opted Deductible (Per claim/ Aggregate/ Corporate) amount or percentage of admissible claim under Co-Payment, Sub Limit if applicable and as specified in the Policy Schedule/ Certificate of Insurance to this Policy.

45.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, including MRD charges (medical records department charges).

46.Any physical, medical or mental condition or Treatment or service that is specifically excluded in the Policy Schedule/ Certificate of Insurance under Special Conditions.

B. Pre-Existing Disease Waiting Period - A waiting period since beginning of cover under the first Policy, specified in the Policy Schedule or Certificate of Insurance shall apply to all Pre-Existing Diseases for each Insured Person.

C. Initial Waiting Period for Hospitalization - A waiting period since beginning of cover under the first Policy, specified in the Policy Schedule/Certificate of Insurance shall apply to any Illness contracted and/or Medical Expenses incurred in respect of any Illness by the Insured Person other than Hospitalization due to Accident

D.Specific Illness Waiting Period - A Waiting Period since beginning of cover under the first Policy, specified in the Policy Schedule/ Certificate of Insurance shall apply to the Treatment, of the following, whether medical or surgical for all Medical Expenses along with their complications on Treatment towards:

a)Cataract

b)Hysterectomy for Menorrhagia or Fibromyoma or prolapse of Uterus unless necessitated by malignancy myomectomy for fibroids

c)Knee Replacement Surgery (other than caused by an Accident), Non-infectious Arthritis, Gout, Rheumatism, Osteoarthritis and Osteoporosis, Joint Replacement Surgery (other than caused by Accident), Prolapse of Intervertebral discs (other than caused by Accident), all Vertebrae Disorders, including but not limited to Spondylitis, Spondylosis, Spondylolisthesis, Congenital Internal Diseases

d)Varicose Veins and Varicose Ulcers

e)Stones in the urinary, uro-genital and biliary systems including calculus diseases

f)Benign Prostate Hypertrophy, all types of Hydrocele

g)Fissure, Fistula in anus, Piles, all types of Hernia, Pilonidal sinus, Hemorrhoids and any abscess related to the anal region

h)Chronic Supportive Otitis Media (CSOM), Deviated Nasal Septum, Sinusitis and related disorders, Surgery on tonsils/Adenoids, Tympanoplasty and any other benign ear, nose and throat disorder or surgery

i)Gastric and duodenal ulcer, any type of Cysts/Nodules/Polyps/internal tumors/skin tumors, and any type of Breast lumps (unless malignant), Polycystic Ovarian Diseases

j)Any Surgery of the genito-urinary system unless necessitated by malignancy

k)Waiting Period for Named Mental Illnesses

If these diseases are Pre-Existing Diseases at the time of proposal or subsequently found to be Pre-Existing Diseases, the Pre-Existing Disease Waiting Periods as mentioned in the Policy Schedule/ Certificate of Insurance shall apply.