EXCLUSIONS
WHAT POLICY DOES NOT COVER:
5.WAITING PERIOD
The company shall not be liable to make any payment under the policy in connection with or in respect of the following expenses till the expiry of waiting period mentioned below:
5.1 Pre-Existing Diseases (Code-Excl01).
5.2 First Thirty Days Waiting Period (Code-Excl03)
5.3 Specific Waiting Period (Code-Excl02)
24 Months Waiting Period
48 Months Waiting Period
6. EXCLUSIONS
The company shall not be liable to make any payment under the policy, in respect of any expenses incurred in connection with or in respect of:
6.1 Investigation & Evaluation (Code-Excl04)
6.2 Rest Cure, rehabilitation and respite care (Code-Excl05)
Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
6.3 Obesity/Weight Control (Code-Excl06)
Expenses related to the surgical treatment of obesity that does not fulfill all the below conditions:
greater than or equal to 40 or
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:
6.4 Change-of-Gender Treatments: (Code-Excl07)
Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.
6.5 Cosmetic or Plastic Surgery: (Code-Excl08)
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the Insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.
6.6 Hazardous or Adventure sports: (Code-Excl09)
Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.
6.7 Breach of law: (Code-Excl10)
Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.
6.8 Excluded Providers: (Code-Excl11)
Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in its website/notified to the policyholders are not admissible. However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim.
6.9 Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.(Code-Excl12)
6.10Treatments received in health hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.(Code-Excl13)
6.11 Dietary supplements and substances 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 hospitalisation claim or day care procedure. (Code-Excl14)
6.12 Refractive Error: (Code-Excl15)
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
6.13 Unproven Treatments: (Code-Excl16)
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.
6.14 Sterility and Infertility: (Code-Excl17)
Expenses related to sterility and infertility. This includes:
6.15 Maternity Expenses (Code-Excl18):
6.16 War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
6.17 Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense. For the purpose of this exclusion:
6.18 Any expenses incurred on Domiciliary Hospitalisation
6.19 Treatment taken outside the geographical limits of India
6.20 a) Stem cell implantation/Surgery/therapy, harvesting, storage or any kind of Treatment using stem cells except as provided for in Clause 4.6.L above; b) Growth Hormone Therapy.
6.21
Congenital External Diseases, Defects or anomalies.
6.22
Circumcision unless necessary for Treatment of an Illness or Injury not excluded hereunder or due to an Accident.
6.23
Cost of routine medical examination and preventive health check-up.
6.24
a) Cost of hearing aids; including optometric therapy; b) cochlear implants unless necessitated by an Accident or required intra-operatively.
6.25
Intentional self-inflicted Injury, attempted suicide
6.26
Treatments other than Allopathy and Ayurvedic, Homeopathic & Unani branches of medicine.
6.27
Any expenses incurred on Outpatient treatment (OPD treatment)
6.28
Unless used intra-operatively, any expenses incurred on prosthesis, corrective devices; External and or durable Medical / Non-medical equipment of any kind used for diagnosis and/or treatment and/or monitoring and/or maintenance and/or support including instruments used in treatment of sleep apnoea syndrome; Infusion pump, Oxygen concentrator, Ambulatory devices, sub cutaneous insulin pump and also any medical equipment, which are subsequently used at home.
6.29
Change of treatment from one system of medicine to another system unless recommended by the consultant/ hospital under whom the treatment is taken.
6.30
Treatments including Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy, chondrocyte or osteocyte implantation, procedures using platelet rich plasma, Trans Cutaneous Electric Nerve Stimulation; Use of oral immunomodulatory/ supplemental drugs.
6.31
Artificial life maintenance including life support machine use, from the date of confirmation by the treating doctor that the patient is in a vegetative state
IRDA Registration no. 545
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