A. WAITING PERIOD - EXCLUSIONS

The Company shall not be liable to make any payment under the policy in connection with or in respect of following expenses till the expiry of the waiting period mentioned below:

1. Pre-Existing Disease Waiting Period (Code- Excl01):

a. Expenses related to the treatment of a pre-existing disease (PED) and its direct complications shall be excluded until the expiry of 48 months of continuous coverage after the date of inception of the first policy with us.

b. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase.

 c. If the Insured Person is continuously covered without any break as defined under the portability norms of the extant IRDAI (Health Insurance) Regulations, then waiting period for the same would be reduced to the extent of prior coverage. d. Coverage under the policy after the expiry of 48 months for any pre-existing disease is subject to the same being declared at the time of application and accepted by us.

B. PERMANENT EXCLUSIONS

B.1 Standard Permanent 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:

2. Investigation & Evaluation (Code-Excl04):

i. Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded;

ii. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.

3. 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:

 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.

4. Obesity/ Weight Control (Code-Excl06):

Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:

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

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

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

 iv. 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 Apnoea

iv. Uncontrolled Type2 Diabetes

5. 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. 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.

7. 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.

 8. 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.

9. 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.

10. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code-Excl12)

 11. Treatments 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)

 12. Dietary supplements and substances that can be purchased without a 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. (CodeExcl14)

13. Refractive Error (Code-Excl15):

 Expenses related to the treatment for correction of eyesight due to refractive error less than 7.5 dioptres.

14. 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.

 15. Sterility and Infertility (Code-Excl17): Expenses related to 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

16. Maternity (Code- Excl18): a. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalisation) except ectopic pregnancy; b. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.

C. SPECIFIC PERMANENT EXCLUSIONS

17. All expenses caused by or arising from or attributable to foreign invasion, an 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 defence, rebellion, revolution, insurrection, military or usurped power.

 18. 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.

19. Stem cell implantation/Surgery, harvesting, storage or any kind of treatment using stem cells except as provided for in clause 6.7 (L) above; growth hormone therapy.

20. Congenital external diseases or defects or anomalies.

21. a) Routine eye-examination expenses, cost of spectacles, contact lenses; b) Cost of hearing-aids; 22. Intentional self-inflicted injury; attempted suicide.

23. Treatments other than Allopathic and AYUSH

24. Treatments including Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP).

 25. Dental treatment or surgery of any kind unless necessitated by disease or accident and requiring hospitalisation

 26. 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

27. Any item(s) or treatment specified in ‘List of Non-Medical Expenses– Payable/Non-Payable’ as per Annexure – 1 of the policy and available on Company web site also, unless specifically covered under the Policy.

28. Any expenses incurred on OPD (Out-Patient) Treatment

29. Vaccination or inoculation of any kind unless it is post animal bite.