1. Ancillary Hospital Charges

Charges related to a Hospital stay not expressly mentioned as being covered, including but not limited to charges for admission, discharge, administration, RMO charges, night charges, registration, documentation and filling, surcharges. Service charges levied by the Hospital shall not be covered.

2. Hazardous Activities

Any claim relating to Hazardous Activities unless declared beforehand and agreed by Us.

3. Artificial life maintenance:

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

• Deep come and unresponsiveness to all form of stimulation; or
• Absent pupillary light reaction; or
• Absent oculovestibular and corneal reflexes; or
• Complete apnea.

4. Behavioral, Neurodevelopmental and Neurodegenerative Disorders:

• Disorders of adult personality including gender related problems, gender change;
• Disorders of speech and language including stammering, dyslexia;
• All Neurodegenerative disorders including Dementia, Alzheimer’s disease and Parkinson’s disease;
• Other medical services for behavioral, neurodevelopment delays and disorders.

5. Circumcision:

Circumcision unless necessary for the treatment of a disease or necessitated by an Accident.

6. Complementary & Alternative Medicine:

Any form of Complementary & Alternative Medicine.

7. Conflict & Disaster:

Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emission, war or war like situation (whether war is declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism, directly or indirectly from nuclear, biological or chemical emission, war or war like situation (weather war is declared or not), rebellion, revolution, acts of terrorism.

8. External Congenital Anomaly:

Screening, counselling or treatment related to external Congenital Anomaly.

9. Convalescence & Rehabilitation:

Hospital accommodation when it is used solely or primarily for any of the following purposes.

• Any service related to Complementary & Alternative Medicine provided for the purpose of Convalescence, Rehabilitation and Respite Care other than for receiving eligible treatment of a type that normally requires a stay in Hospital.
• 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.
• Hospice care – Any service for people who are terminally ill to address medical, physical, social, emotional and spiritual need.

10. Cosmetic and Reconstructive Surgery:

• Any treatment undergone purely for cosmetic or psychological reasons to improve appearance, unless such treatment in Medically Necessary as a part of reconstructive procedure related to cancer or treatment for Injury resulting from Accident or burns, and is required to restore functionality.
• Gynaecomastia, Abdominoplasty, blepharoplasty, mammoplasty, Chemical Peel, Rhinoplasty, Otoplasty, Liposuction and Lipectomy will not be payable even in case of Accident or burn or cancer.

11. Dental/oral treatment:

Treatment, procedures and preventive, diagnostic, restorative, cosmetic service related to disease, disorder and condition related to natural teeth and Gingiva except for Inpatient Hospitalization due to an Accident.

12. Eyesight & Optical Services:

Any treatment to correct refractive errors of the eye, unless required as the result of an Accident. We will not pay for routine eye examination, contact lenses, spectacles or laser eye sight correction.

13. Experimental or Unproven Treatment:

• Service including device, treatment procedure or pharmacological regimens which are considered as experimental or unproven.
• Medical Devices, Vascular or Coronary Stents: Biodegradable (bioresorbable, bioabsorbable) polymer drug eluting stents will be considered as experimental for all purpose.
• Stem Cell Transplant: Any stem call transplant other than for Bone Marrow Transplant.

14. HIV,AIDS, and related complex:

Any condition directly or indirectly caused by or associated with Human Immunodeficiency Virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS), including any condition that is related to HIV or AIDS,

15. Hospitalization not Justified:

Admission solely for the purpose of Physiotherapy, evaluation, investigations, diagnosis or observation service or not consistent with standard treatment guidelines (as defined by Clinical Establishment (Registration and Regulation) Act 2010 and amendments thereafter) or Evidence Based Clinical Practices.

16. Inconsistent, Irrelevant or Incidental Diagnostic procedures:

Charges incurred primarily for diagnostic X-ray or laboratory examination or other diagnostic studies not consistent with or incidental to the current diagnosis and treatment even if the some required confinement at a Hospital.

17. Mental and Psychiatric Condition:

Treatment related to symptoms, complication and consequences of mental Illness, mood disorders, psychotic and non-psychotic disorders such as:

• International self inflicted Injury or attempted suicide by any means.
• Depression, anxiety, dissociative or stress-related disorders.

18.Non-Medical Expenses:

A. Items of personal comfort and convenience.

• Personal attendant or beauty service, cosmetic, toiletry items, guest service and similar incidental expenses or services.
• Issue of medical certificate and examination as to suitability for employment for travel or any other such purpose. Any charges incurred to procure any treatment/Illness related documents pertaining to any period of Hospitalization/Illness.
• Intra Ocular Lens: Any of the following classes of intraocular lens implants for any indication, including aphakia such as Multifocal IOL, Presbyopia or Astigmatism Correcting IOL, Phakic IOL, Pseudoaccommodating IOL.

B. External or Ambulatory Devices.

• External and or durable medical/non-medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD or infusion pump.
• Ambulatory devices such as walkers, crutches, belts, collars, caps, splints, slings, braces, stockings of any kind, diabetic, foot wear, glucometer/ thermometer and similar items and also any medical equipment which is subsequently used at home.
• Visiting Chargers: Any travelling charge for visiting consultant.

19. OPD Treatment:

OPD Treatment is not covered except for animal bite vaccinations to the extent stated in Section 2.9.

20. Obesity and Weight Control Programs:

Service including medical treatment and Surgical Procedures and supplies that are primarily intended to control weight or treat obesity, including morbid obesity, or for the purpose of weight reduction, regardless of the existence of comorbid conditions.

21. Off – label drug or treatment:

Use of pharmaceutical drug for an unapproved indication or in an unapproved age group, dosage, or route of administration as regulated and approved by Central Drugs Standard Control Organization (CDSCO).

22. Puberty and Menopause related Disorders:

Treatment for any symptoms, Illness, complications arising due to physiological condition associated with Puberty, Menopause such as menopausal bleeding or flushing.

23. Reproductive medicine & other Maternity Expenses: Any assessment or treatment method for:

• Birth Control
  Any type of contraception, sterilization, abortion, voluntary termination of pregnancy or family planning.
• Assisted Reproduction
  Infertility service including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, Gestational Surrogacy.
• Sexual disorder and Erectile Dysfunction.
  Treatment of any sexual disorder including impotence (irrespective of the cause) and sex changes or gender reassignments or erectile dysfunction;
• Any costs or expenses related to pregnancy, complication arising from pregnancy or medical termination of pregnancy.
  However, the above exclusions do to not apply to treatment for ectopic pregnancy or accident miscarriage.

24. Robotic Assisted Surgery, Light Amplification by Stimulated Emission of Radiation (LESER) & Light based Treatment:

Any invasive or non invasion procedures in which a robotic surgical system or light based measure is used either in conjugation with base procedure or alone and liability will be based on the agreed tariff rate or Reasonable and Customary Charge for the base procedure including but not limited to Cyberknife, Da Vinci, Laser Ablation, Femto second laser.

25. Sexually transmitted Infections & diseases:

Screening, prevention and treatment for sexually related infection or disease including but not limited to Genital Warts, Syphilis, Gonorrhea, Genital, Herpes, Chlamydia, Public Lice and Trichomoniasis.

26. Sleep disorders:

Treatment for any conditions related to disturbance of normal sleep patterns or behaviors such as Sleep apnea, snoring, etc.

27. Substance related and Addictive Disorders:

Treatment and Complications related to disorders of intoxication, dependence, abuse, and withdrawal caused by drugs and other substance such as alcohol, opiods or nicotine.

28. Unlawful Activity

Any condition occurring as a result of breach of law with criminal intent.

29.Treatment received outside India:

Any treatment or medical services received outside India.

30. Unrecognized Physician or Hospital:

• Treatment or Medical Advice provided by a Medical Practitioner not recognized by the Medical Council of India or by Central Council of Medicine or by Central council of Homeopathy.
• Treatment or Medical Advice related to one system of medicine provided by a Medical Practitioner of another system of medicine.
• Treatment provided by anyone with the same residence as an Insured Person or who is a member of the Insured Person’s immediate family or relatives.
• Treatment provided by Hospital or health facility that is not recognized by the relevant authorities in India.
• Treatment or service received in health hydros, nature cure clinics or any establishment that is not a recognized Hospital or healthcare facility.

31. Generally Excluded Expenses:

Any costs or expenses specified in the list of expenses generally excluded at Annexure.