4.1 During the period of insurance cover, the expenses on treatment of following ailment / diseases / surgeries for specified periods are not payable if contracted and / or manifested during the currency of the policy.
i |
Benign ENT disorders and surgeries i.e. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty etc. |
1 year |
ii |
Polycystic ovarian diseases . |
1 year |
iii |
Surgery of hernia. |
2 years |
iv |
Surgery of hydrocele. |
2 years |
v |
Non infective Arthritis. |
2 years |
vi |
Undescendent Testes. |
2 Years |
vii |
Cataract. |
2 Years |
viii |
Surgery of benign prostatic hypertrophy. |
2 Years |
ix |
Hysterectomy for menorrhagia or fibromyoma.or myomectomy or prolapse of uterus . |
2 Years |
x |
Fissure / Fistula in anus. |
2 Years |
xi |
Piles. |
2 Years |
xii |
Sinusitis and related disorders. |
2 Years |
xiii |
Surgery of gallbladder and bile duct excluding malignancy. |
2 Years |
xiv |
Surgery of genito urinary system excluding malignancy. |
2 Years |
xv |
Pilonidal Sinus. |
2 Years |
xvi |
Gout and Rheumatism. |
2 Years |
xvii |
Hypertension. |
2 Years |
xviii |
Diabetes. |
2 Years |
xix |
Calculus diseases. |
2 Years |
xx |
Surgery for prolapsed inter vertebral disk unless arising from accident. |
2 Years |
xxi |
Surgery of varicose veins and varicose ulcers. |
2 Years |
xxii |
Congenital internal diseases. |
2 Years |
xxiii |
Joint Replacement due to Degenerative condition. |
4 Years |
xxiv |
Age related osteoarthritis and Osteoporosis.. |
4 Years |
4.2 Injury or disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, War like operations (whether war be declared or not) or by nuclear weapons / materials.
4.3 Circumcision (unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to any accident), vaccination, inoculation or change of life or cosmetic or of aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
4.4 Cosmetic surgery for correction of eye sight, cost of spectacles, contact lenses, hearing aids etc.
4.5 Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalisation for treatment.
4.6 Convalescence, general debility, “run down” condition or rest cure, congenital external diseases or defects or anomalies, sterility, any fertility, sub-fertility or assisted conception procedure, venereal diseases, intentional self-injury/suicide, all psychiatric and psychosomatic disorders and diseases / accident due to and or use, misuse or abuse of drugs / alcohol or use of intoxicating substances or such abuse or addiction etc.
4.7 All expenses arising out of any condition directly or indirectly caused by, or associated with Human T-cell Lymph tropic Virus Type III (HTLD - III) or Lymohadinopathy Associated Virus (LAV) or the Mutants Derivative or Variations Deficiency Syndrome or any Syndrome or condition of similar kind commonly referred to as AIDS, HIV and its complications including sexually transmitted diseases..
4.8 Expenses incurred at Hospital or Nursing Home primarily for evaluation / diagnostic purposes which is not followed by active treatment for the ailment during the hospitalised period.
4.9 Expenses on vitamins and tonics, mineral bottled water and allied items unless forming part of treatment for injury or disease as certified by the attending physician.
4.10 Any Treatment arising from or traceable to pregnancy, childbirth, miscarriage, caesarean section, abortion or complications of any of these including changes in chronic condition as a result of pregnancy. .
4.11 Naturopathy treatment, unproven procedure or treatment, experimental or alternative medicine and related treatment including acupressure, acupuncture, magnetic and such other therapies etc.
4.12 Expenses incurred for investigation or treatment irrelevant to the diseases diagnosed during hospitalization or primary reasons for admission. Private nursing charges, Referral fee to family doctors, Out station consultants / Surgeons fees etc.
4.13 Genetical disorders and stem cell implantation / surgery.
4.14 External and or durable Medical / Non medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Infusion pump etc., Ambulatory devices i.e. walker, Crutches, Belts, Collars, Caps, splints, slings, braces, Stockings etc of any kind, Diabetic foot wear, Glucometer / Thermometer and similar related items etc and also any medical equipment which is subsequently used at home etc.
4.15 All non medical expenses including Personal comfort and convenience items or services such as telephone, television, Aya / barber or beauty services, diet charges, baby food, cosmetics, napkins, toiletry items etc, guest services and similar incidental expenses or services etc.
4.16 Change of treatment from one pathy to other pathy unless being agreed / allowed and recommended by the consultant under whom the treatment is taken.
4.17 Treatment of obesity or condition arising therefrom (including morbid obesity) and any other weight control programme, services or supplies etc.
4.18 Any treatment required arising from Insured’s participation in any hazardous activity including but not limited to scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing etc unless specifically agreed by the Insurance Company.
4.19 Any treatment received in convalescent home, convalescent hospital, health hydro, nature care clinic or similar establishments.
4.20 Any stay in the hospital for any domestic reason or where no active regular treatment is given by the specialist.
4.21 Out patient Diagnostic, Medical and Surgical procedures or treatments, non-prescribed drugs and medical supplies, Hormone replacement therapy, Sex change or treatment which results from or is in any way related to sex change.
4.22 Massages, Steam bathing, Shirodhara and alike treatment under Ayurvedic treatment.
4.23 Any kind of Service charges, Surcharges, Admission fees / Registration charges etc levied by the hospital.
4.24 Doctor’s home visit charges, Attendant / Nursing charges during pre and post hospitalization period.
4.25 Treatment which is continued before hospitalization and continued during and after discharge for an ailment / disease / injury different from the one for which hospitalization was necessary.