Employee Policy Conditions

Sr. No.

1

Hospitalization Expenses:

Operation Theatre, OT Consumables and Recovery Room, Prescribed medicines, drugs and dressing for in-patient expenses incurred during the Pre & Post hospitalization (30-90 days respectively)

Covered

2

Pre- Existing Diseases / Ailments :

Covered

3

Congenital Anomalies:

Treatment of Congenital Internal / External diseases, defects anomalies

Covered

4

Nursing & Attendant :

iii. During Hospitalization will be payable only in case of recommendation from treating Doctor.

ii. In cases of ICU /CCU or any other case where the patient is critical and requiring Special Care.

iii. This benefit pays for the services of a qualified and registered nurse benefit for the medically necessary

Covered

5

Surgical & Anesthetists’ Fees :

Surgeon / Team of Surgeons / Assistant Surgeon and Anesthetists’ fees in case of Hospitalization.

Covered

6

Specialist Physician’s fees :

This benefit will be paid in full for regular visits by a specialist physician during stays in the hospital including intensive care by a specialist physician for as long as is required by medical necessity.

Covered

7

Surgical Procedures :

Surgical procedures (inclusive of Doctor’s & Medical Practitioner fees) in care of Hospitalization

Covered

8

Laboratory / Diagnostic Tests, X-Ray, CT Scan, MRI, any other scan:

Covered in case Hospitalized

9

Nebulization, RMO charges, Blood, Oxygen, Dialysis:

Covered in case Hospitalized

10

Psychiatric diseases:

Expenses incurred for treatment of psychiatric and psychosomatic diseases

Covered

11

Advanced Medical Treatment:

All new kinds of approved advanced medical procedures for e-g. laser surgery, stem cell therapy for treatment of a disease is payable on hospitalization /day care surgery

Covered

12

Genetic Disorder and stem cell therapy:

Covered

13

Treatment for Age related Macular Degeneration (ARMD), treatment such as Rotational Field Quantum Magnetic Resonance (RFQMR), Enhanced External Counter pulsation (EECP), etc,

Treatment for all neurological/ macular degenerative disorders shall be covered under the scheme

Covered

14

Enhanced External Counter Pulsation (EECP):

i. Angina or Angina equivalents with poor response to medical treatment and when patient is unwilling to undergo invasive revascularization procedures.

ii. Ejection fraction is less than 35%.

iii. Co-morbid conditions co-exist which increase the risk of surgery e.g. DM, Congestive Cardiac Failure, Cor. Pulmonale, Renal dysfunction, Ischemic or Idiopathic Cardio Myopathy.

Covered

15

Rental Charges: External and or durable Medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Bi-PAP, Infusion pump etc.

Covered

Purchase of the equipment to be subsequently used at home in exceptional cases on medical advice shall also be covered

16

Physiotherapy Charges: The period specified by the Medical Practitioner even if taken at home

Covered

17

OPD Treatment:

Covered in case of Accidents

18

Alternative Therapy :

Reimbursement of Expenses for Hospitalization or Domiciliary treatment under the recognized system of medicines , viz. Ayurvedic ,Unani, Sidha, Homeopathy, if such treatment is taken in a clinic / hospital registered, by the central and state government

Covered

19

Change of Treatment:

Covered in case recommended by Doctor

20

Ambulatory Devices :

Ambulatory devices i.e., walker, crutches, Belts, Collars, Caps, Splints, Slings, Braces, Stockings, Elastocrepe bandages, external orthopedic pads, Subcutaneous insulin pump, Diabetic foot wear, Glucometer (including Glucose Test Strips) / Nebulizer/ prosthetic devise/ Thermometer, alpha I water bed and similar related item

Covered

21

Mortal Remains :

Covered upto a limit of Rs. 10,000/-

22

Dental Root Canal Surgery:

Covered upto a limit of Rs. 7,500/- per annum

23

Taxes and other Charges:

All Taxes, Surcharges, Service Charges, Registration charges, Admission Charges, Nursing, and Administration charges to be payable. Charges for diapers and sanitary pads are payable if necessary as part of the treatment. Charges for Hiring a nurse / attendant during hospitalization will be payable only in case of recommendation from the treating doctor in case ICU / CCU or any other case where the patient is critical and requiring special care

Exclusions

The Insurance Company will not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any Insured Person in connection with or in respect of:

• War like Operations: Injury/disease directly or indirectly caused by or arising from or attributable to War, invasion, Act of Foreign enemy and War like operations (whether war be declared or not).

• Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident.

• Vaccination or inoculation.

• Cosmetic Surgeries: Change of life or cosmetic or aesthetic treatment of any description is not covered.

• Plastic surgery other than as may be necessitated due to an accident or as part of any illness.

• Cost of spectacles and contact lenses, hearing aids.

• Dental treatment or surgery of any kind which are done in a dental clinic and those that are cosmetic in nature excluding Root Canal Surgeries with a limit of INR 7500/- per person.

• Convalescence, rest cure and General debility

Domiciliary Hospitalization / Domiciliary Treatment on outpatient basis : Medical expenses incurred in case of the following diseases which need Domiciliary Hospitalization /domiciliary treatment as may be certified by the attending medical practitioner and or bank's 'medical officer shall be deemed as hospitalization expenses and reimbursed to the extent of 15% on basic SI under domiciliary treatment. The cost of Medicines, Investigations, and consultations, etc. in respect of domiciliary treatment shall be reimbursed for the period stated by the specialist and / or the attending doctor and / or the bank's medical officer, in Prescription. If no period stated, the prescription for the purpose of reimbursement shall be valid for a period not exceeding 90 days. adorable bridesmaid items for teenagers

• Cancer

• Diphtheria

• Wilson's disease

• Leukemia

• Malaria

• Ulcerative Colitis

• Thalassemia

• Non-Alcoholic Cirrhosis of Liver

• Epidermolysisbullosa

• Tuberculosis

• Purpura

• Venous Thrombosis(not caused by smoking)

• Paralysis

• Typhoid

• Aplastic Anaemia

• Cardiac Ailments

• Accidents of Serious Nature

• Psoriasis

• Pleurisy

• Cerebral Palsy

• Third Degree burns

• Leprosy

• Polio

• Arthritis

• Kidney Ailment

• All Strokes Leading to Paralysis

• Hypothyroidism

• All Seizure disorders

• Hemorrhages caused by accidents

• Hyperthyroidism

• Parkinson's diseases

• All animal/reptile/insect bite or sting

• Expenses incurred on Radiotherapy and Chemotherapy in the treatment of Cancer and Leukemia

• Psychiatric disorder including Schizophrenia and Psychotherapy

• Chronic pancreatitis

• Any organ related (chronic) condition

• Tumor

• Physiotherapy

• Sickle cell disease

• Diabetes and its complications

• Immuno Suppressants

• Systemic lupus Erythematous (SLE)

• Hypertension

• Multiple sclerosis / motor neuron disease

• Any connective tissue disorder

• Asthma

• Status Asthmatics

• Varicose veins

• Hepatitis – B

• Sequalea of Meningitis

• Thrombo Embolism Venous Thrombosis / Venous Thrombo embolism (VTE)

• Hepatitis – C

• Osteoporosis

• Growth disorders

• Hemophilia

• Muscular Dystrophies

• Graves' disease

• Myasthenia gravis

• Sleep apnea syndrome(not related to obesity)

• Chronic Pulmonary Disease

• Glaucoma

• Swine flu

• Chronic Bronchitis

Day Care Benefits: Expenses on Hospitalization for minimum period of a day are admissible. However, this time limit is not applied to specific treatments, including

• Adenoidectomy

• Haemo dialysis

• Eye surgery

• Appendectomy

• Fissurectomy / Fistulectomy

• Fracture including hairline fracture /dislocation

• Ascetic / Plueral tapping

• Mastoidectomy

• Radiotherapy

• Auroplasty not Cosmetic in nature

• Hydrocele

• Chemotherapy including parental chemotherapy

• Coronary angiography /Renal

• Hysterectomy

• Lithotripsy

• Coronary angioplasty

• Inguinal/Ventral/Umbilica /Femoral Hernia

• Incision and drainage of abscess

• Dental Surgery

• Parenteral chemotherapy

• Varicocelectomy

• D&C (Dilation & Curettage)

• Polypectomy

• Wound suturing

• Excision of cyst / granuloma / lump / tumor

• Septoplasty

• Sclerotherapy

• FESS

• Piles / fistula

• Varicose Vein Ligation

• Tonsillectomy

• Prostrate surgeries

• All scopies along with biopsies

• Liver aspiration

• Sinusitis surgeries

• Lumbar puncture

• Operations/Micro surgical operations on the nose, middle ear / internal ear, tongue, mouth, face, tonsils & adenoids, salivary glands and salivary ducts, breast, skin & subcutaneous tissues, digestive tract, female / male sexual organs

• The treatment is undertaken under General or Local Anesthesia in a hospital /day care Centre in less than a day because of technological advancement; and which would have otherwise required hospitalization of more than a day.

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