;:'39 UNPRO'EN/EX'ER,ME,rIrnLTREATMENT:

j,
'+FF
,
'
unproven/Experiment_r
' .
r'sI'll'rlished medical practice
,.l_"._
tru"trl", is treatment, including
in rrrors'
--"vs ttr tnoiJunt drug Experiin€Dt?r
L^Pe'mentat thpr:.,, - . ir.l!
therapy, ,..1:-i
which is.

. {r.
not based on
covsRAGEs:
.{ .r .I il;t
Domicili,
o,ru"r"rrrl .Hcspitalization / Dcr-niciliary Treatmenr

*l;**:ini:Jii:.]::L;:uili:."#il:::
'-eait.i ';;,:.: ..'rn" ,.il.(,g
iT*T:, i1.,1[:t
rc the exient o, ilJJ,,"r:tl="$:: ;:,i;j.3,:;::
ror*o'no,
J ::':rn"o o, iii .t't"noin! T:r,o^:
ospiialization
exFenses and
Cencer,l
Pe';arvsis
ll;n:,.:i'l#i;T.",'-Tl:"iubercurosis'
t"t'ittt'""t''n*^"it"t, etvtlilnt;SardiacAirments' preur
,,.."jli:i,,lents, Pleur'
!'.'Jirson's ll1^T: "+: Hi : ::'';.:tl
;: ii,,,:: fi "#
niprheria,'i;1,'-11:tn.:,.rcu
ffi i,lf :' :'#
*o ri:-Desiee
:i
"'iiTi
o'"''''
fi
I

^
;

vnou'-'nro,.nii-.1lin"'"'
""ii'li';
^'in"l:::3' -nvoott'v'oit]'#"''llnot
inJ,,llj^l^'
x 5: ; : fl 3
ttl'ii"^n'i""tu'
caused bv smttingl
" "'

1,..rs1,. , tro,y.r:::r:-N""-ir."i"i,.'ljl1:l"l '"

r:T;"1;:iiIffi
''
tt'
tharnaticr,r, lilj#ft:[ii:l,i*llg",;i,-*t*,'r#;t-
.uq,,"t..'Jir.;rii;
obesitv), any ]i:.:no /
srrp,)r{;5-.nts,"--
animar/rei;,,";,;;;; nt'ttintu-sclerosis
mo
!uwrsu
oy accidents,}ti

org.an rerared ,r'r'rr.j; dvstrophies':;t;;;;;t"'"euron diseaset" q'etus

r.n;"",-Slltoporor';r,.
connective
1::"-'
t.,irborisrn ,ri,:::Y"t' n,."'i",]
n,,",.0",1 '1,,;:::'::1,T:"n,
'"r,i.:fl'onn"'o"' ;;;;.:;ir
sickre .u,, o,'..r"]t;:H:,::::ea svndron,ei""il","","o

, ;;
lil*., i,
::it: ^ * " !:*h,.;! :;
I
l*'J t ,,fi:",j'J. ';ill,ililili x l#i,h
"""1 :onsidered;,;ffi,^f_?*?JllT;.f,i1,"_lJ
irr)e cosr
r, rrnbursed
or |
rJil:'"ut,
InvestiSations

: o;n..,, il, ;,:1j,[:ffTi:,,,.".,.fi,;1#i:,H'l'jj iT,.

' ror a period 5tated,'the p-rescrinr;^- ,".,. ",
in respect
;+":::i"il'[?ifftflif:x]tii,fiff:i#*:
,^r.,.'-"utttg ooCto[
o"",l,i
-"orr oe
""'""''"*n-01";: "i;:-ir;:
not py.6^i:-_:-^vr'rvu / of tf,, and

3 2 cr,t far ,lness to

ou provided to
tlie t
^_^,-,-

:
,
. on rnception ,t tn e .,,- ,- .

ilj*ff: ;:jiit;$;i*,1$+#jii,,,., T,/tr,j.::ffi:#iini:::ilr )l

" Cancer in.ruo;ng:

L"rkemia

L'
-36_-

t\
J)

--qr.,-_>__.&,!
 itr+i#r'!i_ ::,,]i
Fir:Sq:l'r.i:
li.l=...';i
:i::::+:,.
.,t:
":i
..i:.
.*ii:i!;, '': .rari::-'

l'1 :,:. tr.:

i":+:i1.1 ..-
,i:, :iti:: :

:.: .' . t : '_ , : ' I ::r,

End Stage Liver Disease

'Heart Attack
"+-

Kidney Faiftire te

Heart Valve RePlacement SurgerY

to ciairn ihis benefit. Further.tire Employee can claim tire cost of hospitar.ization
Hospitalization is not reqr.rired
on the sarne from the Group Mediclaim Policy as cashless / reimbursement of expenses for the treatment taken

. bY him. /
3.3 Expenses on Hospitalilation for minimurn period cf a day are admissibie. However, th;s tirne iimit is not applied
rc sPecific treatments, such as

Adenoidectomy Hae;.ro diatysis

enclectomy Fissureetb I Fistr.rlectomy

Ascitic y' Fiuerat ta l,.lasloidect
Auroplasty' not Ccsrnetic. in natu re Flvdrocele
5i Coicn ai'y ang,iography /Re ne! i :4 lHi'sterectontY
FivsterectomY
Coronary a asI i ts i tneuinaly' ventral,i umbiiical femoral hernia

ir 7.: ! Par'::rteral chenlotl-teia'Jv

i8 D&C I zl i Fol\,r'sctomv
i--._
tt
Exci si o n of cyst/ 5:E nu ! o n', a;'l u rn p//i'j-: ro;
Eve s l3 I Sepioplasty
Fractrrre includi hairlir're f ract u re /dislocation 29 i Piies/ fistula
Radioiherapy *;]=*q'e11;gqq
Cherr-r o t h e r a py i r,ci u di rrg pa re nta t c6e inothera py

1,1 Lithotri
1C Incision anci dr of al:scesr jl. i Liv.r asoir.rtjan I

Varicocelecto nl' 3J lScl'.roti-re''aPY

$/cunc, suil!ri 35 | Variiose Vein Li3atiorr
All :.copies alongl r"vith
.:
Operations/Micro surgical bperations on the nose,
middle earlinternalear, toftgue, mouth, face, nibarlBuncture
37 Lu
tonsils & adenoids, sa,livary g]ands & salivary ducts,
breast, skin & subcrrtarusus tlssues, digestive
tract, female/rnale sexual organs.

This conCition ,.';iil also not apply in case of stitv irr hospital o{ le-''s t}ran 3 dav provided -

.tbint Note-2-t 14t:; ,aIs

/l ga -37-
/t
u)- ;,
 ,g{+Bt;#!.',,!fl a,{.+"rti;U5
al'' o,,;il"if, riu;lil
{',a!se 3::l) undbr, the ,leit
;:,i

., idatilrop?thy
:: if such treat;i
governmbnt.

3.5 M.{\TERNIIY EXPENSES '

BEA'EFIT EXTENSION
Tne hospitalizat,-
nr a t e r n iy i:, ";fr oi:ff
:jr1" ff :[ffi.',il" I,,ll can
i
be covered
",0; and-Rs. i
t,orrrra I De Iivery. : within
; ;:' 'l,:l"d#y
: ",
rr,OOO)-. i", *sarean u'u wiri iu'
. t.
"r::
Section=
Spcr:*i cc'nditions
applicabre to Maternity
expenses Benefit
Extension:
i" g months ,(rrrnrperiod
under marernity benefit
will be waived from the
iir,. pre-natar poricy.
^ & post.natai charge:
ays and 6o days
,"iul, ",rv, ,;::ffi::;l,l",';Ifi jil:i:,":'"
covered under the
poriiv ,p to :o
-|il h..lissed
iilisg;iiltit
v"t"rnii7b"r'ticns ' or abcriions induced
bi, accicents aie cove
tv' red under the limit
co-pri.at;onq.
cations' in Matern,ty of
rarourd
^r-'^-- inctuding operations.
for extra uterino pregnancv
v,"o".,::;.:'.:::#l;.T.jI.':"',',,,"0I..,i;:il:::ine ectopic presnancy

c,a m," ;";;.;:, ; ;:il:,J"TJ*i:l :::;:::1:J:

lat-1 Day one ". _ o* of chi,dien
Cover:. rvew iorn_bab
b e b T d u ri n g nr
a.' e rn i r A, expense,,n.u,.
";rid".;;;#; "'rlli,::io the
v
[ :il,:_T
nrateitttu"n-.,li'lo.=il,'iltr"i:" the ner'v born "
However if rhe babv.^",.-:-':-"reornad"diiicn .
'-
burrer ,"0r,[i',0"i:;::ff"},;1"u" the san,e shar be

')-,
^ j":idi: ;:ia'.;.ij:f[':;:il9;:"1:]1,.t,:," ,o ,o
attLal maxinrum ,,.r^ olr.,i,=l .to honre if ^,_,,,,: ?,i o:,trip
rtorn hosPiial
mt
to hospita, a,,d
/ or f ra..f-.
on rransrer rron,
d Auto expenses in t"
avairabirity Jj:::]'"*;ffi or
i E ",
p,..-e*i.tine-o,,u",*,/.Airnients:r,..i::fffriJ::*":il,,:il:;;o,,'noln"' center due to Non 6''
r'-vuJc) dr e covered d1i"t tn" lcheme.
3.9 crngcnitar An
anornaries"r.."J::'""i'r:::ffijilrt'uut,nun, or Consenirar:rn;e.rnar ,'........
/ Exiernar diseases,
dere*s
3'1o Psychiatric diseases: -
[xpenses for .

''or withb'trt hospitaiization. -' treatmpnr

""tment ar ^-.._,
of'pslzcl.riatric and'piychosomaticdisea.ses
be payabre with

/ r---;T"kiir- j {ay 2Ot 5

v-/ V ^L
(/
_?o
 :?:i
:::a:;:

'-.'1.'-,.ri'.1111 rli
3,12 =r
.-:.'''...:.-::l.,.1'.;]:i:..'.
t :,r. . ': l
, ,
. ::....,;i r -::.::
,

3.13 Taxes and other Charges : All Taxes, Surcharg9s.,,*.tuj:: Charges , Registralion'charges, Admissisn
Charges , Nursing , and Administration charges
-Z to bepayable'
Charges ior diapers ancl sanitaiy pads are payable if necessary.as part of the treatment .+
Charges'for Hiring a nurse f attendant during hospitalizat'lcn will be payable only In case ot
recornmendation from the treating doctor in case ICU / CCU, Neo nata] nursing care or any other ei6e
where the patient is critical and requiring special care.

3.1.4 Treatrnent for Ge|retic Disorder and stem cell theiapy is covereC under the scheme.

3.1S Treatment for Age related Macular Degeneration (ARMD), treatment such as Rotbtional Field Quantum
Resonance (RFaMR), Enhanced Ex.fernal Counter Pulsation (EECP), etc. arfcovereC uncler the
. magnetic
scheme. TreattRent for all rreurotog,ical/ rnacular degenerative ciisorders shall be covered unCer the
scheme.

3.i6 Rental Charges t,{edical equipmeni of any kind used fcr diagncsls and or
for Exteinal and or curable
treatmenl includirrg CPAP, C.6.PD, Bi-PAP, Infusion pump etc. wiit be covered under the scheme. However
- purchase of the above eguipment to be subsequently used at home irr exceptional cases on medicai
advice shall be covered.
:
-J.li Anrbulatorv cler.,ices i.e., rvalker. cruiches.'Belts, Collars, Caps, Si:;!ii'its, Slings, Biaces, Siockings,
elastocrepe ba6dages, er:iernai oiihooaai:c pacs, sud cuianeous insirlirr pump, Diabetic foot ".''ear,.
Glucorneter iilrcluding Glucose'Tes,t Sirips)/ l'.Jebullzer/ prosthetic devisei Thermorne!er', aipha / v"ater
bec ancj sir-,iilr;- r-el::..::i it:ms etc., v;ili ba co'.,:red un{er the scherne-

3.18 piivsiotnerapy chai;es: Phi:iotherap'; cii:rg,e: siqaii be cc'"ered fri ilre 1;erictl soecified t.1zTtre Niledica!
Practi(iolleleven ii takerr at hcrne' '*
L

All clailis acjmitted ir-i re:peti of ar':y1ail insiirei] oerson/s Curing th'e period c{ ir{surence shall nct erieed
tl-re Sum Insrrred staied in the sci'reCtri,: a1;d Corporate Suffer if aiio/caie.l j

J\,\
The company shali not i:e liabte tc iriake any il:iiment uncler this poic;, i;r re5ii€ci of ar-ry €'x'Je;-,,,,:s
".'llatsoevet
irr,rtrred by any lnsureil Per:cn in connection r,''iil', or in respect of :

i tut of Foreign
4.1lfi.lury ciisease ctirectly oririclirectly carrsed by cr aiising from or a'.triroutable to War, irrvasio5'r,
I
ll €n€m!; War like operations (rvhetlrer rvar be declared or no!).
l1
4,2 a. Circumclsiorr unle-<s necessary for treaiment of a dgeise not excluded heieurrder or as may. be
' necessitated due to an accideni.

b. Vaccination or inoculat;on.

c. Change of life or cosnletic or aesthetic treatment cf any descriptio|l is noi covei'ed.

-39-
:.1i.ff ixijt l,,t
"*:::.t=::,*,,t,
,

ir-,.:.:; i: ' t.:,:,,

,-
i"'-iL '

reraiinsdisorders,[";,;";;::J::,'##j1,1;L'mi:*ffJ:?ili,;"11yyqoi= ].,,::'::
''"
\llexpenses - - ut intoxicatitr;;rffi:tt:;nt;;tment:
-' tntoxicatibn
ljt-":f:t:: arising out of anv
drugiy' a'##
"^.^,.,^- ,. .
any .onoition oir".r.
;l#:ffj::::."y:;J",:";:,i:,3:1,"fi1ffi;ij;.j,ffTiii.l::1;lociareo *i,r, [;i,
4.7
AT:il::T#
**nil::'J,T :s.not":l::'t
i',liJ:,:.1.
:,',:,:':':.1, ", u o,, $,
"r.Nursins {
v,.ith ::TIj:j:j,,i:.I:j,,,;:::::
consistent
;illj3.:,:, ,nlur, .i.li,"i,l**::,::
n.o-_^-
existeflce of presence or ,^.0-",.:,ory examinarions
i::i'ffi;;::"""?::iiri:##;1,",i'1il#ii*.i:"*;'-:::1":'"?:"J"'"J;i"?1'ff'"J
Itiursing Home, dr;ment, sickrress
;:^=^"'
ecornmendecl or injury, ior v
or
by the attend,;; requi.ed'ar a
4() ;;;;; HospitaiZ
anc ronics unress (^ - _-.
i;',H:il lhi;i,;"' 'u,rrng part o!, trestme^r fcr
injury cr disease.s
as certified
1.9 by the

4-10 All non-medicar 'uutect to by nuclear weapon

evpsi-.5sg inclurJino
including cor
a^^ .^ . / rnaieriars.
reievision, r,r"'-:1O""us
j
;::",T,:..1,; :u ; T#, tr. il ff"."';;,i;: :: #iff [, i:: :papet :"
u, o n. n *
: : ;,'i i :
-rnless
and .ul..ron:,nt^|:_
11, ;
)ey are necessitated
"
diepers,

5. .n ^,^,+.^
CONDITTONS: _

5-1 Coniract: the n.^^^--, .

ProPosal form' decl
raration, and the
i/
inrrr.n.u.tnu poiicy issued
shatt conititute
' : the complete
contract or
5.2 Every .
notic or communication
. sh"rr
A
o. .o.l
DM',,'ol,t-':lf:i ;:JilH jti|il: :*il :l"r"''l'
regarding hospitilization

:
b e s ven ., under this Policy
communical red
'5,;::t*;:j:: :,
Tiou

5.3
to the poricy,,,",,J.i,l..t. '.;";;;: ,:il; 'i.,,?.,,nn ,n,*o'on-*rJ
to the policv
The premiur pavable be
'rnay
except on ,J
under this policy
shall ue paia l:
ii ac
_ lt;::: s :,"d :il 1: :::t;::#*i; ,';* i:: lu:,, : :r ffi :J,':: :;: : y,,, ",, uu,*,.
;r:'fi ;.,#*ifi.,;::ffi l:=,[iT:d]:ffi;:r;;';]"*;
of this poricy.s-rrar i:#ffi
*",u",. .;;;;r]€eecJent'to ",.,n ,,.oilttlins
be'done t-o-'
or'

-J-'defon w*
be valid unless "; j:.,H
n! ;.::;;
fl :::*lJ,h*$:l:;::l:il::
.. v \,,u, rseo
of ficial of the Company.

EL -+u-