SCHEME DOCUMENT

Customized exclusively for the registered customers of FINZOOMERS SERVICES PVT LTD

ABOUT CARE HEALTH INSURANCE LIMITED

CARE Health Insurance Limited (formally known as Religare Health Insurance Company Limited) is focused on the
delivery of health insurance services. Our promoter's expertise in the spectrum of financial services, healthcare
delivery and preventive health solutions, coupled with a robust distribution model, offers us a unique edge to
deliver and excel in a business environment that hinges on serviceability and scale. Powered by the best-in-class
product design and a customer centric approach, CARE Health Insurance Limited is committed to delivering on its
innate values of being a responsible, trustworthy and innovative health insurer. CARE Health Insurance Limited is
promoted by these strong entities- Religare Enterprise & Union Bank of India.

POLICY CONDITIONS & BENEFITS

Particulars Description
Coverage Details
Cover Type Individual/Floater
Relationship Type Self/Spouse/4 Dependent Children
Entry Age - Min Adult: 18 years Child:91 Days
Entry Age - Max Adult: 65 years Child: 24 years
Exit Age Adult: Lifelong* Child:25 years
Pre-policy Medical Check-up NO, Good health declaration basis
Policy Tenure 1 Year
Claims payout Cashless (within network) / Re-imbursement
Claims Servicing In - house

Covered Benefits
Hospitalization Expenses :-
Sum Insured (SI) in Rs. 5 Lac / 7 Lac / 10 Lac / 15 Lac
In - patient care Up to SI
Day Care Treatment Up to SI
Pre-hospitalization Medical
30 days
expenses
Post-hospitalization Medical
60 days
expenses
Domestic Road Ambulance Up to Rs.1,000 per hospitalization
Domiciliary Hospitalization Up to SI; if it continues for a period exceeding 3 consecutive days
50% of Sum insured for each claim free year , maximum upto 100% of
NCB
sum insured
Restoration Benefit Up to SI
Second Opinion Once per Major Illness / Injury per policy year
Donor Expenses Up to SI
Health Check-up Once per adult per policy year
Wait Period
30 Days Yes (except for Injuries/Accident)

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 Named Ailment (as defined in
24 Months
Group Care 360 Product)
Pre-existing diseases 24 Months

Sub-limits
On Room rent Single Private Room
ICU charges No Limit
List of Medical Tests covered as a part of Health Check-up
Complete Blood Count, Urine Routine, Blood Group, ESR, Fasting Blood Glucose, S Cholesterol, SGPT,
Creatinine

Policy Terms and Conditions

Preamble: The proposal and declaration given by the proposer and other documents if any shall form the basis of
this Contract and is deemed to be incorporated herein. The two parties to this contract are the Policy
Holder/Insured Members (also referred as Insured) and Care Health insurance Ltd. (also referred as Religare Health
Insurance Company), and all the Provisions of Indian Contract Act, 1872, shall hold good in this regard. The
references to the singular include references to the plural; references to the male include the references to the
female; and references to any statutory enactment include subsequent changes to the same and vice versa. The
sentence construction and wordings in the Policy documents should be taken in its true sense and should not be
taken in a way so as to take advantage of the Company by filing a claim which deviates from the purpose of
Insurance.

In return for premium paid, the Company will pay the Insured in case a valid claim is made:

In consideration of the premium paid by the Policy Holder, subject to the terms & conditions contained herein, the
Company agrees to pay/indemnify the Insured Member(s)/Claimant, the amount of such expenses that are
reasonably and necessarily incurred up to the limits specified against respective benefit in any Cover Period.

Policy Terms & Conditions

For the purposes of interpretation and understanding of the product the Company has defined, herein below some
of the important words used in the product and for the remaining language and the words the Company believes
to mean the normal meaning of the English language as explained in the standard language dictionaries. The words
and expressions defined in the Insurance Act, IRDA Act, regulations notified by the Insurance Regulatory and
Development Authority (“Authority”) and circulars and guidelines issued by the Authority shall carry the meanings
described therein. The terms and conditions, insurance coverage and exclusions, other benefits, various
procedures and conditions which have been built-in to the product are to be construed in accordance with the
applicable provisions contained in the product.
The terms defined below have the meanings ascribed to them wherever they appear in this Policy and, where
appropriate.

Definitions

1. Accidental / Accident is a sudden, unforeseen and involuntary event caused by external and visible
means.
2. Act of God Perils means and includes lightening, storm, tempest, flood, inundation, subsidence, landslide,
earthquake, cyclone, tsunami, volcano and other similar calamities;

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3. Actively at Work Refers to an employee who is actually at work on his/her eligibility date and performing
each and every duty of his/her present occupation on a customary and full- time basis. An employee shall
also be deemed actively at work if he/she is on annual leave and is not absent from work due to long term
illness, irrecoverable condition etc. If an employee is not actively at work on his/her cover start date,
he/she will not be covered.
4. Activities of Daily Living Applies to a member (who is eligible for cover under this policy) and who is aged
at least five 5 years old who cannot perform the following activities:
- Dressing: The ability to put on, take off, secure, and unfasten all garments and as appropriate, any
braces, artificial limbs, or other surgical appliances;
- Feeding: The ability to feed one’s self once food has been prepared and made available;
- Mobility: The ability to move indoors from room to room on level surfaces;
- Toileting: The ability to use the lavatory or otherwise manage bowel and bladder functions so as to
maintain a satisfactory level of personal hygiene;
- Transferring: the ability to move from a bed to an upright chair or wheelchair and vice versa;
- Washing: The ability to wash in the bath or shower (including getting into and out of the bath or shower)
or wash satisfactorily by other means.
5. Age means the completed age of the Insured Member as on his last birthday.
6. Alternative treatments are forms of treatments other than treatment “Allopathy” or “modern medicine”
and include Ayurveda, Unani, Sidha and Homeopathy in the Indian context.
7. Ambulance means a road vehicle operated by a licensed/ authorized service provider and equipped for
the transport and paramedical treatment of persons requiring medical attention.
8. Annexure means the document attached and marked as Annexure to this Policy.
9. Any one illness (not applicable for Travel and Personal Accident Insurance) means continuous period of
illness and includes relapse within 45 days from the date of last consultation with the Hospital/Nursing
Home where treatment was taken.
10. AYUSH Hospital is a healthcare facility wherein medical/surgical/para-surgical treatment procedures and
interventions are carried out by AYUSH Medical Practitioner(s) comprising of any of the following:
a. Central or State Government AYUSH Hospital or
b. Teaching hospital attached to AYUSH College recognized by the Central Government/Central Council
of Indian Medicine/Central Council for Homeopathy; or
c. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system
of medicine, registered with the local authorities, wherever applicable, and is under the supervision
of a qualified registered AYUSH Medical Practitioner and must comply with all the following criterion:
i. Having at least 5 in-patient beds;
ii. Having qualified AYUSH Medical Practitioner in charge round the clock;
iii. Having dedicated AYUSH therapy sections as required;
iv. Maintaining daily records of the patients and making them accessible to the insurance
company’s authorized representative; and
v. Having either Pre-entry level Certificate (or higher level of certificate) issued by National
Accreditation Board for Hospitals and Healthcare Providers (NABH) or State Level Certificate
(or higher level of certificate) under National Quality Assurance Standards (NQAS), issued by
National Health Systems Resources Centre (NHSRC)
11. AYUSH Day Care Centre means and includes Community Health Centre (CHC), Primary Health Centre
(PHC), Dispensary, Clinic, Polyclinic or any such centre which is registered with the local authorities,
wherever applicable, and having facilities for carrying out treatment procedures and medical or
surgical/para-surgical interventions or both under the supervision of registered AYUSH Medical
Practitioner (s) on day care basis without in-patient services and must comply with all the following
criterion:
i. Having qualified registered AYUSH Medical Practitioner(s) in charge;
ii. Having dedicated AYUSH therapy sections as required;

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 iii. Maintaining daily records of the patients and making them accessible to the insurance company’s
authorized representative; and
iv. Having either Pre-entry level Certificate (or higher level of certificate) issued by National
Accreditation Board for Hospitals and Healthcare Providers (NABH) or State Level Certificate (or
higher level of certificate) under National Quality Assurance Standards (NQAS), issued by National
Health Systems Resources Centre (NHSRC)

12. Assistance Service Provider means the service provider specified in the Policy Schedule or as appointed
by the Company from time to time.
13. Cashless Facility means a facility extended by the insurer to the Insured where the payments, of the costs
of treatment undergone by the insured in accordance with the Policy terms and conditions, are directly
made to the network Provider by the company to the extent pre-authorization approved.
14. Certificate of Insurance means the certificate the Company issues to an Insured Member evidencing
cover under the Policy.
15. Claim means a demand made in accordance with the terms and conditions of the Policy for payment of
the specified Benefits in respect of the Insured Member as covered under the Policy.
16. Claimant means a person who possesses a relevant and valid Insurance Policy which is issued by the
Company and is eligible to file a Claim in the event of a covered loss.
17. Common Carrier means any civilian land or water conveyance or Scheduled Airline in each case operated
under a valid license for the transportation of passengers for hire.
18. Company (also referred as Insurer/We/Us) means CARE Health Insurance Company Limited ( formally
known as Religare Health Insurance Co. Ltd).
19. Condition Precedent shall mean a Policy term or condition upon which the Insurer’s liability under the
Policy is conditional upon.
20. Congenital Anomaly refers to a condition(s) which is present since birth, and which is abnormal with
reference to form, structure or position :
(a) Internal Congenital Anomaly –
Congenital anomaly which is not in the visible and accessible parts of the body
(b) External Congenital Anomaly –
Congenital anomaly which is in the visible and accessible parts of the body
21. Co-payment is a cost-sharing requirement under a health insurance policy that provides that the
policyholder/insured will bear a specified percentage of the admissible claim amount. A co-payment does
not reduce the sum insured.
22. Cover End Date means the date specified in Annexure ‘A’(Certificate of Insurance) for the respective
Insured Member on which the Insured Member’s cover under the Policy expires.
23. Cover Period means the period commencing from the Cover Start Date and ending on the Cover End Date
for each Insured Member as specified in Annexure ‘A’ (Certificate of Insurance).
24. Cover Start Date: means the date specified in Annexure ‘A’ (Certificate of Insurance) for the respective
Insured Member on which the Insured Member’s cover under the Policy commences.
25. Country of Residence means the country in which the Insured Member is currently residing and as
specified in the Insured’s address in the Certificate of Insurance
26. Day Care Centre means any institution established for day care treatment of illness and/or injuries or a
medical setup within a hospital and which has been registered with the local authorities, wherever
applicable, and is under the supervision of a registered and qualified medical practitioner AND must
comply with all minimum criteria as under—
(a) has qualified nursing staff under its employment;
(b) has qualified Medical Practitioner/s in-charge;
(c) has a fully equipped operation theatre of its own, where Day Care Treatment is carried out.
(d) maintains daily records of patients and will make these accessible to the insurance company’s
authorized personnel.
27. Day Care Treatment means medical treatment, and/ or Surgical Procedure which is:
(a) undertaken under general or local anesthesia in a Hospital/ Day Care Centre in less than 24
consecutive hours because of technological advancement, and

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 (b) which would have otherwise required a Hospitalization of more than 24 consecutive hours.
Treatment normally taken on an out-patient basis is not included in the scope of this definition. As listed
in Annexure “I”
28. Deductible is a cost-sharing requirement under a health insurance policy that provides that the Insurer
will not be liable for a specified rupee amount in case of indemnity policies and for a specified number of
days/hours in case of hospital cash policies which will apply before any benefits are payable by the
insurer. A deductible does not reduce the Sum Insured.
Note: Under this Policy, deductible for a specified number of days/hours is applicable on the following
Benefits in addition to the deductible applicable on Indemnity / hospital cash benefits
29. Dental Treatment means a treatment related to teeth or structures supporting teeth including
examinations, fillings (where appropriate), crowns, extractions and surgery.
30. Dependent means a person who is a member of the Primary Insured Member’s family who is legally
wedded spouse, natural or legally adopted child, dependent parents, dependent parent-in-law,
dependent brothers , dependent sisters and who is named in Annexure “A” to the Policy as an Insured
Member;
31. Dependent Child refers to a child (natural or legally adopted), who is financially dependent on the
primary insured or proposer and does not have his/her independent sources of income.
32. Disclosure to Information Norm: The Policy shall be void and all premium paid hereon shall be forfeited
to the Company, in the event of misrepresentation, mis-description or non-disclosure of any material fact.
33. Domiciliary Hospitalization means medical treatment for an illness/disease/injury which in the normal
course would require care and treatment at a Hospital but is actually taken while confined at home under
any of the following circumstances:
(a) The condition of the patient is such that he/she is not in a condition to be removed to a
Hospital, or
(b) The patient takes treatment at home on account of non-availability of room in a Hospital.

34. Diagnosis means pathological conclusion drawn by a registered medical practitioner, supported by
acceptable Clinical, radiological, histological, histo-pathological and laboratory evidence wherever
applicable.
35. Emergency Care (Emergency) means management for an illness or injury which results in symptoms
which occur suddenly and unexpectedly and requires immediate care by a medical practitioner to prevent
death or serious long term impairment of the insured member’s health.
36. Grace Period means the specified period of time immediately following the premium due date during
which payment can be made to renew or continue a Policy in force without loss of continuity benefits
such as waiting periods and coverage of Pre-existing Diseases. Coverage is not available for the period for
which no premium is received.
37. Hazardous Activities (or Adventure sports) means any sport or activity or Adventure sport, which is
potentially dangerous to the Insured whether he is trained or not. Such sport/activity includes stunt
activities of any kind, adventure racing, base jumping, biathlon, big game hunting, black water rafting,
BMX stunt/ obstacle riding, bobsleighing/ using skeletons, bouldering, boxing, canyoning, caving/ pot
holing, cave tubing, rock climbing/ trekking/ mountaineering, cycle racing, cyclo cross, drag racing,
endurance testing, hand gliding, harness racing, hell skiing, high diving , hunting, ice hockey, ice
speedway, jousting, judo, karate, kendo, lugging, risky manual labor, marathon running, martial arts,
micro – lighting, modern pentathlon, motor cycle racing, motor rallying, parachuting, paragliding/
parapenting, piloting aircraft, polo, power lifting, power boat racing, quad biking, river boarding, scuba
diving, river bugging, rodeo, roller hockey, rugby, ski acrobatics, ski doo, ski jumping, ski racing, sky diving,
small bore target shooting, speed trials/ time trials, triathlon, water ski jumping, weight lifting or wrestling
of any type.
38. Hospital (not applicable for Overseas Travel Insurance) means any institution established for in-patient
care and day care treatment of illness and/or injuries and which has been registered as a hospital with the
local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the
enactments specified under the Schedule of Section 56(1) of the said Act OR complies with all minimum
criteria as under:
(a) has qualified nursing staff under its employment round the clock;
(b) has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at least 15
in-patient beds in all other places;
(c) has qualified Medical Practitioner(s) in charge round the clock;

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 (d) has a fully equipped operation theatre of its own where surgical procedures are carried out;
(e) maintains daily records of patients and makes these accessible to the insurance company’s
authorized personnel.
39. Hospitalization (not applicable for Overseas Travel Insurance) means admission in a Hospital for a
minimum period of 24 consecutive ‘In-patient Care’ hours except for specified procedures/treatments,
where such admission could be for a period of less than 24 consecutive hours.
40. Immediate Family Member means an Insured Member’s lawful spouse, children only.
41. Indemnity/Indemnify means compensating the Policy Holder/Insured Member up to the extent of
Expenses incurred, on occurrence of an event which results in a financial loss and is covered as the
subject matter of the Insurance Cover.
42. Illness means a sickness or a disease or a pathological condition leading to the impairment of normal
physiological function and requires medical treatment.
(a) Acute condition - Acute condition is a disease, illness or injury that is likely to respond quickly to
treatment which aims to return the person to his or her state of health immediately before suffering the
disease/ illness/ injury which leads to full recovery
(b) Chronic condition - A chronic condition is defined as a disease, illness, or injury that has one or more of
the following characteristics:
I. It needs ongoing or long-term monitoring through consultations, examinations, check-ups, and
/or tests;
II. It needs ongoing or long-term control or relief of symptoms;
III. It requires rehabilitation for the patient or for the patient to be specially trained to cope with
IV. It continues indefinitely;
V. It recurs or is likely to recur.
43. Injury means accidental physical bodily harm excluding illness or disease solely and directly caused by
external, violent and visible and evident means which is verified and certified by a Medical Practitioner.
44. In-patient Care (not applicable for Overseas Travel Insurance) means treatment for which the Insured
Member has to stay in a Hospital for more than 24 hours for a covered event.
45. Insured Event means an event that is covered under the Policy; and which is in accordance with the Policy
Terms & Conditions.
46. Insured Member (Insured) means a person whose name specifically appears under Insured in the
Annexure A or the Certificate of Insurance and is a covered group member.
47. Intensive Care Unit (ICU) means an identified section, ward or wing of a Hospital which is under the
constant supervision of a dedicated Medical Practitioner(s), and which is specially equipped for the
continuous monitoring and treatment of patients who are in a critical condition, or require life support
facilities and where the level of care and supervision is considerably more sophisticated and intensive
than in the ordinary and other wards.
48. ICU Charges or (Intensive care Unit) Charges means the amount charged by a Hospital towards ICU
expenses on a per day basis which shall include the expenses for ICU bed, general medical support
services provided to any ICU patient including monitoring devices, critical care nursing and intensivist
charges
49. Medical Advice means any consultation or advice from a Medical Practitioner including the issue of any
prescription or follow-up prescription.
50. Medically Dependent means mentally or physically disabled, unable to perform ‘Activities of Daily living’
without the assistance or direction of another person
51. Medical Expenses means those expenses that an Insured Member has necessarily and actually incurred
for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as
these are no more than would have been payable if the Insured Member had not been insured and no
more than other Hospitals or doctors in the same locality would have charged for the same medical
treatment.
52. Medical Practitioner (not applicable for Overseas Travel Insurance) is a person who holds a valid
registration from the Medical Council of any State or Medical Council of India or Council for Indian
Medicine or for Homeopathy set up by the Government of India or a State Government and is thereby
entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of
license.
For Benefits / optional Extensions effective outside India:

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 Medical Practitioner means a person who holds a valid registration issued by the Medical
Council/Statutory Regulatory Authority for Medical Education in that Country and is thereby entitled to
practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of license.
53. Medically Necessary (not applicable for Overseas Travel Insurance) means any treatment, tests,
medication, or stay in Hospital or part of a stay in Hospital which:
(a) Is required for the medical management of the Illness or Injury suffered by the Insured Member;
(b) Must not exceed the level of care necessary to provide safe, adequate and appropriate medical
care in scope, duration, or intensity;
(c) Must have been prescribed by a Medical Practitioner;
(d) Must conform to the professional standards widely accepted in international medical practice or
by the medical community in India.
54. Network Provider (not applicable for Overseas Travel Insurance) means the Hospitals enlisted by an
Insurer, TPA or jointly by an Insurer and TPA to provide medical services to an Insured by a Cashless
Facility.
55. Nominee means the person named in the Certificate of Insurance who is nominated to receive the
benefits under this Policy in accordance with the terms of the Policy, if the Insured Member is deceased.
56. Non-Allopathic Medical Practitioner for the purpose of Alternative Forms of Medicine means a Medical
Practitioner qualified and practicing Ayurveda or Unani or Sidha or Homeopathic forms of Medicine for
treatment of Illness/Injury, and registered as per Indian Medicine Central Council Act, 1970.
57. Non-Network Provider means any hospital, day care centre or other provider that is not part of the
network.
58. Notification of Claim means the process of intimating a claim to the insurer or TPA through any of the
recognized modes of communication.
59. OPD Treatment (Out-patient Care) is one in which the Insured visits a clinic/hospital or associated facility
like a consultation room for diagnosis and treatment based on the advice of a Medical Practitioner. The
Insured is not admitted as a day care or in-patient.
60. Physiotherapist refers to a person who is licensed to practice as a physiotherapist where the treatment is
to take place and is recognized as a physiotherapist.
61. Preferred Provider means the Hospital empanelled by the Company or TPA and enlisted on the Preferred
Provider Network List, specified in the Policy Schedule (and as updated by the Company from time to
time).
An updated list of ‘Preferred Provider Network’ may be obtained from the Company’s website or the call
centre.
62. Policy means these Policy Terms & Conditions, Optional Extensions (if any), the Proposal Form, Policy
Schedule, Endorsements, Member List and Annexures which form part of the policy contract and shall be
read together.
63. Policy Schedule is a Schedule attached to and forming part of this Policy.
64. Policy Year means a period of one year commencing on the Policy Period Start Date or any anniversary
thereof.
65. Policyholder (also referred as You) means the person or the entity who is the Group Administrator and
named in the Policy Schedule as the Policyholder.
66. Policy Period means the period commencing from the Policy Period Start Date and ending on the Policy
Period End Date of the Policy as specifically appearing in the Policy Schedule.
67. Policy Period End Date means the date on which the Policy expires, as specifically appearing in the Policy
Schedule.
68. Policy Period Start Date means the date on which the Policy commences, as specifically appearing in the
Policy Schedule.
69. Post-hospitalization Medical Expenses means Medical Expenses incurred during pre-defined number of
days immediately after the Insured Member is discharged from the Hospital provided that:
i. Such Medical Expenses are incurred for the same condition for which the Insured Member’s
Hospitalization was required and
ii. The inpatient Hospitalization claim for such Hospitalization is admissible by the Company.
70. Pre-existing Diseases means any condition, ailment, injury or disease:
a.) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy
issued by the insurer or

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 b.) For which medical advice or treatment was recommended by, or received from, a physician
within 48 months prior to the effective date of the policy or its reinstatement.
c.) A condition for which any symptoms and or signs if presented and have resulted within three
months of the issuance of the policy in a diagnostic illness or medical condition.

71. Pre-hospitalization Medical Expenses Means Medical Expenses incurred during pre-defined number of
days preceding the hospitalization of the Insured Member, provided that :
i. Such Medical Expenses are incurred for the same condition for which the Insured Member’s
Hospitalization was required, and
ii. The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
72. Prescription Refers to out-patient drugs (excluding supplements, vitamins and traditional medicine) and
dressings as prescribed by a medical practitioner for the treatment of a medical condition covered by your
member’s plan. For avoidance of doubt, prescription will not include vitamins nor supplements nor over
the counter medication even if they are prescribed by a medical practitioner.
73. Preventive Care means any kind of treatment taken as a pro-active care measure without actual
requirement or symptoms of a disease or illness.
74. Primary Insured Member means employee or a member of group who satisfies and continues to satisfy
the eligibility criteria specified in the Certificate of Insurance and who is named in Annexure “A” to the
Policy as an Insured Member.
75. Qualified Nurse (not applicable for Overseas Travel Insurance) is a person who holds a valid registration
from the Nursing Council of India or the Nursing Council of any state in India.
76. Reasonable and Customary Charges (not applicable for Overseas Travel Insurance) means the charges for
services or supplies, which are the standard charges for the specific provider and consistent with the
prevailing charges in the geographical area for identical or similar services, taking into account the nature
of the Illness/ Injury involved.
77. Rehabilitation means assisting an Insured Member who, following a medical condition, requires
assistance in physical, vocational, independent living and educational pursuits to restore him to the
position in which he was in, prior to such medical condition occurring.
78. Renewal defines the terms on which the contract of insurance can be renewed on mutual consent with a
provision of grace period for treating the renewal continuous for the purpose of gaining credit for pre-
existing diseases, time-bound exclusions and for all waiting periods.
79. Room Rent means the amount charged by a Hospital towards Room & Boarding expenses and shall
include the associated medical expenses.
80. Single Private Room means an air conditioned room in a Hospital where a single patient is accommodated
and which has an attached toilet (lavatory and bath). Such room type shall be the most basic and the most
economical of all accommodations available as a Single room in that Hospital.
81. Senior Citizen means any person who has completed sixty or more years of age as on the date of
commencement or renewal of the policy.
82. Specialized Practitioner refers to a or practitioner who specializes in at least one of the following
acupuncture, osteopathy, chiropractic or Chinese traditional medicine and is qualified and registered in
the country where the out-patient treatment is to take place.
83. Service Provider means any person, organization, institution that has been empanelled with the Company
to provide Services specified under the benefits.
84. Subrogation (Applicable to other than Health Policies and health sections of Travel and PA policies) means
the right of the Insurer to assume the rights of the Insured Member to recover expenses paid out under
the Policy that may be recovered from any other source.
85. Sum Insured (Base Coverage Amount) means the amount specified against each Benefit for Member in
the Policy Schedule which represents Our maximum liability for that Insured Member for any and all
Claims incurred in respect of that Insured Member during the Cover Period.
86. Surgery/Surgical Procedure means manual and/or operative procedure(s) required for treatment of an
Illness or Injury, correction of deformities and defects, diagnosis and cure of diseases, relief of suffering
or prolongation of life, performed in a Hospital or a Day Care Centre by a Medical Practitioner.
87. Third Party Administrator or TPA means any person who is licensed under the IRDA (Third Party
Administrators-Health Services) Regulations, 2001 by the Authority, and is engaged, for a fee or
remuneration by an Insurance Company, for the purposes of providing health services.

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88. Twin Sharing Room means a Hospital room where at least two patients are accommodated at the same
time. Such room shall be the most basic and the most economical of all accommodations available as
twin sharing rooms in that Hospital.
89. Unproven/Experimental Treatment means a treatment including drug experimental therapy which is not
based on established medical practice in India, is treatment experimental or unproven.
90. Variable Medical Expenses means those Medical Expenses as listed below which vary in accordance with
the Room Rent or Room Category or ICU Charges applicable in a Hospital:
(a) Room, boarding, nursing and operation theatre expenses as charged by the Hospital where the
Insured Member availed medical treatment;
(b) Intensive Care Unit charges;
(c) Fees charged by surgeon, anesthetist, Medical Practitioner;
(d) Investigation expenses incurred towards diagnosis of ailment requiring Hospitalization.
Expenses related to the Hospitalization will be considered in proportion to the room rent stated in
the Policy.
91. Medical Practitioner means a person who holds a valid registration issued by the Medical
Council/Statutory Regulatory Authority for Medical Education in that Country and is thereby entitled to
practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of license.
Refers to a person (other than you, your member, or a business partner or a relative of yours or your
member) has the primary degrees in the practice of Allopathy and surgery following attendance at a
recognized medical school and who is licensed to practice Allopathy by the relevant licensing authority
where the treatment is given. By ‘recognized medical school’ we mean “a medical school which is listed in
AVICENNA Directory, which is in collaboration with the World Health Organization and the World
Federation for Medical Education”.
92. Network Provider means Hospitals enlisted by an insurer or by a Assistance Service Provider together to
provide services to an insured on payment by a cashless facility;
93. Qualified Nurse means a person who holds a valid registration issued by the Nursing Council/Statutory
Regulatory Authority for Medical Education in that Country and thereby entitled to render Nursing Care
within the scope and jurisdiction of license.
94. Reasonable and customary (R&C) means charges or treatment for medical care which shall be considered
by the Company or by Company’s medical advisers to be reasonable and customary to the extent that
they do not exceed the general level of charges or treatment being made by others of similar standing in
the locality where the charges or treatment are incurred when giving like or comparable treatment.
If the charges are higher than customary or the treatment is not reasonable and customary, the Company
will only pay the amount which is, in the Company’s experience, customarily charged and Insured has to
pay the rest.

Scope of Cover

If an Insured Member is diagnosed with an Illness or suffers an Injury which requires the Insured Member to be
admitted in a Hospital due to Medically Necessary conditions, subject to the Coverage opted, during the Cover
Year, and while the Policy in force for:

In-patient Care (Hospitalization)

The Company will indemnify the Medical Expenses incurred which are Reasonable and Customary Charges that are
Medically Necessary towards In-patient Care Hospitalization of the Insured Member, maximum up to the Coverage
Amount, as specified in the Certificate of Insurance, provided that the Hospitalization is for a minimum period of
24 consecutive hours and was prescribed in written, by a Medical Practitioner, where Insured is covered for
hospital charges incurred for eligible treatment given between admission and discharge of hospital.

Day Care Treatment

The Company will indemnify the Medical Expenses incurred which are Reasonable and Customary Charges that are
Medically Necessary towards Day Care Treatment of the Insured Member, up to the Coverage Amount specified in
the Certificate of Insurance provided that:

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1. the Day Care Treatment is listed as per the Annexure-I to Policy Terms & Conditions; and
2. the period of treatment of the Insured Member in Hospital/Day Care Centre does not exceed 24 hours; and
3. the Day Care Treatment was taken on the advice of a Medical Practitioner

Pre-Hospitalization Medical Expenses and Post-Hospitalization Medical Expenses

The Company will indemnify the Insured Member for Relevant Medical Expenses incurred which are Medically
Necessary, through Cashless (within network) / Re-imbursement, maximum up to the Coverage Amount, as
specified in the Certificate of Insurance, provided that the Medical Expenses so incurred are related to the same
Illness/Injury for which the Company has accepted the Insured Member’s Claim under Hospitalization Expenses
and subject to the conditions specified below:

1. Under Relevant Pre-hospitalization Medical Expenses, for a period of 30 days immediately prior to the Insured
Member’s date of admission to the Hospital, provided that the Company shall not be liable to make payment
for any Pre-hospitalization Medical Expenses that were incurred before the Cover Start Date;
2. Under Relevant Post-hospitalization Medical Expenses, for a period of 60 days immediately after the Insured
Member’s date of discharge from the Hospital.
3. The number of consultations covered by this benefit is limited to once per day.
4. This benefit does not cover follow-up consultation or treatment after the Insured Member is discharged from
an in-patient rehabilitation facility.

Note
i. The date of admission to Hospital for the purpose of this Benefit shall be the date of the first admission to
the Hospital for the Illness deemed or Injury sustained to be Any One Illness; and
ii. The date of discharge from Hospital for the purpose of this Benefit shall be the last date of discharge from
the Hospital in relation to the Illness deemed or Injury sustained to be Any One Illness.

Room Rent

If the Insured Member is admitted in a Hospital room where the Room Category opted or Room Rent incurred is
higher than the eligible Room Category/ Room Rent as specified in the Certificate of Insurance, then,

● The Insured Member shall bear the ratable proportion of the total Variable Medical Expenses (including
applicable surcharge and taxes thereon) in the proportion of the difference between the Room Rent
actually incurred and the Room Rent specified in the Certificate of Insurance or the Room Rent of the
entitled Room Category to the Room Rent actually incurred.

The Certificate of Insurance will specify the eligibility of Room Rent or Room Category applicable for the Insured
Member under the Policy. Room Rent or Room Category available under this Policy is mentioned as follows:

1) Single Private Room: If the Certificate of Insurance states ‘Single Private Room’ as eligible Room Category,
it means the maximum eligible Room Category in case of Hospitalization of the Insured Member payable
by the Company is limited to stay in a Single Private Room.

Intensive Care Unit Charges (ICU Charges):

If the Insured Member is admitted in an ICU where the ICU charges incurred are higher than the ICU Charges
specified in the Certificate of Insurance, then the Insured Member shall bear the ratable proportion of the total
Variable Medical Expenses (including applicable surcharge and taxes thereon) in the proportion of the difference
between the ICU charges actually incurred and the ICU Charges specified in the Certificate of Insurance to the ICU
charges actually incurred.

The Certificate of Insurance will specify the Limit of ICU Charges applicable for the Insured Person under the Policy.
The ICU Charges available under this Policy are as follows:

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 1) If the Certificate of Insurance states the eligibility of ICU Charges of the Insured Member as ‘no sub-limit’,
it means that there is no separate restriction on ICU Charges incurred towards stay in ICU during
Hospitalization

Domestic Road Ambulance

We will indemnify for the reasonable and Customary Charges necessarily incurred on availing Ambulance services
offered by a Hospital or by an Ambulance service provider as specified in the Certificate of Insurance, for the
Insured Member’s necessary transportation provided that the necessity of such Ambulance transportation is
certified by the treating Medical Practitioner and subject to the conditions specified below:
(i) Such Transportation is from the place of occurrence of Medical Emergency of the Insured Member, to the
nearest Hospital; and/or
(ii) Such Transportation is from one Hospital to another Hospital for the purpose of providing better Medical
aid to the Insured Member, following an Emergency.

Note: In this product, Ambulance is covered up to Rs. 1,000 per hospitalization

Donor Expenses

We will indemnify the Insured Member, through Cashless or Reimbursement Facility, up to the amount specified
against this Benefit, for the Medical Expenses incurred in respect of the donor, for any organ transplant surgery
during the Cover Year, subject to the conditions specified below:

(i) The Organ donor is an eligible donor in accordance with The Transplantation of Human Organs Act,
1994 (amended) and other applicable laws and rules.
(ii) The Insured Member is the recipient of the Organ so donated by the Organ Donor.
(iii) We indemnify for transplantation of kidneys, heart, liver, lung or bone marrow required as a result
of an eligible medical condition and provided these organ(s) came from a relative or a legally
certified and verified source of donation
(iv) We will not be liable to pay the Medical Expenses incurred by the Insured Member towards Pre-
Hospitalization and Post Hospitalization Medical Expenses or any other Medical Expenses in respect
of the donor consequent to the harvesting.
(v) Clause (37) under Permanent Exclusions, is superseded to the extent covered under this Benefit.

Domiciliary Hospitalization

We will indemnify the Insured Member, only through Reimbursement Facility, maximum up to the Coverage
Amount, for the Medical Expenses incurred towards Domiciliary Hospitalization, i.e., Coverage extended when
Medically Necessary treatment is taken at home, subject to the conditions specified below:

(i) The Domiciliary Hospitalization continues for a period exceeding 3 consecutive days.
(ii) The Medical Expenses are incurred during the Cover Year.
(iii) The Medical Expenses are Reasonable and Customary Charges which are necessarily incurred.
(iv) Any Pre Hospitalization and Post Hospitalization Medical Expenses shall not be payable under this Benefit.
(v) Any Maternity related expenses shall not be payable under this Benefit
(vi) Any Medical Expenses incurred for the treatment in relation to any of the following diseases shall not be
payable under this Benefit:
1. Asthma;
2. Bronchitis;
3. Chronic Nephritis and Chronic Nephritic Syndrome;
4. Diarrhoea and all types of Dysenteries including Gastro-enteritis;
5. Diabetes Mellitus and Diabetes Insipidus;
6. Epilepsy;
7. Hypertension;

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 8. Influenza, cough or cold;
9. All Psychiatric or Psychosomatic Disorders;
10. Pyrexia of unknown origin for less than 10 days;
11. Tonsillitis and Upper Respiratory Tract Infection including Laryngitis and Pharyngitis;
12. Arthritis, Gout and Rheumatism.
13. Terminal and Mental Illness

No Claim Bonus

a) At the end of each Cover Year, the Company will enhance the Coverage Amount under Hospitalization Expenses
by 50 percentage (as specified in Certificate of Insurance), on a cumulative basis, as a No Claims Bonus for each
completed and continuous Cover Year, provided that no Claim has been paid by the Company in the expiring Cover
Year for that Insured Member, and subject to the conditions specified below:
i. In any Cover Year, the accrued No Claims Bonus shall not exceed 100% of the Coverage Amount
available in the renewed Policy.
ii. The No Claims Bonus shall not enhance or be deemed to enhance any Conditions as prescribed
under Clause 1(j).
iii. For a Floater policy, the No Claims Bonus shall be available on Floater basis and shall accrue only
if no Claim has been made in respect of any Insured Member during the expiring Cover Year. The
No Claims Bonus which is accrued during the claim-free Cover Year will only be available to those
Insured Members who were insured in such claim-free Cover Year and continue to be insured in
the subsequent Cover Year.
iv. The entire No Claims Bonus will be forfeited if the Policy is not continued / renewed on or before
Cover End Date or the expiry of the Grace Period whichever is later.
v. The No Claims Bonus shall be applicable on an annual basis subject to continuation of the Policy.
vi. If the Insured Members in the expiring policy are covered on Individual basis and thus have
accumulated the No Claims Bonus for each Insured Member in the expiring policy, and such
expiring policy is renewed with the Company on a Floater basis, then the No Claims Bonus to be
carried forward for credit in this Policy would be the least No Claims Bonus amongst all the
Insured Members.
vii. If the Insured Members in the expiring policy are covered on a Floater basis and such Insured
Members renew their expiring Policy with the Company by splitting the Floater Coverage Amount
in to 2 (two) or more Floater / Individual covers, then the No Claims Bonus of the expiring Policy
shall be apportioned to such renewed Policy in the proportion of the Coverage Amount of each
of the renewed Policy.
viii. In the event of a Claim occurring during any Cover Year, the accrued No Claims Bonus will be
reduced at same rate at which it is accrued at the commencement of next Cover Year.
ix. If Claim has been reported in expiring Cover Year but No Claims Bonus has been made available
by the Company in the next Cover Year and if such Claim is ultimately paid, the No Claims Bonus
which is made available for that Cover Year will be reduced/recovered (in case claim amount has
been paid against No Claim Bonus amount)
x. In case Coverage Amount under the Policy is reduced at the time of renewal, the applicable No
Claims Bonus shall also be reduced in proportion to the Coverage Amount.
xi. In case Coverage Amount under the Policy is increased at the time of renewal, the No Claims
Bonus shall be calculated on the Coverage Amount applicable on the last completed Cover Year.
xii. Accrued ‘No Claims Bonus’ under this Policy can be utilized for Hospitalization Expenses and for
all its Optional benefits except for Corporate floater if opted under Hospitalization Expenses .
xiii. In case no claim is made in a particular Cover Year, No Claims Bonus would be credited
automatically to the subsequent Cover year, even in case of multi-year Policies
xiv. All conditions applicable to Hospitalization Expenses will be applicable for this Benefit.
xv. This Benefit is not available for Employer - Employee Policies

a) In addition to the above, the Policyholder has the option to opt for no reduction in the accrued No Claims
Bonus in the event of a Claim occurring during any Cover Year

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Restoration Benefit
We will indemnify the Insured Member maximum up to SI.

Domestic Second Opinion

If the Insured Member is diagnosed with Once per Major Illness / Injury per policy year , up on that Insured
Member’s request, the Company shall arrange for a Second Opinion from a Medical Practitioner within India
from its network regarding the diagnosis of such Major Illness.

Second Opinion will be based only on the information and documentation provided to the Company, which
will be shared with the Medical Practitioner, and is subject to the conditions specified below:

a) This Benefit can be availed maximum once by an Insured Member during the Cover Year for each
Major Illness.
b) The Insured Member is free to choose whether or not to obtain the Second Opinion and, if
obtained, then whether or not to act on it.
c) This Benefit is for additional information purposes only and does not and should not be deemed
to substitute the Insured Member’s visit or consultation to an independent Medical Practitioner.
d) The Company does not provide a Second Opinion or make any representation as to the adequacy
or accuracy of the same, the Insured Member’s or any other person’s reliance on the same or the
use to which the Second Opinion is put.
e) The Company does not assume any liability for and shall not be responsible for any actual or
alleged errors, omissions or representations made by any Medical Practitioner or in any Second
Opinion or for any consequences of actions taken or not taken in reliance thereon.
f) The Policyholder/Insured Member shall hold the Company harmless for any loss or damage
caused by or arising out of or in relation to any opinion, advice, prescription, actual or alleged
errors, omissions or representations made by the Medical Practitioner or for any consequences
of any action taken or not taken in reliance thereon.
g) Any Second Opinion provided under this Benefit shall not be valid for any medico-legal purposes.
h) The Second Opinion does not entitle the Insured Member to any consultation from or further
opinions from that Medical Practitioner.

i) For the purposes of this Benefit only, Major Illness means any one of the following only:

1. Benign Brain Tumor

2. Cancer
3. End Stage Lung Failure
4. Myocardial Infraction
5. Coronary Artery Bypass Graft
6. Heart Valve Replacement
7. Coma
8. End Stage Renal Failure
9. Stroke
10. Major Organ Transplant
11. Paralysis
12. Motor Neuron Disorder
13. Multiple Sclerosis
14. Major Burns
15. Total Blindness

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 Health Check-up

The Company will indemnify the Insured member, Once per adult per policy year as specified in the
Certificate of Insurance, for the Medical Expenses incurred in respect of that Insured Member’s Health
check-up tests (as specified in the Certificate of Insurance) either offered as a standard or customized
package as per customer needs.

WAITING PERIODS & EXCLUSIONS

Wait Periods applicable under this Policy for All Conditions under Hospitalization Expenses are

Initial wait period

Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be
excluded except claims arising due to an accident, provided the same are covered. This exclusion shall not,
however, apply if the Insured Person has Continuous Coverage for more than twelve months. The referred waiting
period is made applicable to the enhanced sum insured in the event of granting higher sum insured subsequently.

Specific Wait Period for Named Ailments

I. Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the
expiry of 24 months of continuous coverage after the date of inception of the first policy with the Company.
This exclusion shall not be applicable for claims arising due to an accident.
II. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase.
III. If any of the specified disease/procedure falls under the waiting period specified for pre-Existing diseases,
then the longer of the two waiting periods shall apply.
IV. The waiting period for listed conditions shall apply even if contracted after the policy or declared and accepted
without a specific exclusion.
V. If the Insured Person is continuously covered without any break as defined under the applicable norms on
portability stipulated by IRDAI, then waiting period for the same would be reduced to the extent of prior
coverage.
VI. List of specific diseases/procedures:
● Any treatment related to Arthritis (if non-infective), Osteoarthritis and Osteoporosis, Gout,
Rheumatism, Spinal Disorders(unless caused by accident), Joint Replacement Surgery(unless caused
by accident), Arthroscopic Knee Surgeries/ACL Reconstruction/Meniscal and Ligament Repair
● Surgical treatments for Benign ear, nose and throat (ENT) disorders and surgeries (including but not
limited to Adenoidectomy, Mastoidectomy, Tonsillectomy and Tympanoplasty), Nasal Septum
Deviation, Sinusitis and related disorders
● Benign Prostatic Hypertrophy
● Cataract
● Dilatation and Curettage
● Fissure / Fistula in anus, Hemorrhoids / Piles, Pilonidal Sinus, Gastric and Duodenal Ulcers
● Surgery of Genito-urinary system unless necessitated by malignancy
● All types of Hernia & Hydrocele
● Hysterectomy for menorrhagia or Fibromyoma or prolapse of uterus unless necessitated by
malignancy
● Internal tumours, skin tumours, cysts, nodules, polyps including breast lumps (each of any kind)
unless malignant
● Kidney Stone / Ureteric Stone / Lithotripsy / Gall Bladder Stone
● Myomectomy for fibroids
● Varicose veins and varicose ulcers
● Genetic disorders
● Parkinson's or Alzheimer's disease or Dementia;

Wait Period for Pre-existing Diseases:

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 I. Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be
excluded until the expiry of 24 months of continuous coverage after the date of inception of the first policy
with insurer.
II. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase.
III. 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.
IV. Coverage under the policy after the expiry of 24 months for any pre-existing disease is subject to the same
being declared at the time of application and accepted by Insurer

Permanent Exclusions

Below mentioned are the common exclusions which are applicable to all the Base and Optional benefits of Group
Care 360:-

1. Any item or condition or treatment specified in List of Non-Medical Items (Annexure – II).
2. Any pre-existing injury / illness or disability and any complications thereof and its associated medical
conditions unless we had agreed otherwise in writing
3. 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 following an accident, expenses up to the stage
of stabilization are payable but not the complete claim.
Note: Refer BLACKLISTED hospital list on www:carehealthinsurance.com for list of excluded hospitals.
4. Any condition directly or indirectly caused by or associated with any sexually transmitted disease,
including Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis,
Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV, Human T-
Cell Lymphotropic Virus Type III (HTLV–III or IITLB-III) or Lymphadinopathy Associated Virus (LAV) or the
mutants derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind;
5. Maternity: Code Excl18
a. Medical treatment expenses traceable to childbirth (including complicated deliveries and
caesarean sections incurred during hospitalization) except ectopic pregnancy;
b. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of
pregnancy during the policy period.
c. Any treatment directly related to surrogacy whether the member is acting as surrogate, or is the
intended parent;
d. Any treatment begun or for which the need has arisen during the first ninety (90) days after
birth, for any child conceived by artificial means or any form of assisted conception or if the child
is born via surrogacy;
6. Birth control, Sterility and Infertility: Code- Excl17
a. Expenses related to Birth Control, sterility and infertility. This includes:
b. Any type of contraception, sterilization
c. Assisted Reproduction services including artificial insemination and advanced reproductive
technologies such as IVF, ZIFT, GIFT, ICSI
7. Gestational Surrogacy
8. Reversal of sterilization;
9. Treatment taken from anyone who is not a Medical Practitioner or from a Medical Practitioner who is
practicing outside the discipline for which he is licensed or any kind of self-medication;
10. Charges incurred in connection with routine eye examinations and ear examinations, dentures, crowns,
artificial teeth and all other similar external appliances and / or devices whether for diagnosis or
treatment;
11. Refractive Error: (Code- Excl15)
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres
12. Unproven Treatments: Code- Excl16

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 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.
13. Expenses incurred on advanced treatment methods other than as mentioned in clause 2.1 (h)
14. Any expenses incurred on providing or fitting any external prosthesis or orthosis or appliance or medical
aids or durable medical equipment of any kind, like wheelchairs, walkers, crutches, ambulatory devices,
unless allowed under the Policy, cost of Cochlear implants;
15. Any treatment related to sleep disorder or sleep apnea syndrome, general debility convalescence and any
treatment in an establishment that is not a Hospital;
16. Treatment of any external Congenital Anomaly or Illness or defects or anomalies including their
associated medical conditions or chronic medical conditions or vegetative state cover ( on the basis of
declaration by the treating doctor) or treatment relating to external birth defects;
17. We define vegetative state as a condition of profound non-responsiveness with no sign of awareness or
consciousness or a functioning mind, even if the Insured can open their eyes and breathe unaided, and
the person does not respond to stimuli such as calling their name or touching. This state must have
remained for at least four (4) weeks with no sign of improvement or there could be no recovery;
a. Treatment whilst staying in a hospital for more than ninety (90) continuous days for permanent
neurological damage on the basis of declaration by the treating doctor. It is stated that
treatment up to 90 days for permanent neurological damage will be covered under this Policy;
18. Treatment of mental retardation, arrested or incomplete development of mind of a person, subnormal
intelligence or mental intellectual disability

19. Obesity/ Weight Control(Code- Excl06)

a. Expenses related to the surgical treatment of obesity that does not fulfill all the below
conditions:
b. Surgery to be conducted is upon the advice of the Doctor
c. The surgery/Procedure conducted should be supported by clinical protocols
d. The member has to be 18 years of age or older and
e. Body Mass Index (BMI);
i. greater than or equal to 40 or
ii. 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:
1. Obesity-related cardiomyopathy
2. Coronary heart disease
3. Severe Sleep Apnea
4. Uncontrolled Type2 Diabetes

20. 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;
21. 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;
22. Out-patient treatment;
23. Treatment received outside India;
24. Domiciliary hospitalization or treatment;
25. Investigation & Evaluation(Code- Excl04)
a. Expenses related to any admission primarily for diagnostics and evaluation purposes only are
excluded.
b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and
treatment are excluded;
26. 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:

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 a. 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.
b. Any services for people who are terminally ill to address physical, social, emotional and spiritual
needs;
27. An Insured Member operating or learning to operate any aircraft, or performing duties as a member of
the crew on any aircraft or Scheduled Airline or any airline personal;
28. An Insured Member flying in an aircraft other than as a fare paying passenger in a Scheduled Airline;
29. Participation in actual or attempted felony, riot, civil commotion or criminal misdemeanor or activity;
30. Professional fees charged by a member of the Insured Member’s immediate family or by a person
normally resident in the household of the Insured or under his employment;
31. Training for or participating in professional sport of any kind or any sport for which the insured receives a
salary or monetary reimbursement, including grants or sponsorship;
32. The Insured Member serving in any branch of the military, navy, air force or any branch of armed forces
or any paramilitary forces;
33. Radioactive contamination whether arising directly or indirectly ionizing radiation, toxic, explosive or
other hazardous properties of nuclear material;
34. Circumcision unless necessary for treatment of an Illness or as may be necessitated due to an Accident;
35. All preventive care, Vaccination including Inoculation and Immunizations (except in case of post-bite
treatment) and tonics;
36. Dietary supplements and substances that can be purchased without prescription, including but not limited
to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of
hospitalization claim or day care procedure (Code- Excl14);
37. All expenses related to donor treatment, including screening, surgery to remove organs from the donor,
in case of transplant surgery;
38. Non-Allopathic Treatment or treatment related to any unrecognized systems of medicine;
39. War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities,
civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest,
restraints and detainment of all kinds;
40. 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;
41. Act of self-destruction or self-inflicted Injury, attempted suicide or suicide while sane or insane or Illness
or Injury attributable to consumption, use, misuse or abuse of tobacco, Areca nut intoxicating drugs and
alcohol or hallucinogens;
42. Any charges incurred to procure documents related to treatment or Illness pertaining to any period of
Hospitalization or Illness or any administration costs or any other charges of a non-medical nature in
connection with the provision and/or performance of medical supplies and/or services;
43. Personal comfort and convenience items or services including but not limited to T.V. (wherever
specifically charged separately), charges for access to cosmetics, hygiene articles, body care products and
bath additives, as well as similar incidental services and supplies;
44. Expenses related to any kind of RMO charges, Service charge, Surcharge, night charges levied by the
hospital under whatever head or any room upgrades, menu items not included as standard or visitors
meals;
45. Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any
other cause or event contributing concurrently or in any other sequence to the loss, claim or expense. For
the purpose of this exclusion:
a. Nuclear attack or weapons means the use of any nuclear weapon or device or waste or
combustion of nuclear fuel or the emission, discharge, dispersal, release or escape of fissile/
fusion material emitting a level of radioactivity capable of causing any Illness, incapacitating
disablement or death;
b. Chemical attack or weapons means the emission, discharge, dispersal, release or escape of any
solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of
causing any Illness, incapacitating disablement or death;
c. Biological attack or weapons means the emission, discharge, dispersal, release or escape of any
pathogenic (disease producing) micro-organisms and/or biologically produced toxins (including

17 | Page
 genetically modified organisms and chemically synthesized toxins) which are capable of causing
any Illness, incapacitating disablement or death;
d. In addition to the foregoing, any loss, claim or expense of whatsoever nature directly or indirectly
arising out of, contributed to, caused by, resulting from, or in connection with any action taken in
controlling, preventing, suppressing, minimizing or in any way relating to the above is also
excluded.
46. Impairment of an Insured Person’s intellectual faculties by abuse of stimulants or depressants unless
prescribed by a medical practitioner;
47. Continuous ambulatory peritoneal dialysis. Coverage for ‘Continuous ambulatory peritoneal dialysis’ is
available on OPD basis and as part of Pre-Post hospitalization expenses;
48. Charges for items not listed in the policy schedule applicable to the member or considered as not
medically necessary or which may be considered as elective;
49. Alopecia wigs and/or toupee and all hair or hair fall treatment and products including any investigations;
all forms of acne;
50. Any treatment taken in a clinic, rest home, convalescent home for the addicted, detoxification center,
sanatorium, home for the aged, remodeling clinic or similar institutions;
51. Any medical or physical condition or treatment or service, which is specifically excluded under the Policy
Schedule including the associated medical conditions shown on the endorsement;
52. Cryopreservation or harvesting or storage of stem cells as a preventive measure against possible
disease/illness/injury, or implantation or re-implantation of living cells or living tissue whether autologous
or provided by a donor;
53. Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.
Code- Excl12
54. Any other weight management services, treatment and supplies unless requires hospitalization and
surgery ;
55. Treatments received in heath 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)
56. Hormone Replacement Therapy;
57. 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;
58. The evacuation would involve moving Insured Member from a remote location where there is no or
limited access;
59. Dental, Orthodontics, Periodontics, Endodontic or any preventative dentistry no matter who gives the
treatment;
60. Charges for residential stays in Hospital which are not medically necessary or are incurred for social or
domestic reasons or for reasons which are not directly connected with treatment or where the Hospital
has effectively become the place of domicile or permanent abode;
61. Any charges made by the medical practitioner, hospital, laboratory or any such medical services which are
not reasonable and customary;
62. Genetic tests undertaken to establish whether or not the Insured may be genetically disposed to the
development of a medical condition in the future unless requires for current medical treatment;
63. Insured Person suffering from or has been diagnosed with or has been treated for Down’s
Syndrome/Turner’s Syndrome/Sickle Cell Anaemia/ Thalassemia Major/G6PD deficiency prior to the first
Policy Start Date, then costs of treatment related to or arising from the disorder whether directly or
indirectly will be treated as a Pre-existing Disease and will not be covered within first 48 months from the
date of first issuance of the Policy
64. Ear or body piercing and tattooing or treatment needed as a result of any of these;
65. Any charges for treatment incurred during a period for which the premium is not paid;
66. Any claim or part of a claim in which the member has to pay a deductible or co-insurance (where
applicable). In such a claim, we will only pay the balance of the claim after we have deducted the excess
(or deductible or co-insurance) amount;
67. All bank or credit or foreign exchange charges when the claims payment is made in a currency other than
the policy currency upon the member’s request;
68. Bacterial infections (except pyogenic infection which occurs through an Accidental cut or wound);

18 | Page
 69. Any other conditions at the discretion of Underwriter

Note: In addition to the foregoing, any loss, claim or expense of whatsoever nature directly or indirectly arising
out of, contributed to, caused by, resulting from, or in connection with any action taken in controlling,
preventing, suppressing, minimizing or in any way relating to the above Permanent Exclusions shall also be
excluded.

CLAIMS

How to file your Claim

Our principal purpose for our existence is to ensure that Insured Members enjoy hassle-free access to best-in-class
healthcare delivery facilities, and we live this objective through our seamless claim process.

Please refer to the following steps in the claim procedure to ensure smooth processing of the same

Reimbursement of treatment expenses incurred at Network/Non Network Hospitals:

Step 1: Claim Intimation

In case of unplanned hospitalization, call and inform us/ Our TPA within 24 hours of your admission. However, if
your hospitalization is planned, kindly intimate Us / Our TPA 48 hours prior to your admission.

The following information is to be provided during the claim intimation-

▪ Policy holder’s name

▪ Claimant’s name and customer ID
▪ Hospital details
▪ Diagnosis and treatment details
▪ Approximate claim amount
▪ Date of admission

We will provide a reference ID for all future communication pertaining to the claim request

Step 2: Initiating the Claim process

The Claim form can be downloaded from our website www.careinsurance.com

The completed claim form has to be sent to us along with the following documents –

▪ Duly filled and signed claim form

▪ Original receipts/bills and discharge voucher of the hospital/nursing home
▪ Original bills of chemists supported by prescriptions
▪ Original Investigation reports and payment receipts
▪ Other case papers as mentioned in Claims Form
▪ Doctor consultation papers and bills
▪ Any other document which is required by Us/Our TPA to adjudicate the claim

Additional documents needed to claim under Personal Accident benefit:-

It is a condition precedent to our liability under these Benefits that the following information and documentation
shall be submitted to us immediately and in any event within 30 days of the event giving rise to the Claim under
these Benefits:

▪ Medical reports giving the details of the Accident, nature of Injury and the details of treatment provided,
Admission and Death Summary, Accident Report
▪ Original Death Certificate; if applicable

19 | Page
▪ Disability Certificate issued by CMO (Chief Medical Officer) as appointed by the Hospital Authorities; if
applicable
▪ A newspaper cutting about accident (if available)
▪ Certificate from Bank for outstanding amount of loan

The claim form and additional documents are to be sent to us at the following address:
CARE Health Insurance Company Limited
Unit No. 604 - 607, 6th Floor, Tower C,
Unitech Cyber Park, Sector-39,
Gurugram-122001 (Haryana)

You can also submit the claim form and additional documents in case You have selected TPA, the name, contact
details etc. is mentioned in the Policy certificate for the selected TPA.

Step 3: Claim Processing and Reimbursement

If your request for reimbursement of expenses is approved, you will be duly intimated by us/ Our TPA.

In case of any information deficiency or further information requirements, you will be communicated instantly to
ensure resolution of the same at the earliest

If your request for claims is declined, you will be communicated the same along with valid reason(s) for rejection.
However, if the Insured Member/ Insured Member’s representative has further documents to
enhance/substantiate his case for claim, the same can also be sent to us/ Our TPA; and if found rational, the case
will be reopened for review of the documents and response, if any.

We /Our TPA will ensure that you are updated at all important stages of your claim process. To help us serve you
better, please ensure the following-

▪ The Pre-authorization/claim form is filled completely, sincerely and truly and all the required
documents are submitted along with the form and in original, wherever specified
▪ Retain a copy of the duly filled forms
▪ Please quote the member ID/reference number for all communication related to the above.

Free Look Period

o The Policyholder/Insured Member may, within 15 days from the receipt of the Policy document, return the
Policy stating reasons for his objection, if the Policyholder disagrees with any Policy terms and conditions.
o If no Claim has been made during the free look period under the Policy, then CARE Health Insurance will
refund the full premium through Master Policy Holder. All rights under the Policy will immediately stand
extinguished on the free look cancellation of the Policy.
o Provision for Free look period is not applicable and available at the time of renewal of the Policy.

Cancellation / Termination

You may also give 15 days’ notice in writing, to Us, for the cancellation of this Policy, in which case We shall from
the date of receipt of the notice cancel the Policy and refund the premium for the unexpired period of this Policy
at the short period scales as mentioned below, provided that no refund shall be made for those Insured Member
who has incurred Claim under the Policy.

Cancellation date from Policy Period Start Date Policy Tenure – 1 Year
Up to 1 month 75.00%
1 month to 3 months 50.00%
3 months to 6 months 25.00%
6 months to 12 months 0.00%
Refund % to be applied on total premium received as on the date of receipt of the cancellation request

20 | Page
In case of demise of the Primary Insured Member,
• Where the Policy covers only the Primary Insured Member, this Policy shall stand null and void from the date
and time of demise of the Primary Insured Member.
• Where the Policy covers other Insured Members, this Policy shall continue till the end of Cover Period for the
other Insured Members. If the other Insured Members wish to continue with the same Policy, the Company
will renew the Policy subject to the appointment of a Primary Insured Member provided that:
• Written notice in this regard is given to the Company before the Cover End Date; and
• A Person who satisfies the Company’s criteria to become a Primary Insured Member. The criteria being:
(a) He / She should become a member of the Group against whom the Master policy is issued.
(b) He / She should satisfy the age limit criteria as mentioned in the product

• If Policyholder cancels the Policy after the Free look period or demise of Insured where he/she is the only
insured in the Policy, then the Company will refund 50% of the instalment premium for the unexpired
instalment period, provided no Claim has been made under the Policy

Limitation of Liability

Any Claim under this Policy for which the notification or intimation of Claim is received 12 calendar months after
the event or occurrence giving rise to the Claim shall not be admissible, unless the Policyholder or the Insured
Member proves to the Company satisfaction that the delay in reporting of the Claim was for reasons beyond the
Insured Member’s control.

Communication

● Any communication meant for the Company must be in writing and be delivered to its address shown in the
Policy Schedule/ Certificate of Insurance. Any communication meant for the Policyholder or Insured Member
will be sent by the Company to his last known address or the address as shown in the Policy Schedule/
Certificate of Insurance.
● All notifications and declarations for the Company must be in writing and sent to the address specified in the
Policy Schedule/ Certificate of Insurance. Agents are not authorized to receive notices and declarations on the
Company’s behalf.
● Notice and instructions will be deemed served 10 days after posting or immediately upon receipt in the case of
hand delivery, facsimile or e-mail.

Alterations in the Policy

This Policy constitutes the complete contract of insurance. No change or alteration shall be valid or effective unless
approved in writing by the Company, which approval shall be evidenced by a written endorsement signed and
stamped by the Company.
Out of all the details of the various benefits provided in the Policy Terms and Conditions, only the details
pertaining to benefits chosen by policyholder as per Policy Schedule shall be considered relevant

Electronic Transactions

The Policyholder and Insured Member agrees to adhere to and comply with all such terms and conditions as the
Company may prescribe from time to time, and hereby agrees and confirms that all transactions effected by or
through facilities for conducting remote transactions including the Internet, World Wide Web, electronic data
interchange, call centers, tele-service operations (whether voice, video, data or combination thereof) or by means
of electronic, computer, automated machines network or through other means of telecommunication, established
by or on behalf of the Company, for and in respect of the Policy or its terms shall constitute legally binding and
valid transactions when done in adherence to and in compliance with the Company’s terms and conditions for such
facilities, as may be prescribed from time to time. Any terms and conditions related to electronic transactions shall
be within the approved Policy Terms and Conditions

21 | Page
Continuity Benefits

The company will grant continuity of benefits which were available to the Insured Members under a group
insurance policy in the immediately preceding Cover Period provided that:

i. The company shall be liable to provide continuity of only those benefits ( for e.g: Initial wait period, wait
period of Specific Diseases etc)which are applicable under the Policy;
ii. The Insured Members to whom continuity benefits will be provided should be covered under the group
insurance policy;
iii. Insured Members covered under this Policy shall have the right to migrate from this Policy to an individual
health insurance policy or a family floater policy offered by the company and the credit for wait periods
would be given in the opted individual health insurance policy or a family floater policy offered by the
company. Application for this Policy is made within 45 days before, but not earlier than 60 days from the
expiry of that group insurance policy
iv. Insured Member can apply only at the time of renewal of the group Policy.

Obligation in respect to minor

If an Insured Member is less than 18 years of age, the Primary Insured Member shall be responsible for ensuring
compliance with all terms and conditions of this Policy on behalf of that Insured Member.

Nominee

The Primary Insured Member can at the inception or at any time before the expiry of the Policy, make the
nomination for the purpose of payment of Claims.

Any change of nomination shall be communicated to the Company in writing and such change shall be effective
only when an endorsement to the Policy is made by the Company.

In case of any Insured Member other than the Primary Insured Member under the Policy, for the purpose of
payment of Claims in the event of death, the default nominee would be the Primary Insured Member.

Proximate Clause

The Company covers the Policyholder/Insured Member only to the extent of Proximity cause which means active
and efficient cause that sets in motion a chain of events which brings about a result, without the intervention of
any force started and working actively from a new and independent source.

Sanctions and Compliance with Laws

This insurance does not apply to the extent that trade or economic sanctions or other similar laws or regulations
prohibit the coverage provided by this insurance.

GRIEVANCE PROCESS

The Company has developed proper procedures and effective mechanism to address complaints, if any of the
customers. The company is committed to comply with the Regulations, standards which have been set forth in the
Regulations, Circulars issued from time to time in this regard.

If you or the Insured Member or Dependent have a grievance that You or the Insured Member or Dependent wish
Us to redress, You or the Insured Member may contact Us with the details of their grievance through:

Website www.careinsurance.com

22 | Page
E-mail [email protected]
Customer Care 1800-102-4488 / 1860-500-4488
Post /Courier Any of Our branch offices or our correspondence address, during normal business days

If the Insured Member is not satisfied with our redressal of their grievance through one of the above methods, You
or the Insured Member may contact Our Head of Customer Service at:
The Grievance Cell,
Unit No. 604 - 607, 6th Floor, Tower C,
Unitech Cyber Park,
Sector-39, Gurugram-122001 (Haryana)

If the Insured Member is not satisfied with our redressal of their grievance through one of the above methods, You
or the Insured Member may approach the nearest Insurance Ombudsman for resolution of their grievance.

DISCLAIMER

This is only a summary of product features. The actual benefits available are as described in the policy, and will be
subject to the policy Terms and Conditions. Please seek the advice of your insurance advisor if you require any
further information or clarification or contact us.

STATUTORY WARNING

Prohibition of Rebates (under section 41 of Insurance Act, 1938): No person shall allow or offer to allow, either
directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of
any kind of risk relating to lives or property, in India any rebate of the whole or part of the commission payable or
any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a Policy
accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of
the insurers.
Any person making default in complying with the provision of this section shall be punished with fine, which may
extent to five hundred rupees.

Insurance is a subject matter of solicitation.

IRDA Registration number: 148

23 | Page
ANNEXURE I

List of Day Care Surgeries

Cardiology Related: 27. TRANSORAL INCISION AND DRAINAGE OF A

PHARYNGEAL ABSCESS
1. CORONARY ANGIOGRAPHY 28. TONSILLECTOMY WITHOUT ADENOIDECTOMY
29. TONSILLECTOMY WITH ADENOIDECTOMY
Critical Care Related: 30. EXCISION AND DESTRUCTION OF A LINGUAL
TONSIL
2. INSERT NON- TUNNEL CV CATH 31. REVISION OF A TYMPANOPLASTY
3. INSERT PICC CATH ( PERIPHERALLY INSERTED 32. OTHER MICROSURGICAL OPERATIONS ON THE
CENTRAL CATHETER ) MIDDLE EAR
4. REPLACE PICC CATH ( PERIPHERALLY INSERTED 33. INCISION OF THE MASTOID PROCESS AND
CENTRAL CATHETER ) MIDDLE EAR
5. INSERTION CATHETER, INTRA ANTERIOR 34. MASTOIDECTOMY
6. INSERTION OF PORTACATH 35. RECONSTRUCTION OF THE MIDDLE EAR
36. OTHER EXCISIONS OF THE MIDDLE AND INNER
Dental Related: EAR
37. INCISION (OPENING) AND DESTRUCTION
7. SPLINTING OF AVULSED TEETH (ELIMINATION) OF THE INNER EAR
8. SUTURING LACERATED LIP 38. OTHER OPERATIONS ON THE MIDDLE AND
9. SUTURING ORAL MUCOSA INNER EAR
10. ORAL BIOPSY IN CASE OF ABNORMAL TISSUE 39. EXCISION AND DESTRUCTION OF DISEASED
PRESENTATION TISSUE OF THE NOSE
11. FNAC 40. OTHER OPERATIONS ON THE NOSE
12. SMEAR FROM ORAL CAVITY 41. NASAL SINUS ASPIRATION
42. FOREIGN BODY REMOVAL FROM NOSE
ENT Related: 43. OTHER OPERATIONS ON THE TONSILS AND
ADENOIDS
13. MYRINGOTOMY WITH GROMMET INSERTION 44. ADENOIDECTOMY
14. TYMPANOPLASTY (CLOSURE OF AN EARDRUM 45. LABYRINTHECTOMY FOR SEVERE VERTIGO
PERFORATION/RECONSTRUCTION OF THE 46. STAPEDECTOMY UNDER GA
AUDITORY OSSICLES) 47. STAPEDECTOMY UNDER LA
15. REMOVAL OF A TYMPANIC DRAIN 48. TYMPANOPLASTY (TYPE IV)
16. KERATOSIS REMOVAL UNDER GA 49. ENDOLYMPHATIC SAC SURGERY FOR
17. OPERATIONS ON THE TURBINATES (NASAL MENIERE'S DISEASE
CONCHA) 50. TURBINECTOMY
18. TYMPANOPLASTY (CLOSURE OF AN EARDRUM 51. ENDOSCOPIC STAPEDECTOMY
PERFORATION/RECONSTRUCTION OF THE 52. INCISION AND DRAINAGE OF PERICHONDRITIS
AUDITORY OSSICLES) 53. SEPTOPLASTY
19. REMOVAL OF KERATOSIS OBTURANS 54. VESTIBULAR NERVE SECTION
20. STAPEDOTOMY TO TREAT VARIOUS LESIONS 55. THYROPLASTY TYPE I
IN MIDDLE EAR 56. PSEUDOCYST OF THE PINNA - EXCISION
21. REVISION OF A STAPEDECTOMY 57. INCISION AND DRAINAGE - HAEMATOMA
22. OTHER OPERATIONS ON THE AUDITORY AURICLE
OSSICLES 58. TYMPANOPLASTY (TYPE II)
23. MYRINGOPLASTY (POST-AURA/ENDAURAL 59. REDUCTION OF FRACTURE OF NASAL BONE
APPROACH AS WELL AS SIMPLE TYPE -I 60. THYROPLASTY TYPE II
TYMPANOPLASTY) 61. TRACHEOSTOMY
24. FENESTRATION OF THE INNER EAR 62. EXCISION OF ANGIOMA SEPTUM
25. REVISION OF A FENESTRATION OF THE INNER 63. TURBINOPLASTY
EAR 64. INCISION & DRAINAGE OF RETRO
26. PALATOPLASTY PHARYNGEAL ABSCESS
65. UVULO PALATO PHARYNGO PLASTY

24 | Page
66. ADENOIDECTOMY WITH GROMMET 101. EPIDIDYMECTOMY
INSERTION 102. INCISION OF THE BREAST ABSCESS
67. ADENOIDECTOMY WITHOUT GROMMET 103. OPERATIONS ON THE NIPPLE
INSERTION 104. EXCISION OF SINGLE BREAST LUMP
68. VOCAL CORD LATERALISATION PROCEDURE 105. INCISION AND EXCISION OF TISSUE IN THE
69. INCISION & DRAINAGE OF PARA PHARYNGEAL PERIANAL REGION
ABSCESS 106. SURGICAL TREATMENT OF HEMORRHOIDS
70. TRACHEOPLASTY 107. OTHER OPERATIONS ON THE ANUS
108. ULTRASOUND GUIDED ASPIRATIONS
Gastroenterology Related: 109. SCLEROTHERAPY, ETC.
110. LAPAROTOMY FOR GRADING LYMPHOMA
71. CHOLECYSTECTOMY AND CHOLEDOCHO- WITH SPLENECTOMY/LIVER/LYMPH NODE
JEJUNOSTOMY/ BIOPSY
DUODENOSTOMY/GASTROSTOMY/EXPLORATI 111. THERAPEUTIC LAPAROSCOPY WITH LASER
ON COMMON BILE DUCT 112. APPENDICECTOMY WITH/WITHOUT
72. ESOPHAGOSCOPY, GASTROSCOPY, DRAINAGE
DUODENOSCOPY WITH POLYPECTOMY/ 113. INFECTED KELOID EXCISION
REMOVAL OF FOREIGN BODY/DIATHERMY OF 114. AXILLARY LYMPHADENECTOMY
BLEEDING LESIONS 115. WOUND DEBRIDEMENT AND COVER
73. PANCREATIC PSEUDOCYST EUS & DRAINAGE 116. ABSCESS-DECOMPRESSION
74. RF ABLATION FOR BARRETT'S OESOPHAGUS 117. CERVICAL LYMPHADENECTOMY
75. ERCP AND PAPILLOTOMY 118. INFECTED SEBACEOUS CYST
76. ESOPHAGOSCOPE AND SCLEROSANT 119. INGUINAL LYMPHADENECTOMY
INJECTION 120. INCISION AND DRAINAGE OF ABSCESS
77. EUS + SUBMUCOSAL RESECTION 121. SUTURING OF LACERATIONS
78. CONSTRUCTION OF GASTROSTOMY TUBE 122. SCALP SUTURING
79. EUS + ASPIRATION PANCREATIC CYST 123. INFECTED LIPOMA EXCISION
80. SMALL BOWEL ENDOSCOPY (THERAPEUTIC) 124. MAXIMAL ANAL DILATATION
81. COLONOSCOPY ,LESION REMOVAL 125. PILES
82. ERCP 126. A)INJECTION SCLEROTHERAPY
83. COLONSCOPY STENTING OF STRICTURE 127. B)PILES BANDING
84. PERCUTANEOUS ENDOSCOPIC GASTROSTOMY 128. LIVER ABSCESS- CATHETER DRAINAGE
85. EUS AND PANCREATIC PSEUDO CYST 129. FISSURE IN ANO- FISSURECTOMY
DRAINAGE 130. FIBROADENOMA BREAST EXCISION
86. ERCP AND CHOLEDOCHOSCOPY 131. OESOPHAGEAL VARICES SCLEROTHERAPY
87. PROCTOSIGMOIDOSCOPY VOLVULUS 132. ERCP - PANCREATIC DUCT STONE REMOVAL
DETORSION 133. PERIANAL ABSCESS I&D
88. ERCP AND SPHINCTEROTOMY 134. PERIANAL HEMATOMA EVACUATION
89. ESOPHAGEAL STENT PLACEMENT 135. UGI SCOPY AND POLYPECTOMY OESOPHAGUS
90. ERCP + PLACEMENT OF BILIARY STENTS 136. BREAST ABSCESS I& D
91. SIGMOIDOSCOPY W / STENT 137. FEEDING GASTROSTOMY
92. EUS + COELIAC NODE BIOPSY 138. OESOPHAGOSCOPY AND BIOPSY OF GROWTH
93. UGI SCOPY AND INJECTION OF ADRENALINE, OESOPHAGUS
SCLEROSANTS BLEEDING ULCERS 139. ERCP - BILE DUCT STONE REMOVAL
140. ILEOSTOMY CLOSURE
General Surgery Related: 141. COLONOSCOPY
142. POLYPECTOMY COLON
94. INCISION OF A PILONIDAL SINUS / ABSCESS 143. SPLENIC ABSCESSES LAPAROSCOPIC
95. FISSURE IN ANO SPHINCTEROTOMY DRAINAGE
96. SURGICAL TREATMENT OF A VARICOCELE AND 144. UGI SCOPY AND POLYPECTOMY STOMACH
A HYDROCELE OF THE SPERMATIC CORD 145. RIGID OESOPHAGOSCOPY FOR FB REMOVAL
97. ORCHIDOPEXY 146. FEEDING JEJUNOSTOMY
98. ABDOMINAL EXPLORATION IN 147. COLOSTOMY
CRYPTORCHIDISM 148. ILEOSTOMY
99. SURGICAL TREATMENT OF ANAL FISTULAS 149. COLOSTOMY CLOSURE
100. DIVISION OF THE ANAL SPHINCTER 150. SUBMANDIBULAR SALIVARY DUCT STONE
(SPHINCTEROTOMY) REMOVAL

25 | Page
151. PNEUMATIC REDUCTION OF 193. THERAPEUTIC CURETTAGE WITH
INTUSSUSCEPTION COLPOSCOPY/BIOPSY/DIATHERMY/CRYOSURG
152. VARICOSE VEINS LEGS - INJECTION ERY/
SCLEROTHERAPY 194. LASER THERAPY OF CERVIX FOR VARIOUS
153. RIGID OESOPHAGOSCOPY FOR PLUMMER LESIONS OF UTERUS
VINSON SYNDROME 195. OTHER OPERATIONS ON THE UTERINE CERVIX
154. PANCREATIC PSEUDOCYSTS ENDOSCOPIC 196. INCISION OF THE UTERUS (HYSTERECTOMY)
DRAINAGE 197. LOCAL EXCISION AND DESTRUCTION OF
155. ZADEK'S NAIL BED EXCISION DISEASED TISSUE OF THE VAGINA AND THE
156. SUBCUTANEOUS MASTECTOMY POUCH OF DOUGLAS
157. EXCISION OF RANULA UNDER GA 198. INCISION OF VAGINA
158. RIGID OESOPHAGOSCOPY FOR DILATION OF 199. INCISION OF VULVA
BENIGN STRICTURES 200. CULDOTOMY
159. EVERSION OF SAC 201. SALPINGO-OOPHORECTOMY VIA
160. UNILATERAL LAPAROTOMY
161. ILATERAL 202. ENDOSCOPIC POLYPECTOMY
162. LORD'S PLICATION 203. HYSTEROSCOPIC REMOVAL OF MYOMA
163. JABOULAY'S PROCEDURE 204. D&C
164. SCROTOPLASTY 205. HYSTEROSCOPIC RESECTION OF SEPTUM
165. CIRCUMCISION FOR TRAUMA 206. THERMAL CAUTERISATION OF CERVIX
166. MEATOPLASTY 207. MIRENA INSERTION
167. INTERSPHINCTERIC ABSCESS INCISION AND 208. HYSTEROSCOPIC ADHESIOLYSIS
DRAINAGE 209. LEEP
168. PSOAS ABSCESS INCISION AND DRAINAGE 210. CRYOCAUTERISATION OF CERVIX
169. THYROID ABSCESS INCISION AND DRAINAGE 211. POLYPECTOMY ENDOMETRIUM
170. TIPS PROCEDURE FOR PORTAL HYPERTENSION 212. HYSTEROSCOPIC RESECTION OF FIBROID
171. ESOPHAGEAL GROWTH STENT 213. LLETZ
172. PAIR PROCEDURE OF HYDATID CYST LIVER 214. CONIZATION
173. TRU CUT LIVER BIOPSY 215. POLYPECTOMY CERVIX
174. PHOTODYNAMIC THERAPY OR ESOPHAGEAL 216. HYSTEROSCOPIC RESECTION OF
TUMOUR AND LUNG TUMOUR ENDOMETRIAL POLYP
175. EXCISION OF CERVICAL RIB 217. VULVAL WART EXCISION
176. LAPAROSCOPIC REDUCTION OF 218. LAPAROSCOPIC PARAOVARIAN CYST EXCISION
INTUSSUSCEPTION 219. UTERINE ARTERY EMBOLIZATION
177. MICRODOCHECTOMY BREAST 220. LAPAROSCOPIC CYSTECTOMY
178. SURGERY FOR FRACTURE PENIS 221. HYMENECTOMY( IMPERFORATE HYMEN)
179. SENTINEL NODE BIOPSY 222. ENDOMETRIAL ABLATION
180. PARASTOMAL HERNIA 223. VAGINAL WALL CYST EXCISION
181. REVISION COLOSTOMY 224. VULVAL CYST EXCISION
182. PROLAPSED COLOSTOMY- CORRECTION 225. LAPAROSCOPIC PARATUBAL CYST EXCISION
183. TESTICULAR BIOPSY 226. REPAIR OF VAGINA ( VAGINAL ATRESIA )
184. LAPAROSCOPIC CARDIOMYOTOMY( HELLERS) 227. HYSTEROSCOPY, REMOVAL OF MYOMA
185. SENTINEL NODE BIOPSY MALIGNANT 228. TURBT
MELANOMA 229. URETEROCOELE REPAIR - CONGENITAL
186. LAPAROSCOPIC PYLOROMYOTOMY( INTERNAL
RAMSTEDT) 230. VAGINAL MESH FOR POP
231. LAPAROSCOPIC MYOMECTOMY
Gynecology Related: 232. SURGERY FOR SUI
233. REPAIR RECTO- VAGINA FISTULA
187. OPERATIONS ON BARTHOLIN’S GLANDS (CYST) 234. PELVIC FLOOR REPAIR( EXCLUDING FISTULA
188. INCISION OF THE OVARY REPAIR)
189. INSUFFLATIONS OF THE FALLOPIAN TUBES 235. URS + LL
190. OTHER OPERATIONS ON THE FALLOPIAN TUBE 236. LAPAROSCOPIC OOPHORECTOMY
191. DILATATION OF THE CERVICAL CANAL 237. NORMAL VAGINAL DELIVERY AND VARIANTS
192. CONISATION OF THE UTERINE CERVIX
Neurology Related:

26 | Page
238. FACIAL NERVE PHYSIOTHERAPY 290. ADJUVANT RADIOTHERAPY
239. NERVE BIOPSY 291. AFTERLOADING CATHETER BRACHYTHERAPY
240. MUSCLE BIOPSY 292. CONDITIONING RADIOTHEARPY FOR BMT
241. EPIDURAL STEROID INJECTION 293. EXTRACORPOREAL IRRADIATION TO THE
242. GLYCEROL RHIZOTOMY HOMOLOGOUS BONE GRAFTS
243. SPINAL CORD STIMULATION 294. RADICAL CHEMOTHERAPY
244. MOTOR CORTEX STIMULATION 295. NEOADJUVANT RADIOTHERAPY
245. STEREOTACTIC RADIOSURGERY 296. LDR BRACHYTHERAPY
246. PERCUTANEOUS CORDOTOMY 297. PALLIATIVE RADIOTHERAPY
247. INTRATHECAL BACLOFEN THERAPY 298. RADICAL RADIOTHERAPY
248. ENTRAPMENT NEUROPATHY RELEASE 299. PALLIATIVE CHEMOTHERAPY
249. DIAGNOSTIC CEREBRAL ANGIOGRAPHY 300. TEMPLATE BRACHYTHERAPY
250. VP SHUNT 301. NEOADJUVANT CHEMOTHERAPY
251. VENTRICULOATRIAL SHUNT 302. ADJUVANT CHEMOTHERAPY
303. INDUCTION CHEMOTHERAPY
Oncology Related: 304. CONSOLIDATION CHEMOTHERAPY
305. MAINTENANCE CHEMOTHERAPY
252. RADIOTHERAPY FOR CANCER 306. HDR BRACHYTHERAPY
253. CANCER CHEMOTHERAPY
254. IV PUSH CHEMOTHERAPY Operations on the salivary glands & salivary
255. HBI-HEMIBODY RADIOTHERAPY ducts:
256. INFUSIONAL TARGETED THERAPY
257. SRT-STEREOTACTIC ARC THERAPY 307. INCISION AND LANCING OF A SALIVARY
258. SC ADMINISTRATION OF GROWTH FACTORS GLAND AND A SALIVARY DUCT
259. CONTINUOUS INFUSIONAL CHEMOTHERAPY 308. EXCISION OF DISEASED TISSUE OF A SALIVARY
260. INFUSIONAL CHEMOTHERAPY GLAND AND A SALIVARY DUCT
261. CCRT-CONCURRENT CHEMO + RT 309. RESECTION OF A SALIVARY GLAND
262. 2D RADIOTHERAPY 310. RECONSTRUCTION OF A SALIVARY GLAND
263. 3D CONFORMAL RADIOTHERAPY AND A SALIVARY DUCT
264. IGRT- IMAGE GUIDED RADIOTHERAPY 311. OTHER OPERATIONS ON THE SALIVARY
265. IMRT- STEP & SHOOT GLANDS AND SALIVARY DUCTS
266. INFUSIONAL BISPHOSPHONATES
267. IMRT- DMLC Operations on the skin & subcutaneous tissues:
268. ROTATIONAL ARC THERAPY
269. TELE GAMMA THERAPY 312. OTHER INCISIONS OF THE SKIN AND
270. FSRT-FRACTIONATED SRT SUBCUTANEOUS TISSUES
271. VMAT-VOLUMETRIC MODULATED ARC 313. SURGICAL WOUND TOILET (WOUND
THERAPY DEBRIDEMENT) AND REMOVAL OF DISEASED
272. SBRT-STEREOTACTIC BODY RADIOTHERAPY TISSUE OF THE SKIN AND SUBCUTANEOUS
273. HELICAL TOMOTHERAPY TISSUES
274. SRS-STEREOTACTIC RADIOSURGERY 314. LOCAL EXCISION OF DISEASED TISSUE OF THE
275. X-KNIFE SRS SKIN AND SUBCUTANEOUS TISSUES
276. GAMMAKNIFE SRS 315. OTHER EXCISIONS OF THE SKIN AND
277. TBI- TOTAL BODY RADIOTHERAPY SUBCUTANEOUS TISSUES
278. INTRALUMINAL BRACHYTHERAPY 316. SIMPLE RESTORATION OF SURFACE
279. ELECTRON THERAPY CONTINUITY OF THE SKIN AND
280. TSET-TOTAL ELECTRON SKIN THERAPY SUBCUTANEOUS TISSUES
281. EXTRACORPOREAL IRRADIATION OF BLOOD 317. FREE SKIN TRANSPLANTATION, DONOR SITE
PRODUCTS 318. FREE SKIN TRANSPLANTATION, RECIPIENT SITE
282. TELECOBALT THERAPY 319. REVISION OF SKIN PLASTY
283. TELECESIUM THERAPY 320. OTHER RESTORATION AND RECONSTRUCTION
284. EXTERNAL MOULD BRACHYTHERAPY OF THE SKIN AND SUBCUTANEOUS TISSUES.
285. INTERSTITIAL BRACHYTHERAPY 321. CHEMOSURGERY TO THE SKIN.
286. INTRACAVITY BRACHYTHERAPY 322. DESTRUCTION OF DISEASED TISSUE IN THE
287. 3D BRACHYTHERAPY SKIN AND SUBCUTANEOUS TISSUES
288. IMPLANT BRACHYTHERAPY 323. RECONSTRUCTION OF DEFORMITY/DEFECT IN
289. INTRAVESICAL BRACHYTHERAPY NAIL BED

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324. EXCISION OF BURSIRTIS
325. TENNIS ELBOW RELEASE Orthopedics Related:

Operations on the Tongue: 356. SURGERY FOR MENISCUS TEAR

357. INCISION ON BONE, SEPTIC AND ASEPTIC
326. INCISION, EXCISION AND DESTRUCTION OF 358. CLOSED REDUCTION ON FRACTURE,
DISEASED TISSUE OF THE TONGUE LUXATION OR EPIPHYSEOLYSIS WITH
327. PARTIAL GLOSSECTOMY OSTEOSYNTHESIS
328. GLOSSECTOMY 359. SUTURE AND OTHER OPERATIONS ON
329. RECONSTRUCTION OF THE TONGUE TENDONS AND TENDON SHEATH
330. OTHER OPERATIONS ON THE TONGUE 360. REDUCTION OF DISLOCATION UNDER GA
361. ARTHROSCOPIC KNEE ASPIRATION
Ophthalmology Related: 362. SURGERY FOR LIGAMENT TEAR
363. SURGERY FOR
331. SURGERY FOR CATARACT HEMOARTHROSIS/PYOARTHROSIS
332. INCISION OF TEAR GLANDS 364. REMOVAL OF FRACTURE PINS/NAILS
333. OTHER OPERATIONS ON THE TEAR DUCTS 365. REMOVAL OF METAL WIRE
334. INCISION OF DISEASED EYELIDS 366. CLOSED REDUCTION ON FRACTURE,
335. EXCISION AND DESTRUCTION OF DISEASED LUXATION
TISSUE OF THE EYELID 367. REDUCTION OF DISLOCATION UNDER GA
336. OPERATIONS ON THE CANTHUS AND 368. EPIPHYSEOLYSIS WITH OSTEOSYNTHESIS
EPICANTHUS 369. EXCISION OF VARIOUS LESIONS IN COCCYX
337. CORRECTIVE SURGERY FOR ENTROPION AND 370. ARTHROSCOPIC REPAIR OF ACL TEAR KNEE
ECTROPION 371. CLOSED REDUCTION OF MINOR FRACTURES
338. CORRECTIVE SURGERY FOR BLEPHAROPTOSIS 372. ARTHROSCOPIC REPAIR OF PCL TEAR KNEE
339. REMOVAL OF A FOREIGN BODY FROM THE 373. TENDON SHORTENING
CONJUNCTIVA 374. ARTHROSCOPIC MENISCECTOMY - KNEE
340. REMOVAL OF A FOREIGN BODY FROM THE 375. TREATMENT OF CLAVICLE DISLOCATION
CORNEA 376. HAEMARTHROSIS KNEE- LAVAGE
341. INCISION OF THE CORNEA 377. ABSCESS KNEE JOINT DRAINAGE
342. OPERATIONS FOR PTERYGIUM 378. CARPAL TUNNEL RELEASE
343. OTHER OPERATIONS ON THE CORNEA 379. CLOSED REDUCTION OF MINOR DISLOCATION
344. REMOVAL OF A FOREIGN BODY FROM THE 380. REPAIR OF KNEE CAP TENDON
LENS OF THE EYE 381. ORIF WITH K WIRE FIXATION- SMALL BONES
345. REMOVAL OF A FOREIGN BODY FROM THE 382. RELEASE OF MIDFOOT JOINT
POSTERIOR CHAMBER OF THE EYE 383. ORIF WITH PLATING- SMALL LONG BONES
346. REMOVAL OF A FOREIGN BODY FROM THE 384. IMPLANT REMOVAL MINOR
ORBIT AND EYEBALL 385. K WIRE REMOVAL
347. CORRECTION OF EYELID PTOSIS BY LEVATOR 386. POP APPLICATION
PALPEBRAE SUPERIORIS RESECTION 387. CLOSED REDUCTION AND EXTERNAL FIXATION
(BILATERAL) 388. ARTHROTOMY HIP JOINT
348. CORRECTION OF EYELID PTOSIS BY FASCIA 389. SYME'S AMPUTATION
LATA GRAFT (BILATERAL) 390. ARTHROPLASTY
349. DIATHERMY/CRYOTHERAPY TO TREAT 391. PARTIAL REMOVAL OF RIB
RETINAL TEAR 392. TREATMENT OF SESAMOID BONE FRACTURE
350. ANTERIOR CHAMBER PARACENTESIS/ 393. SHOULDER ARTHROSCOPY / SURGERY
CYCLODIATHERMY/CYCLOCRYOTHERAPY/ 394. ELBOW ARTHROSCOPY
GONIOTOMY/TRABECULOTOMY AND 395. AMPUTATION OF METACARPAL BONE
FILTERING AND ALLIED OPERATIONS TO TREAT 396. RELEASE OF THUMB CONTRACTURE
GLAUCOMA 397. INCISION OF FOOT FASCIA
351. ENUCLEATION OF EYE WITHOUT IMPLANT 398. CALCANEUM SPUR HYDROCORT INJECTION
352. DACRYOCYSTORHINOSTOMY FOR VARIOUS 399. GANGLION WRIST HYALASE INJECTION
LESIONS OF LACRIMAL GLAND 400. PARTIAL REMOVAL OF METATARSAL
353. LASER PHOTOCOAGULATION TO TREAT 401. REPAIR / GRAFT OF FOOT TENDON
RATINAL TEAR 402. REVISION/REMOVAL OF KNEE CAP
354. BIOPSY OF TEAR GLAND 403. AMPUTATION FOLLOW-UP SURGERY
355. TREATMENT OF RETINAL LESION 404. EXPLORATION OF ANKLE JOINT

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405. REMOVE/GRAFT LEG BONE LESION 448. RECTAL-MYOMECTOMY
406. REPAIR/GRAFT ACHILLES TENDON 449. RECTAL PROLAPSE (DELORME'S PROCEDURE)
407. REMOVE OF TISSUE EXPANDER 450. DETORSION OF TORSION TESTIS
408. BIOPSY ELBOW JOINT LINING 451. EUA + BIOPSY MULTIPLE FISTULA IN ANO
409. REMOVAL OF WRIST PROSTHESIS 452. CYSTIC HYGROMA - INJECTION TREATMENT
410. BIOPSY FINGER JOINT LINING
411. TENDON LENGTHENING Plastic Surgery Related:
412. TREATMENT OF SHOULDER DISLOCATION
413. LENGTHENING OF HAND TENDON 453. CONSTRUCTION SKIN PEDICLE FLAP
414. REMOVAL OF ELBOW BURSA 454. GLUTEAL PRESSURE ULCER-EXCISION
415. FIXATION OF KNEE JOINT 455. MUSCLE-SKIN GRAFT, LEG
416. TREATMENT OF FOOT DISLOCATION 456. REMOVAL OF BONE FOR GRAFT
417. SURGERY OF BUNION 457. MUSCLE-SKIN GRAFT DUCT FISTULA
418. INTRA ARTICULAR STEROID INJECTION 458. REMOVAL CARTILAGE GRAFT
419. TENDON TRANSFER PROCEDURE 459. MYOCUTANEOUS FLAP
420. REMOVAL OF KNEE CAP BURSA 460. FIBRO MYOCUTANEOUS FLAP
421. TREATMENT OF FRACTURE OF ULNA 461. BREAST RECONSTRUCTION SURGERY AFTER
422. TREATMENT OF SCAPULA FRACTURE MASTECTOMY
423. REMOVAL OF TUMOR OF ARM/ ELBOW 462. SLING OPERATION FOR FACIAL PALSY
UNDER RA/GA 463. SPLIT SKIN GRAFTING UNDER RA
424. REPAIR OF RUPTURED TENDON 464. WOLFE SKIN GRAFT
425. DECOMPRESS FOREARM SPACE 465. PLASTIC SURGERY TO THE FLOOR OF THE
426. REVISION OF NECK MUSCLE (TORTICOLLIS MOUTH UNDER GA
RELEASE )
427. LENGTHENING OF THIGH TENDONS Thoracic surgery Related:
428. TREATMENT FRACTURE OF RADIUS & ULNA
429. REPAIR OF KNEE JOINT 466. THORACOSCOPY AND LUNG BIOPSY
467. EXCISION OF CERVICAL SYMPATHETIC CHAIN
Other operations on the mouth & face: THORACOSCOPIC
468. LASER ABLATION OF BARRETT'S OESOPHAGUS
430. EXTERNAL INCISION AND DRAINAGE IN THE 469. PLEURODESIS
REGION OF THE MOUTH, JAW AND FACE 470. THORACOSCOPY AND PLEURAL BIOPSY
431. INCISION OF THE HARD AND SOFT PALATE 471. EBUS + BIOPSY
432. EXCISION AND DESTRUCTION OF DISEASED 472. THORACOSCOPY LIGATION THORACIC DUCT
HARD AND SOFT PALATE 473. THORACOSCOPY ASSISTED EMPYAEMA
433. INCISION, EXCISION AND DESTRUCTION IN DRAINAGE
THE MOUTH
434. OTHER OPERATIONS IN THE MOUTH Urology Related:

Pediatric surgery Related: 474. HAEMODIALYSIS

475. LITHOTRIPSY/NEPHROLITHOTOMY FOR RENAL
435. EXCISION OF FISTULA-IN-ANO CALCULUS
436. EXCISION JUVENILE POLYPS RECTUM 476. EXCISION OF RENAL CYST
437. VAGINOPLASTY 477. DRAINAGE OF PYONEPHROSIS/PERINEPHRIC
438. DILATATION OF ACCIDENTAL CAUSTIC ABSCESS
STRICTURE OESOPHAGEAL 478. INCISION OF THE PROSTATE
439. PRESACRAL TERATOMAS EXCISION 479. TRANSURETHRAL EXCISION AND
440. REMOVAL OF VESICAL STONE DESTRUCTION OF PROSTATE TISSUE
441. EXCISION SIGMOID POLYP 480. TRANSURETHRAL AND PERCUTANEOUS
442. STERNOMASTOID TENOTOMY DESTRUCTION OF PROSTATE TISSUE
443. INFANTILE HYPERTROPHIC PYLORIC STENOSIS 481. OPEN SURGICAL EXCISION AND DESTRUCTION
PYLOROMYOTOMY OF PROSTATE TISSUE
444. EXCISION OF SOFT TISSUE 482. RADICAL PROSTATOVESICULECTOMY
RHABDOMYOSARCOMA 483. OTHER EXCISION AND DESTRUCTION OF
445. MEDIASTINAL LYMPH NODE BIOPSY PROSTATE TISSUE
446. HIGH ORCHIDECTOMY FOR TESTIS TUMOURS 484. OPERATIONS ON THE SEMINAL VESICLES
447. EXCISION OF CERVICAL TERATOMA

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485. INCISION AND EXCISION OF PERIPROSTATIC 510. URSL WITH STENTING
TISSUE 511. URSL WITH LITHOTRIPSY
486. OTHER OPERATIONS ON THE PROSTATE 512. CYSTOSCOPIC LITHOLAPAXY
487. INCISION OF THE SCROTUM AND TUNICA 513. ESWL
VAGINALIS TESTIS 514. BLADDER NECK INCISION
488. OPERATION ON A TESTICULAR HYDROCELE 515. CYSTOSCOPY & BIOPSY
489. EXCISION AND DESTRUCTION OF DISEASED 516. CYSTOSCOPY AND REMOVAL OF POLYP
SCROTAL TISSUE 517. SUPRAPUBIC CYSTOSTOMY
490. OTHER OPERATIONS ON THE SCROTUM AND 518. PERCUTANEOUS NEPHROSTOMY
TUNICA VAGINALIS TESTIS 519. CYSTOSCOPY AND "SLING" PROCEDURE.
491. INCISION OF THE TESTES 520. TUNA- PROSTATE
492. EXCISION AND DESTRUCTION OF DISEASED 521. EXCISION OF URETHRAL DIVERTICULUM
TISSUE OF THE TESTES 522. REMOVAL OF URETHRAL STONE
493. UNILATERAL ORCHIDECTOMY 523. EXCISION OF URETHRAL PROLAPSE
494. BILATERAL ORCHIDECTOMY 524. MEGA-URETER RECONSTRUCTION
495. SURGICAL REPOSITIONING OF AN ABDOMINAL 525. KIDNEY RENOSCOPY AND BIOPSY
TESTIS 526. URETER ENDOSCOPY AND TREATMENT
496. RECONSTRUCTION OF THE TESTIS 527. VESICO URETERIC REFLUX CORRECTION
497. IMPLANTATION, EXCHANGE AND REMOVAL 528. SURGERY FOR PELVI URETERIC JUNCTION
OF A TESTICULAR PROSTHESIS OBSTRUCTION
498. OTHER OPERATIONS ON THE TESTIS 529. ANDERSON HYNES OPERATION
499. EXCISION IN THE AREA OF THE EPIDIDYMIS 530. KIDNEY ENDOSCOPY AND BIOPSY
500. OPERATIONS ON THE FORESKIN 531. PARAPHIMOSIS SURGERY
501. LOCAL EXCISION AND DESTRUCTION OF 532. INJURY PREPUCE- CIRCUMCISION
DISEASED TISSUE OF THE PENIS 533. FRENULAR TEAR REPAIR
502. AMPUTATION OF THE PENIS 534. MEATOTOMY FOR MEATAL STENOSIS
503. OTHER OPERATIONS ON THE PENIS 535. SURGERY FOR FOURNIER'S GANGRENE
504. CYSTOSCOPICAL REMOVAL OF STONES SCROTUM
505. CATHETERISATION OF BLADDER 536. SURGERY FILARIAL SCROTUM
506. LITHOTRIPSY 537. SURGERY FOR WATERING CAN PERINEUM
507. BIOPSY OFTEMPORAL ARTERY FOR VARIOUS 538. REPAIR OF PENILE TORSION
LESIONS 539. DRAINAGE OF PROSTATE ABSCESS
508. EXTERNAL ARTERIO-VENOUS SHUNT 540. ORCHIECTOMY
509. AV FISTULA - WRIST 541. CYSTOSCOPY AND REMOVAL OF FB

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 ANNEXURE –II

Sr. No. Annexure – II List of Expenses Generally Excluded ("Non-medical") in Hospital Indemnity Policy
List I – Optional Items

BABY FOOD EYELET COLLAR

BABY UTILITIES CHARGES SLINGS
BEAUTY SERVICES BLOOD GROUPING AND CROSS MATCHING OF DONORS
SAMPLES
BELTS/ BRACES SERVICE CHARGES WHERE NURSING CHARGE ALSO CHARGED
BUDS Television Charges
COLD PACK/HOT PACK SURCHARGES
CARRY BAGS ATTENDANT CHARGES
EMAIL / INTERNET CHARGES EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS
PART OF BED CHARGE)
FOOD CHARGES (OTHER THAN PATIENT's BIRTH CERTIFICATE
DIET PROVIDED BY HOSPITAL)
LEGGINGS CERTIFICATE CHARGES
LAUNDRY CHARGES COURIER CHARGES
MINERAL WATER CONVEYANCE CHARGES
SANITARY PAD MEDICAL CERTIFICATE
TELEPHONE CHARGES MEDICAL RECORDS
GUEST SERVICES PHOTOCOPIES CHARGES
CREPE BANDAGE MORTUARY CHARGES
DIAPER OF ANY TYPE WALKING AIDS CHARGES
CERVICAL COLLAR OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL)
SPLINT SPACER
DIABETIC FOOT WEAR SPIROMETRE
KNEE BRACES (LONG/ SHORT/ HINGED) NEBULIZER KIT
KNEE IMMOBILIZER/SHOULDER STEAM INHALER
IMMOBILIZER
LUMBO SACRAL BELT ARMSLING
NIMBUS BED OR WATER OR AIR BED THERMOMETER
CHARGES
AMBULANCE COLLAR KIDNEY TRAY
AMBULANCE EQUIPMENT MASK
ABDOMINAL BINDER OUNCE GLASS
PRIVATE NURSES CHARGES- SPECIAL OXYGEN MASK
NURSING CHARGES
SUGAR FREE Tablets PELVIC TRACTION BELT
CREAMS POWDERS LOTIONS (Toiletries are PAN CAN
not payable, only prescribed medical
pharmaceuticals payable)
ECG ELECTRODES TROLLY COVER
GLOVES UROMETER, URINE JUG
NEBULISATION KIT AMBULANCE
ANY KIT WITH NO DETAILS MENTIONED VASOFIX SAFETY
[DELIVERY KIT, ORTHOKIT, RECOVERY KIT,
ETC]

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 Sr. No. List of Expenses Generally Excluded ("Non-medical")in Hospital Indemnity Policy
List II – Items that are to be subsumed into Room Charges

BABY CHARGES (UNLESS SPECIFIED/INDICATED) TISSUE PAPER

HAND WASH TOOTH PASTE
SHOE COVER TOOTH BRUSH
CAPS BED PAN
CRADLE CHARGES FACE MASK
COMB FLEXI MASK
EAU-DE-COLOGNE / ROOM FRESHNERS HAND HOLDER
FOOT COVER SPUTUM CUP
GOWN DISINFECTANT LOTIONS
SLIPPERS LUXURY TAX
HVAC DISCHARGE PROCEDURE CHARGES
HOUSE KEEPING CHARGES DAILY CHART CHARGES
AIR CONDITIONER CHARGES ENTRANCE PASS / VISITORS PASS CHARGES
IM IV INJECTION CHARGES EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE
CLEAN SHEET FILE OPENING CHARGES
INCIDENTAL EXPENSES / MISC. CHARGES (NOT
BLANKET/WARMER BLANKET
EXPLAINED)
ADMISSION KIT PATIENT IDENTIFICATION BAND / NAME TAG
DIABETIC CHART CHARGES PULSEOXYMETER CHARGES
DOCUMENTATION CHARGES / ADMINISTRATIVE
EXPENSES

Sr. No. List of Expenses Generally Excluded ("Non-medical")in Hospital Indemnity Policy
List III – Items that are to be subsumed into Procedure Charges

HAIR REMOVAL CREAM MICROSCOPE COVER

DISPOSABLES RAZORS CHARGES (for site SURGICAL BLADES, HARMONICSCALPEL,SHAVER
preparations)
EYE PAD SURGICAL DRILL
EYE SHEILD EYE KIT
CAMERA COVER EYE DRAPE
DVD, CD CHARGES X-RAY FILM
GAUSE SOFT BOYLES APPARATUS CHARGES
GAUZE COTTON
WARD AND THEATRE BOOKING CHARGES COTTON BANDAGE
ARTHROSCOPY AND ENDOSCOPY INSTRUMENTS SURGICAL TAPE
APRON TORNIQUET
ORTHOBUNDLE, GYNAEC BUNDLE

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 Sr. No. List of Expenses Generally Excluded ("Non-medical")in Hospital Indemnity Policy
List IV – Items that are to be subsumed into costs of treatment

ADMISSION/REGISTRATION CHARGES HIV KIT

HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC ANTISEPTIC MOUTHWASH
PURPOSE
URINE CONTAINER LOZENGES
BLOOD RESERVATION CHARGES AND ANTE NATAL MOUTH PAINT
BOOKING CHARGES
BIPAP MACHINE VACCINATION CHARGES
CPAP/ CAPD EQUIPMENTS ALCOHOL SWABES
INFUSION PUMP– COST SCRUB SOLUTION/STERILLIUM
HYDROGEN PEROXIDE\SPIRIT\ DISINFECTANTS ETC Glucometer & Strips
NUTRITION PLANNING CHARGES - DIETICIAN URINE BAG
CHARGES- DIET CHARGES

Sr. No. List of Expenses Generally Excluded ("Non-medical")in Hospital Indemnity Policy
List V – Additional Non Payable Items

BRUSH WASHING CHARGES

COSY TOWEL MEDICINE BOX
MOISTURISER PASTE BRUSH COMMODE
POWDER Digestion gels
BARBER CHARGES NOVARAPID
OIL CHARGES VOLINI GEL/ ANALGESIC GEL
BED UNDER PAD CHARGES ZYTEE GEL
COST OF SPECTACLES/ CONTACT LENSES/ HEARING AHD
AIDS, ETC.,
DENTAL TREATMENT EXPENSES THAT DO NOT VISCO BELT CHARGES
REQUIRE HOSPITALISATION
HOME VISIT CHARGES EXAMINATION GLOVES
DONOR SCREENING CHARGES OUTSTATION CONSULTANT'S/ SURGEON'S FEES
BAND AIDS, BANDAGES, STERLILE INJECTIONS, PAPER GLOVES
NEEDLES, SYRINGES
BLADE REFERAL DOCTOR'S FEES
MAINTAINANCE CHARGES SOFNET
PREPARATION CHARGES SOFTOVAC
STOCKINGS

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