Рет қаралды 3,489
आपकी Health Insurance policy में कवर नहीं होने वाली चौकाने वाली बीमारियां
Creating a KZbin video on the topic of "Permanent Exclusions in Health Insurance Policies" can provide valuable information to viewers looking to understand the intricacies of their health insurance coverage. Here's a structured outline for the video:
6.4. 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.
6.5. 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:
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.
6.6. Obesity/ Weight Control (Code-Excl06)
Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
a. Surgery to be conducted is upon the advice of the Doctor.
b. The surgery/Procedure conducted should be supported by clinical protocols.
c. The member has to be 18 years of age or older and;
d. 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
6.7. 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.
6.8. 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.
6.9. 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, parajumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.
6.10. 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.
6.11. Excluded Providers (Code-Excl11)
Expenses incurred towards treatment in any Hospital or by any Medical Practitioner or any other provider specifically excluded by Us and disclosed in Our
website / notified to the Policyholders are not admissible. However, in case of life threatening situations or following an Accident, expenses up to the stage
of stabilization are payable but not the complete claim.
6.12. Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code-Excl12)
6.13. 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)
6.14. 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)
6.15. Refractive Error (Code-Excl15)
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
6.16. Unproven Treatments (Code-Excl16)
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.
6.17. Sterility and Infertility (Code-Excl17)
Expenses related to sterility and infertility. This includes:
a. Any type of contraception, sterilization
b. Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization
6.18. Maternity Expenses (Code-Excl18)
customercare@insuranceseva.com
Toll free no- 18008900455