ACTIV ONE VIP

1 Investigation & Evaluation (Excl-04)

Expenses solely for diagnostic evaluation; Non-related diagnostic expenses not incidental to current treatment

2 Rest, Cure, Rehabilitation and Respite Care (Code- Excl05)

Expenses for enforced bed rest admissions; Custodial care for daily living; Services for terminally ill individuals' needs.

3 Obesity/ Weight Control (Code- Excl06)

Self-initiated obesity surgery without the advice of a doctor; Inclusion criteria for surgery: BMI ≥ 40, age > 18, clinical-protocol supported surgery; BMI 35+ with comorbidities like severe sleep apnea, coronary heart disease, Obesity-related cardiomyopathy, uncontrolled Type-2 Diabetes Mellitus covered after failed non-invasive weight loss methods.

4 Change-of-Gender treatments (Code- Excl07)

Expenses for changing body characteristics to opposite sex

5 Cosmetic or plastic Surgery (Code- Excl08)

Cosmetic/plastic surgery unless for reconstruction after Accident, Burn, Cancer, or to remove immediate health risk, certified by Medical Practitioner.

6 Hazardous or Adventure sports (Code- Excl09)

Treatment due to participation in hazardous/adventure sports, e.g., mountaineering, scuba diving, motor racing; Not limited to specified activities.

7 Breach of law (Code- Excl10)

Treatment resulting from Insured Person's criminal acts.

8 Excluded Providers (Code- Excl11)

Treatment from providers listed on website; Emergency care paid till stabilization, not full claim.

9 Treatment for, Alcoholism, drug or substance abuse or any addictive condition (Code- Excl12)

10 Treatments received in health hydros, nature cure clinics, spas or similar establishments (Code- Excl13)

11 Dietary supplements and substances (Code- Excl14)

Over-the-counter dietary supplements; Exceptions for prescribed supplements during hospitalization or day care

12 Refractive Error (Code- Excl15)

Treatment for refractive error < 7.5 dioptres

13 Unproven Treatments (Code- Excl16)

Unproven treatments, services, supplies lacking medical documentation

14 Sterility and Infertility (Code- Excl17)

Expenses for sterility, infertility treatments, contraception, assisted reproduction, gestational surrogacy, sterilization reversal.

15 Maternity Expenses (Code- Excl18)

Childbirth-related medical expenses (except ectopic pregnancy); Miscarriage expenses (unless due to accident) and lawful pregnancy termination.

16 Circumstantial Exclusion

Any illness or injury due to war, rebellion, armed resistance, acts of terrorism and nuclear or radiological emissions.

17 Behavioural Exclusions

Suicide/self-harm, illegal acts, injury from alcohol/intoxicating substance use, and non-prescription drug use.

18 Medical Exclusions

• Routine exams and check-ups, except as specified in Annual Health Check-up terms.
• Circumcisions, unless medically necessary or part of an illness or injury treatment plan.
• Conditions treatable on an outpatient basis without hospitalization
• Preventive care, vaccinations (except post bite), and physical/psychiatric/physiological examinations or testing
• External Abnormalities to a new-born baby
• Dental/oral treatment for natural teeth and gingiva, unless required during Hospitalization due to an Accident.
• Any form of AYUSH treatment, unless expressly mentioned in the policy document.

19 Prosthesis and Devices Exclusion

Hearing aids, spectacles, wigs, prosthesis, medical equipment, and cochlear implants.

20 Non-Medical Expenses

Items listed in Annexure (I) Lists I, II, III, and IV are not covered unless they are part of in-patient hospitalization; this exemption does not apply if Claims Protect is included in the base benefit or opted as an optional cover* and specified in the Policy Schedule.

21 Specific treatment Exclusion

Involving Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP) , Treatment involving Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy, KTP Laser Surgeries, Cyber Knife Treatment, Femto Laser Surgeries, Bioabsorbable Stents, Bioabsorbable Valves, Bioabsorbable Implants. Use of Radio Frequency (RF) probe for ablation.

22 Activities and Profession Exclusions: Unrecognised Physician/Hospital

Treatment by unregistered practitioners, unlicensed and unauthorized practitioners' fees, and treatments by family members or resident practitioners without pre-approval.

23 Geographical Exclusion

Limitation to the geographical coverage in USA & Canada will be applied

Note- ^For the complete list of exclusions and details, refer to policy terms and conditions.

*Refer to your Policy Schedule for the applicability of the cover