A Plus Health Insurance Policy Wording

A PLUS HEALTH INSURANCE
A. Preamble
We will provide the insurance coverage specified in the Policy to the Insured Persons up to the Sum
Insured specified against each benefit, subject to (i) The Policy is based on the statements and
declaration provided in the Proposal Form by the Proposer and is subject to i.e the receipt of full
premium (ii) the terms, conditions, and exclusions of this Policy,
Your policy comprises:
• The preamble [the current part] which introduces the policy document, describes the structure of
the document and sets the general rules;
• The policy wording which lists and details the available coverage, benefits, claims and grievance
redressal procedure, exclusions and other terms and conditions of cover;
• The proposal, which is the information You provide to us and which forms the basis for this
insurance cover;
• The policy schedule - a separate document customized for you showing the cover details opted
for by You and offered by Us to You. It is to be noted that the schedule may amend the policy
and only those Parts shown as covered in your schedule are insured;
• Any other written alteration otherwise issued by us in writing (such as an endorsement) that varies
or modifies the above documents.
B. Definitions
B.1. Standard Definitions:
1. Accident means a sudden, unforeseen, and involuntary event caused by external, visible and violent
means.
2. Any One Illness means continuous period of illness and it includes relapse within forty five days from
the date of last consultation with the hospital where treatment has been taken.
3. AYUSH Treatment refers to hospitalization treatments given under Ayurveda, Yoga and Naturopathy,
Unani, Siddha and Homeopathy systems.
4. An 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 and/or has equipped operation
theatre where surgical procedures are to be carried out;
iv. Maintaining daily records of the patients and making them accessible to the insurance
company’s authorized representative.

UIN : UNIHLIP23125V012223
5. AYUSH Day Care Centre means and includes Community Health Centre (CHC), Primary Health Centre
(PHC), Dispensary, Clinic, Polyclinic or any such health 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 and/or has equipped operation
theatre where surgical procedures are to be carried out;
iii. Maintaining daily records of the patients and making them accessible to the insurance
company’s authorized representative.
6. Cashless Facility means a facility extended by the insurer to the insured where the payments, of the
costs of treatment undergone by the insured person in accordance with the Policy terms and conditions,
are directly made to the network provider by the insurer to the extent pre-authorization is approved.
7. Condition Precedent means a Policy term or condition upon which the Company’s liability under the
Policy is conditional upon.
8. 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.
9. Co-payment means a cost sharing requirement under a health insurance policy that provides that the
policyholder/insured will bear a specified percentage of the admissible claims amount. A co-payment
does not reduce the Sum Insured.
10. Cumulative Bonus means any increase or addition in the Sum Insured granted by the insurer without
an associated increase in premium.
11. Day Care Centre means any institution established for day care treatment of disease/ 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:
i. has qualified nursing staff under its employment;
ii. has qualified medical practitioner (s) in charge;
iii. has a fully equipped operation theatre of its own where surgical procedures are carried
out
iv. maintains daily records of patients and shall make these accessible to the Company’s
authorized personnel.
12. Day Care Treatment means medical treatment, and/or surgical procedure which:
i. Is undertaken in a hospital/day care centre involving less than twenty-four hours of in-
patient stay because of technological advancement, and
ii. would have otherwise required a hospitalization of more than twenty four hours. [Treatment
taken on an out-patient basis is not included in the scope of this definition.]
13. Dental Treatment means a treatment carried out by a dental practitioner including examinations,
fillings (where appropriate), crowns, extractions, and surgery.
14. Disclosure to information norm is the policy shall be void and all premium paid thereon shall be
forfeited to the Company in the event of misrepresentation, mis-description or non-disclosure of any
material fact.
15. 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 undertaken while confined
at home under medical advice and under any of the following compelling circumstances;
i The condition of the patient is such that he/she is not in a condition to be removed to a
hospital.
or

ii The patient takes treatment at home on account of non-availability of room in a hospital.
16. Emergency Care 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 person’s health.
17. Grace Period means specified period of time immediately following the premium due date during
which a payment can be made to renew or continue the Policy in force without loss of continuity
benefits such as waiting period and coverage of pre-existing diseases. Coverage is not available for
the period for which no premium is received.
18. Hospital means any institution established for in-patient care and day care treatment of disease/
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
Schedule of Section 56(1) of the said Act, OR complies with all minimum criteria as under:
i. has qualified nursing staff under its employment round the clock;
ii. has at least ten inpatient beds, in those towns having a population of less than ten lakhs and
fifteen inpatient beds in all other places;
iii. has qualified medical practitioner (s) in charge round the clock;
iv. has a fully equipped operation theatre of its own where surgical procedures are carried
out
v. maintains daily records of patients and shall make these accessible to the Company’s
authorized personnel.
19. Hospitalization means admission in a hospital for a minimum period of twenty four (24) consecutive
‘In-patient care’ hours except for specified procedures/ treatments, where such admission could be
for a period of less than twenty four (24) consecutive hours.
20. Illness means a sickness or a disease or pathological condition leading to the impairment of normal
physiological function which manifests itself during the policy period and requires medical treatment.
i Acute Condition means a disease, illness or injury that is likely to response 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.
ii Chronic Condition means a disease, illness, or injury that has one or more of the following
characteristics
a) it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /
or tests
b) it needs ongoing or long-term control or relief of symptoms
c) it requires rehabilitation for the patient or for the patient to be special trained to cope with it
d) it continues indefinitely
e) it recurs or is likely to recur
21. Injury means accidental physical bodily harm excluding illness or disease solely anddirectly caused
by external, violent and visible and evident means which is verified and certified by a medical
practitioner.
22. In-Patient Care means treatment for which the insured person has to stay in a hospital for more than
24 hours for a covered event.
23. ICU (Intensive Care Unit) 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.
24. ICU (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.
25. Maternity expenses means;
a) Medical treatment expenses traceable to childbirth (including complicated deliveries and
caesarean sections incurred during hospitalization.
b) Expenses towards lawful medical termination of pregnancy during the policy period.

26. Medical Advice means any consultation or advice from a Medical Practitioner including the issue of
any prescription or follow up prescription.
27. Medical Expenses means those expenses that an insured person 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 person had not been
insured and no more than other hospitals or doctors in the same locality would have charged for the
same medical treatment.
28. Medically Necessary Treatment means any treatment, tests, medication, or stay in hospital or part
of a stay in hospital which
i. is required for the medical management of illness or injury suffered by the insured;
ii. must not exceed the level of care necessary to provide safe, adequate and appropriate
medical care in scope, duration, or intensity;
iii. must have been prescribed by a medical practitioner;
iv. must conform to the professional standards widely accepted in international medical
practice or by the medical community in India.
29. Medical Practitioner means 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 the license. Medical Practitioner should
not be the Insured or close family member.
30. Migration means, the right accorded to health insurance policyholders (including all members under
family cover and members of group Health insurance policy), to transfer the credit gained for pre-
existing conditions and time bound exclusions, with the same insurer.
31. Network Provider means hospitals enlisted by insurer, TPA or jointly by an insurer and TPA to
provide medical services to an insured by a cashless facility.
32. New Born Baby means a baby born during the Period of Insurance to a female Insured Person, who
has Continuous Coverage as per Maternity Waiting period and is aged 90 Day.
33. Non- Network Provider means any hospital that is not part of the network.
34. Notification of Claim means the process of intimating a claim to the Insurer or TPA through any of
the recognized modes of communication.
35. Out-Patient (OPD) Treatment means treatment 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.
36. Pre-Existing Disease (PED): Pre-existing disease 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
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.
37. Pre-hospitalization Medical Expenses means medical expenses incurred during pre-defined
number of days preceding the hospitalization of the Insured Person, provided that:
i. Such Medical Expenses are incurred for the same condition for which the Insured Person’s
Hospitalization was required, and
ii. The In-patient Hospitalization claim for such. Hospitalization is admissible by the Insurance
Company.
38. Post-hospitalization Medical Expenses means medical expenses incurred during pre-defined
number of days immediately after the insured person is discharged from the hospital provided that:
i Such Medical Expenses are for the same condition for which the insured person’s hospitalization
was required, and
ii The inpatient hospitalization claim for such hospitalization is admissible by the Insurance
Company.
39. Portability means the right accorded to an individual health insurance policyholder
(including family cover), to transfer the credit gained for pre-existing conditions and time
bound exclusions, from one insurer to another or from one plan to another of the same insurer.

40. Qualified Nurse means a person who holds a valid registration from the Nursing Council of India or
the Nursing Council of any state in India.
41. Reasonable and Customary charges mean 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 .
42. Renewal: Renewal means 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.
43. Room Rent means the amount charged by a hospital towards Room and Boarding expenses and
shall include the associated medical expenses.
44. Surgery or 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 and prolongation of life, performed in a hospital or day care centre by a medical
practitioner.
45. Unproven/experimental treatment means treatment including drug experimental therapy, which is
not based on established medical practice in India, is treatment experimental or unproven.
B.2. Specific Definitions
1. Age means age of the Insured person on last birthday as on date of commencement of the Policy.
2. Break in Policy means the period of gap that occurs at the end of the existing policy term, when the
premium due for renewal on a given policy is not paid on or before the premium renewal date or
within 30 days thereof
3. Claim free year means coverage under the Policy for a period of one year during which no claim is
paid or payable under the terms and conditions of the Policy in respect of Insured Person.
4. Family means, the Family that consists of the proposer and any one or more of the family members
as mentioned below:
i. Self,
ii. legally married spouse (as long as they continue to be married),
iii. son,
iv. daughter,
v. mother,
vi. father,
vii. brother,
viii. sister,
ix. mother in-law,
x. father in-law,
xi. grandfather,
xii. grandmother,
xiii. grandson,
xiv. granddaughter,
xv. son in-law,
xvi. daughter in-law,
xvii. brother in-law,
xviii. sister in-law,
xix. nephew,
xx. niece.
Note: Coverage for newborn babies eligible under the definition of family shall be available subject to their
inclusion in the policy with due advance payment of premium and shall be subject otherwise to the terms and
conditions of the policy including waiting periods.

5. Insured Person means person(s) named in the schedule of the Policy.
6. Policy means these Policy wordings, the Policy Schedule and any applicable endorsements or extensions
attaching to or forming part thereof. The Policy contains details of the extent of cover available to the
Insured person, what is excluded from the cover and the terms & conditions on which the Policy is issued
to The Insured person
7. Policy Period means period of one policy year as mentioned in the schedule for which the
Policy is issued.
8. Policy Schedule means the Policy Schedule attached to and forming part of Policy
9. Policy year means a period of twelve months beginning from the date of commencement of the policy
period and ending on the last day of such twelve-month period. For the purpose of subsequent years,
policy year shall mean a period of twelve months commencing from the end of the previous policy year
and lapsing on the last day of such twelve-month period, till the policy period, as mentioned in the
schedule
10. Renal failure is a condition in which the kidneys lose the ability to remove waste and balance Acute
renal failure (arf) is the abrupt loss of kidney function, resulting in the retention of metabolic waste
products and dysregulation of volume and electrolytes of body fluids. The medical term Acute Kidney
Injury (AKI) has now largely replaced ARF in the medical communities (Injury not necessarily related to
Accidents), reflecting the recognition that smaller decrements in kidney function that do not result in overt
organ failure are of substantial clinical relevance and are associated with increased morbidity and
mortality.
11. Chronic renal failure: End stage kidney disease characterized by irreversible failure of both
kidneys to function normally, as a result of which either regular dialysis (hemodialysis or peritoneal
dialysis) is instituted or a renal transplantation becomes necessary. The diagnosis has to be confirmed by
a specialist medical practitioner.
12. Renal transplantation: Kidney transplantation is a surgical procedure to remove healthy and
functioning kidney from a living or brain-dead donor and implant it into a patient with non-functioning
kidneys.
13. Sub-limit means a cost sharing requirement under a health insurance policy in which an insurer would
not be liable to pay any amount in excess of the pre-defined limit
14. Sum Insured means the pre-defined limit specified in the Policy Schedule. Sum Insured represents
the maximum, total and cumulative liability for any and all claims made under the Policy, in respect of
that Insured Person (on Individual basis) or all Insured Persons (on Floater basis) during the Policy Year.
15. Third Party Administrator (TPA) means a Company registered with the Authority, and engaged by
an insurer, for a fee or by whatever name called and as may be mentioned in the health services
agreement, for providing health services.
16. Waiting Period means a period from the inception of this Policy during which specified
diseases/treatments are not covered. On completion of the period, diseases/treatments shall be covered
provided the Policy has been continuously renewed without any break.
17. We/Us/Company means Universal Sompo General Insurance Company
18. You/Your means the person who has taken this Policy and is shown as Insured or the first insured (if
more than one) in the Schedule.
C. Benefits/Coverages
The following benefits are payable subject to Terms and Conditions of the policy:
1. Inpatient Treatment
We will cover expenses for hospitalization due to disease/illness/Injury during the policy period that
requires an Insured Person’s admission in a hospital as an inpatient. Medical expenses directly related to
the hospitalization for;

a. Reasonable and Customary Charges for Room Rent for accommodation in Hospital room up to
Category as per opted Sum Insured and as specified in the Policy Schedule.
b. Intensive Care Unit charges for accommodation in ICU,
c. Operation theatre charges,
d. Fees of Medical Practitioner/ Surgeon,
e. Anesthetist,
f. Qualified Nurses,
g. Specialists,
h. Cost of diagnostic tests,
i. Medicines,
j. Drugs and consumables, blood, oxygen, surgical appliances and prosthetic devices recommended
by the attending Medical Practitioner and that are used intra operatively during a Surgical
Procedure.
k. Modern Treatment
Following Modern Treatments will be covered up to the Sum Insured (wherever medically
indicated) either as -Inpatient or as part of Day Care Treatment in a Hospital;
i. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
ii. Balloon Sinuplasty
iii. Deep Brain stimulation
iv. Oral chemotherapy
v. Immunotherapy- Monoclonal Antibody to be given as injection
vi. Intra vitreal injections
vii. Robotic surgeries
viii. Stereotactic radio surgeries
ix. Bronchical Thermoplasty
x. Vaporisation of the prostrate (Green laser treatment or holmium laser treatment)
xi. IONM - (Intra Operative Neuro Monitoring)
xii. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for
haematological conditions to be covered.
2. Pre- Hospitalization
We will cover for expenses for Pre-Hospitalization Consultations, investigations and medicines
incurred up to the Number of days as mentioned in the Policy Schedule before the date of
admission to the hospital. The benefit is payable if We have admitted a claim under Section C.1
3. Post- Hospitalization
We will cover for expenses for Post Hospitalization Consultations, investigations and medicines
incurred up to the Number of days as mentioned in the Policy Schedule after discharge from the
hospital. The benefit is payable if We have admitted a claim under Section C.1
4. Day Care Procedures

We will cover expenses for listed Day Care Treatment due to disease/illness/Injury during the
policy period taken at a hospital or a Day Care Centre. The list of such day care procedures
covered is attached as an Annexure I. Treatment normally taken on out-patient basis is not
included in the scope of this cover.
5. Ayush Treatment
We will pay for the Medical Expenses incurred by the Insured Person in any AYUSH Hospital for
Inpatient Care under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems
of medicines during each Policy Year up to the limit mentioned in the Policy Schedule.
6. Domiciliary Treatment

We will cover for expenses related to Domiciliary Hospitalization of the insured person if the
treatment exceeds beyond three days. The treatment must be for management of an illness and
not for enteral feedings or end of life care. At the time of claiming under this benefit, we shall
require certification from the treating doctor fulfilling the conditions as mentioned under the
definitions of this policy.
7. Second Opinion
We will provide You a second opinion from Network Provider or Medical Practitioner, if an
Insured Person is diagnosed with the below mentioned Illnesses during the Policy Period and not be
valid for any medico legal purposes. The expert opinion would be directly sent to the Insured
Person.
i. Cancer
ii. Kidney Failure
iii. Myocardial Infarction
iv. Angina
v. Coronary bypass surgery
vi. Stroke/Cerebral hemorrhage
vii. Organ failure requiring transplant
viii. Heart Valve replacement
ix. Brain tumors
This benefit can be availed by an Insured Person once during a Policy Year.
8. Ambulance Cover
We will cover for expenses incurred on transportation of Insured Person in a registered ambulance
to a Hospital for an admission, in case of an Emergency or from one hospital to another hospital
for better medical facilities and treatment, subject to the limit specified in Policy Schedule per
Hospitalization. For this claim to be paid, the claim must be
admissible under section C.1 of this policy.
9. Auto Restore Benefit

We will restore the Sum insured up to 100% of Base Sum Insured, in the event
of complete or partial utilization of the Base Sum Insured due to any claim admitted
during the Policy Year irrespective of the utilization of the Cumulative Bonus.
Special Conditions:
a. This Automatic Restore Benefit shall be applied only once during each Policy Year and
any unutilized amount, in whole or in part, will not be carried forward to the
subsequent Policy Year.
b. The Base Sum Insured restoration under the Automatic Restore Benefit would be
triggered only upon complete or partial utilization of the Base Sum Insured by the way of
first claim admitted under the Policy, and be available for subsequent claims thereafter in
the Policy Year, for the Insured Person.
c. In case of a family floater policy, the Automatic Restore Benefit will be available on
floater basis for all Insured Persons covered under the Policy and will operate in
accordance with the above conditions.
10. OPD Expenses (ONLY FOR Diamond plan)

We will reimburse expenses incurred on Outpatient Treatment for the Insured Persons as
mentioned in the Policy Schedule, provided that

i. This limit will apply on Individual basis in case of Individual Policy and on
Family Floater basis in case of Family Floater Policy and
ii. The condition of minimum Hospitalization of 24 hours as an in-patient under
Benefit stands deleted.
iii. The reimbursement of claims under this extension shall be done only once
during each Policy Year of the Policy Period. No claim will be admissible which
is made 30 days after the expiry of Policy.
iv. You have renewed the Policy consecutively without a break.
v. Any claim made in respect of this benefit will be not be subject to In-patient
Sum Insured and will not affect entitlement to a Cumulative Bonus and health
check up, if applicable.
vi. Exclusion F.ii.6 stands deleted.
11. Global Cover (Applicable only for Diamond plan)

We will reimburse the Medical Expenses of the Insured Person incurred outside India for
not more than 180 consecutive days and maximum up to the sum insured, provided that
the diagnosis was made in India and referred by Medical Practioner for which the insured
member(s) travels abroad for treatment outside India as mentioned in the Policy Schedule.
Global Cover is applicable subject to following terms and Conditions;
i. A Deductible of 10% on Sum Insured will apply for expenses under all the respective
covers separately for each claim.
ii. The payment of any claim under this benefit will be in Indian Rupees based on the rate of
exchange as on the date of invoice, published by Reserve Bank of India (RBI) and shall be
used for conversion of foreign currency into Indian Rupees for claims payment. If these
rates are not published on the date of invoice, the exchange rate next published by RBI
shall be considered for conversion.
iii. All other terms and conditions of the respective Section and Covers under the policy shall
remain unaltered.
iv. Only basic sum insured along with Cumulative Bonus can be used for this Coverage.
12. Psychiatric Illness
We will pay for the Medical Expenses, related to Psychiatric Illness, provided that:
a) The first diagnosis and Hospitalization, as an inpatient, was during the Policy Period.
b) This also has a waiting period and Sub-Limit as opted by You and mentioned in Your
Policy Schedule for specific Psychiatric illnesses or disorders listed in the table below.
Waiting period shall be as per the ‘“Specific Waiting Period.ii.3’” Section stated in Your
Schedule against this Cover which shall apply from the date of inception of the first policy
with Us, provided that the Policy has been renewed continuously with Us without break,
with Psychiatric as a benefit since inception of the first policy.
ICD Code Psychiatric Illness & Disorders
F20- F29 Schizophrenia, schizotypal and delusional disorders
F30- F39 Mood [affective] disorders
F40- F48 Neurotic, stress-related and somatoform disorders
F99- F99 Unspecified mental disorder
C) Hospitalization under this benefit shall be subject to prior approval from Us, except in
cases of emergencies.

13. Organ Donor
We will cover for Medical and surgical Expenses of the organ donor for harvesting the organ
where an Insured Person is the recipient provided that:
vii. The organ donor is any person whose organ has been made available in accordance
and in compliance with The Transplantation of Human Organs (Amendment) Bill, 2011
and the organ donated is for the use of the Insured Person, and
viii. ii. We have accepted an inpatient Hospitalization claim for the insured member under
In Patient Hospitalization Treatment (Section C.1).
14. Assistance Services

The company will provide the below services which will be available when the
Insured/Insured member(s) is/are more than 150 kilometers away from their residential
address as provided in the Proposal Form. The services would be provided by the
company /through our appointed Service provider, with prior intimation and acceptance
by the Company.
a. Medical Consultation, Evaluation and Referral: In case of any emergency, The

Company/our Service Provider will evaluate, troubleshoot and make immediate
recommendations including referrals to qualified doctors and/or hospitals.
b. Medical Monitoring and Case Management: A team of doctors, nurses, and other
medically trained personnel would be in regular communication with the attending
physician and hospital, monitors appropriate levels of care and relay necessary and
legally permissible information to the members of the Family / employer.
c. Emergency Medical Evacuation: If the Insured / Insured member/s becomes ill or
injured in an area where appropriate care is not available, the Company /via Service
Provider will intervene and use available transportation, equipment and personnel
necessary to evacuate the Individual safely to the nearest facility for medical care. This
shall also include Air Ambulance services if required.
d. Medical Repatriation (Transportation): When medically necessary, as determined
by Company and the consulting Medical Practitioner, transportation under medical
supervision shall be provided in respect of the Insured Person to the residential address as
mentioned in the Schedule, provided that the Insured Person is medically cleared for travel
via commercial carrier, and provided further that the transportation can be accomplished
without compromising the Insured Person’s medical condition.
e. Compassionate Visit: When an Insured Person/s is/are hospitalized for more

than seven (7) consecutive days, The Company/ Service Provider will arrange for a family
member or a personal friend to travel to visit the Insured Person/s, by providing an
appropriate means of transportation.
15. Wellness Services

The Company offers a comprehensive program to maintain the health and overall wellbeing of
the insured person. The insured person is provided with an individual access to web based
Health portal at Company’s website and/or a Wellness mobile application by the Company
where he/she can perform various healthcare activities as listed below.

i. Health Risk Assessment (HRA): HRA is process of health risk assessment with the help of a
questionnaire, by collecting the information from the insured in a systematic manner and
evaluate their health risks. The Health Risk Assessment generates a statistical estimate of
insured person’s overall health risk status and quality of lifestyle. The HRA shall be self-
performed by the insured person. We will aid the insured person to complete the HRA
whenever required.
ii. Electronic Health Records: the Insured person can store the medical test reports,
prescriptions and other consultation papers in the personalized portal which gets digitized
to help create a complete health profile of the insured person. The medical test reports
along with HRA as specified above will provide a health score to depict the health status of
the insured person.
iii. Health Screening: Basis the health score of the insured person, the insured person shall be
categorized as Healthy, in which case there will be no trigger for medical screening. If the
score depicts unhealthy status, medical screening is advised to the insured person along with
a “Health Goal” which is identified post identification of risk factors for improving insured
person’s overall well-being.
“Health Goal”, which basically takes a deep dive in the identified risk areas to establish the
focus points in that particular risk area.
iv. Wellness Reward Program:
The Wellness Reward Program (WRP) aims to encourage the insured person to perform
certain activities to stay active and medically fit. WRP is an award program wherein
the Insured Person can earn the reward points termed as “USGI Coins” by
performing the activities as mentioned in the below Table. The points can be
redeemed against array of options provided as mentioned hereunder which would
help the Insured to improve his/her overall Health Status.
(i) For an individual as well as Family Floater policy, the earning of USGI coins shall be
considered on individual member basis up to the maximum limit as specified under every
category per policy year.
(ii) The Company shall specify the Wellness Rewards – Earning and Redemption categories as
well as Earned but not utilized USGI coins in the policy schedule. The details of USGI coins
would also be available at the Company’s Health Portal and/or Mobile Application.
(iii) USGI coins earned in this section of the policy are valid up to 4 years from the date of
renewal of this policy (including any grace period applicable) and would not be carried
forward thereafter.
(iv) Each USGI coin shall have the value equivalent to Rs.0.25.
(v) The USGI coins can be earned in the following ways as mentioned in the given Table:
Table: Earn Rewards (in form of USGI coins)
Rewards/ Max USGI Coins

USGI Coins earned by
Activities for Earning Wellness Rewards
earned by Individual Per
Individual Policy Year
On completion of HRA on HRA Completion within 90 days
Health Portal/Mobile from Policy Inception Date 500 500
application
HRA outcome without any Cover 2.5 to 3.5 lakhs steps in a
100/month 500
adverse report month

HRA Outcome of having Large Cover minimum 2 lakhs steps in a
100/month 500
waist size ( > 40 inches) month
Cover above 2 lakh steps in a
150/month 1000
month
Blood pressure for a known Blood Pressure is below or equal
case of Hypertension to -
SBP:120-140 mm/Hg
150/month 500
DBP: 80-90 mm/Hg
SBP - Systolic Blood Pressure;
DBP – Diastolic Blood Pressure
Blood sugar levels for a known HBA1C within normal limits
case of Diabetes ≤ 5.6 150/quarter 500
Lipid profile Level for a known Lipid level are normal within
case of Dyslipidemia range as applicable to the 150/quarter 500
Laboratory
Body Mass Index (BMI) for a BMI between 31 to 35 and
known case of High BMI Insured reduce your BMI to the Optimum 100/quarter 200
Person /s >=30 optimum BMI range
BMI between 35 to 39 and
reduce your BMI to the optimum 150/quarter 300
range
BMI between 40 to 42 and
reduce your BMI to the optimum 250/quarter 500
range
Health Tests for Heart Related, on Submission of Reports
Blood Sugar, Thyroid/Lipid etc. 150/quarter 300
Monitoring
Annual membership for Provide attendance
Dance/Zumba/Aerobic/Gymna Register/letter/medal/trophies/
150/quarter 400
stic/ Yoga/Gym/Swimming BIB number (as applicable) from
the respective facility provider.
Participate in professional sport Provide attendance
events like Register/letter/medal/trophies/
100 /event 500
Marathon/Cyclothon/Swimatho BIB number (as applicable) from
n the respective facility provider.
Competitive Sports: School Participation Certificate from
20/sport 50
Level School
Competitive Sports: Participation Certificate from
75/sport 150
National/State Level relevant sports authority
Download the Wellness
150 150
Application
Refer a Friend to buy USGI
100/referral 300
policy
Sum Insured Enhancement 100 100
Pledge to Quit Smoking 150 150
Water Intake 3-4 litres per day, to be updated
50/month 200
on App
Redemption of USGI coins:
Sr. No Categories to Redeem the USGI Coins Limit on Redemption

1 Facilities as mentioned under ‘ Health & Wellness 20% of USGI coins upto Rs.200
Program: Everyday Healthcare’
2 Dental Care except cosmetic treatment 30% of USGI coins upto Rs.300
3 Cost of Vaccinations 30% of USGI coins upto Rs.300
4 Cost of Spectacle Lenses 30% of USGI coins upto Rs.300
5 Laser surgery for correction of refractory errors 30% of USGI coins upto Rs.300
6Any Hospitalizations which is Non-admissible as per 50% of USGI coins upto Rs.500
the Policy terms and conditions as specified
under ‘ In-patient Hospitalization’
7 You can also redeem your Rewards against Claim 20% of USGI coins upto Rs.200
of yours/your family member/s who are insured
with Us under retail Health Indemnity product
8 Discount on premium while renewing your Policy 30% of USGI coins upto Rs.300
D. Add On Covers
1. Pre-Existing Disease Waiting Period Waiver
Notwithstanding anything to the contrary in the Policy, it is hereby declared and agreed
that, on payment of additional premium, waiting period applicable to all Pre-Existing
Diseases for each Insured Person before benefits are payable under the Policy is modified
to 12 Months.
For the purpose of this extension, Waiting Period- Section G.3.1 shall be modified.
2. Maternity Cover
We will pay the Maternity Expenses incurred towards the delivery of a baby and/or
treatment related to any complication of pregnancy or medically necessary termination.
This is up to the Sum Insured opted by You and as mentioned in Your Policy Schedule
against this Section, during the Policy Period provided that:
a) Female Insured Person’s legally married spouse is also covered under this Policy, unless
specifically waived by Us(Example, if You are a single parent, this clause will not
apply). This also has a waiting period. Waiting period as opted by you and mentioned
in your Policy Schedule shall apply from the date of inception of the first policy with us,
provided that the policy has been renewed continuously with us without break, with
maternity as a benefit.
b) The maternity benefit is limited to cover up to two living children. However, there is no
restriction on the number of medically necessary and lawful termination of pregnancies.
c) If on renewal without any break in coverage, the sum insured is increased, there is a
fresh waiting period as opted by You and mentioned in Your Policy Schedule applied to
the increased part of the Sum Insured.
d) Any complications arising out of or as a consequence of maternity/childbirth / New
Born Baby will also be covered within the limit of Sum Insured, available under this
benefit.
3. Diabetes Day 1 cover (ONLY FOR Diamond plan)

We will Pay you (Aged 18 years and above) for the Medical Expenses under Outpatient
treatment for Diabetes up to the Sum Insured, mentioned in the Policy Schedule.
This treatment can be availed at Our Network Providers and /Empanelled Service

Providers (such as Outpatient clinics or Physicians /Diagnostic centre)) for chronic condition
i.e Diabetes.
For ease of understanding definitions of Diabetes as below:

Diabetes mellitus is a chronic, progressive disease in which impaired insulin production
leads to high blood glucose (sugar) levels, and without good self-management and proper
treatment, the increased glucose (sugar) in the blood affects and damages every organ in
the body, which causes serious health consequences.
Outpatient Treatment for this coverage means;
(i) Medical Practitioner’s consultations;
(ii) Diagnostic test
(iii) Medicines
4. Hypertension Day 1 Cover (ONLY FOR Diamond plan)

We will Pay you (Aged 18 years and above) for the Medical Expenses under Outpatient
treatment for Hypertension up to the Sum Insured, mentioned in the Policy Schedule.
This treatment can be availed at Our Network Providers and /Empanelled Service
Providers (such as Outpatient clinics or Physicians /Diagnostic centre)) for chronic condition
i.e Hypertension.
For ease of understanding definitions of Hypertension as below:

Hypertension is the term used to describe a persistent elevated blood pressure, commonly
referred to as high blood pressure, and if this chronic disease is not treated
appropriately, is a major risk factor for heart disease, stroke, kidney disease and even
eye diseases.
Outpatient Treatment for this coverage means;

(i) Medical Practitioner’s consultations.
(ii) Diagnostic test
(iii)Medicines
5. Non-Medical Items
We will pay for Non-Medical Expenses upto the limit mentioned in Schedule of Coverage
in the Policy Schedule on Medically necessary Hospitalization of Insured Person for claims
admissible under section C.1. In view of this Cover as per List 1 of Annexure 2.
E. Renewal Benefit
1. Cumulative Bonus

In case of no claim has been made by any insured person, we will increase the base sum
insured as per the variant opted, provided the Policy is renewed continuously:
Silver Gold Diamond
20% of Base Sum Insured, 50% of Base Sum Insured, 50% of Base Sum Insured,
Maximum to 100% per Maximum to 100% per Maximum to 200% per
Renewal Renewal Renewal
In case of claim is made in the expiring policy year then you will not earn No Claim
Bonus on Policy renewal. However, if there is no claim made in subsequent Policy Year,
you will earn No Claim Bonus.
2. Preventive Health Check- up
We will reimburse the cost of a Preventive Health Check-up, up to the limits specified below
as per plan of the Insured Person who was covered during the previous Policy Year. This
Cover does NOT carry forward if it is not claimed and shall not be provided if the
Policy is not Renewed further. the below mentioned limits are applicable for each Insured
Person per Policy Year in case of Individual Policy and cumulatively for all Insured Persons
per Policy Year in case of Family Floater Policy.
The same can be opted within 90 Days of the Renewal.
Silver Gold Diamond

Preventive Health Check Preventive Health Check up Preventive Health Check up
up every claim free Year every claim free Year up to every Year up to Rs.5000
up to Rs.1000 Rs.2500
Special Condition
F. Exclusions
F.i. Standard Exclusions:
The Company shall not be liable to make any payment under the policy, in respect of any expenses
incurred in connection with or in respect of:
1. Investigation & Evaluation(Code- Excl04)

a. Expenses related to any admission primarily for diagnostics and evaluation purposes.
b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and
treatment
2. 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:
i 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.

ii Any services for people who are terminally ill to address physical, social, emotional and
spiritual needs.
3. Obesity/ Weight Control (Code- Excl06)

Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
1) Surgery to be conducted is upon the advice of the Doctor

2) The surgery/Procedure conducted should be supported by clinical protocols
3) The member has to be 18 years of age or older and
4) Body Mass Index (BMl);
a) greater than or equal to 40 or
b) 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:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type2 Diabetes
4. 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.
5. 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. 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.
7. 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.
8. 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 or following an
accident, expenses up to the stage of stabilization are payable but not the complete claim.
9. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences
thereof.(Code- Excl12)

10. 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)
11. 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)
12. Refractive Error:(Code- Excl15)

Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5
dioptres.
13. 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.
14. Sterility and Infertility: (Code- Excl17)

Expenses related to sterility and infertility. This includes:
(i) Any type of contraception, sterilization
(ii) Assisted Reproduction services including artificial insemination and advanced
reproductive technologies such as IVF, ZIFT, GIFT, ICSI
(iii) Gestational Surrogacy
(iv) Reversal of sterilization
F.ii. Specific Exclusions:
1. 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.
2. 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 genetically modified organisms and chemically synthesized toxins) which are
capable of causing any Illness, incapacitating disablement or death.
3. Any expenses incurred on OPD treatment.( Applicable for Silver & Gold Plan)
4. Treatment taken outside the geographical limits of India.

5. In respect of the existing diseases, disclosed by the insured and mentioned in the policy schedule
(based on insured’s consent), policyholder is not entitled to get the coverage for specified ICD
codes.
G. 3. Waiting Period
The Company shall not be liable to make any payment under the policy in connection with or in respect
of following expenses till the expiry of waiting period mentioned below:
1. Pre-Existing Diseases (Code- Excl01)

a) Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications
shall be excluded until the expiry of 36 months of continuous coverage after the date of
inception of the first policy with us.
b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum
insured increase.
c) 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.
d) Coverage under the policy after the expiry of 36 months for any pre-existing disease is subject
to the same being declared at the time of application and accepted by us.
2. Specific Waiting Period: (Code- Excl02)
a) Expenses related to the treatment of the following listed conditions, surgeries/treatments shall
be excluded until the expiry of 24/48 months of continuous coverage, as may be the case after
the date of inception of the first policy with the insurer. This exclusion shall not be applicable for
claims arising due to an accident.
b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum
insured increase.
c) 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.
d) The waiting period for listed conditions shall apply even if contracted after the policy or
declared and accepted without a specific exclusion.
e) If the Insured Person is continuously covered without any break under the policy, then waiting
period for the same would be reduced to the extent of prior coverage.
i. 24 Months waiting period

1. All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps
2. Benign ear, nose, throat disorders
3. Benign prostate hypertrophy
4. Cataract and age related eye ailments
5. Gastric/ Duodenal Ulcer
6. Gout and Rheumatism
7. Hernia of all types
8. Hydrocele
9. Non Infective Arthritis
10. Piles, Fissures and Fistula in anus
11. Pilonidal sinus, Sinusitis and related disorders
12. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident
13. Skin Disorders
14. Stone in Gall Bladder and Bile duct, excluding malignancy

15. Stones in Urinary system
16. Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapsed uterus
17. Varicose Veins and Varicose Ulcers
18. Renal Failure
19. Puberty and Menopause related Disorders
20. Behavioural and Neuro-DevelopHIV Disorders:
a. Disorders of adult personality
b. Disorders of speech and language including stammering, dyslexia
ii 48 Months waiting period

1. Joint Replacement due to Degenerative Condition
2. Age-related Osteoarthritis & Osteoporosis
3. Treatment of HIV illness, stress or psychological disorders and neurodegenerative disorders.
4. Age Related Macular Degeneration (ARMD)
5. Genetic diseases or disorders
3. First Thirty Days Waiting Period (Code- Excl03)

i 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.
ii This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more
than twelve months.
iii The within referred waiting period is made applicable to the enhanced sum insured in the event
of granting higher sum insured subsequently.
4. Maternity Expenses (Code-Excl18) [Thirty six months waiting period]

i Medical treatment expenses traceable to childbirth (including complicated deliveries and
caesarean sections incurred during hospitalization) except ectopic pregnancy;
ii Expenses towards miscarriage and the related lawful medical termination of pregnancy during
the policy period are included under the scope of cover up to the limit specified in Policy
Schedule.
5. Out-patient Treatment Waiting Period of 3 years

The expenses covered under benefit Out – Patient treatment shall be excluded for a period of
3 years unless You were insured continuously and without interruption for at least 3 years under
any other Indian insurer’s or Our individual health insurance Policy for reimbursement of medical
costs incurred by You as an Out-patient in a Hospital or Out-patient Treatment Centre.
H. General Terms & Clauses

H.1. Standard General Terms And Clauses:
1. Disclosure of Information
The Policy shall be void and all premium paid thereon shall be forfeited to the Company in the
event of misrepresentation, mis-description or non-disclosure of any material fact.
2. Condition Precedent to Admission of Liability

The due observance and fulfilment of the terms and conditions of the policy, by the insured person,
shall be a condition precedent to any liability of the Company to make any payment for claim(s)
arising under the policy.
(Explanation: “Bank rate” shall mean the rate fixed by the Reserve Bank of India (RBl) at the
beginning of the financial year in which claim has fallen due).The Clause shall be suitably modified
by the insurer based on the amendment(s), if any to the relevant provisions of Protection of
Policyholder’s Interests Regulations, 2017)
3. Claim Settlement (provision for Penal Interest)
i. The Company shall settle or reject a claim, as the case may be, within 30 days from the
date of receipt of last necessary document.
ii. In the case of delay in the payment of a claim, the Company shall be liable to pay interest
to the policyholder from the date of receipt of last necessary document to the date of
payment of claim at a rate 2% above the bank rate.
iii. However, where the circumstances of a claim warrant an investigation in the opinion of the
Company, it shall initiate and complete such investigation at the earliest, in any case not
later than 30 days from the date of receipt of last necessary document. In such cases, the
Company shall settle or reject the claim within 45 days from the date of receipt of last
necessary document.
iv. In case of delay beyond stipulated 45 days, the Company shall be liable to pay interest
to the policyholder at a rate 2% above the bank rate from the date of receipt of last
necessary document to the date of payment of claim.
4. Complete Discharge
Any payment to the policyholder, insured person or his/ her nominees or his/ her legal
representative or assignee or to the Hospital, as the case may be, for any benefit under the policy
shall be a valid discharge towards payment of claim by the Company to the extent of that amount
for the particular claim.
5. Multiple Policies
i. In case of multiple policies taken by an insured person during a period from one or more
insurers to indemnify treatment costs, the insured person shall have the right to require a
settlement of his/her claim in terms of any of his/her policies. In all such cases the insurer
chosen by the insured person shall be obliged to settle the claim as long as the claim is within
the limits of and according to the terms of the chosen policy.
ii. Insured person having multiple policies shall also have the right to prefer claims under this
policy for the amounts disallowed under any other policy / policies even if the sum insured is
not exhausted. Then the insurer shall independently settle the claim subject to the terms and
conditions of this policy.
iii. If the amount to be claimed exceeds the sum insured under a single policy, the insured person
shall have the right to choose insurer from whom he/she wants to claim the balance amount.
iv. Where an insured person has policies from more than one insurer to cover the same risk on
indemnity basis, the insured person shall only be indemnified the treatment costs in accordance
with the terms and conditions of the chosen policy.
6. Fraud
If any claim made by the insured person, is in any respect fraudulent, or if any false statement, or

declaration is made or used in support thereof, or if any fraudulent means or devices are used by
the insured person or anyone acting on his/her behalf to obtain any benefit under this policy, all
benefits under this policy and the premium paid shall be forfeited.
Any amount already paid against claims made under this policy but which are found fraudulent
later shall be repaid by all recipient(s)/policyholder(s), who has made that particular claim, who
shall be jointly and severally liable for such repayment to the insurer.
For the purpose of this clause, the expression "fraud" means any of the following acts committed by
the insured person or by his agent or the hospital/doctor/any other party acting on behalf of the
insured person, with intent to deceive the insurer or to induce the insurer to issue an insurance policy:
a) the suggestion, as a fact of that which is not true and which the insured person does not
believe to be true;
b) the active concealment of a fact by the insured person having knowledge or belief of the fact;
c) any other act fitted to deceive; and
d) any such act or omission as the law specially declares to be fraudulent
The Company shall not repudiate the claim and / or forfeit the policy benefits on the ground of
Fraud, if the insured person / beneficiary can prove that the misstatement was true to the best of
his knowledge and there was no deliberate intention to suppress the fact or that such misstatement
of or suppression of material fact are within the knowledge of the insurer.
7. Cancellation
i. The policyholder may cancel this policy by giving 15days’ written notice and in such an
event, the Company shall refund premium for the unexpired policy period as detailed
below.
Cancellation Period
Cover Period Within From 1 month From 3 month From 6 months During During
1 month to 3 months to 6 months to 1 year 2nd 3rd Year
Year
1 year 75% 50% 25% 0% NA NA
2 year 75% 65% 50% 25% 0% NA
3 year 75% 70% 60% 45% 11% 0%
Notwithstanding anything contained herein or otherwise, no refunds of premium shall be

made in respect of Cancellation where any claim has been admitted or has been lodged
or any benefit has been availed by the insured person under the policy.
ii. The Company may cancel the policy at any time on grounds of misrepresentation, non-
disclosure of material facts, fraud by the insured person by giving 15 days’ written notice.
There would be no refund of premium on cancellation on grounds of misrepresentation, non-
disclosure of material facts or fraud.
8. Migration
The insured person will have the option to migrate the policy to other health insurance
products/plans offered by the company by applying for migration of the policy atleast 30 days
before the policy renewal date as per IRDAI guidelines on Migration. If such person is presently
covered and has been continuously covered without any lapses under any health insurance
product/plan offered by the company, the insured person will get the accrued continuity benefits
in waiting periods as per IRDAI guidelines on migration.

9. Portability
The insured person will have the option to port the policy to other insurers by applying to such insurer
to port the entire policy along with all the members of the family, if any, at least 45 days before,
but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to
portability. If such person is presently covered and has been continuously covered without any lapses
under any health insurance policy with an Indian General/Health insurer, the proposed insured
person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on
portability of Health Insurance policies.
10. Renewal of Policy

The policy shall ordinarily be renewable except on grounds of fraud, misrepresentation by the
insured person.
i. The Company shall endeavour to give notice for renewal. However, the Company is not
under obligation to give any notice for renewal.
ii. Renewal shall not be denied on the ground that the insured person had made a claim or
claims in the preceding policy years.
iii. Request for renewal along with requisite premium shall be received by the Company before
the end of the policy period.
iv. At the end of the policy period, the policy shall terminate and can be renewed within the
Grace Period of 30 days to maintain continuity of benefits without break in policy.
Coverage is not available during the grace period.
v. No loading shall apply on renewals based on individual claims experience.
11. Withdrawal of Policy

i. In the likelihood of this product being withdrawn in future, the Company will intimate the
insured person about the same 90 days prior to expiry of the policy.
ii. Insured Person will have the option to migrate to similar health insurance product available
with the Company at the time of renewal with all the accrued continuity benefits such as
cumulative bonus, waiver of waiting period. as per IRDAI guidelines, provided the policy
has been maintained without a break.
12. Moratorium Period

After completion of eight continuous years under the policy, no look back is to be applied. This
period of eight years is called as moratorium period. The moratorium would be applicable for the
sums insured of the first policy and, subsequently, completion of 8 continuous years would be
applicable from the date of enhancement of sums insured only on the enhanced limits. After the
expiry of Moratorium Period no health insurance claim shall be contestable except for proven fraud
and permanent exclusions specified in the policy contract. The policies would, however, be subject
to all limits, sub limits, co-payments, deductibles as per the policy contract.
13. Premium Payment in Installments

If the insured person has opted for Payment of Premium on an instalment basis i.e .monthly,
Quarterly, Half Yearly as mentioned in the policy Schedule/Certificate of Insurance, the following
Conditions shall apply (notwithstanding any terms to the contrary elsewhere in the policy).
i. Grace Period of 15 days would be given to pay the instalment premium due for the policy.
ii. During such grace period, coverage will not be available from the due date of instalment
premium till the date of receipt of premium by Company.

iii. The insured person will get the accrued continuity benefit in respect of the “Waiting Periods”,
“Specific Waiting Periods” in the event of payment of premium within the stipulated grace
Period.
iv. No interest will be charged If the instalment premium is not paid on due date.
v. In case of instalment premium due not received within the grace period, the policy will get
cancelled.
vi. In the event of a claim, all subsequent premium instalments shall immediately become due
and payable.
vii. The company has the right to recover and deduct all the pending instalments from the claim
amount due under the policy.
14. Possibility of Revision of Terms of the Policy Including the Premium Rates
The Company, with prior approval of IRDAI, may revise or modify the terms of the policy including
the premium rates. The insured person shall be notified three months before the changes are
effected.
15. Free look period

The Free Look Period shall be applicable on new individual health insurance policies and not on
renewals or at the time of porting/migrating the policy. The insured person shall be allowed free
look period of fifteen days from date of receipt of the policy document to review the terms and
conditions of the policy, and to return the same if not acceptable. If the insured has not made any
claim during the Free Look Period, the insured shall be entitled to
i. a refund of the premium paid less any expenses incurred by the Company on medical
examination of the insured person and the stamp duty charges or
ii. where the risk has already commenced and the option of return of the policy is exercised by the
insured person, a deduction towards the proportionate risk premium for period of cover or
iii. Where only a part of the insurance coverage has commenced, such proportionate premium
commensurate with the insurance coverage during such period
16. Nomination:
The policyholder is required at the inception of the policy to make a nomination for the purpose of
payment of claims under the policy in the event of death of the policyholder. Any change of
nomination shall be communicated to the company in writing and such change shall be effective only
when an endorsement on the policy is made. In the event of death of the policyholder, the Company
will pay the nominee {as named in the Policy Schedule/Policy Certificate/Endorsement (if any)} and
in case there is no subsisting nominee, to the legal heirs or legal representatives of the policyholder
whose discharge shall be treated as full and final discharge of its liability under the policy.
17. Loading:
i. We may apply a risk loading on the premium payable (based upon the declarations made in the
proposal form and the health status of the persons proposed for insurance).
ii. The loading shall only be applied basis an outcome of Our medical underwriting.
iii. These loadings are applied from Commencement Date of the Policy including subsequent
renewal(s) with Us or on the receipt of the request of increase in Sum Insured (for the increased Sum
Insured). We will inform You about the applicable risk loading through communication.
18. Redressal of Grievance

In case of any grievance the insured person may contact the company through
Universal Sompo General Insurance Co. Ltd.

Unit No. 601 & 602, 6th Floor, Reliable Tech Park, Cloud City Campus; Gut No-31, Mouje
Elthan, Thane- Belapur Road, Airoli, Navi Mumbai- 400708
➢ Toll Free Numbers: 1800-200-5142
➢ Landline Numbers: (022)- 41659800
➢ E-mail Address: contactus@universalsompo.com
Note: Please include Your Policy number for any communication with us.
Insured person may also approach the grievance cell at any of the company’s branches with
the details of grievance
If Insured person is not satisfied with the redressal of grievance through one of the above
methods, insured person may contact the grievance officer at grievance@universalsompo.com
For updated details of grievance officer, kindly refer the link

https://universalsompo.com/resourse-grievance-redressal
If Insured person is not satisfied with the redressal of grievance through above methods, the
insured person may also approach the office of Insurance Ombudsman of the respective
area/region for redressal of grievance as per Insurance Ombudsman Rules 2017.
Grievance may also be lodged at IRDAI Integrated Grievance Management System -

https://igms.irda.gov.in/
H.2. Specific General Terms And Clauses:
1. Enhancement of Sum Insured

You may seek enhancement of Sum Insured in writing before payment of premium for renewal,
which may be granted at Our discretion. Before granting such request for enhancement of Sum
Insured, We have the right to have You examined by a Medical Practitioner authorized by Us
or the TPA. Our consent for enhancement of Sum Insured is dependent on the recommendation
of the Medical Practitioner and subject to limits as stated by the Company.
Enhancement of Sum Insured will not be considered for: In respect of any enhancement of Sum
Insured, exclusions code – Excl01, Excl02 and Excl03 would apply to the additional Sum Insured
from such date.
I. Claim Procedure
1. Procedure for Cashless claims:
i Treatment may be taken in a network provider and is subject to pre-authorization by the

Company or its authorized TPA.
ii Cashless request form available with the network provider and TPA shall be completed and
sent to the Company/TPA for authorization.
iii The Company/ TPA upon getting cashless request form and related medical information
from the insured person/ network provider will issue pre-authorization letter to the hospital
after verification.
iv At the time of discharge, the insured person has to verify and sign the discharge papers,
pay for non-medical and inadmissible expenses.
v The Company / TPA reserves the right to deny pre-authorization in case the insured person
is unable to provide the relevant medical details.

vi In case of denial of cashless access, the insured person may obtain the treatment as per
treating doctor’s advice and submit the claim documents to the Company / TPA for
reimbursement.
2. Procedure for reimbursement of claims:
For reimbursement of claims the insured person may submit the necessary documents to
Company within the prescribed time limit as specified hereunder.
SI No Type of Claim Prescribed Time limit

Reimbursement of hospitalization, day care Within thirty days of date of discharge
1.
and pre hospitalization expenses from hospital
Reimbursement of post hospitalization Within fifteen days from completion of
2.
expenses post hospitalization treatment
For Global Cover reimbursement: The Insured Person will have to submit all the necessary
documents to Company in India within prescribed limit.
3. Notification of Claim
Notice with full particulars shall be sent to the Company as under:

i Within 24 hours from the date of emergency hospitalization required or before the Insured
Person’s discharge from Hospital, whichever is earlier.
ii At least 48 hours prior to admission in Hospital in case of a planned Hospitalization.
4. Documents to be submitted:
The reimbursement claim is to be supported with the following documents and submitted within
the prescribed time limit.
i Duly Completed claim form

ii Photo Identity proof of the patient
iii Medical practitioner’s prescription advising admission
iv Original bills with itemized break-up
v Payment receipts
vi Discharge summary including complete medical history of the patient along with other
details.
vii Investigation/ Diagnostic test reports etc. supported by the prescription from attending
medical practitioner
viii OT notes or Surgeon’s certificate giving details of the operation performed (for surgical
cases).
ix Sticker/Invoice of the Implants, wherever applicable.
x MLR(Medico Legal Report copy if carried out and FIR (First information report) if
registered, where ever applicable.
xi NEFT Details (to enable direct credit of claim amount in bank account) and cancelled
cheque

xii KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh
as per AML Guidelines
xiii Legal heir/succession certificate , wherever applicable
xiv Any other relevant document required by Company/TPA for assessment of the claim.
Note:
1. Documentation consistent with Telemedicine Practice Guidelines [2020] circulated by the

Medical Council of India shall also be allowed under this policy along with the ones involving
standard, in-person consultation with a medical practitioner.
2. The company shall only accept bills/invoices/medical treatment related documents only in
the Insured Person’s name for whom the claim is submitted
3. In the event of a claim lodged under the Policy and the original documents having been
submitted to any other insurer, the Company shall accept the copy of the documents and
claim settlement advice, duly certified by the other insurer subject to satisfaction of the
Company
4. Any delay in notification or submission may be condoned on merit where delay is proved
to be for reasons beyond the control of the Insured Person
J. Grievance & Ombudsman

Office Details Jurisdiction of Office
Union Territory,District)
AHMEDABAD - Shri Kuldip Singh Gujarat,
Office of the Insurance Ombudsman, Dadra & Nagar Haveli,
Jeevan Prakash Building, 6th floor, Daman and Diu.
Tilak Marg, Relief Road,
Ahmedabad – 380 001.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@cioins.co.in
BENGALURU - Karnataka.
Office of the Insurance Ombudsman,
Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in

BHOPAL - Madhya Pradesh
Office of the Insurance Ombudsman, Chattisgarh.
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Near New Market,
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@cioins.co.in
BHUBANESHWAR - Shri Suresh Chandra Panda Orissa.

62, Forest park,
Bhubneshwar – 751 009.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@cioins.co.in
CHANDIGARH - Punjab,
Office of the Insurance Ombudsman, Haryana(excluding
S.C.O. No. 101, 102 & 103, 2nd Floor, Gurugram, Faridabad,
Batra Building, Sector 17 – D, Sonepat and Bahadurgarh)
Chandigarh – 160 017. Himachal Pradesh, Union
Tel.: 0172 - 2706196 / 2706468 Territories of Jammu &
Fax: 0172 - 2708274 Kashmir,
Email: bimalokpal.chandigarh@cioins.co.in Ladakh & Chandigarh.
CHENNAI - Tamil Nadu,
Office of the Insurance Ombudsman, Tamil Nadu
Fatima Akhtar Court, 4th Floor, 453, PuducherryTown and
Anna Salai, Teynampet, Karaikal (which are part of
CHENNAI – 600 018. Puducherry).
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
Email: bimalokpal.chennai@cioins.co.in
DELHI - Shri Sudhir Krishna Delhi &

Office of the Insurance Ombudsman, Following Districts of
2/2 A, Universal Insurance Building, Haryana - Gurugram,
Asaf Ali Road, Faridabad, Sonepat &
New Delhi – 110 002. Bahadurgarh.
Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@cioins.co.in

GUWAHATI - Assam,
Office of the Insurance Ombudsman, Meghalaya,
Jeevan Nivesh, 5th Floor, Manipur,
Nr. Panbazar over bridge, S.S. Road, Mizoram,
Guwahati – 781001(ASSAM). Arunachal Pradesh,
Tel.: 0361 - 2632204 / 2602205 Nagaland and Tripura.
Email: bimalokpal.guwahati@cioins.co.in
HYDERABAD - Andhra Pradesh,
Office of the Insurance Ombudsman, Telangana,
6-2-46, 1st floor, "Moin Court", Yanam and
Lane Opp. Saleem Function Palace, part of Union Territory of
A. C. Guards, Lakdi-Ka-Pool, Puducherry.
Hyderabad - 500 004.
Tel.: 040 - 23312122
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@cioins.co.in
JAIPUR - Rajasthan.
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@cioins.co.in
ERNAKULAM - Ms. Poonam Bodra Kerala,

Office of the Insurance Ombudsman, Lakshadweep,
2nd Floor, Pulinat Bldg., Mahe-a part of Union
Opp. Cochin Shipyard, M. G. Road, Territory of Puducherry.
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@cioins.co.in
KOLKATA - Shri P. K. Rath West Bengal,

Office of the Insurance Ombudsman, Sikkim,
Hindustan Bldg. Annexe, 4th Floor, Andaman & Nicobar
4, C.R. Avenue, Islands.
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341
Email: bimalokpal.kolkata@cioins.co.in

LUCKNOW -Shri Justice Anil Kumar Srivastava Districts of Uttar Pradesh :
Office of the Insurance Ombudsman, Lalitpur, Jhansi, Mahoba,
6th Floor, Jeevan Bhawan, Phase-II, Hamirpur, Banda,
Nawal Kishore Road, Hazratganj, Chitrakoot, Allahabad,
Lucknow - 226 001. Mirzapur, Sonbhabdra,
Tel.: 0522 - 2231330 / 2231331 Fatehpur, Pratapgarh,
Fax: 0522 - 2231310 Jaunpur,Varanasi, Gazipur,
Email: bimalokpal.lucknow@cioins.co.in Jalaun, Kanpur, Lucknow,
Unnao, Sitapur, Lakhimpur,
Bahraich, Barabanki,
Raebareli, Sravasti, Gonda,
Faizabad, Amethi,
Kaushambi, Balrampur,
Basti, Ambedkarnagar,
Sultanpur, Maharajgang,
Santkabirnagar, Azamgarh,
Kushinagar, Gorkhpur,
Deoria, Mau, Ghazipur,
Chandauli, Ballia,
Sidharathnagar.
MUMBAI - Goa,
Office of the Insurance Ombudsman, Mumbai Metropolitan
3rd Floor, Jeevan Seva Annexe, Region
S. V. Road, Santacruz (W), excluding Navi Mumbai &
Mumbai - 400 054. Thane.
Tel.:
69038821/23/24/25/26/27/28/28/29/30/31
Fax: 022 - 26106052
Email: bimalokpal.mumbai@cioins.co.in
NOIDA - Shri Chandra Shekhar Prasad State of Uttaranchal and

Office of the Insurance Ombudsman, the following Districts of
Bhagwan Sahai Palace Uttar Pradesh:
4th Floor, Main Road, Agra, Aligarh, Bagpat,
Naya Bans, Sector 15, Bareilly, Bijnor, Budaun,
Distt: Gautam Buddh Nagar, Bulandshehar, Etah, Kanooj,
U.P-201301. Mainpuri, Mathura, Meerut,
Tel.: 0120-2514252 / 2514253 Moradabad,
Email: bimalokpal.noida@cioins.co.in Muzaffarnagar, Oraiyya,
Pilibhit, Etawah,
Farrukhabad, Firozbad,
Gautambodhanagar,
Ghaziabad, Hardoi,
Shahjahanpur, Hapur,
Shamli, Rampur, Kashganj,
Sambhal, Amroha, Hathras,
Kanshiramnagar,
Saharanpur.

PATNA - Shri N. K. Singh Bihar,
Office of the Insurance Ombudsman, Jharkhand.
2nd Floor, Lalit Bhawan,
Bailey Road,
Patna 800 001.
Tel.: 0612-2547068
Email: bimalokpal.patna@cioins.co.in
PUNE - Shri Vinay Sah Maharashtra,
Office of the Insurance Ombudsman, Area of Navi Mumbai and
Jeevan Darshan Bldg., 3rd Floor, Thane
C.T.S. No.s. 195 to 198, excluding Mumbai
N.C. Kelkar Road, Narayan Peth, Metropolitan Region.
Pune – 411 030.
Tel.: 020-41312555
Email: bimalokpal.pune@cioins.co.in
Annexure 1 – DAYCARE PROCEDURES
DAY CARE PROCEDURES- ANNEXURE C

A. Cardiology:
1. Coronary Angiography
B. Critical Care:
1. Insert Non - Tunnel CV Cath

2. Insert PICC CATH (Peripherally Inserted Central Catheter )
3. Replace PICC CATH (Peripherally Inserted Central Catheter)
4. Insertion Catheter, Intra Anterior
5. Insertion of Portacath
C. Dental :
1. Suturing Lacerated Lip

2. Suturing Oral Mucosa
3. Oral Biopsy In Case Of Abnormal Tissue Presentation
4. FNAC
D. ENT :

1. Bronchical Thermoplasty for Asthma
2. Myringotomy With Grommet Insertion
3. Tymanoplasty (closure Of An Eardrum Perforation reconstruction Of The Auditory Ossicles)
4. Removal Of A Tympanic Drain
5. Keratosis Removal Under GA
6. Operations On The Turbinates (nasal Concha)
7. Removal Of Keratosis Obturans
8. Stapedotomy To Treat Various Lesions In Middle Ear
9. Revision Of A Stapedectomy
10. Other Operations On The Auditory Ossicles
11. Myringoplasty (post-aura/endaural Approach As Well As Simple Type-I Tympanoplasty)
12. Fenestration Of The Inner Ear
13. Revision Of A Fenestration Of The Inner Ear
14. Palatoplasty
15. Transoral Incision And Drainage Of A Pharyngeal Abscess
16. Tonsillectomy Without Adenoidectomy
17. Tonsillectomy With Adenoidectomy
18. Excision And Destruction Of A Lingual Tonsil
19. Revision Of A Tympanoplasty
20. Other Microsurgical Operations On The Middle Ear
21. Incision Of The Mastoid Process And Middle Ear
22. Mastoidectomy Reconstruction Of The Middle Ear
23. Other Excisions Of The Middle And Inner Ear
24. Incision (opening) And Destruction (elimination) Of The Inner Ear
25. Other Operations On The Middle And Inner Ear
26. Excision And Destruction Of Diseased Tissue Of The Nose
27. Other Operations On The Nose
28. Nasal Sinus Aspiration
29. Foreign Body Removal From Nose
30. Other Operations On The Tonsils And Adenoids
31. Adenoidectomy
32. Labyrinthectomy For Severe Vertigo
33. Stapedectomy Under GA
34. Stapedectomy Under LA
35. Tympanoplasty (type IV)
36. Endolymphatic Sac Surgery For Meniere's Disease
37. Turbinectomy
38. Endoscopic Stapedectomy
39. Incision And Drainage Of Perichondritis
40. Septoplasty
41. Vestibular Nerve Section
42. Thyroplasty Type I
43. Pseudocyst Of The Pinna - Excision
44. Incision And Drainage - Haematoma Auricle
45. Tympanoplasty (Type II)
46. Reduction Of Fracture Of Nasal Bone

47. Thyroplasty Type II
48. Tracheostomy
49. Excision Of Angioma Septum
50. Turbinoplasty
51. Incision & Drainage Of Retro Pharyngeal Abscess
52. Uvulo Palato Pharyngo Plasty
53. Adenoidectomy With Grommet Insertion
54. Adenoidectomy Without Grommet Insertion
55. Vocal Cord Lateralisation Procedure
56. Incision & Drainage Of Para Pharyngeal Abscess
57. Tracheoplasty
58. Total excision of Pinna
59. Middle ear polypectomy
60. Nasal septum cauterisation (and bilateral)
61. Excision of lesion of Internal nose
62. Balloon Sinuplasty
E. Gastroenterology :
1. Cholecystectomy And Choledocho-jejunostomy/Duodenostomy / Gastrostomy / Exploration
Common Bile Duct
2. Esophagoscopy, Gastroscopy, Duodenoscopy With Polypectomy/Removal Of Foreign
Body/diathermy Of Bleeding Lesions
3. Pancreatic Pseudocyst Eus & Drainage
4. RF Ablation For Barrett's Oesophagus
5. ERCP And Papillotomy
6. Esophagoscope And Sclerosant Injection
7. EUS + Submucosal Resection
8. Construction Of Gastrostomy Tube
9. EUS + Aspiration Pancreatic Cyst
10. Small Bowel Endoscopy (therapeutic)
11. Colonoscopy, Lesion Removal
12. ERCP
13. Colonscopy Stenting Of Stricture
14. Percutaneous Endoscopic Gastrostomy
15. EUS And Pancreatic Pseudo Cyst Drainage
16. ERCP And Choledochoscopy
17. Proctosigmoidoscopy Volvulus Detorsion
18. ERCP And Sphincterotomy
19. Esophageal Stent Placement
20. ERCP + Placement Of Biliary Stents
21. Sigmoidoscopy W / Stent
22. EUS + Coeliac Node Biopsy
23. UGI Scopy And Injection Of Adrenaline, Sclerosants Bleeding Ulcers
F. General Surgery:
1. Robotic surgeries
2. Incision Of A Pilonidal Sinus / Abscess

3. Fissure In Ano Sphincterotomy
4. Surgical Treatment Of A Varicocele And A Hydrocele Of the Spermatic Cord
5. Orchidopexy
6. Abdominal Exploration In Cryptorchidism
7. Surgical Treatment Of Anal Fistulas
8. Division Of The Anal Sphincter (sphincterotomy)
9. Epididymectomy
10. Incision Of The Breast Abscess
11. Operations On The Nipple
12. Excision Of Single Breast Lump
13. Incision And Excision Of Tissue In The Perianal Region
14. Surgical Treatment Of Hemorrhoids
15. Other Operations On The Anus
16. Ultrasound Guided Aspirations
17. Sclerotherapy, Etc.
18. Laparotomy For Grading Lymphoma With Splenectomy / liver/ lymph Node Biopsy
19. Therapeutic Laparoscopy With Laser
20. Appendicectomy With/without Drainage
21. Infected Keloid Excision
22. Axillary Lymphadenectomy
23. Wound Debridement And Cover
24. Abscess-decompression
25. Cervical Lymphadenectomy
26. Infected Sebaceous Cyst
27. Inguinal Lymphadenectomy
28. Incision And Drainage Of Abscess
29. Suturing Of Lacerations
30. Scalp Suturing
31. Infected Lipoma Excision
32. Maximal Anal Dilatation
33. Piles a. Injection Sclerotherapy b. Piles Banding
34. Liver Abscess- Catheter Drainage
35. Fissure In Ano-Fissurectomy
36. Fibroadenoma Breast Excision
37. Oesophageal Varices Sclerotherapy
38. ERCP - Pancreatic Duct Stone Removal
39. Perianal Abscess I&d
40. Perianal Hematoma Evacuation
41. UGI Scopy And Polypectomy Oesophagus
42. Breast Abscess I& D
43. Feeding Gastrostomy
44. Oesophagoscopy And Biopsy Of Growth Oesophagus
45. ERCP - Bile Duct Stone Removal
46. Ileostomy Closure
47. Colonoscopy
48. Polypectomy Colon
49. Splenic Abscesses Laparoscopic Drainage

50. UGI Scopy And Polypectomy Stomach
51. Rigid Oesophagoscopy For FB Removal
52. Feeding Jejunostomy
53. Colostomy
54. Ileostomy
55. Colostomy Closure
56. Submandibular Salivary Duct Stone Removal
57. Pneumatic Reduction Of Intussusception
58. Varicose Veins Legs - Injection Sclerotherapy
59. Rigid Oesophagoscopy For Plummer Vinson Syndrome
60. Pancreatic Pseudocysts Endoscopic Drainage
61. Zadek's Nail Bed Excision
62. Subcutaneous Mastectomy
63. Excision Of Ranula Under GA
64. Rigid Oesophagoscopy For Dilation Of Benign Strictures
65. Eversion Of Sac -unilateral -bilateral
66. Lord's Plication
67. Jaboulay's Procedure
68. Scrotoplasty
69. Circumcision For Trauma
70. Meatoplasty
71. Intersphincteric Abscess Incision And Drainage
72. PSOAS Abscess Incision And Drainage
73. Thyroid Abscess Incision And Drainage
74. Tips Procedure For Portal Hypertension
75. Esophageal Growth Stent
76. Pair Procedure Of Hydatid Cyst Liver
77. Tru Cut Liver Biopsy
78. Photodynamic Therapy Or Esophageal Tumour And Lung Tumour
79. Excision Of Cervical Rib
80. Laparoscopic Reduction Of Intussusception
81. Microdochectomy Breast
82. Surgery For Fracture Penis
83. Sentinel Node Biopsy
84. Parastomal Hernia
85. Revision Colostomy
86. Prolapsed Colostomy- Correction
87. Testicular Biopsy
88. Laparoscopic Cardiomyotomy( Hellers)
89. Sentinel Node Biopsy Malignant Melanoma
90. Laparoscopic Pyloromyotomy( Ramstedt)
G. Gynecology:
1. Operations On Bartholin’s Glands (cyst)
2. Incision Of The Ovary
3. Insufflations Of The Fallopian Tubes
4. Other Operations On The Fallopian Tube

5. Dilatation Of The Cervical Canal
6. Conisation Of The Uterine Cervix
7. Therapeutic Curettage With Colposcopy / Biopsy /Diathermy / Cryosurgery
8. Laser Therapy Of Cervix For Various Lesions Of Uterus
9. Other Operations On The Uterine Cervix
10. Incision Of The Uterus (hysterectomy)
11. Local Excision And Destruction Of Diseased Tissue Of The Vagina And The Pouch Of Douglas
12. Incision Of Vagina
13. Incision Of Vulva
14. Culdotomy
15. Salpingo-oophorectomy Via Laparotomy
16. Endoscopic Polypectomy
17. Hysteroscopic Removal Of Myoma
18. D&c
19. Hysteroscopic Resection Of Septum
20. Thermal Cauterisation Of Cervix
21. Mirena Insertion
22. Hysteroscopic Adhesiolysis
23. Leep
24. Cryocauterisation Of Cervix
25. Polypectomy Endometrium
26. Hysteroscopic Resection Of Fibroid
27. LLETZ
28. Conization
29. Polypectomy Cervix
30. Hysteroscopic Resection Of Endometrial Polyp
31. Vulval Wart Excision
32. Laparoscopic Paraovarian Cyst Excision
33. Uterine Artery Embolization
34. Laparoscopic Cystectomy
35. Hymenectomy( Imperforate Hymen)
36. Endometrial Ablation
37. Vaginal Wall Cyst Excision
38. Vulval Cyst Excision
39. Laparoscopic Paratubal Cyst Excision
40. Repair Of Vagina ( Vaginal Atresia )
41. Hysteroscopy, Removal Of Myoma
42. TURBT
43. Vaginal Mesh For POP
44. Laparoscopic Myomectomy
45. Surgery For SUI
46. Repair Recto- Vagina Fistula
47. Pelvic Floor Repair( Excluding Fistula Repair)
48. URS + LL
49. Laparoscopic Oophorectomy
50. Normal Vaginal Delivery And Variants
51. Excision of lesion of vulva

52. Amputation of cervix uteri
H. Neurology :
1. IONM – (Intra Operative Neuro Monitoring)
2. Facial Nerve Glycerol Rhizotomy
3. Spinal Cord Stimulation
4. Motor Cortex Stimulation
5. Stereotactic Radiosurgery
6. Percutaneous Cordotomy
7. Intrathecal Baclofen Therapy
8. Entrapment Neuropathy Release
9. Diagnostic Cerebral Angiography
10. VP Shunt
11. Ventriculoatrial Shunt
12. Deep Brain stimulation
I. Oncology :
1. Radiotherapy For Cancer
2. Cancer Chemotherapy
3. IV Push Chemotherapy
4. HBI-hemibody Radiotherapy
5. Infusional Targeted Therapy
6. SRT-stereotactic ARC Therapy
7. SC Administration Of Growth Factors
8. Continuous Infusional Chemotherapy
9. Infusional Chemotherapy
10. CCRT-concurrent Chemo + RT
11. D Radiotherapy
12. D Conformal Radiotherapy
13. IGRT- Image Guided Radiotherapy
14. IMRT- Step & Shoot
15. Infusional Bisphosphonates
16. IMRT- DMLC
17. Rotational Arc Therapy
18. Tele Gamma Therapy
19. FSRT-fractionated SRT
20. VMAT-volumetric Modulated Arc Therapy
21. SBRT-stereotactic Body Radiotherapy
22. Helical Tomotherapy
23. SRS-stereotactic Radiosurgery
24. X-knife SRS
25. Gammaknife SRS
26. TBI- Total Body Radiotherapy
27. Intraluminal Brachytherapy
28. Electron Therapy
29. TSET-total Electron Skin Therapy
30. Extracorporeal Irradiation Of Blood Products

31. Telecobalt Therapy
32. Telecesium Therapy
33. External Mould Brachytherapy
34. Interstitial Brachytherapy
35. Intracavity Brachytherapy
36. D Brachytherapy
37. Implant Brachytherapy
38. Intravesical Brachytherapy
39. Adjuvant Radiotherapy
40. Afterloading Catheter Brachytherapy
41. Conditioning Radiothearpy For BMT
42. Nerve Biopsy
43. Muscle Biopsy
44. Epidural Steroid Injection
45. Extracorporeal Irradiation To The Homologous Bone Grafts
46. Radical Chemotherapy
47. Neoadjuvant Radiotherapy
48. LDR Brachytherapy
49. Palliative Radiotherapy
50. Radical Radiotherapy
51. Palliative Chemotherapy
52. Template Brachytherapy
53. Neoadjuvant Chemotherapy
54. Adjuvant Chemotherapy
55. Induction Chemotherapy
56. Consolidation Chemotherapy
57. Maintenance Chemotherapy
58. HDR Brachytherapy
59. mmunotherapy - Monoclonal Antibody to be given as injection
60. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological
conditions
J. Salivary Glands & Salivary Ducts:

1. Incision And Lancing Of A Salivary Gland And A Salivary Duct
2. Excision Of Diseased Tissue Of A Salivary Gland And A Salivary Duct
3. Resection Of A Salivary Gland
4. Reconstruction Of A Salivary Gland And A Salivary Duct
5. Other Operations On The Salivary Glands And Salivary Ducts
6. Open extraction of calculus from parotid duct
K. Skin & Subcutaneous Tissues:
1. Other Incisions Of The Skin And Subcutaneous Tissues

2. Surgical Wound Toilet (wound Debridement) And Removal Of Diseased Tissue Of The Skin And
Subcutaneous Tissues
3. Local Excision Of Diseased Tissue Of The Skin And Subcutaneous Tissues
4. Other Excisions Of The Skin And Subcutaneous Tissues

5. Simple Restoration Of Surface Continuity Of The Skin And Subcutaneous Tissues
6. Free Skin Transplantation, Donor Site
7. Free Skin Transplantation, Recipient Site
8. Revision Of Skin Plasty
9. Other Restoration And Reconstruction Of The Skin And Subcutaneous Tissues.
10. Chemosurgery To The Skin.
11. Destruction Of Diseased Tissue In The Skin And Subcutaneous Tissues
12. Reconstruction Of Deformity/defect In Nail Bed
13. Excision Of Bursirtis
14. Tennis Elbow Release
L. Tongue:
1. Incision, Excision And Destruction Of Diseased Tissue Of The Tongue
2. Partial Glossectomy
3. Glossectomy
4. Reconstruction Of The Tongue
5. Other Operations On The Tongue
M. Ophthalmology :
1. Surgery For Cataract
2. Incision Of Tear Glands
3. Other Operations On The Tear Ducts
4. Incision Of Diseased Eyelids
5. Excision And Destruction Of Diseased Tissue Of The Eyelid
6. Operations On The Canthus And Epicanthus
7. Corrective Surgery For Entropion And Ectropion
8. Corrective Surgery For Blepharoptosis
9. Removal Of A Foreign Body From The Conjunctiva
10. Removal Of A Foreign Body From The Cornea
11. Incision Of The Cornea
12. Operations For Pterygium
13. Other Operations On The Cornea
14. Removal Of A Foreign Body From The Lens Of The Eye
15. Removal Of A Foreign Body From The Posterior Chamber Of The Eye
16. Removal Of A Foreign Body From The Orbit And Eyeball
17. Correction Of Eyelid Ptosis By Levator Palpebrae Superioris Resection (bilateral)
18. Correction Of Eyelid Ptosis By Fascia Lata Graft (bilateral)
19. Diathermy/cryotherapy To Treat Retinal Tear
20. Anterior Chamber Paracentesis / Cyclodiathermy /Cyclocryotherapy / Goniotomy Trabeculotomy
And Filtering And Allied Operations To Treat Glaucoma
21. Enucleation Of Eye Without Implant
22. Dacryocystorhinostomy For Various Lesions Of Lacrimal Gland
23. Laser Photocoagulation To Treat Ratinal Tear
24. Biopsy Of Tear Gland
25. Treatment Of Retinal Lesion
26. Curettage/cryotherapy of lesion of eyelid
27. Intra vitreal injections

N. Orthopedics :
1. Surgery For Meniscus Tear
2. Incision On Bone, Septic And Aseptic
3. Closed Reduction On Fracture, Luxation Or Epiphyseolysis With Osteosynthesis
4. Suture And Other Operations On Tendons And Tendon Sheath
5. Reduction Of Dislocation Under GA
6. Arthroscopic Knee Aspiration
7. Surgery For Ligament Tear
8. Surgery For Hemoarthrosis/pyoarthrosis
9. Removal Of Fracture Pins/nails
10. Removal Of Metal Wire
11. Closed Reduction On Fracture, Luxation
12. Reduction Of Dislocation Under GA
13. Epiphyseolysis With Osteosynthesis
14. Excision Of Various Lesions In Coccyx
15. Arthroscopic Repair Of Acl Tear Knee
16. Closed Reduction Of Minor Fractures
17. Arthroscopic Repair Of PCL Tear Knee
18. Tendon Shortening
19. Arthroscopic Meniscectomy - Knee
20. Treatment Of Clavicle Dislocation
21. Haemarthrosis Knee- Lavage
22. Abscess Knee Joint Drainage
23. Carpal Tunnel Release
24. Closed Reduction Of Minor Dislocation
25. Repair Of Knee Cap Tendon
26. ORIF With K Wire Fixation- Small Bones
27. Release Of Midfoot Joint
28. ORIF With Plating- Small Long Bones
29. Implant Removal Minor
30. K Wire Removal
31. Closed Reduction And External Fixation
32. Arthrotomy Hip Joint
33. Syme's Amputation
34. Arthroplasty
35. Partial Removal Of Rib
36. Treatment Of Sesamoid Bone Fracture
37. Shoulder Arthroscopy / Surgery
38. Elbow Arthroscopy Amputation Of Metacarpal Bone
39. Release Of Thumb Contracture
40. Incision Of Foot Fascia
41. Partial Removal Of Metatarsal
42. Repair / Graft Of Foot Tendon
43. Revision/removal Of Knee Cap
44. Amputation Follow-up Surgery
45. Exploration Of Ankle Joint
46. Remove/graft Leg Bone Lesion

47. Repair/graft Achilles Tendon
48. Remove Of Tissue Expander
49. Biopsy Elbow Joint Lining
50. Removal Of Wrist Prosthesis
51. Biopsy Finger Joint Lining
52. Tendon Lengthening
53. Treatment Of Shoulder Dislocation
54. Lengthening Of Hand Tendon
55. Removal Of Elbow Bursa
56. Fixation Of Knee Joint
57. Treatment Of Foot Dislocation
58. Surgery Of Bunion
59. Tendon Transfer Procedure
60. Removal Of Knee Cap Bursa
61. Treatment Of Fracture Of Ulna
62. Treatment Of Scapula Fracture
63. Removal Of Tumor Of Arm/ Elbow Under RA/GA
64. Repair Of Ruptured Tendon
65. Decompress Forearm Space
66. Revision Of Neck Muscle (torticollis Release )
67. Lengthening Of Thigh Tendons
68. Treatment Fracture Of Radius & Ulna
69. Repair Of Knee Joint
O. Mouth & Face:

1. External Incision And Drainage In The Region Of The Mouth, Jaw And Face
2. Incision Of The Hard And Soft Palate
3. Excision And Destruction Of Diseased Hard And Soft Palate
4. Incision, Excision And Destruction In The Mouth
5. Other Operations In The Mouth
6. Operations on uvula
P. Pediatric Surgery :
1. Excision Of Fistula-in-ano
2. Excision Juvenile Polyps Rectum
3. Vaginoplasty
4. Dilatation Of Accidenta L Caustic Stricture Oesophageal
5. Presacral Teratomas Excision
6. Removal Of Vesical Stone
7. Excision Sigmoid Polyp
8. Sternomastoid Tenotomy
9. Infantile Hypertrophic Pyloric Stenosis Pyloromyotomy
10. Excision Of Soft Tissue Rhabdomyosarcoma
11. Mediastinal Lymph Node Biopsy
12. High Orchidectomy For Testis Tumours
13. Excision Of Cervical Teratoma
14. Rectal-myomectomy

15. Rectal Prolapse (delorme's Procedure)
16. Detorsion Of Torsion Testis
17. EUA + Biopsy Multiple Fistula In Ano
Q. Plastic Surgery :
1. Construction Skin Pedicle Flap
2. Gluteal Pressure Ulcer-excision
3. Muscle-skin Graft, Leg
4. Removal Of Bone For Graft
5. Muscle-skin Graft Duct Fistula
6. Removal Cartilage Graft
7. Myocutaneous Flap
8. Fibro Myocutaneous Flap
9. Breast Reconstruction Surgery After Mastectomy
10. Sling Operation For Facial Palsy
11. Split Skin Grafting Under RA
12. Wolfe Skin Graft
13. Plastic Surgery To The Floor Of The Mouth Under GA
R. Thoracic Surgery :
1. Thoracoscopy And Lung Biopsy
2. Excision Of Cervical Sympathetic Chain Thoracoscopic
3. Laser Ablation Of Barrett's Oesophagus
4. Pleurodesis
5. Thoracoscopy And Pleural Biopsy
6. EBUS + Biopsy
7. Thoracoscopy Ligation Thoracic Duct
8. Thoracoscopy Assisted Empyaema Drainage
9. Operations for drainage of pleural cavity
S. Urology :
1. Vaporisation of the prostrate (Green laser treatment or holmium laser treatment)
2. Haemodialysis
3. Lithotripsy/nephrolithotomy For Renal Calculus
4. Excision Of Renal Cyst
5. Drainage Of Pyonephrosis/perinephric Abscess
6. Incision Of The Prostate
7. Transurethral Excision And Destruction Of Prostate Tissue
8. Transurethral And Percutaneous Destruction Of Prostate Tissue
9. Open Surgical Excision And Destruction Of Prostate Tissue
10. Radical Prostatovesiculectomy
11. Other Excision And Destruction Of Prostate Tissue
12. Operations On The Seminal Vesicles
13. Incision And Excision Of Periprostatic Tissue
14. Other Operations On The Prostate
15. Incision Of The Scrotum And Tunica Vaginalis Testis
16. Operation On A Testicular Hydrocele
17. Excision And Destruction Of Diseased Scrotal Tissue

18. Other Operations On The Scrotum And Tunica Vaginalis Testis
19. Incision Of The Testes
20. Excision And Destruction Of Diseased Tissue Of The Testes
21. Unilateral Orchidectomy
22. Bilateral Orchidectomy
23. Surgical Repositioning Of An Abdominal Testis
24. Reconstruction Of The Testis
25. Implantation, Exchange And Removal Of A Testicular Prosthesis
26. Other Operations On The Testis
27. Excision In The Area Of The Epididymis
28. Operations On The Foreskin
29. Local Excision And Destruction Of Diseased Tissue Of The Penis
30. Amputation Of The Penis
31. Other Operations On The Penis
32. Cystoscopical Removal Of Stones
33. Lithotripsy
34. Biopsy Oftemporal Artery For Various Lesions
35. External Arterio-venous Shunt
36. AV Fistula - Wrist
37. URSL With Stenting
38. URSL With Lithotripsy
39. Cystoscopic Litholapaxy
40. ESWL
41. Bladder Neck Incision
42. Cystoscopy & Biopsy
43. Cystoscopy And Removal Of Polyp
44. Suprapubic Cystostomy
45. Percutaneous Nephrostomy
46. Cystoscopy And "SLING" Procedure.
47. TUNA- Prostate
48. Excision Of Urethral Diverticulum
49. Removal Of Urethral Stone
50. Excision Of Urethral Prolapse
51. Mega-ureter Reconstruction
52. Kidney Renoscopy And Biopsy
53. Ureter Endoscopy And Treatment
54. Vesico Ureteric Reflux Correction
55. Surgery For Pelvi Ureteric Junction Obstruction
56. Anderson Hynes Operation
57. Kidney Endoscopy And Biopsy
58. Paraphimosis Surgery
59. Injury Prepuce- Circumcision
60. Frenular Tear Repair
61. Meatotomy For Meatal Stenosis
62. Surgery For Fournier's Gangrene Scrotum
63. Surgery Filarial Scrotum
64. Surgery For Watering Can Perineum

65. Repair Of Penile Torsion
66. Drainage Of Prostate Abscess
67. Orchiectomy
68. Cystoscopy And Removal Of FB
69. Endoscopic anti-reflux procedure (and bilateral)
70. Excision of urethral caruncle
71. Dilatation of urethra (including cystoscopy)
Annexure 2 -
List I
SI No Item
1 BABY FOOD
2 BABY UTILITIES CHARGES
3 BEAUTY SERVICES
4 BELTS/ BRACES
5 BUDS
6 COLD PACK/HOT PACK
7 CARRY BAGS
8 EMAIL / INTERNET CHARGES
9 FOOD CHARGES (OTHER THAN PATIENT’s DIET PROVIDED BY HOSPITAL)
10 LEGGINGS
11 LAUNDRY CHARGES
12 MINERAL WATER
13 SANITARY PAD
14 TELEPHONE CHARGES
15 GUEST SERVICES
16 CREPE BANDAGE
17 DIAPER OF ANY TYPE
18 EYELET COLLAR
19 SLINGS
20 BLOOD GROUPING AND CROSS MATCHING OF DONORS SAMPLES
21 SERVICE CHARGES WHERE NURSING CHARGE ALSO CHARGED
22 Television Charges
23 SURCHARGES
24 ATTENDANT CHARGES
25 EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS PART OF BED CHARGE)
26 BIRTH CERTIFICATE
27 CERTIFICATE CHARGES
28 COURIER CHARGES

29 CONVEYANCE CHARGES
30 MEDICAL CERTIFICATE
31 MEDICAL RECORDS
32 PHOTOCOPIES CHARGES
33 MORTUARY CHARGES
34 WALKING AIDS CHARGES
35 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL)
36 SPACER
37 SPIROMETRE
38 NEBULIZER KIT
39 STEAM INHALER
40 ARMSLING
41 THERMOMETER
42 CERVICAL COLLAR
43 SPLINT
44 DIABETIC FOOT WEAR
45 KNEE BRACES (LONG/ SHORT/ HINGED)
46 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER
47 LUMBO SACRAL BELT
48 NIMBUS BED OR WATER OR AIR BED CHARGES
49 AMBULANCE COLLAR
50 AMBULANCE EQUIPMENT
51 ABDOMINAL BINDER
52 PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES
53 SUGAR FREE Tablets
CREAMS POWDERS LOTIONS (Toiletries are not payable, only prescribed medical
54
pharmaceuticals payable)
55 ECG ELECTRODES
56 GLOVES
57 NEBULISATION KIT
58 ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC]
59 KIDNEY TRAY
60 MASK
61 OUNCE GLASS
62 OXYGEN MASK
63 PELVIC TRACTION BELT
64 PAN CAN
65 TROLLY COVER

66 UROMETER, URINE JUG
67 AMBULANCE
68 VASOFIX SAFETY
List II — Items that are to be subsumed into Room Charges
SI No Item
1 BABY CHARGES (UNLESS SPECIFIED/INDICATED)
2 HAND WASH
3 SHOE COVER
4 CAPS
5 CRADLE CHARGES
6 COMB
7 EAU-DE-COLOGNE / ROOM FRESHNERS
8 FOOT COVER
9 GOWN
10 SLIPPERS
11 TISSUE PAPER
12 TOOTH PASTE
13 TOOTH BRUSH
14 BED PAN
15 FACE MASK
16 FLEXI MASK
17 HAND HOLDER
18 SPUTUM CUP
19 DISINFECTANT LOTIONS
20 LUXURY TAX
21 HVAC
22 HOUSE KEEPING CHARGES
23 AIR CONDITIONER CHARGES
24 IM IV INJECTION CHARGES
25 CLEAN SHEET
26 BLANKET/WARMER BLANKET
27 ADMISSION KIT
28 DIABETIC CHART CHARGES
29 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES
30 DISCHARGE PROCEDURE CHARGES

31 DAILY CHART CHARGES
32 ENTRANCE PASS / VISITORS PASS CHARGES
33 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE
34 FILE OPENING CHARGES
35 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)
36 PATIENT IDENTIFICATION BAND / NAME TAG
37 PULSEOXYMETER CHARGES
List III — Items that are to be subsumed into Procedure Charges
SI No. Item
1 HAIR REMOVAL CREAM
2 DISPOSABLES RAZORS CHARGES (for site preparations)
3 EYE PAD
4 EYE SHEILD
5 CAMERA COVER
6 DVD, CD CHARGES
7 GAUSE SOFT
8 GAUZE
9 WARD AND THEATRE BOOKING CHARGES
10 ARTHROSCOPY AND ENDOSCOPY INSTRUMENTS
11 MICROSCOPE COVER
12 SURGICAL BLADES, HARMONICSCALPEL,SHAVER
13 SURGICAL DRILL
14 EYE KIT
15 EYE DRAPE
16 X-RAY FILM
17 BOYLES APPARATUS CHARGES
18 COTTON
19 COTTON BANDAGE
20 SURGICAL TAPE
21 APRON
22 TORNIQUET
23 ORTHOBUNDLE, GYNAEC BUNDLE
List IV — Items that are to be subsumed into costs of treatment
SI No. Item

1 ADMISSION/REGISTRATION CHARGES
2 HOSPITALIZATION FOR EVALUATION/ DIAGNOSTIC PURPOSE
3 URINE CONTAINER
4 BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING CHARGES
5 BIPAP MACHINE
6 CPAP/ CAPD EQUIPMENTS
7 INFUSION PUMP— COST
8 HYDROGEN PEROXIDE\SPIRIT\ DISINFECTANTS ETC
9 NUTRITION PLANNING CHARGES – DIETICIAN CHARGES- DIET CHARGES
10 HIV KIT
11 ANTISEPTIC MOUTHWASH
12 LOZENGES
13 MOUTH PAINT
14 VACCINATION CHARGES
15 ALCOHOL SWABES
16 SCRUB SOLUTION/STERILLIUM
17 Glucometer& Strips
18 URINE BAG


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