What are the exclusions under group health insurance?

1Answer

Common exclusions are listed below:

  • Injury or disease directly or indirectly caused by or arising from or attributable to War,

  • Invasion, Act of Foreign Enemy, Warlike operation (whether war be declared or not) and by Nuclear Weapons/materials

  • Cost of Spectacles, Contact Lenses, Hearing Aids, cost of buying any external device Circumcision

  • Cosmetic or aesthetic treatment of any description

  • Plastic surgery other than as may be necessitated due to an accident or as a part of any illness

  • Convalescence, general debility ‘Run-down' condition or test cure, congenital external disease or defects or anomalies, Sterility(infertility), venereal disease, intentional self-injury and use of intoxicating drugs/alcohol

  • Expense on buying vitamins & tonics unless forming part of treatment & certified by treating Doctor

  • Charges incurred at Hospital primarily for diagnostic, X-Ray or laboratory examinations or any other diagnostic studies not consistent with or incidental to the diagnosis or treatment of the disease, illness or injury for which the claim is payable will not be settled. Only related treatment charges and diagnostic charges are payable

  • Diagnostic charges & treatment cost incurred for cases where no active line of treatment was followed stands excluded from coverage

  • Voluntary medical termination of pregnancy during the first 12 weeks from the date of conception

  • Acquired Immune Deficiency Syndrome (AIDS)

  • Treatment for genetic disorders/ stem-cell treatment

Please refer to policy documents and general exclusions documents at time of issuance. 

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