Академический Документы
Профессиональный Документы
Культура Документы
2009
Sl. No
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Category of
Expenses Not Admissible
Expenses
Room Charges Additional Room charges / bed charges for attendant
Related
Attender Bed Charges
Excess of ICU & Nursing Charges per Day
Excess of ICU & Nursing Charges for Additional Day Charged by Hospital
Excess of ICU/ Normal Ward with Nursing Charges in excess of 25% of Sum Insured
Excess of Room Rent & Nursing Charges for Additional Day Charged by Hospital
Excess of Room Rent & Nursing Charges Limit per day
Excess of Room Rent & Nursing Charges beyond 25% of SI per Hospitalisation/ Illness
Investigation
Charges
Related
Professional
Charges
Related
Excess of Investigation Charges for the Eligible Category of Room Rent & Nursing Charges
Expenses for investigation/ Treatment irrelevant to the disease for which admitted or diagnosed
Investigation Charges for CAG where no CAG Report received
Investigation Charges in Main Bill where no reports received
Investigation Charges included already in Main Hospital Bill
Investigation Charges not related to the Diagnosis
Investigation Reports for Bio-Chemistry not received
Investigation Reports for Hematology not received
Investigation Reports for Micro-Biology not received
Investigation Reports for Radiology (X-ray/ MRI/ CT/ ECG) not received
Investigation Reports for Urine not received
Lab Charges for Reports not Enclosed
Anesthetist Charges disproportionate to Surgeon's fee
Dietitian Charges
Excess of Professional Charges for the Eligible Category of Room Rent & Nursing Charges
Excess of Professional Charges paid outside the Hospital Main Bill in excess of 25% of SI
where it is paid by cheque
Excess of Professional Charges paid outside the Hospital Main Bill in excess of 10% of SI
where it is paid by cash
Excess of Proportionate Professional Charges for the Eligible Category of Room Rent &
Nursing Charges
Excess of Sub-limit of 25% for Ayurvedic/ Unani/ Homeopathic Treatment
Excess of Sub-limit of 25% for Professional Charges
Excess of Sub-limit of 50% for Charges other than Room Rent & Professional Charges
Injection Charges (as Nursing Charges included in Room Charges)
IV Fluid Infusion Charges (as Nursing Charges included in Room Charges)
MLC Doctor Charges
Multiple Consultation Charges not related to Diagnosed Ailments
Nursing Charges as Maximum Charges allowed under Room Rent
Opinion Charges
Outstation Consultant's/ Surgeon's Fees in excess of the Hospital Tariff charges
Preparation Charges
Private Nurses Charges- Special Nursing Charges
Remarks
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Category of
Expenses
Maternity
Related
Charges
Hospital
Charges
Remarks
Sl. No
Category of
Expenses
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Service Charges Where Nursing Charge also Charged
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Surcharges
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Telephone Charges
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Television & Air Conditioner Charges
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Washing Charges
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Water Charges (levied by Hospital)
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X-ray Film
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Aesthetic Treatment/ Surgery
Therapies/
Treatments not Hormone Replacement Therapy
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Admissible
under the
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Infertility/ Sub-fertility/ Assisted Conception Procedure
Policy
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Naturopathy Treatment Charges
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Non-allopathic Treatment Charges
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Stem Cell Implantation/ Surgery
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Weight Control Programs/ Supplies/ Services
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Yoga Charges
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Ailment Related Any Expenses when the patient is diagnosed Retro Virus + or suffering from /HIV/ Aids etc is
detected
Expenses
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Dental Treatment Expenses that do not require Hospitalisation
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Obesity ( Including Morbid Obesity) Treatment
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Psychiatric & Psychosomatic Disorders - treatment charges
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Sexually Transmitted Diseases - treatment
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Surgery for Correction of Eye Sight like Myopia/ Hypermetropia/ Ambliopia/ Presbiopia/
Astigmatism/ Strabismus etc.,
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Consumables
Accucheck
Alex Sugar Free
Remarks
Sl. No
Consumables
Category of
Expenses
Remarks
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Blade
Clean sheet
Cliniplast
Cotton
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Cotton Bandage
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Eye Drape
Eyelet Collar
Eye Pad
Eye Shield
Foot Cover
Gauze
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Gauze Soft
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In case of open wound And post-Operative infected wounds payable if Dressing charges are not charged in the bill
In case of open wound And post -Operative infected wounds payable if Dressing charges are not charged in the bill
Payable only in case of Varicose Vein Surgery/ Accident with
open wounds
Not payable - Part of Dressing Charges
Payable only when prescribed
Disposable items that cannot be reused will be payable
Payable up to 15 No. in case of Surgery & two gloves per day for
open wound when dressing charge is not charged
Disposable items that cannot be reused will be payable
Disposable items that cannot be reused will be payable
Payable in case of eye surgery
In case of open wound And post -Operative infected wounds payable if Dressing charges are not charged in the bill
In case of open wound And post -Operative infected wounds payable if Dressing charges are not charged in the bill
Payable only if prescribed for medicinal use
To allow - 10 in general and 25 in case of surgery
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Category of
Expenses
Durable Items
Not Allowable
Remarks
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Category of
Expenses
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Re-usable
Items
Toiletry Items
Kits
Arm sling
Bed Pan
Belts
Blanket/warmer blanket
Bottles
Braces
Brush
Camera Cover
Caps
Cervical Collar
Cold pack/hot pack
Collars
Cost of Spectacles/ Contact Lenses/ Hearing Aids etc.,
Diabetic Foot Wear
Kidney Tray
Knee Braces ( long/ short/ hinged)
Knee Immobilizer/Shoulder Immobilizer
Lumbo Sacral Belt
Microscope Cover
Pelvic Traction Belt
Rib Binder/ Abdomen Binder
Slings
Spectacles
Tourniquet
Urine Can/ Urine Jug/ Urine Container
Urometer
Comb
Cosmetics
Creams
Moisturiser / Paste / Brush
Mouth Paint
Mouth Washes like Listerene
Tissue Paper
Tooth Brush
Tooth Paste
Towel
Admission kit
Remarks
Hospital Rental only payable
In case of Post-hospitalisation expenses, cost of Oxygen
prescribed payable but not the cost of the cylinder
Sl. No
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Category of
KitsExpenses
Any Kit with no details mentioned [Delivery kit, Ortho-kit, Recovery kit, etc]
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Eye Kit
Hernia Kit
Dis-allowable
Expenses
HIV Kit
Nebulizer Kit
Amount claimed already paid under Cashless Claim
Amount Paid by the Patient
Bills Beyond Permitted Post-hopsitalisation Period
Bills Beyond Permitted Pre-hopsitalisation Period
Bills in the Name other than the Insured Patient
Bills not in Proper Format/ not Serially Numbered & Printed Bill
Charges paid to organ donors
Concession Given by the Hospital
Co-pay
Credit Bills - No Cash Paid Receipt
Discount Agreed with TPA by the Hospital
Discount Given to the Insured
Duplicate Bills
Excess of Agreed Package Rate
Excess of Limit per Hospitalisation
Excess of OT Charges for the Eligible Category of Room Rent & Nursing Charges
Excess of Reasonable, necessary & Customary Charges
Expenses exceeding Pre-hospitalisation Limit
Expenses exceeding Post-hospitalisation Limit
Expenses related to Prescription on Discharge
Health Drinks - Horlicks, Viva Bournvita & Protein Powder including Lactogen
Hospitalisation for Evaluation/ Diagnostic Purpose
Miscellaneous - Details not furnished
No Bills for claimed amount
Policy Excess
Remarks
To find out the contents of the Kit and if they are medically
required, payable
Disposable items that cannot be reused will be payable
To find out the contents of the Kit and if they are medically
required, payable
Payable when specifically prescribed