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Advanced Procedures Excluded By Name

A set of advanced procedures is excluded by exact name - high-technology treatments the policy will not pay for even though hospitals offer them. Before you agree to a procedure with a brand-style name, check that name against the policy's own list.

Growth Hormone Therapy

Growth hormone therapy is excluded by name, and the clause gives no exception for a diagnosed deficiency. If a child needs it, you pay for it yourself - often lakhs of rupees a year, for several years.

Hormone Replacement Therapy

Hormone replacement therapy is excluded by name - the treatment used to replace hormones the body no longer makes, most often around menopause or after surgery that removes the ovaries or testes. You pay for it yourself.

Mental Health Assessments

Physical, psychiatric and psychological examinations and testing are excluded by name. This clause does not reach the treatment that follows: whether that treatment is paid is settled by each policy's own mental-health cover. But the assessment that leads to it is on you.

Procedures Using An RF Probe

Any procedure using a radio-frequency probe - for example cardiac ablation for an arrhythmia, varicose vein treatment, tumour ablation or nerve ablation for chronic pain - is excluded. Some policies pay for it if the insurer approves the procedure in writing before it happens; the clause quoted for each policy tells you whether that route exists.

Stem Cell Therapy

Stem cell therapy - treatment that uses stem cells to repair damaged blood, tissue or organs - is excluded. Where a policy makes an exception, most often for stem cells used in a bone marrow transplant, its own wording says so.

AYUSH Beyond The Named Benefit

Nutritional Supplements In Hospital

Admissions And Charges Judged Unnecessary

The insurer can refuse an admission it judges was not medically needed - and, where the policy's own wording says so, any charge it judges above the going rate. It is the widest discretion in a policy and it applies to every claim, so keep the treating doctor's reasons on the file.

Conditions Excluded On Your Own Policy

Something can be written out of your cover for good, named on your own Policy Schedule when the policy is underwritten. Policies differ in how far that reaches: some can exclude only a disease that is declared and agreed to be excluded at the start, others any illness, injury, treatment or service the schedule names. The printed policy document does not list it, so read your schedule as soon as the policy is issued and ask the insurer to explain anything you do not recognise. Where a policy sets an end date for such an exclusion, or requires your written agreement to it, its own wording says so.

Expensive Drug Infusions

Expensive drug infusions, biologics most of all, are handled separately from ordinary hospital treatment. Some policies pay for them only when you are admitted, and refuse the same drug given in an outpatient infusion chair. Others refuse the admission that was arranged so that the infusion could be given, and a clause may name other costly infusions alongside, such as immunoglobulin or bone-strengthening drugs. Either way a large cost, often a repeated one, stays with you. The clause quoted for each policy tells you which way its own wording runs.

Injections Into A Joint

Injections given into a joint, and the platelet-rich plasma and cartilage treatments offered for knee and joint pain, are excluded. Some clauses bar the treatment itself. Others bar only the admission that was arranged so that the injection could be given, and some reach wider, to an injection into a lesion or to the medicines infused alongside it. The clause quoted for each policy tells you which, and names the injections it means.

Sleep Apnoea And Feeling Run Down

Sleep apnoea is excluded, and some clauses widen the same exclusion to general weakness or a run-down condition. Some clauses bar only the investigation, so the sleep study that would find apnoea is on you. Others bar the condition itself, and then the treatment that follows is on you as well. The clause quoted for each policy tells you which.

Spinal Manipulation And Muscle Stimulation

Treatment that works by adjusting the spine or manipulating the skeleton, and muscle stimulation by any means, are not paid, whatever the reason for them. Where a policy writes a way back in, most often for setting a fracture or a dislocation, its own clause says so - and it also names any fracture it leaves out.

Therapies Outside AYUSH

Systems of medicine a policy does not recognise are not paid for. Where the policy grants an AYUSH benefit, that benefit covers Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy, and it overrides this clause as far as it reaches. Therapies outside those six - acupressure, acupuncture, magnetic therapy, reflexology, chiropractic - stay excluded, and each policy names its own.

Armed Forces Duty

Consumable Medical Supplies

Consumable medical supplies such as elastic stockings and diabetic test strips are excluded by name. You pay for them yourself, even during an admission the insurer otherwise pays for.

Hair Loss Treatment

Organ Donor Costs

The costs that sit around an organ donation, both finding and screening a possible donor and the expenses the insured person runs up in donating, are not paid as ordinary treatment. A donor’s own treatment is paid only as far as a policy’s organ-donor benefit reaches, and whatever that benefit leaves out stays with you. The clause quoted for each policy tells you which of these costs its own wording removes.

Self-Medication

Transplants Outside The Law

An admission for an organ transplant that does not comply with the Transplantation of Human Organs Act, 1994 is not paid.

Treatment Outside A Hospital

A policy pays for treatment given at a place that meets its own definition of a Hospital or of a Day Care Centre. If the treatment is given at a facility that does not meet that definition, the expenses are not paid, even when the same treatment inside a hospital would have been paid for. If a policy allows an exception, its own clause states that exception.