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Specific Exclusions
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1
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Waiting Period: The Policy shall not cover Hospitalization or Quarantine within 15 days of Certificate Period Start Date.
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2
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Co-habitation: No claim shall be payable where the Insured Person was living with and sharing the same address as that of person(s) who were Diagnosed with COVID-19 or Quarantined at the time of Proposal.
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3
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Unauthorized Testing center: Testing done at a Diagnostic center other than the ones authorized by the Union Health Ministry of India. shall not be recognized under this Policy.
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4
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Out of India: Diagnosis and/or Treatment taken outside India is not covered.
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5
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Undefined Conditions: Treatment taken for any condition or disease other than COVID-19 is not covered 6.Self-Quarantine: Self-Quarantine is not covered.
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7
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Negative or Inconclusive Reports: If the test report is negative or if Insured Person is ‘Patients under investigation’ (PUI) with inconclusive reports, no claim will be admissible under Hospitalization Cover of this Policy.
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8
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Breach of law (Code: Excl 10): Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.
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9
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Cluster Containment operations carried out by State or Central Government to contain the spread of SARS-CoV2 virus. Any self-isolation as a result of such Cluster Containment operations will not be considered as Quarantine and is not covered under this Policy.
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10
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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): 11.Domiciliary/OPD Treatment: Any expenses incurred on Domiciliary Hospitalization and OPD treatment.
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12
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Excluded Providers (Code: Excl 11): 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/Certificate Holders 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.(For updated and detailed list of Excluded Providers refer website-
www.reliancegeneral.co.in )
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13
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Investigation & Evaluation (Code: Excl04)
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14
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Expenses related to any admission primarily for diagnostics and evaluation purposes
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15
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Any diagnostic expenses which are not related or not incidental to the current Diagnosis and treatment are excluded
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16
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Lockdown: Lockdown means an emergency protocol that prevents people from leaving an area or a state of isolation or restricted access instituted as a security measure by the Government. Any self-isolation as a result of such Lockdown will not be considered as Quarantine and is not covered under this Policy.
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17
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Willful Act/Negligence: Willful acts or willful gross negligence of the Insured Person.
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18
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Unproven Treatments-Code (Code: Excl 16): 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.
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19
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All Standard terms and conditions of product are applicable.
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