NON-ADMISSIBLE EXPENSES effective

Transcription

1 Epenses NON-ADMISSIBLE EXPENSES effecte Epenses Not Admissible 1 i Room Charges Additional Room charges / bed charges for attendant Related Attender Bed Charges Ecess of ICU & Nursing Charges per Day Ecess of ICU & Nursing Charges for Additional Day Charged by Hospital Ecess of ICU/ Normal Ward with Nursing Charges in ecess of 25% of Sum Insured i Ecess of Room Rent & Nursing Charges for Additional Day Charged by Hospital Ecess of Room Rent & Nursing Charges Limit per day Ecess of Room Rent & Nursing Charges beyond 25% of SI per Hospitalisation/ Illness 2 i Inestigation Ecess of Inestigation Charges for the Eligible Room Rent & Nursing Charges Charges Epenses for inestigation/ Treatment irreleant to the disease for which admitted or diagnosed Related Inestigation Charges for CAG where no CAG Report receed Inestigation Charges in Main Bill where no reports receed Inestigation Charges included already in Main Hospital Bill i Inestigation Charges not related to the Diagnosis Inestigation Reports for Bio-Chemistry not receed Inestigation Reports for Hematology not receed i Inestigation Reports for Micro-Biology not receed Inestigation Reports for Radiology (X-ray/ MRI/ CT/ ECG) not receed i Inestigation Reports for Urine not receed Lab Charges for Reports not Enclosed 3 i Professional Anesthetist Charges disproportionate to Surgeon's fee Charges Dietitian Charges Related Ecess of Professional Charges for the Eligible Room Rent & Nursing Charges i i i i Ecess of Professional Charges paid outside the Hospital Main Bill in ecess of 25% of SI where it is paid by cheque Ecess of Professional Charges paid outside the Hospital Main Bill in ecess of 10% of SI where it is paid by cash Ecess of Proportionate Professional Charges for the Eligible Room Rent & Nursing Charges Ecess of Sub-limit of 25% for Ayuredic/ Unani/ Homeopathic Treatment Ecess of Sub-limit of 25% for Professional Charges Ecess 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 Maimum Charges allowed under Room Rent Opinion Charges Outstation Consultant's/ Surgeon's Fees in ecess of the Hospital Tariff charges Preparation Charges Prate Nurses Charges- Special Nursing Charges

2 Epenses Epenses Not Admissible i Psychiatric Consultation Charges Referral Doctor's Fees 4 i Maternity Ante-natal Consultation Charges Related Ante-natal Epenses Charges Ante-natal Epenses without Hospitalisation (whereer Maternity is coered) Anti-D / Rhoclone etc Immunisation for RH Negate Mother Carrying RH Posite Baby Payable only in first pregnancy proided Graida status is L- o. If it is L-1 not payable. Baby Bottles i Baby Food Baby Powder Baby Set i Birth Certificate Maternity related Consultations i Maternity related Epenses Post-natal Consultation Charges Post-natal Epenses Post-natal Epenses without Hospitalisation (whereer Maternity is coered) Pre-natal Consultation Charges i Pre-natal Epenses Pre-natal Epenses without Hospitalisation (whereer Maternity is coered) Vaccine Charges for Baby 5 i Hospital AC Charges Charges Admission fee Payable under Certain Policies - Pl Check the policy Adance Amount Paid Ambulance Charges eceeding the Policy Limit Ambulance - Transport charges Payable only if the Policy specifically coers i Attendant / Ayah / Ward boy Charges Barber charges Beauty Serices i Body Wash CD / DVD/ Video cassette Charges i Commode Charges Daily Chart Charges Diabetic Chart Charges Documentation Charges / Administrate Epenses Donor Screening Charges Payable under certain policies - Within the terms and conditions of the insurance policy i / Internet Charges Electricity Charges (leied by Hospital) Entrance Pass / Visitors Pass Charges i Establishment Charges i File Charges File Opening Charges

3 i i i i i 7 i i Epenses 8 i Consumables Accucheck Ale Sugar Free Epenses Not Admissible Gate Pass Charges Guest Serices Home Nursing Charges Home Visit Charges Incidental Epenses / Misc. Charges (Not Eplained) Insurance Processing Charges Laundry Charges Luury Ta Medical Certificate Medical Record Charges Medico Legal Charges / MLC Charges Mortuary Charges Nutrition Planning Charges Patient Identification Band / Name Tag Photocopy Charges Registration Charges / Fee i l li l l l l 6 i Therapies/ Aesthetic Treatment/ Surgery Hormone Replacement Therapy Treatments not Admissible under the Policy Ailment Related Epenses Serice Charges Where Nursing Charge also Charged Surcharges Telephone Charges Teleision & Air Conditioner Charges Washing Charges Water Charges (leied by Hospital) X-ray Film Infertility/ Sub-fertility/ Assisted Conception Procedure Naturopathy Treatment Charges Non-allopathic Treatment Charges Stem Cell Implantation/ Surgery Weight Control Programs/ Supplies/ Serices Yoga Charges Any Epenses when the patient is diagnosed Retro Virus + or suffering from /HIV/ Aids etc is detected Dental Treatment Epenses that do not require Hospitalisation Obesity ( Including Morbid Obesity) Treatment Psychiatric & Psychosomatic Disorders - treatment charges Seually Transmitted Diseases - treatment Surgery for Correction of Eye Sight like Myopia/ Hypermetropia/ Ambliopia/ Presbiopia/ Astigmatism/ Strabismus etc., Payable under Certain Policies. If Admission Charges admitted this cannot be admitted. Hospitalisation eclusely for Hormonal Replacement Therapy not warranted - Not payable Payable only under Policies where PED is coered by way of Deletion of the Eclusion or by way of entitlement after lapse of specified period of claim free duration

4 Epenses Epenses Not Admissible Apron / Drape / Linen If it is disposable one, to allow Band Aid Not payable - Part of Dressing Charges Bandages Not -payable - Part of Dressing Charges i Betadine \Scrub solution \Hydrogen Peroide\Spirit\Sterillium \ Dettol etc - charges in ecess Reasonable Amount not Eceeding Rs. 100 allowable Blade Surgical Blades are payable in case of Surgery Clean sheet Disposable items that cannot be reused will be payable i Cliniplast Cotton In case of open wound And post-operate infected wounds - i Cotton Bandage In case of open wound And post -Operate infected wounds - Cozy sheet/cozy towel Crepe bandage Payable only in case of Varicose Vein Surgery/ Accident with open wounds Curapore/ Micropore - Adhese Bandage Not payable - Part of Dressing Charges Diaper i Diegene Gel Payable only when prescribed Drapes Disposable items that cannot be reused will be payable Eau-de-Cologne / Room Fresheners i Eamination Gloes - in Ecess Payable up to 15 No. in case of Surgery & two gloes per day for open wound when dressing charge is not charged Eye Drape Disposable items that cannot be reused will be payable i Eyelet Collar Eye Pad Disposable items that cannot be reused will be payable Eye Shield Payable in case of eye surgery Foot Coer Gauze In case of open wound And post -Operate infected wounds - i Gauze Soft In case of open wound And post -Operate infected wounds - Gels - Volini/ Zytee Payable only if prescribed for medicinal use Gloes - Sterile (For Surgery) To allow - 10 in general and 25 in case of surgery Glucometer/ Gluco Strips/ Accu Check etc Gown Hand Holder Hand Rub Hand Wash Leggings Payable only if prescribed for medicinal use i i i i l Loban Lotions Mask / Face Mask/ Flei Mask Medicine Bo Microshield Payable only if prescribed for medicinal use

5 Epenses Epenses Not Admissible li l l l Micropore Mineral Water Napkins/ Towels Nebulisation Mask Payable when specifically prescribed l Noarapid Payable when specifically prescribed li l l li One Touch Sure Strip Ortho bundle, Gynaec Bundle Ounce Glass Oygen Mask l Pads li l l l l li l l li l li l l l l l li l l Pan Can Paper gloes Plain Sheet Resource Powder Sanitary Pad / Sanitary Napkins Shoe Coer Slippers Soap, Powder, Shampoo and other Toiletries Sofnet Softoac Spacer Specimen Bottle Spirometer Splint SPO2 Probe Sputum Cup Steam Inhaler Stockings Surgical Blades,Harmonic Scalpel,Shaer Disposable items that cannot be reused will be payable li l li l l Surgical Drill TED Stockings\ Stockings Thermometer Trolley Coer Under Pads 9 i Durable Items Abdominal Belt / Binder Not Allowable Abdominal Drain Kit Alpha bed/ water bed etc Ambulance Collar Ambulance Equipment i Ambulatory Deices like Walker/ Crutches / Wheel Chair, etc., Arthroscopy & Endoscopy Instruments Only rental charged by the hospital allowed. Purchase of Instruments not allowed. CPAP/ CAPD Equipments Hospital Rental only payable

6 Epenses Epenses Not Admissible i Infusion Pump - Cost Hospital Rental only payable Instrument Charges where no details of procedure/ Instrument used is gen i Oygen Cylinder (for usage outside the hospital) In case of Post-hospitalisation epenses, cost of Oygen prescribed payable but not the cost of the cylinder 10 i Re-usable Arm sling Items Bed Pan Belts Blanket/warmer blanket Bottles i Braces Brush Camera Coer i Caps Payable up to 5 Nos - if disposable one payable in case of Surgery Cerical Collar i Cold pack/hot pack Collars Cost of Spectacles/ Contact Lenses/ Hearing Aids etc., Diabetic Foot Wear Kidney Tray i Knee Braces ( long/ short/ hinged) Knee Immobilizer/Shoulder Immobilizer i Lumbo Sacral Belt Microscope Coer i i Pelic Traction Belt Rib Binder/ Abdomen Binder Slings Spectacles Tourniquet Urine Can/ Urine Jug/ Urine Container Urometer 11 i Toiletry Items Comb Cosmetics Creams Payable only if prescribed for medicinal use Moisturiser / Paste / Brush Mouth Paint Payable when specifically prescribed i Mouth Washes like Listerene Payable when specifically prescribed Tissue Paper Tooth Brush i Tooth Paste Towel 12 i Kits Admission kit

7 Epenses Epenses Not Admissible Any Kit with no details mentioned [Delery kit, Ortho-kit, Recoery kit, etc] Eye Kit To find out the contents of the Kit and if they are medically required, payable Disposable items that cannot be reused will be payable Hernia Kit To find out the contents of the Kit and if they are medically required, payable HIV Kit i Nebulizer Kit Payable when specifically prescribed 13 i Dis-allowable Amount claimed already paid under Cashless Claim Epenses 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 i Bills not in Proper Format/ not Serially Numbered & Printed Bill Charges paid to organ donors Concession Gen by the Hospital i Co-pay Credit Bills - No Cash Paid Receipt i Discount Agreed with TPA by the Hospital Discount Gen to the Insured Duplicate Bills Ecess of Agreed Package Rate Ecess of Limit per Hospitalisation i Ecess of OT Charges for the Eligible Room Rent & Nursing Charges Ecess of Reasonable, necessary & Customary Charges Epenses eceeding Pre-hospitalisation Limit i Epenses eceeding Post-hospitalisation Limit Epenses related to Prescription on Discharge Not Payable under Cashless Claim i Health Drinks - Horlicks, Va Bournita & Protein Powder including Lactogen Admissible only to the etent prescribed Hospitalisation for Ealuation/ Diagnostic Purpose Miscellaneous - Details not furnished No Bills for claimed amount Policy Ecess