c.

If the Insured Person is continuously covered without any break as de�ned under the portability
norms of the extant IRDAI (Health Insurance) Regulations, then waiting period for the same would be
reduced to the extent of prior coverage.

d. Coverage under the policy after the expiry of 24 months for any pre-existing disease is subject to the
same being declared at the time of application and accepted by us.

10. General Exclusions:

We will neither be liable nor make any payment for any claim in respect of any Insured Person which is
caused by, arising from or in any way attributable to any of the following exclusions, unless expressly stated
to the contrary in this Policy.

Medical Exclusions:

i. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof
.(Code-Excl12)

ii. Alcoholic pancreatitis

iii. Expenses related to surgical treatment of obesity that does not ful�l the below conditions (Code-Excl06):

a. Surgery to be conducted is upon the advice of the Doctor

b. The surgery/Procedure conducted should be supported by clinical protocols

c. The member has to be 18 years of age or older and

d. Body Mass Index (BMI);

i. greater than or equal to 40 or

ii. greater than or equal to 35 in conjunction with any of the following severe co-morbidities
following failure of less invasive methods of weight loss:

1. Obesity-related cardiomyopathy

2. Coronary heart disease

3. Severe Sleep Apnea

4. Uncontrolled Type2 Diabetes

iv. Congenital External Diseases, defects or anomalies;

v. Stem cell therapy; however hematopoietic stem cells for bone marrow transplant for haematological
conditions will be covered under bene�t In-Patient Treatment or Day Care Procedures of this policy;

vi. Growth hormone therapy;

vii. Sleep-apnoea

viii. Admission primarily for administration of Intra-articular or intra-lesional injections or Intravenous

ix. Investigation and evaluation (Code-Excl04):

a. Expenses related to any admission primarily for diagnostics and evaluation purposes only are
excluded.

b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment
are excluded.

x. Venereal disease, sexually transmitted disease or illness;

9
Tata AIG General Insurance Company Limited
Registered O�ce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013, Maharashtra, India
24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Email: [email protected] • Website: www.tataaig.com
IRDA of India Registration No.: 108 • CIN: U85110MH2000PLC128425 • Tata AIG MediCare Premier UIN: TATHLIP23167V032223
 xi. Expenses related to Sterility and infertility (Code-Excl17). This includes:

i. Any type of contraception, sterilization

ii. Assisted Reproduction services including arti�cial insemination and advanced reproductive
technologies such as IVF, ZIFT, GIFT, ICSI

iii. Gestational Surrogacy

iv. Reversal of sterilization

xii. Refractive error (Code -Excl15): Expenses related to the treatment for correction of eye sight due to
refractive error less than 7.5 dioptres.

xiii. Change-of-Gender treatments (Code- Excl 07): Expenses related to any treatment, including surgical
management, to change characteristics of the body to those of the opposite sex

xiv. Cosmetic or Plastic Surgery (Code – Excl08): Expenses for cosmetic or plastic surgery or any treatment
to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of
medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be
considered a medical necessity, it must be certi�ed by the attending Medical Practitioner.

xv. Rest cure, rehabilitation and respite care (Code-Excl05):

a. Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This
also includes:

i. Custodial care either at home or in a nursing facility for personal care such as help with activities of
daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled
persons.

ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.

xvi. All preventive care, vaccination including inoculation and immunisations (except in case of post- bite
treatment and other vaccines explicitly covered);

xvii. Unproven treatments (Code-Excl16) : 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 signi�cant medical documentation to support their e ectiveness.

xviii. Dental treatment or surgery of any kind except as speci�ed in ‘Inpatient Treatment – Dental’.

xix. Maternity (Code - Excl18):

a. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean
sections incurred during hospitalization) except ectopic pregnancy;

b. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy
during the policy period

xx. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds
registered as a nursing home attached to such establishments or where admission is arranged wholly or
partly for domestic reasons. (Code -Excl13)

xxi. 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)

xxii. Any existing disease speci�cally mentioned as Permanent exclusion in the Policy Schedule

Non-Medical Exclusions:

I. War or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or

10
Tata AIG General Insurance Company Limited
Registered O�ce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013, Maharashtra, India
24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Email: [email protected] • Website: www.tataaig.com
IRDA of India Registration No.: 108 • CIN: U85110MH2000PLC128425 • Tata AIG MediCare Premier UIN: TATHLIP23167V032223