ACTIV ONE NXT

1 Investigation & Evaluation

Expenses solely for diagnostic evaluation; Non-related diagnostic expenses not incidental to current treatment.

2 Rest, Cure, Rehabilitation and Respite Care

Expenses for enforced bed rest admissions; Custodial care for daily living; Services for terminally ill individuals' needs.

3 Obesity/ Weight Control

Self-initiated obesity surgery without the advice of a doctor; Inclusion criteria for surgery: BMI ≥ 40, age > 18, clinical-protocol supported surgery; BMI 35+ with comorbidities like severe sleep apnea, coronary heart disease, Obesity-related cardiomyopathy, uncontrolled Type-2 Diabetes Mellitus covered after failed non-invasive weight loss methods.

4 Change-of-Gender treatments

Expenses for changing body characteristics to opposite sex

5 Cosmetic or plastic Surgery

Cosmetic/plastic surgery unless for reconstruction after Accident, Burn, Cancer, or to remove immediate health risk, certified by Medical Practitioner.

6 Hazardous or Adventure sports

Treatment due to participation in hazardous/adventure sports, e.g., mountaineering, scuba diving, motor racing; Not limited to specified activities.

7 Breach of law

Treatment resulting from Insured Person's criminal acts.

8 Excluded Providers

Treatment from providers listed on website; Emergency care paid till stabilization, not full claim.

9 Treatment for, Alcoholism, drug or substance abuse or any addictive condition

10 Treatments received in heath hydros, nature cure clinics, spas or similar establishments

11 Dietary supplements and substances

Over-the-counter dietary supplements; Exceptions for prescribed supplements during hospitalization or day care

12 Refractive Error

Treatment for refractive error < 7.5 dioptres

13 Unproven Treatments

Unproven treatments, services, supplies lacking medical documentation

14 Sterility and Infertility

Expenses for sterility, infertility treatments, contraception, assisted reproduction, gestational surrogacy, sterilization reversal.

15 Maternity Expenses

Childbirth-related medical expenses (except ectopic pregnancy); Miscarriage expenses (unless due to accident) and lawful pregnancy termination

16 Circumstantial Exclusion

Any illness or injury due to war, rebellion, armed resistance, acts of terrorism and nuclear or radiological emissions.

17 Behavioural Exclusions

Suicide/self-harm, illegal acts, injury from alcohol/intoxicating substance use, and non-prescription drug use.

18 Medical Exclusions

• Routine exams and check-ups, except as specified in Annual Health Check-up terms
• Circumcisions, unless medically necessary or part of an illness or injury treatment plan.
• Conditions treatable on an outpatient basis without hospitalization
• Preventive care, vaccinations (except post bite), and physical/psychiatric/physiological examinations or testing
• External Abnormalities to a new-born baby
• Dental/oral treatment for natural teeth and gingiva, unless required during Hospitalization due to an Accident
• Any form of AYUSH treatment, unless expressly mentioned in the policy document

19 Prosthesis and Devices Exclusion

Hearing aids, spectacles, wigs, prosthesis, medical equipment, and cochlear implants, unless specified in optional coverage*- Durable Medical Equipment Cover.

20 Non-Medical expenses

Items listed in Annexure (I) Lists I, II, III, and IV are not covered unless they are part of in-patient hospitalization; this exemption does not apply if Claims Protect is included in the base benefit or opted as an optional cover* and specified in the Policy Schedule.

21 Specific treatment Exclusion

Involving Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP) , Treatment involving Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy, KTP Laser Surgeries, Cyber Knife Treatment, Femto Laser Surgeries, Bioabsorbable Stents, Bioabsorbable Valves, Bioabsorbable Implants. Use of Radio Frequency (RF) probe for ablation

22 Activities and Profession Exclusions: Unrecognised Physician/Hospital

Treatment by unregistered practitioners, unlicensed and unauthorized practitioners' fees, and treatments by family members or resident practitioners without pre-approval.

23 Geographical Exclusion

Treatment taken outside India, unless specified to be covered in the Policy Schedule