Andhra Bank
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AB Arogyadaan Scheme
 

 1. ELIGIBILITY OF NON-NETWORK HOSPITAL/NURSING HOMES

HOSPITAL / NURSING HOME means any institution in India established for indoor care and treatment of sickness and injuries and which
EITHER
a. has been registered as a hospital or nursing home with the local authorities and is under the supervision of a registered and qualified Medical Practitioner.
OR

b. should comply with minimum criteria as under:

It should have at least 15 inpatient beds
ii. Fully equipped operation theatre of its own wherever surgical operations are carried out.
iii. Fully qualified nursing staff under its employment round the clock.
iv. Fully qualified Doctor(s) should be in-charge round the clock.
   N.B.: In Class 'C' towns condition of number of beds be reduced to 10
v. The term 'Hospital/ Nursing home' shall not include an establishment which is a place of rest, a place for the aged, a place for drug-addict or place of alcoholics, a hotel or a similar place.
vi. Surgical operation means manual and/ or operative procedures for correction of deformities and defects, repair of injuries, diagnosis and cure of diseases, relief of suffering and prolongation of life.

 
 2. OTHER FEATURES

a) ANYONE ILLNESS
Any one illness will be deemed to mean continuous period of illness and it includes relapse within 105 days from the date of discharge from the Hospital/Nursing Home from where the treatment was taken. Occurrence of same illness after a lapse of 105 days as stated above will be considered as fresh illness for the purpose of this policy.
b) PRE-HOSPITALISATION
Relevant medical expenses incurred during period upto 30 days prior to hospitalization on disease/ illness/injury sustained will be as part of claim.
c) POST HOSPITALIZATION
Relevant medical expenses incurred during period up to 60 days post hospitalization on disease/illness/injury sustained will be as part of claim.
d) EXCLUSIONS
The Insurer  shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any Insured Person in connection with or in respect of:

  1.  Any Pre-existing condition (s) as defined in the policy, until 36 months of continuous coverage of such insured person have elapsed since inception of his / her policy with the Company.
  2. Any disease other than those stated in clause 3 below, contracted by the Insured person during the first 30 days from the commencement date of the policy. This condition 2 shall not, however, apply in case of the Insured person having been covered under this scheme or Group Insurance Scheme with the Company for a continuous period of preceding 12 months without any break.
  3. During the first year of the operation of the policy, the expenses on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy/Myomectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital internal disease, Fistula in anus, piles, Sinusitis and related disorders, Gall Bladder Stone removal, Gout & Rheumatism, Calculus Diseases, Age-related Osteoarthritis & Osteoporosis are not payable.
  4. Injury / disease directly or indirectly caused by or arising from or attributable to invasion, Act of Foreign enemy, War like operations (whether war be declared or not)
  5. a. Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be   necessitated due to an accident
    b.   Vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description
    c. Plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
  6. Cost of spectacles, contact lenses and hearing aids.
  7. Dental treatment or surgery of any kind including hospitalisation.
  8. Convalescence, general debility; run-down condition or rest cure, congenital external disease or defects or anomalies, Sterility, Venereal disease, intentional self injury and use of intoxication drugs / alcohol. However, treatment relation to all Psychiatric and Psychosomatic Disorders, AIDS or AIDS-like Syndrome, Genetic and Chromosomal Disorders are extended for Coverage under the policy
  9. All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymph tropic Virus Type III (HTLB - III) or lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.
  10. Charges incurred at Hospital or Nursing Home primarily for diagnosis, X-ray or Laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any ailment, sickness or injury, for which confinement is required at a Hospital / Nursing Home.
  11. Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician
  12. Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon / materials.
  13. Treatment arising from or traceable to pregnancy (including voluntary Termination of pregnancy) and childbirth (including caesarean section).
  14. Naturopathy Treatment, Ayurvedic treatment, Homeopathy, acupressure, acupuncture, magnetic and such other therapies.
  15. External and or durable Medical / Non-medical equipment of any kind used for diagnosis and/or treatment and/or monitoring and/or maintenance and/or support including CPAP, CAPD, Infusion pump, Oxygen concentrator etc., Ambulatory devices i.e., walker, crutches, Belts, Collars, Caps, Splints, Slings, Braces, Stockings, etc., of any kind, Diabetic foot wear, Glucometer / Thermometer and similar related items and also any medical equipment, which are subsequently used at home.
  16. Any kind of Service charges, Surcharges, Admission Fees/Registration Charges levied by the hospital.
  17. All non-Medical expenses of any kind whatsoever.
  18. Domiciliary Hospitalisation benefits are not covered under the Policy.
  19. Total Knee Replacement (TKR) will be covered after 3 continuous renewals of the Policy applicable for fresh policies taken from 09.06.2014.
  20. Ailments pertaining to or arising out of Obesity and Psychiatric/Psychosomatic disorders are not covered under the Policy.
 
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