Health Alpha

Conditions or treatments that the policy clearly says it will not cover.

• Pre-existing diseases and their direct complications are subject to the applicable waiting period.
• The listed specified diseases and procedures are subject to their applicable waiting period unless caused by an accident.
• Illnesses during the first 30 days of the policy are excluded, except accidents.
• Admission mainly for diagnostics and evaluation, and diagnostic expenses unrelated to the current treatment.
• Enforced bed rest, custodial care and services for terminally ill patients.
• Surgical treatment of obesity that does not satisfy the policy conditions.
• Change-of-gender treatments except where covered under the optional Gender Reassignment cover or applicable law.
• Cosmetic or plastic surgery unless medically necessary or covered under the applicable exception.
• Treatment needed because of professional participation in hazardous or adventure sports.
• Treatment arising from committing or attempting a breach of law with criminal intent.
• Treatment at providers excluded by SBI General, subject to emergency stabilisation provisions.
• Treatment for alcoholism, drug or substance abuse or addictive conditions and their consequences.
• Treatment at health hydros, nature cure clinics, spas or similar establishments.
• Dietary supplements and substances available without prescription, unless prescribed as part of a covered hospital or day care claim.
• Correction of refractive error below the applicable threshold, except where covered under Vision Correction.
• Unproven treatments.
• Sterility and infertility treatment, including IVF and other assisted reproduction, except under the optional Assisted Reproduction cover.
• Maternity and childbirth except where covered under the optional Maternity cover. Ectopic pregnancy is treated separately under the policy.
• Intentional self-injury or attempted suicide.
• Charges for obtaining medical certificates and expenses that are not reasonable and customary.
• Artificial life maintenance where treatment will not result in recovery.
• Circumcision unless medically necessary for disease or following an accident.
• Convalescence, general debility and run-down condition except where specifically covered.
• Hospital stays that are not medically necessary or are unduly long under accepted medical guidelines.
• Existing diseases disclosed and specifically listed by ICD code in the policy schedule.
• Items listed as non-payable in the policy annexure unless Consumables Cover is selected.
• Nuclear, chemical or biological attack or weapons, and war or war-like events.
• Outpatient treatment and non-prescribed drugs except where covered by the optional OPD Cover.
• Personal comfort items such as television, telephone and guest services.
• Treatment outside India except where covered by the optional Global Cover.
• Treatment by an unqualified practitioner, treatment outside the practitioner’s licensed discipline and self-medication.
• Vaccination or inoculation except where specifically covered, such as post-bite treatment or Child Vaccination.