Unless expressly stated to the contrary in this Policy, HDFC Life will not make any payment for any claim in respect of any Life Assured if it is directly or indirectly caused by, arises from or is in any way attributable to any of the following: Treatment for congenital disease or deformity, including physical defects present from birth will not be covered by the policy. Hospitalization and/or surgery is/are not in accordance with the diagnosis and treatment of the condition for which the hospital confinement or surgery was required; Any condition with respect to the covered benefits, for which the insured had signs or symptoms, and/or was diagnosed, and/or received medical advice/treatment within the waiting period. Elective surgery or treatment which is not medically necessary; Weight reduction or weight improvement regardless of whether the same is caused (directly or indirectly) by a medical condition; Study and treatment of sleep apnoea; Routine eye tests, any dental treatment or surgery of cosmetic nature, extraction of impacted tooth/teeth, orthodontics or orthognathic surgery, or tempero-mandibular joint disorder except as necessitated by an accidental injury and warranting hospitalization Outpatient treatment Hospitalization and/or surgery relating to infertility or impotency, sex change or any treatment related to it, abortion, sterilization and contraception including any complications relating thereto; Hospitalization and/or surgery for treatment arising from pregnancy and it’s complications which shall include childbirth or miscarriage; Hospitalisation primarily for any purpose which in routine could have been carried out on an out-patient basis and which is not followed by an active treatment or intervention during the period of hospitalization. Experimental or unproven procedures or treatments, devices or pharmacological regimens of any description (not recognized by Indian Medical Council) or hospitalization for treatment under any system other than allopathy; Any mental or psychiatric condition including but not limited to insanity, mental or nervous breakdown / disorder, depression, dementia, or psychosomatic disorders. Alzheimer’s disease will also be excluded from all the covered benefits except Critical Illness. Convalescence, rest cure, sanatorium treatment, rehabilitation measures, respite care, long term nursing care or custodial care and general debility or exhaustion (run down condition) Directly or indirectly arising from alcohol, drug or unless taken in accordance to the dosage and duration as prescribed by the independent medical practitioner substance abuse and any illness or accidental physical injury which may be suffered after consumption of intoxicating substances, liquors or drugs; Directly or indirectly arising from or consequent upon war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, terrorism, rebellion, active participation in strikes, riots or civil commotion, revolution, insurrection or military or usurped power and Sexually transmitted diseases or any treatment in the presence of HIV infection Acquired Cosmetic or plastic surgery except to the extent that such surgery is necessary for the repair of damage caused solely by accidental injuries, cancer or burns. Treatment of xanthelesema, , acne and alopecia; circumcision unless necessary for treatment of a disease or necessitated due to an accident Nuclear disaster, radioactive contamination and/or release of nuclear or atomic energy; Injury or illness caused by intentionally self-inflicted injuries; or any attempts of suicide while sane or insane; or deliberate exposure to exceptional danger (except in an attempt to save human life); Injury or illness caused by violation or attempted violation of the law, or resistance to arrest; or by active participation in an act with criminal intent. Injury or illness caused by professional sports, racing of any kind, scuba diving, aerial sports, activities such as hand-gliding, ballooning, and any other hazardous activities or sports unless agreed by special endorsement; Hospitalization where the Life Assured is a donor for any organ transplant; Any injury, sickness or disease received as a result of aviation, gliding or any form of aerial flight other than on a scheduled commercial airline as a bona fide passenger (whether fare paying or not), pilot or crew member Treatment to relieve symptoms caused by ageing, puberty, or other natural physiological cause, such as menopause and hearing loss caused by maturing or ageing. Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health. Treatment of abnormalities, deformities, or Illnesses present only because they have been passed down through the generations of the family. Treatment for, or related to developmental problems, including Learning difficulties, such as dyslexia and behavioural problems, including Attention Deficit Hyperactivity Disorder (ADHD). In addition to the above, no Critical Illness Benefit will be payable for any of the following: Date of diagnosis within 90 days from date of commencement or reinstatement of cover Critical Illness Benefit, where death occurs within 30 days of the date of diagnosis Policy in the lapsed condition as on the date of diagnosis Any more than one claim in respect of Critical Illness Benefit Non-fulfilment of eligibility criteria for Critical Illness Benefit covered under the policy
Unless expressly stated to the contrary in this Policy, HDFC Life will not make any payment for any claim in respect of any Life Assured if it is directly or indirectly caused by, arises from or is in any way attributable to any of the following: Treatment for congenital disease or deformity, including physical defects present from birth will not be covered by the policy. Hospitalization and/or surgery is/are not in accordance with the diagnosis and treatment of the condition for which the hospital confinement or surgery was required; Any condition with respect to the covered benefits, for which the insured had signs or symptoms, and/or was diagnosed, and/or received medical advice/treatment within the waiting period. Elective surgery or treatment which is not medically necessary; Weight reduction or weight improvement regardless of whether the same is caused (directly or indirectly) by a medical condition; Study and treatment of sleep apnoea; Routine eye tests, any dental treatment or surgery of cosmetic nature, extraction of impacted tooth/teeth, orthodontics or orthognathic surgery, or tempero-mandibular joint disorder except as necessitated by an accidental injury and warranting hospitalization Outpatient treatment Hospitalization and/or surgery relating to infertility or impotency, sex change or any treatment related to it, abortion, sterilization and contraception including any complications relating thereto; Hospitalization and/or surgery for treatment arising from pregnancy and it’s complications which shall include childbirth or miscarriage; Hospitalisation primarily for any purpose which in routine could have been carried out on an out-patient basis and which is not followed by an active treatment or intervention during the period of hospitalization. Experimental or unproven procedures or treatments, devices or pharmacological regimens of any description (not recognized by Indian Medical Council) or hospitalization for treatment under any system other than allopathy; Any mental or psychiatric condition including but not limited to insanity, mental or nervous breakdown / disorder, depression, dementia, or psychosomatic disorders. Alzheimer’s disease will also be excluded from all the covered benefits except Critical Illness. Convalescence, rest cure, sanatorium treatment, rehabilitation measures, respite care, long term nursing care or custodial care and general debility or exhaustion (run down condition) Directly or indirectly arising from alcohol, drug or unless taken in accordance to the dosage and duration as prescribed by the independent medical practitioner substance abuse and any illness or accidental physical injury which may be suffered after consumption of intoxicating substances, liquors or drugs; Directly or indirectly arising from or consequent upon war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, terrorism, rebellion, active participation in strikes, riots or civil commotion, revolution, insurrection or military or usurped power and Sexually transmitted diseases or any treatment in the presence of HIV infection Acquired Cosmetic or plastic surgery except to the extent that such surgery is necessary for the repair of damage caused solely by accidental injuries, cancer or burns. Treatment of xanthelesema, , acne and alopecia; circumcision unless necessary for treatment of a disease or necessitated due to an accident Nuclear disaster, radioactive contamination and/or release of nuclear or atomic energy; Injury or illness caused by intentionally self-inflicted injuries; or any attempts of suicide while sane or insane; or deliberate exposure to exceptional danger (except in an attempt to save human life); Injury or illness caused by violation or attempted violation of the law, or resistance to arrest; or by active participation in an act with criminal intent. Injury or illness caused by professional sports, racing of any kind, scuba diving, aerial sports, activities such as hand-gliding, ballooning, and any other hazardous activities or sports unless agreed by special endorsement; Hospitalization where the Life Assured is a donor for any organ transplant; Any injury, sickness or disease received as a result of aviation, gliding or any form of aerial flight other than on a scheduled commercial airline as a bona fide passenger (whether fare paying or not), pilot or crew member Treatment to relieve symptoms caused by ageing, puberty, or other natural physiological cause, such as menopause and hearing loss caused by maturing or ageing. Artificial life maintenance, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health. Treatment of abnormalities, deformities, or Illnesses present only because they have been passed down through the generations of the family. Treatment for, or related to developmental problems, including Learning difficulties, such as dyslexia and behavioural problems, including Attention Deficit Hyperactivity Disorder (ADHD). In addition to the above, no Critical Illness Benefit will be payable for any of the following: Date of diagnosis within 90 days from date of commencement or reinstatement of cover Critical Illness Benefit, where death occurs within 30 days of the date of diagnosis Policy in the lapsed condition as on the date of diagnosis Any more than one claim in respect of Critical Illness Benefit Non-fulfilment of eligibility criteria for Critical Illness Benefit covered under the policy