INCLUSIONS and EXCLUSIONS for CHAP – XX
INCLUSIONS
- Daily Room & Board Accommodation in a Standard Private Room
- Indicated use of ICU, CCU and special unit cases
- Surgeon’s fee including pre-surgical assessment and normal post-surgical care
- Anesthesiologist’s Fee, services and medications for general/spinal anesthesia or other form of anesthesia deemed necessary of surgical procedure
- Hospital Facilities and Services including operating theater and recovery room fees; Oxygen and its administration; X-ray and required diagnostic laboratory examinations; surgical appliances; medicines and drugs prescribed and billed by the hospital during confinement; blood and blood plasma; blood transfusions and intravenous fluids; prosthetic devices; dressings, plaster casts, sutures and other miscellaneous supplies directly related to the medical management of the patient.
- Professional fees including specialist’s fee for physician (non-surgical visits) like pathologist, radiologist, therapist, etc.
EXCLUSIONS
The following conditions and all expenses related to it are NOT covered:
- Routine medical check up or executive check up.
- Miscellaneous charges not related to the medical management of the patient (i.e. add-on power/electric charges, etc.)
- Pregnancy screening and other expenses related to childbirth, surgical delivery, miscarriage, abortion including their complications, prenatal, postnatal case as well as nursing care for the newborn.
- Herbal medicines, non-therapeutic supplements, vitamins, and other medicines not related hospitalization confinements.
- Psychotic, mental or nervous/anxiety disorders including any neuroses and their physiological or psychosomatic manifestations;
- Injury or illness arising directly or indirectly out of consumption of alcohol, misuse or irrational use of drugs, solvent or any addicting and habit forming drug which causes complications that will require treatment or medical intervention.
- Loss or damage directly occasioned by, happening through or in consequences of war or any act of war, invasion, act of foreign enemy, mutiny, civil commotion assuming the proportions or amounting to a popular rising, riot, strike, lock-out, military rising, insurrection, rebellion, revolution, military or usurped power, martial law or loot, sack or pillage in connection therewith, confiscation or nationalization or requisition or destruction of or damage to property by or under the order of any government or public or local authority or any act or condition incident to any of the above or influencing of any de jure or de facto government by terrorism or any violent means;
- Treatments or services due to suicide, attempted suicide, intentionally self-inflicted injury;
- Injury or illness arising directly or indirectly out of any participation in an illegal and unlawful activity;
- Assault or fighting provoked by the insured, and illegal activity or deliberate exposure to exceptional danger except in an effort to save human life;
- Participating in (but not limited to) the following activities including the practice and actual competition: racing of any kind, professional sports, contact sports, motorcycling, dressage, skydiving, parasailing, hang gliding, flying, caving, rock or mountain climbing, recreational or sport diving, etc. and drowning
- Screening and treatment for Sexually Transmitted Diseases, AIDS, ARC (AIDS Related Complex), and all complications arising therefrom;
- Expenses for chronic dermatologic condition, treatment, management and sequelae;
- Screening and treatment for error of refraction, laser or eye surgery to correct refractive error;
- Cosmetic surgery or any cosmetic related complications, eye glasses/contact lenses, hearing aids and prescriptions thereof except as may be required for re-constructive
- Professional fees of medico-legal officer.
