Tender Notice Dt - Department of Health , J&K
Tender Notice Dt - Department of Health , J&K Tender Notice Dt - Department of Health , J&K
Annexure-8Exclusions to the RSBY PolicyEXCLUSIONS: (IPD & DAY CARE PROCEDURES)The Company shall not be liable to make any payment under this policyin respect of any expenses whatsoever incurred by any Insured Personin connection with or in respect of:1) Conditions that do not require hospitalization: Condition that do notrequire hospitalization and can be treated under Out Patient Care. Outpatient Diagnostic, Medical and Surgical procedures or treatments unlessnecessary for treatment of a disease covered under day care procedureswill not be covered.Further expenses incurred at Hospital or Nursing Home primarily forevaluation / diagnostic purposes only during the hospitalized period andexpenses on vitamins and tonics etc unless forming part of treatment forinjury or disease as certified by the attending physician.Any dental treatment or surgery which is corrective, cosmetic or ofaesthetic procedure, filling of cavity, root canal including wear and tearetc. unless arising from disease or injury and which requireshospitalisation for treatment.2) Congenital external diseases: Congenital external diseases or defects oranomalies, Convalescence, general debility, “run down” condition or restcure.3) Drug and Alcohol Induced illness: Diseases / accident due to and oruse, misuse or abuse of drugs / alcohol or use of intoxicating substancesor such abuse or addiction etc.4) Sterilization and Fertility related procedures: Sterility, any fertility,sub-fertility or assisted conception procedure. Hormone replacementtherapy, Sex change or treatment which results from or is in any wayrelated to sex change.5) Vaccination: Vaccination, inoculation or change of life or cosmetic or ofaesthetic treatment of any description, plastic surgery other than as maybe necessitated due to an accident or as a part of any illness.Circumcision (unless necessary for treatment of a disease not excludedhereunder or as may be necessitated due to any accident),6) War, Nuclear invasion: Injury or disease directly or indirectly caused byor arising from or attributable to War, Invasion, Act of Foreign Enemy,61
War like operations (whether war be declared or not) or by nuclearweapons / materials.7) Suicide: Intentional self-injury/suicide, all psychiatric and psychosomaticand related disorders8) Naturopathy, Homeopathy, Unani, Siddha, Ayurveda: Naturopathy,Homeopathy, Unani, Siddha, Ayurveda treatment, unproven procedure ortreatment, experimental or alternative medicine including acupressure,acupuncture, magnetic and such other therapies etc. Any treatmentreceived in convalescent home, convalescent hospital, health hydro,nature care clinic or similar establishments.EXCLUSIONS UNDER MATERNITY BENEFIT CLAUSE:The Company shall not be liable to make any payment under this policyin respect of any expenses whatsoever incurred by any Insured Personin connection with or in respect of:a. Expenses incurred in connection with voluntary medical termination ofpregnancy are not covered except induced by accident or other medicalemergency to save the life of mother.b. Normal hospitalisation period is less than 48 hours from the time ofdelivery/ operations associated therewith for this benefit.c. Pre-natal expenses under this benefit; however treatment in respect ofany complications requiring hospitalisation prior to delivery can betaken care under medical procedures.62
- Page 11 and 12: iii) Those facilities undertaking s
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- Page 15 and 16: Insurance Act 1938.2. Premium payme
- Page 17 and 18: (d)(e)(f)pre-defined fee.An enrollm
- Page 19 and 20: ) Beneficiary has balance in his/ h
- Page 21 and 22: intermediary institutions for the p
- Page 23 and 24: to as the “Call Centre Service”
- Page 25 and 26: The parties shall refer such disput
- Page 27 and 28: for the insurer to download.ii. Dis
- Page 29 and 30: esponsibility of the Insurer to ens
- Page 31 and 32: 36. Notification of Award And Signi
- Page 33 and 34: details of the scheme as mentioned
- Page 35 and 36: SECTION B - FINANCIAL PROPOSAL(KIND
- Page 37 and 38: SECTION D -DECLARATION BY THE BIDDE
- Page 39 and 40: Annexure - 3UNDERTAKING BY THE BIDD
- Page 41 and 42: Annexure 5Format for Providing Addi
- Page 43 and 44: O.T. Charges, Medicines and Drugs,
- Page 45 and 46: 34 FP00300010 J32 Ethmoidectomy - E
- Page 47 and 48: 123 FP00500048 Q43 Duplication of I
- Page 49 and 50: 212 FP00500137 K51 Ileostomy 7 17,5
- Page 51 and 52: 301 FP00600020 D27 Ovarectomy/Oophr
- Page 53 and 54: 390 FP00900048 K25 Vagotomy with Py
- Page 55 and 56: 477 FP01100044Closed Reduction and
- Page 57 and 58: 12 PAEDIATRIC565 FP01200001 Q79 Abd
- Page 59 and 60: 653 FP01400045 N28 Repair of Ureter
- Page 61: 743 FP01800016 B53744 FP01800017 B5
- Page 65 and 66: Draft MoU Between Insurance Company
- Page 67 and 68: 4. Insurer has on the basis of desi
- Page 69 and 70: 5. The Hospital shall ensure that m
- Page 71 and 72: 2.5 Within a period of 12 hours fro
- Page 73 and 74: 2. The hospital undertakes to uphol
- Page 75 and 76: All official correspondence, report
- Page 77 and 78: 3. Notwithstanding anything to the
- Page 79 and 80: each of the terms of this Agreement
- Page 81 and 82: Annexure IHospital Services- Admiss
- Page 83 and 84: Case 3: In case of in-sufficient fu
- Page 85 and 86: Qualifying Criteria for Smart Card
- Page 87 and 88: Annexure 14List of Public Hospitals
- Page 89 and 90: 2. Smart card:2.1. OverviewA smart
- Page 91 and 92: esponsible for each of these to the
- Page 93 and 94: • Licensed system software• Cer
- Page 95 and 96: chip personalization. It is mandato
- Page 97 and 98: Annexure 17Guidelines for the RSBY
- Page 99 and 100: 1.3.1. Re-issuance of a card: This
- Page 101 and 102: 2. District Server1.3.4.4.1. The ca
Annexure-8Exclusions to the RSBY PolicyEXCLUSIONS: (IPD & DAY CARE PROCEDURES)The Company shall not be liable to make any payment under this policyin respect <strong>of</strong> any expenses whatsoever incurred by any Insured Personin connection with or in respect <strong>of</strong>:1) Conditions that do not require hospitalization: Condition that do notrequire hospitalization and can be treated under Out Patient Care. Outpatient Diagnostic, Medical and Surgical procedures or treatments unlessnecessary for treatment <strong>of</strong> a disease covered under day care procedureswill not be covered.Further expenses incurred at Hospital or Nursing Home primarily forevaluation / diagnostic purposes only during the hospitalized period andexpenses on vitamins and tonics etc unless forming part <strong>of</strong> treatment forinjury or disease as certified by the attending physician.Any dental treatment or surgery which is corrective, cosmetic or <strong>of</strong>aesthetic procedure, filling <strong>of</strong> cavity, root canal including wear and tearetc. unless arising from disease or injury and which requireshospitalisation for treatment.2) Congenital external diseases: Congenital external diseases or defects oranomalies, Convalescence, general debility, “run down” condition or restcure.3) Drug and Alcohol Induced illness: Diseases / accident due to and oruse, misuse or abuse <strong>of</strong> drugs / alcohol or use <strong>of</strong> intoxicating substancesor such abuse or addiction etc.4) Sterilization and Fertility related procedures: Sterility, any fertility,sub-fertility or assisted conception procedure. Hormone replacementtherapy, Sex change or treatment which results from or is in any wayrelated to sex change.5) Vaccination: Vaccination, inoculation or change <strong>of</strong> life or cosmetic or <strong>of</strong>aesthetic treatment <strong>of</strong> any description, plastic surgery other than as maybe necessitated due to an accident or as a part <strong>of</strong> any illness.Circumcision (unless necessary for treatment <strong>of</strong> a disease not excludedhereunder or as may be necessitated due to any accident),6) War, Nuclear invasion: Injury or disease directly or indirectly caused byor arising from or attributable to War, Invasion, Act <strong>of</strong> Foreign Enemy,61
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