Basic Treatment
Rs. 200,000
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All the secondary health care services normally provided at secondary level private and public sector hospitals including DHQ and THQ hospitals
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The services may include but not limited to:
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Accidents and emergencies
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General Medicine
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General Surgery
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Orthopedics
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Gynae and Obstetrics
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Pediatrics
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Ophthalmology and
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ENT
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Advanced Treatment
Rs. 400,000
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Accident and Emergency (All the medical/surgical emergency care which can’t be provided in secondary care hospitals)
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Cardiovascular problems
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Complications of Diabetes
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Management of all type of Cancers
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Management of Genito-urinary diseases including Dialysis and Transplant
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Management of Neurosurgical diseases
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Complications of secondary care diseases/procedures needing referral to tertiary care hospitals
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Artificial limbs (Prosthetics)
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Breast Cancer Screening
Additional Coverage
Rs. 400,000
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Cancer treatment (Chemo, Radio, Surgery)
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Kidney transplant
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Accident & emergency
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ICU care
Exclusion List
The following treatment, items, conditions, activities and their related or consequential expenses are not included in Sehat Card Plus program.
- Costs resulting from self-inflicted injury, attempted suicide, abuse of alcohol, drug addiction or sexual disorders and treatment of sexually transmitted diseases.
- Psychotic mental or nervous disorders (including any neuroses and their physiological manifestation) or sensual reassignment (whether or not of psychological reasons).
- Treatment or investigation of fertility, infertility, sterilization or contraception and any complication relating thereto or hormone treatment and investigations.
- Participation in or training for any dangerous or hazardous sport, pastime or competi0on or any professional sport.
- Injuries as a result of an illegal act by the person
- Injury or treatment is resulting from war, riots, invasion, the act of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, mutiny, civil commotion assuming the proportions of or amounting to a popular uprising, military uprising, insurrection, rebellion, military or usurped power or any act of any person acting on or on behalf of or in connection with any Organization actively directed towards the overthrow or to the influencing of any Health Department or ruling body by force, terrorism or violence.
- Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste, from the process of nuclear fission or from any nuclear weapons material.
- Services or treatment in any spa, hydro clinic, sanatorium, nursing home or long term-care facility that is not a hospital.
- Experimental or unproven treatment.
- Cosmetic procedure, Cosmetic plastic surgeries and hair transplants and dental procedure including examination, D rays, Extractions, filling, general dental care/treatment orthodontic treatment or oral surgery except as a result of emergency due to accident.
- Cost of correction of refractive errors of the eye and procedures such as Radial Keratotomy and Excimer Laser.
- Routine medical examinations or check-ups including charges arising out of any hospital confinement or admission primarily for diagnostic purposes (except Breast Cancer Screening), routine eye or ear examinations, vaccinations, medical certificate, examination for employment or travel, spectacles, contact lenses, hearing rids and any treatment that is not considered medically necessary.
- Cosmetic or plastic surgery, unless it is reconstructive surgery necessitated by an injury that occurred during the period whilst the insured person was covered under this Agreement and subject to the limits and sub-limits stated in the Benefits package.
- Any charges in respect of the donor for organ transplant claims (excluding kidney transplant of the already eligible/matched donor).
- Treatment received in a location other than the empanel health care facilities.
- Any Outpatient Treatment
- Corrective devices and medical appliances which are not surgically required.
- Unjustified hospital admission.
- Screening, grouping and cross-matching of blood donor.
- Personal comfort items such as charges for telephone, convenience items, meals or other items not medically necessary.
- Natural Catastrophes or epidemics/pandemics including but not limited to flood, earthquake, avalanche and cyclone etc.
- All dental treatment or oral surgery except trauma.