√ indicates services which are covered
x indicates services not covered under the specific plan

C.     EXCLUSIONS:

The following are excluded from all HyBasic Travel Plan: –
1. Other advanced and complex investigation not listed in the covered services
2. Elective, Intermediate, Major & Complex Major Surgeries and Procedures including but not limited
to Breast Surgery, Endocrine Surgery, Oesophageal Surgery, Abdominal Surgery, Anorectal Surgery,
Liver Surgery, Abdominal Wall Surgery, Gynaecology Surgery, Orthopaedic Surgery, Urology,
Thoracic surgery, Neurosurgery, e.t.c.
3. Ante-Natal Care & Delivery services including but not limited to Antenatal examinations and supply
of drugs, Management of complications in pregnancy, Delivery room services, Management of
Labour, Normal & assisted delivery, Caesarean section delivery, Shirodkar operation, Post-natal
Check.
4. Non-Emergency Chronic Disease Management.
5. Congenital abnormalities
6. Consultations with unrecognized consultants, hospitals, family doctors, therapists, dental
practitioners or complementary medicines practitioners
7. Dental care not listed in the covered services
8. Family Planning Services
9. Dental Care Services
10. Ophthalmic Care Services
11. Renal Dialysis
12. Health screening/Well Person’s check
13. Herbal drugs, non-prescription drugs, food supplements and experimental drugs and treatment
14. HIV/AIDS Care & Treatment
15. Home care and domiciliary services
16. Intensive care treatment
17. Interstate travel for services not available in State
18. Investigations and treatment for problems relating to infertility e.g hormone profiles, laparoscopy,
hydrotubation, hysterosalpingogram, I.V.F, G.I.F.T and artificial insemination
19. Joint replacements and prosthetic limbs
20. Learning difficulties, behavioral and developmental problems
21. All Covid-19 testing and treatment
22. Psychiatric illness /Treatment
23. Neonatal Services including but not limited to male circumcision, ear piercing, treatment of mild
or moderate neonatal sepsis, phototherapy.
24. Neonatal intensive care (incubator care) or special care baby unit services
25. Routine and Additional immunizations
26. Other optical services not listed in covered services
27. Overseas treatment and transplant surgery
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28. Plastic/cosmetic surgeries
29. Room upgrades beyond that specified in the plan benefits
30. Self-inflicted injuries
31. Speech disorders
32. Treatment of obesity
33. Virility enhancing drugs
34. Mortuary Services (Cleaning, Embalmment, Storage, Autopsy)
35. Any other treatment, service, procedure or investigation not listed in the schedule of covered
medical services

D. NOTE

1. Maximum Beneficiary age limit is 60 years
2. Plan is valid for 30 days only and subject to 1 week waiting period. The plan will become active one
week after the date of activation, and expires automatically 30 Days after activation.
3. All benefits are subject to their respective sectional limits which is described as: Inpatient Limit,
Outpatient Limit and Pharmacy Benefit Limit. However, within the respective sectional limit, there
are specific benefit limits as well. Consequently, in the event that any specific benefit limit under the
sectional limit is exhausted, the remaining limit in that section will only cover other benefits within
the section apart from the one that the specific benefit limit has been exhausted.