Room rent is capped at 1% of the sum insured per day, while intensive care is limited to 2% per day. Where the Insured opts for accommodation above the eligible category, all associated charges are proportionately deducted from the admissible claim in the ratio of the eligible rent to the rent actually charged.

This deduction is applied across the entire hospital bill (surgeon, anaesthetist, operation theatre, investigation, diagnostics, pharmacy and in-room consumables), not to the room tariff alone. Eligibility is assessed at admission and reapplied to each day of the stay, and no waiver is granted even where the higher category was the only room available.

Single private and air-conditioned rooms billed above the eligible tariff attract the same scaling, and the eligible slab is fixed to the sum insured in force on the date of claim. The proportionate deduction is computed before any cumulative bonus or restored sum is applied to the claim.

Any resulting shortfall is borne by the Insured, over and above every other sub-limit, co-payment and deductible recorded in the schedule. These provisions apply to cashless and reimbursement claims alike, cannot be waived by verbal assurance, and may be revised at each renewal of the policy.

A co-payment of 20% shall be borne by the Insured on each and every admissible claim, irrespective of the cause of hospitalisation. The Company's liability is limited to the balance amount remaining after the co-payment has been deducted from the admissible sum.

The co-payment is calculated on the admissible amount after all sub-limits and deductibles have been applied, and before any cumulative bonus or restored sum is taken into account. It applies to cashless and reimbursement claims alike, with no annual cap on the amount the Insured contributes.

The percentage is fixed for the policy term and stated on the schedule. A voluntary co-payment opted for a lower premium is applied in addition to any mandatory co-payment, and the two are charged together on every claim during the year.

A zone-based co-payment may also apply where treatment is taken outside the Insured's declared home city or zone. None of these contributions can be set aside by prior assurance, and the applicable percentages may be revised at each renewal. The co-payment due is shown as a distinct line in every claim settlement statement, and is recovered from the Insured before the balance is released to the hospital under a cashless claim or to the policyholder under reimbursement.

Cataract surgery is limited per eye for each policy year, and joint replacement is capped per joint irrespective of the sum insured. Specified procedures carry their own monetary ceilings, and where several sub-limits apply to one admission they stack, with any amount in excess of the cap left unreimbursed.

Caps apply per procedure and per policy year, whichever exhausts first, and bilateral procedures are treated as two separate capped events. Hernia, piles and similar listed procedures carry their own ceilings, and day-care procedures are subject to the same disease-wise limits.

Each sub-limit is applied before the deductible and the co-payment are calculated, so the Insured may bear a far larger share of the bill than the headline sum insured would suggest. The ceilings are stated in absolute terms and are not indexed to medical inflation.

The schedule of capped procedures may be updated at each renewal, and a procedure not separately listed is still subject to any overarching limit. Amounts above the applicable cap are borne in full by the Insured, in addition to every other restriction in the policy. Caps are assessed against billed amounts rather than negotiated package rates, and a second opinion obtained at the Insured's own cost does not lift any applicable ceiling.

Specified conditions carry a 24-month waiting period from the date of policy inception, and any claim arising before that period has been served is not payable. Pre-existing diseases follow a longer waiting period as set out in the schedule.

An initial 30-day waiting period applies to all illnesses other than those arising from accidents. Specific surgeries and listed treatments carry their own waiting periods, ranging from twenty-four to forty-eight months as individually listed in the policy document.

Maternity and certain named benefits carry separate waiting periods that run independently of the others. Waiting periods restart in full if the cover lapses beyond the grace period, and only continuous renewal preserves the time already served.

Where the policy is ported from another insurer, portability credits may reduce but do not necessarily waive the waiting periods still to be served. The applicable periods are those in force on the date the condition is first diagnosed or treated. A fresh proposal underwritten after a break in cover is treated as a new policy, so every initial and condition-specific waiting period begins again from the new commencement date, regardless of the years previously held; accident cover alone is available from the first day.

Robotic and other advanced procedures are reimbursed only up to a stated percentage of the sum insured, or a fixed amount, whichever is lower. These caps apply even where the treatment is medically advised and necessary, and the balance is borne in full by the Insured.

The sub-limit is shared across all modern treatment methods taken in a policy year, and is applied per hospitalisation and per year combined. Listed methods include oral chemotherapy, deep-brain stimulation and similar advanced technologies named in the schedule.

Stem-cell therapy and immunotherapy are payable only where they are expressly listed, and any treatment outside the named list is treated as excluded. Experimental and unproven treatments are excluded in full, regardless of medical opinion or outcome.

The applicable percentage and monetary cap are stated in the schedule and may be revised at each renewal. Any expense above the cap does not count towards the deductible and cannot be recovered under any other section of the policy. Where a procedure could be performed by a conventional or a modern method, reimbursement is assessed against the conventional cost unless the modern method is the only clinically viable option named in the policy, and the cap is not enhanced by any bonus.

Gloves, syringes, personal protective equipment and similar consumables, together with administrative and documentation charges, are excluded from the admissible claim. Such items are not reimbursable under any circumstances and are borne entirely by the Insured.

Registration, admission and discharge charges are treated as non-payable, as are attendant, telephone and food charges raised for the patient's visitors. Items billed without a supporting prescription are not considered for reimbursement at all.

The exclusion list is revised from time to time at the Company's discretion, and any item later added to it ceases to be payable from the date of revision. Disputed items are settled against the published non-payable schedule in force on the date of claim.

These deductions are made over and above every other limit, sub-limit and co-payment in the policy, and the non-payable list follows a published standard schedule where applicable. The Insured is advised to verify each charge against the schedule before settlement. Where an item appears on both the payable and non-payable lists the more specific entry prevails, and any tax or levy charged on a non-payable item is itself treated as non-payable and borne by the Insured.