Standard exclusion — Excl06

Obesity/ Weight Control

These are IRDAI's codes and IRDAI's words, not ours.

Official wording — reproduced verbatim

What the standard text says

Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:

1) Surgery to be conducted is upon the advice of the Doctor

2) The surgery/Procedure conducted should be supported by clinical protocols

3) The member has to be 18 years of age or older and

4) Body Mass Index (BMI);

a) greater than or equal to 40 or

b) greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss:

i. Obesity-related cardiomyopathy

ii. Coronary heart disease

iii. Severe Sleep Apnea

iv. Uncontrolled Type2 Diabetes

Source: IRDAI, Guidelines on Standardization of Exclusions in Health Insurance Contracts, page 7. Open the official PDF ↗

In plain English — our reading

What that means on the page

Surgery for obesity is excluded unless every stated condition is met: medical advice, clinical-protocol support, the minimum age, and one of the specified BMI and health-condition tests.

This explains the standard wording. Your policy schedule, endorsements and other clauses may change how the document applies to you.