IOB Health Care Plus Policy

We, at USGI always endeavor to bring the best of Insurance products and services to our esteemed customers. In order to cater to the needs of the customers of Indian Overseas Bank, we have designed the IOB Health Care Plus Policy in association with Indian Overseas Bank.

The IOB Health Care Plus Policy is a complete health Insurance Plan that covers you, your spouse and two dependent children and dependent parents, under this unique family floater gives you the flexibility of taking one policy that covers the entire family under a single sum insured.

1. Who can take the Policy?
The scheme provides for Mediclaim Insurance cover, which is available to all the customers of IOB maintaining a S.B. or C.D account with them including NRI customers. However, the cover is available for treatment in hospitals in India only.

2. Eligibility
All account holders of Indian Overseas Bank within the age band of 18 to 65 years are eligible to take the Policy.

The enrollment age under the policy is from 1 day to 65 years.

The minimum age for the proposer should be 18 years.

An individual may cover himself/ herself and his/ her spouse, dependent children under Plan A of the Policy and himself/herself, his/her spouse, dependent children and dependent parents under Plan B of the policy.

The maximum age under till which dependent male child can be covered is 21 years of age and dependent female child can be covered is 25 years or till she marries, whichever is earlier. Dependent children below 3 months can be covered with at least one parent under the Policy.

3. Sum Insured:

Hospitalization cover:
Choice of Sum Insured ranges from Rs 50,000 to Rs 5,00,000 in multiples of Rs 50,000 . High range sum insured is available under the policy is 7,50,000 , 10,00,000 , 12,50,000 & 15,00,000.

Optional Extension:
Capital Sum Insured for Optional Extension of Personal Accident (Accidental Death only) ranges from Rs 50,000/- to Rs 500,000 in multiples of 50,000. High range sum insured is available under the policy is 7,50,000 , 10,00,000 , 12,50,000 & 15,00,000.

4. Policy Tenure:
Long Term Policy: The Policy term from one year to three years is available under individual policies. The policy can be renewed lifetime

5. What is covered under the Policy?
The Hospitalization expenses of the insured when Insured sustains any injury or contracts any disease and is advised hospitalization by a Medical Practitioner We will pay Reasonable and Customary charges of the following Hospitalization expenses:

1. The Medical Expenses incurred on Room, Boarding and Nursing Expense as provided in the Hospital/ Nursing Home

2. The Medical Expenses incurred on Medical Practitioner/ Anesthetist, Consultant fees,Surgeons fees and similar expenses

3. The Medical Expenses incurred on Anesthesia, Blood, Oxygen, Operation Theatre, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs, Cost of Organs and similar expenses.

4. The medical expenses on treatment arising from or traceable to pregnancy, childbirth and expenses on the treatment of the newly born child up to 5% of the sum insured, subject to such treatment not being carried out before the completion of 9 months from the commencement of the policy

5. The Medical Expenses incurred in the 30 days immediately prior before the date You were Hospitalized, provided that any Nursing expenses during Pre Hospitalization will be considered only if Qualified Nurse is employed on the advice of the attending Medical Practitioner for the duration specified

6. The Medical Expenses incurred in the 60 days immediately after Your date of discharge from Hospital provided that any Nursing expenses during Pre Hospitalization will be considered only if Qualified Nurse is employed on the advice of the attending Medical Practitioner for the duration specified

7. Cost of Health Checkup: Insured Person shall be entitled for reimbursement of cost of medical checkup once at the end of a block of every three claim free Policies. The reimbursement shall not exceed the amount equal to 1% of the average Basic Sum Insured during the block of four claim free Policies.

Additional benefits

8. In case of hospitalization of children below 12 years, a lump sum amount of Rs.1000/- as Out of Expenses to any of the parents during the policy period.

9. Ambulance charges in connection with any admissible claim limited to Rupees 1000/- per policy period.

10. In case of death in hospital, funeral expenses are reimbursed up to Rs.1000/ over and above the sum insured subject to the original illness/accident claim admitted under the policy.

NB:
Expenses on Vitamins and Tonics only if forming part of treatment as certified by the attending Medical Practitioner.

a) The Hospitalization expenses incurred for treatment of any one illness under agreed package charges of the Hospital/Nursing Home will be restricted to 75% of the Sum Insured.

b) Cashless facility for the medical treatment carried out in Network Hospital/ Nursing home is available through our nominated Third Party Administrator (TPA)

c) A co-payment of 20% shall be applicable on each and every claim of Insured Person who is above 55 years of age under the Policy

d) If medical expenses are incurred under two Policy Periods, the total liability shall not exceed the Sum Insured of the Policy during which the Insured Person's medical treatment commenced and the entire claim will be considered under that Policy only

e) Expenses on hospitalization for a minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatments, i.e. Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Lithotripsy (Kidney stone removal), D&C, Tonsillectomy taken in the Hospital / Nursing Home and where in the insured is discharged on the same day, such treatment will be considered to have been taken under hospitalization benefit. This condition will also not apply in case of stay in Hospital for less than 24 hours provided (a) the treatment is such that it necessitates hospitalization and the procedure involves specialized infrastructural facilities available in hospitals (b) due to technological advances hospitalization is required for less than 24 hours only.

Extensions under the Policy

Personal Accident Death cover
In case you have opted for additional cover against Personal Accident- Death only benefit and have paid additional premium, We will pay a lump sum amount as mentioned in the table below in the event of Accidental Death of the Insured whose name is appearing in the Schedule forming part of this Policy.



Discount, Loading and Co-pay (if any)

Co-payment: 20% co-pay shall be applicable on each and every claim of Insured above 55 years of age

Long Term Policy: The Policy can be taken for a period of two/ three years and discount as under would be provided



6. Pre Policy Medical Checkup:

The Company would require submission of Medical Reports for ECG and Blood Sugar (Fasting+ PP) when the Insured Person is above 50 years.

This requirement will only be for fresh Proposals with sum insured options INR 7,50,000 and above and, when the Sum Insured is enhanced for INR 7,50,000 and above at the time of renewal.

50% of such medical examination costs shall be reimbursed by us, if the proposal is accepted.

7. Additional Benefits under the Policy

i. Tax benefit: Only the Medical Premium Component (excluding Service Tax thereon) is eligible for rebate under Section 80D of the Income Tax Act.

ii. Portability:
The Insured Person will have the option to port the Policy to other insurers as per extant Guidelines related to portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance plan with an Indian General/Health insurer as per Guidelines on portability, the proposed Insured Person will get all the accrued continuity benefits in waiting periods as under:

i The waiting periods specified in Section 6 shall be reduced by the number of continuous preceding years of coverage of the Insured Person under the previous health insurance Policy.

ii Portability benefit will be offered to the extent of sum of previous sum insured and accrued bonus (as part of the base sum insured), portability benefit shall not apply to any other additional increased Sum Insured.


iii. Free Look Period: (Not applicable on renewals)

The Free Look Period shall be applicable at the inception of the Policy and not on renewals or at the time of porting the policy.

The insured shall be allowed a period of fifteen days from date of receipt of the Policy to review the terms and conditions of the Policy, and to return the same if not acceptable.

If the insured has not made any claim during the Free Look Period, the insured shall be entitled to

i a refund of the premium paid less any expenses incurred by the Company on medical examination of the insured person and the stamp duty charges; or

ii where the risk has already commenced and the option of return of the Policy is exercised by the insured, a deduction towards the proportionate risk premium for period of cover or

iii Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage during such period;

10. What is not covered under the Policy? (Major Exclusions under the Policy)

A. Investigation & Evaluation

B. Rest Cure, Rehabilitation and Respite Care

C. Obesity/ Weight Control

D. Change-of-Gender Treatments

E. Cosmetic or plastic Surgery

F. Hazardous or Adventure sports

G. Breach of law

H. Excluded Providers

I. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.

J. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.

K. Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure

L. Refractive Error

M. Unproven Treatments

N. Sterility and Infertility

O. Maternity Expenses