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The Policy can be taken by an individual for covering himself / herself and his/ her family i.e. spouse, dependent children up to 25 years of age and dependent parents.
WHO CAN TAKE THE POLICY?
The Policy can be taken by an individual for covering himself / herself and his/ her family i.e. spouse, dependent children up to 25 years of age and dependent parents.
Eligibility
Entry age for you (the proposer) is 18 years and you can opt for this policy up to the age of 70years.
Policy renewals will be for your lifetime.
Entry age for dependent children is 6 months.
No pre-acceptance medical tests up to 55 years of age, however, if you are above 55 years, then, you may require undergoing medical tests at our listed diagnostic centers, 50% cost of which will be borne by us in case of accepted proposals.
Pre-Medical Tests: Fasting Sugar Blood, BP report and ECG may be required to be submitted to us on request. Validity period of theses test 15 days or less immediately prior to the acceptance your health proposal under this policy. Any tests carried out older than 15 days prior to acceptance of this proposal would not be considered for acceptance and fresh test of the current date i.e. the date of proposal would be taken into consideration.
After the medical examination, the coverage under the product would not be refused/ declined but would be amended to exclude the coverage permanently for the ailments/ diseases & its related complications substantiated in pre-policy medical examination. These facts would be disclosed to the customers clearly and the acceptance in writing from the insured would be sought before issuing the policy and in case customer does not accept the condition for permanently excluding the coverage for the related disease, then the company would have an option for denying the coverage. USGI also confirm that no loading and discount in the premium would be extended for these cases falling in the above category.
What is covered under the Policy?
The Policy comprises of three sections
Section 1: Hospital Confinement Benefit A Daily Allowance as under would be payable upon normal hospitalization other than an admission in ICU for a maximum number of days as opted by you when you opt for coverage under this Section. The choice would be given to you to opt for any of the following options and remittance of premium accordingly
Section 2: Intensive Care Benefit: The amount as chosen by you from the above options shall be doubled when you/ your family member during the course of their treatment is admitted in an ICU other than normal hospitalization. Further during the course of treatment, if the hospitalization is for ICU and then shifting to the normal ward then confining therein , then ICU period of stay and normal Hospital Confinement period stay will be counted separately and Benefit will be paid separately as per the eligible amount for these this according to the no of days stayed separately.
Section 3: Convalescence Benefit: A convalescence benefit of Rs 10,000 shall become payable under the policy if your or your covered family member's hospitalization exceeds 21 days and this benefit would not become payable if the Hospital Cash Period is opted for 30 days or more maximum up to 180 days
You can choose to cover Hospital Cash for a fixed no of 15, 30, 45, 60, 90 or 180 days as per your requirement. Other than the above mentioned prescribed no of days, the other combination of days cannot be chosen
Additional Benefits under the Policy
1. Long Term Policy Discount: The Policy can be taken for a period of one, two or three years and discount as under would be provided when the policy is bought from us for longer terms by paying premium in a single installment
Even If the policy is purchased for 2years/3 years at once by paying the premium in one instalment, the Benefits will be applicable only on annual basis of the policy.
2. Family discount: Get Family discount of 5% towards total the total premium of the policy
3. Group Discount: The purpose of including group in the filed product is to the extent of issuing policy document as group in view of our Bancassurance Business Model where the premium is being collected by our Corporate Agent (Bank Partner and its associates) from their customers and remitted to USGI as a one signal amount. In the captioned cases, the policy is issued master policy as Bank Partner Name A/C Various Customer Name, but each Individual & its family member's insured therein is treated as Individual in nature for which the product is filed and individual policy certificate is issued to each customer, hence, we have not made the provision of any Group Discount in the product filed. We further confirm that on individual basis if the family members are covered, we have extended the family member discount and the same would follow if the policy is issued as Group to Bank Partner and its associates
4. Portability If You were insured continuously and without a break under another Indian retail health insurance policy with Us or any other Indian General Insurance company, it is understood and agreed that:
If You wish to exercise the Portability Benefit, We should have received Your application with complete documentation at least 45 days before the expiry of Your present period of insurance;
This benefit is available only at the time of renewal of the existing health insurance policy.
The Portability Benefit shall be applied subject to the following:
Your proposal shall be subject to Our medical underwriting
Any modification or amendment in the terms and the applicability of the Portability Benefit in accordance with the provisions of the regulations and guidance issued by the Insurance Regulatory and Development Authority as amended from time to time, shall apply as on the date of proposal.
5. Free Look-up period The Policy shall have a free look period. The free look period shall be applicable at the inception of the policy and:
You will be allowed a period of at least 15 days from the date of receipt of the Policy to review the terms and conditions of the Policy and to return the same if not acceptable
If You have not made any claim during the free look period, You shall be entitled to
A refund of the premium paid less any expenses incurred by Us on Your medical examination and the stamp duty charges or;
Where the risk has already commenced and the option of return of the policy is exercised by You, a deduction towards the proportionate risk premium for period on cover or;
Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period.
What is not covered under the Policy?
We shall not be liable to make any payment for any claim directly or indirectly caused by, based on, arising out of or howsoever attributable to any of the following:
1. Pre-existing diseases will not be covered until 48 months of continuous coverage have elapsed, since inception of the first Policy with us; but:
1. If you are presently covered and have been continuously covered without any break under:
an individual health insurance plan with an Indian insurer for the reimbursement of medical costs for inpatient treatment in a Hospital, or any other similar health insurance plan from us, then, Pre-existing diseases exclusion of the Policy stands deleted and shall be replaced entirely with the following:
The waiting period for all Pre-existing diseases shall be reduced by the number of Your continuous preceding years of coverage under the previous health insurance policy; AND
If the proposed Sum Insured for you is more than the Sum Insured applicable under the previous health insurance policy (other than as a result of the application of Cumulative Bonus), then the reduced waiting period shall only apply to the extent of the Sum Insured under the previous health insurance policy.
2. Treatment of following diseases within the first one year from the commencement of the Policy, will not be payable:
Cataract
Benign Prostatic Hypertrophy
Myomectomy, Hysterectomy unless because of malignancy
Hernia, Hydrocele
Fistula in anus, Piles
Arthritis, gout, rheumatism
Joint replacements unless due to accident
Sinusitis and related disorders
Stones in the urinary and biliary systems
Dilatation and curettage
Skin and all internal tumors/cysts/nodules/polyps of any kind including breast lumps unless malignant/ adenoids and hemorrhoids
Dialysis required for chronic renal failure
Surgery on tonsils and sinuses
Gastric and Duodenal ulcers
However, the waiting period of 1 year will not apply if You were insured continuously and without interruption for at least 1 year under any other Indian insurer's similar health insurance policy from us or any of the Indian insurers.
You will be given the Portability credit of the waiting period based on the number of years of continuous and uninterrupted insurance cover
3. Any Sickness that has been classified as an Epidemic by the Central or State Government.
4. General debility, nervous or other breakdown, rest cure, congenital diseases or defect or anomaly, sterility, sterilization or infertility (diagnosis and treatment), any sanatoriums, spa or rest cures or long term care or hospitalization undertaken as a preventive or recuperative measure
5. Sickness requiring Hospitalization within the first 30 days from the commencement date of the Policy Period unless the Policy is renewed without interruption with the Company or the policy is a renewal of similar health insurance policy from any of the other Indian insurers and We have accepted your proposal with portability.
6. Any payment in case of more than one claim under the Policy during any one period of insurance by which the maximum liability of the Company in that period exceeds the Sum Insured.
7. Payment of compensation in respect of injury, hospitalization resulting -
From intentional self-injury, suicide or attempted suicide.
Self-exposure to needless perils except in an attempt to save human life.
Whilst under the influence of liquor or drugs or other intoxicants.
Emotional distress
Whilst engaging in aviation or ballooning whilst mounting into, dismounting from or travelling in any aircraft or balloon other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world.
Directly or indirectly, caused by venereal disease, AIDS or insanity.
Arising or resulting from committing any breach of law with criminal intent or participating in an actual or attempted felony, riot, crime, misdemeanor or civil commotion.
Whilst engaging in racing, hunting, mountaineering, ice hockey, winter sports and the like.
Due to war or ionizing radiation or nuclear perils.
Whilst working in underground mines or explosive mines, electric installation with high tension supply, or as jockey or circus personnel or any such occupations of similar hazard.
Congenital anomalies or any complications or conditions arising therefrom; or
8. Any loss resulting directly or indirectly, contributed or aggravated or prolonged by childbirth or from pregnancy (except Ectopic Pregnancy)
9. Any treatment not performed by a Physician or any treatment of a purely experimental nature.
10. Circumcision, cosmetic or aesthetic treatments of any description change of life surgery or treatment, plastic surgery (unless necessary for the treatment of Illness or accidental Bodily Injury as a direct result of the insured event and performed within 6 months of the same).
11. Dental treatment or surgery of any kind unless necessitated by Accidental Bodily Injury.
12. Hospitalization for the sole purpose of traction, physiotherapy or any ailment for which hospitalization is not warranted due to advancement in medical technology
13. Naval or military operations of the armed forces or air force and participation in operations requiring the use of arms or which are ordered by military authorities for combating terrorists, rebels and the like.
14. All kind of Alternate Treatment
