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The Policy covers reimbursement of Hospitalization Expenses for Illness/ Injury sustained.
Salient features of the Policy
COVERAGE: The Policy covers reimbursement of Hospitalization Expenses for Illness/ Injury sustained.
In event of any claim being admissible, following Reasonable and Customary expenses are reimbursable under the policy:
Room, boarding and nursing expenses as provided by the Hospital not exceeding 1.0 % of the Sum Insured per day or actual, whichever is less.
Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses not exceeding 2.0 % of the Sum Insured per day, or actual, whichever is less.
Surgeon, Anesthetist, Medical Practitioner, Consultants Specialist fees.
Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like pacemaker, Relevant Laboratory/Diagnostic test, X-Ray and other medical expenses related to the treatment.
Pre-hospitalization medical expenses up to 30 days period.
Post hospitalization medical expenses up to 60 days period.
LIMIT ON PAYMENT FOR CATARACT
Company's liability for payment of any claim relating to Cataract shall be limited to Actual or maximum of Rs.24000 (inclusive of all charges, excluding service tax), for each eye, whichever is less.
AYUSH: Expenses incurred for Ayurvedic/Homeopathic/Unani Treatment are admissible up to 25% of the sum insured provided the treatment for illness/disease and accidental injuries, is taken in a Government hospital or in any institute recognized by Government and /or accredited by Quality Council Of India / National Accreditation Board on Health, excluding centers for spas, massage and health rejuvenation procedures.
Ambulances services- 1.0 % of the sum insured or actual, whichever is less, subject to maximum of Rs. 2,500/- in case patient has to be shifted from residence to hospital for admission in Emergency Ward or ICU or from one Hospital to another Hospital by fully equipped ambulance for better medical facilities.
Hospitalization expenses (excluding cost of organ) incurred on the donor during the course of organ transplant to the insured person. The Company's liability towards expenses incurred on the donor and the insured recipient shall not exceed the sum insured of the insured person receiving the organ.
Zones
Persons paying Zone I premium can avail treatment in any Zone. There will not be any zone deduction in such cases.
Persons paying Zone II premium can avail treatment in Zone II, Zone III and Zone IV. There will not be any zone deduction in such cases.
Persons paying Zone II premium but availing treatment in Zone I will have to bear 10% as Co-Pay for each admissible claim.
Persons paying Zone III premium can avail treatment in Zone III and Zone IV. There will not be any zone deduction in such cases.
Persons paying Zone III premium but availing treatment in Zone II will have to bear 10% as Co-Pay for each admissible claim.
Persons paying Zone III premium but availing treatment in Zone I will have to bear 20% as Co-Pay for each admissible claim.
Person paying Zone IV premium can avail treatment in Zone III and Zone IV. There will not be any zone deduction in such cases.
Person paying Zone IV premium but availing treatment in Zone II, will have to bear 10% as Co-Pay for each admissible claim.
Person paying Zone IV premium but availing treatment in Zone I, will have to bear 20% as Co-Pay for each admissible claim.
60 days
Post hospitalization medical expenses up to 60 days period.
30 days
Pre-hospitalization medical expenses up to 30 days period
1 % of the sum insured
1.0 % of the sum insured or actual, whichever is less, subject to maximum of Rs. 2,500/- in case patient has to be shifted from residence to hospital for admission in Emergency Ward or ICU or from one Hospital to another Hospital by fully equipped ambulance for better medical facilities
Treatment are admissible up to 25% of the sum insured
Expenses incurred for Ayurvedic/Homeopathic/Unani Treatment are admissible up to 25% of the sum insured provided the treatment for illness/disease and accidental injuries, is taken in a Government hospital or in any institute recognized by Government and /or accredited by Quality Council Of India / National Accreditation Board on Health, excluding centers for spas, massage and health rejuvenation procedures
Covered limited to Actual or maximum of Rs.24000
Company's liability for payment of any claim relating to Cataract shall be limited to Actual or maximum of Rs.24000 (inclusive of all charges, excluding service tax), for each eye, whichever is less
1% of the Sum Insured per day
Room, boarding and nursing expenses as provided by the Hospital not exceeding 1.0 % of the Sum Insured per day or actual, whichever is less
As per the Zone
Co-Payment are applicable as per the Zone
