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The Policy can be opted on an Individual basis or Family Floater basis.
I. ELIGIBILITY
A) AGE
Minimum Entry Age (Child): 91 days
Minimum Entry Age (Adult): 18 years
Maximum Entry Age: No limit on age for the Sum Insured of 2 Lac; For all other Sum Insured, the maximum entry age is limited to 70 years.
Children aged 91 days to 5 years can be covered with at least one parent covered with Us.
Renewable (Adult): Lifetime.
Renewable (Dependent Child): Up to 30 Years.
B) COVER TYPE
The Policy can be opted on an Individual basis or Family Floater basis.
Family Floater - One Family will share a single Sum Insured. A Family Floater policy can cover Self, legal spouse, 3 dependent children, Parents/Parents-in-Law.
Non-Floater - Each Insured Person under the Policy will have a separate Sum Insured.
C) POLICY TENURE
This policy will be available for 1/2/3 years.
II. FEATURES
This Policy offers following benefits up to the applicable Sum Insured for each benefit.
In Patient Hospitalization
Policy covers following medical expenses incurred for in-patient hospitalization (minimum 24 hrs.) due to an illness/disease/injury -
a) Room Rent charges
b) Intensive Care Unit (ICU) charges
c) Operation Theatre charges
d) Fees of Medical Practitioner/ Surgeon / Anesthetist / Specialists
e) Nursing charges
f) Physiotherapy, Investigation & Diagnostic procedures
g) Medicines, Drugs and Consumables
h) Blood, Oxygen, Surgical appliances
i) The cost of prosthetic and other devices or equipment recommended by the attending Medical Practitioner and if implanted internally during a Surgical Procedure.
If You are admitted in a room where the Room Rent is higher than the limit opted as specified in the Policy Schedule then, we will proportionately deduct associate medical expenses.
Associate Medical Expenses include medical expenses related to Nursing Charges, Operation Theatre Charges, Fees of Medical practitioner/ surgeon/ anaesthetist/ specialist and Physiotherapy charges.
All day care procedures are covered, Up to the Sum Insured
Medical Expenses incurred for a day care procedure/ treatment/ surgery as an Inpatient requiring less than 24 hours of hospitalization due to advancement in medical science. Any treatment in an Out-Patient Department (OPD) is not covered.
Covered Up to 180 days
Post-Hospitalization Medical Expenses incurred immediately after the Insured Person's discharge from the hospital up to 180 days. Claim under In-Patient hospitalization or Day Care Treatment must be admissible
Covered Up to 90 days
Pre-hospitalization Medical Expenses incurred immediately before the Insured Person's hospitalization up to 90 days. Claim under In-Patient hospitalization or Day Care Treatment must be admissible.
Covered
Expenses incurred towards transportation by an ambulance for treatment in a hospital in case of an emergency, shifting to another hospital for super specialty treatment and also when ambulance service required for shifting to home after discharge from the hospital. The necessity of an ambulance must be certified by the treating Medical Practitioner
Covered Upto the sum insured.
Medical expenses incurred for in-patient hospitalization for the treatment taken under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy in a government hospital, teaching hospitals of AYUSH colleges and AYUSH hospitals recognized by a government authority upto the sum insured.
Covered Upto the sum insured
Expenses incurred towards transportation by an Air Ambulance for treatment of a disease / illness / injury in case of an emergency, that requires admission to a Hospital. The necessity of an ambulance must be certified by the treating Medical Practitioner. Policy does not provide cover for the return transportation of Insured Person's to his home by air ambulance
Not Covered
Eyesight, Hearing Aids & External prosthesis. Dental Treatment and Surgery of any kind, other than arising out of an Accident and subsequently requiring Hospitalization
Covered Upto the sum insured
Expenses for in patient hospitalization due to life threatening Illness incurred outside India, up to the Policy Sum Insured provided that the hospitalization is medically necessary, and the medical practitioner certifies that the insured is suffering from a life threatening illness which requires Emergency Care and such treatment cannot be postponed until the Insured Person returns to India
Family Covered in this Policy
A Family Floater policy can cover Self, legal spouse, 3 dependent children, Parents/Parents-in-Law
Health Check up at the end of every claim free policy year
Health check-up benefit is available for each insured member 18 years of age, at the end of every claim free policy year
No Capping On Room Rent
No Capping On Room Rent
Sum Insured will be enhanced by 10% on each claim free policy year
Sum Insured will be enhanced by 10% on each claim free policy year subject to a maximum of 50%. In case of a claim in a given policy year, the Cumulative Bonus shall be decreased by 10% in the subsequent policy year but will not reduce the Base Sum Insured
Covered 100% of S.I
100% of S.I will be reinstated in case the S.I is completely exhausted
voluntary copayment
You will have to bear the cost sharing percentage, that you have opted at the time of proposal application, of the admissible claim amount of each claim. A Co- Payment does not reduce the Sum Insured. Co Payment options - 10%/20%/30%
Covered after 24 months Upto the sum insured
Maternity Expenses up to a maximum of 2 deliveries or terminations during the lifetime of a Female prospect of age 18 years and above. Waiting Period of 24 months will be applicable
Covered Up to the Sum Insured
Domiciliary Hospitalization i.e. treatment at home (including pre and post Hospitalization medical expenses) if medical treatment is continuously required for at least three (3) days, in which case the cost of medical treatment for the entire period shall be payable subject to: (i) the condition of the patient is such that he/she is not in a condition to be removed to a Hospital, or (ii) the patient takes treatment at home on account of non-availability of room in a Hospital
