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The policy covers all the members of the family under a single Sum Insured. Family comprising of self, spouse and Dependent children can be covered.
KEY BENEFITS
Children between the age of 3 months and 18 years are covered provided either or both parents are covered concurrently.
Sum Insured ranges between Rs. 2lacs to Rs.10 lacs in multiples of Rs.50,000/- up to Rs.5 lac and from Rs.5 lac to Rs.10 lacs in multiples of Rs.1 lac.
SALIENT FEATURES
The policy covers all the members of the family under a single Sum Insured. Family comprising of self, spouse and Dependent children can be covered. The age of the proposer shall be between 18 and 80 years.
COVERAGE
The Policy provides the following benefits.
Hospitalization expenses
Room, Boarding and Nursing expenses not exceeding 1% of the Sum Insured or actual whichever is less. ICU not exceeding 2% of the Sum Insured or actual whichever is less.
Expenses incurred for Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.
Expenses incurred on Anesthetic, blood, oxygen, Operation theatre charges, surgical appliances, Medicines & drugs, dialysis, chemotheraphy, radiotheraphy, cost of artificial limbs, cost of prosthetic devices implanted during surgical
procedure like Pacemaker, orthopaedic implants, infra cardiac valve replacements, vascular stents, relevant laboratory/diagnostic tests, x-ray and similar expenses that are medically necessary and hospitalization expenses (excluding
cost of organ) incurred for donor in respect of organ transplant to the insured.
Pre-hospitalization expenses incurred up to 30 days prior to date of admission and Post-hospitalization expenses incurred up to 60 days from the date of discharge subject to a maximum limit of 10% of the Sum Insured.
Expenses for the following illness restricted to
Cataract - 10% of SI subject to maximum of Rs.25,000/- per eye.
Hernia - 15% of SI subject to maximum of Rs.1,00,000/-
Hysterectomy - 20% of SI subject to maximum of Rs.1,00,000/-
Day Care Treatment
Certain specified Day Care procedures which require less than 24 hours hospitalization.
AYUVERDIC TREATMENT
Treatment taken in a Government Hospital or in any Institute recognized by the Government and/or accredited by Quality Council of India/National Accreditation Board on Health.
Cashless facility in more than 7000 hospitals across Pan India.
No claim discount of 3% per year after three continuous claim free years subject to maximum of 15%.
Free Look period of 15 days shall be applicable for all fresh policies.
Free Medical check-up once at the end of three consecutive claim free years up to 1% of the average Sum Insured during the preceding three policy periods.
Premium paid for self, spouse, dependent children and dependent parents are exempt from Income Tax under Section 80-D of the IT act as per rules in force.
EXCLUSIONS
All Pre-existing diseases upto 48 months of continuous coverage with us.
Any disease contracted during the first 30 days of inception of policy.
Waiting period of 2/4 years for certain specified illness/treatment.
Vaccination and Inoculation other than for animal bite.
General debility and Run down conditions
Circumcision, Cosmetic surgery, Plastic surgery.
HIV/AIDS
Psychiatric and psychosomatic disorders
Injury arising out of drug/alcohol abuse.
Pregnancy, ailments related thereto and child birth
War, act of foreign enemy, ionizing radiation and nuclear weapon.
Naturopathy
Experimental or unproven treatment
All external equipments
Dental treatments
Covered all day care treatment
We will cover the Medical Expenses incurred on the Insured Persons Day Care Treatment during the Policy Period following an Illness or Injury that occurs during the Policy Period provided that the Medical Expenses are incurred in case of Day Care Treatment or Surgery undertaken for the Illness/condition covered under Base Cover that requires less than 24 hours due to advance in technology, including for any procedure which requires a period of specialized observation
Covered Upto 60 day
Post- hospitalization Medical Expenses incurred due to an Illness or Injury that occurs during the period upto 60 days after the discharge from the hospital, subject to a maximum of 10% of Sum Insured.
Covered Upto 30 day
We will cover, on a reimbursement basis, the Insured Person's Pre hospitalization Medical Expenses incurred due to an Illness or Injury that occurs during the period upto 30 days prior to hospitalization
Covered
We will cover the costs incurred up to: 0.5% of the Sum Insured subject to a maximum of Rs. 2500 per event and ii. 1% of the Sum Insured subject to a maximum of Rs. 5000 per policy period
Covered to the limits linked to the Sum Insured
We will pay the reasonable & customary Charges incurred as in-patient for an Insured Person in case of Medically Necessary Treatment taken during Hospitalization subject to the limits linked to the Sum Insured, as mentioned in the policy and as also in table of benefits
Covered to 10% of Sum Insured
Expenses in respect of the Cataract surgeries will be restricted to 10% of Sum Insured subject to maximum of Rs. 50,000/- per eye. This limit is applicable per hospitalization / surgery
Covered
Family Covered in this Policy
48 months
Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 48 months of continuous coverage after the date of inception of the first policy with us.
Covered -up up to 1% of average Sum Insured of preceding 3 years
Expenses incurred towards cost of health check-up up to 1% of average Sum Insured of preceding 3 years subject to a maximum of Rs. 5000 per person for policies issued on individual sum insured basis / Rs. 10000 per policy period for policies issued on floater basis for a block of every three claim free years provided the health check-up is done at network hospitals/diagnostic center authorized by us within a year from the date when it got due and the policy is in force.
Covered 1% of Sum Insured
1% of Sum Insured
Covered Restore Sum Insured equal to 100% of the Basic Sum Insured
If the Basic Sum Insured is exhausted completely or partially due to claims made and paid/ accepted as payable during the Policy Year, then it is agreed that a Restore Sum Insured equal to 100% of the Basic Sum Insured will be automatically and instantly available for the particular Policy Year
Covered Upto SI
We shall pay the Medical Expenses incurred as an In-patient for a delivery (including caesarean section) or lawful medical termination of pregnancy during the Policy Period limited to two deliveries or terminations or either during the lifetime of the Insured Person
