K Bank Health Care Plus

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 Karnataka Bank, we have designed the K Bank Health Care Plus in association with Karnataka Bank.

The K Bank Health Care Plus is a complete health Insurance Plan that covers you, your spouse and two dependent children and dependent parents and unlike any other regular policy, wherein a family has to take individual policies for each member, this unique family floater gives you the flexibility of taking one policy that covers the entire family under a single sum insured.

The Policy takes care of the hospitalization expenses, subject to maximum Sum Insured, in respect of the following eventualities:
a. Sudden illness
b. An accident
c. Any surgery that is required in respect of any disease.

1. Who can take the Policy?
The scheme provides for Mediclaim Insurance cover, which is available to all the customers of K Bank 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 Karnataka Bank within the age band of 18 to 65 years are eligible to take the Policy.

The enrollment age under the policy is from 5 years to 65 years. Persons above 65 years of age, can be covered, if there has been a continuous cover under any Health Insurance Policy taken from any Indian Insurance Company without any break in insurance

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.

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, when the Sum Insured is enhanced at the time of renewal or when there is break in insurance for more than 15 days. 50% of such medical examination costs shall be reimbursed by us, if the proposal is accepted.

The maximum renewal age under the Policy is 80 years. We shall, however, provide you with an option to migrate to a substitute product if you have reached maximum renewable age under the policy. The same option of migrating to substitute health product shall be available to your children when they reach their maximum renewal age under the Policy. All due credits for the continuous number of years for which you/your children have been covered under the Policy without break shall provide under the substitute product.

3. What is covered under the Policy?

1. Basic Coverage
The Policy covers reimbursement of Hospitalization expenses for illness/ diseases contracted or injury sustained by the Insured Person. In the event of any claim becoming admissible under Policy, the company will pay to the Hospital/ Nursing Home/ Insured person but not exceeding Sum Insured selected for the family as stated in the Schedule and subject to terms and conditions of the Policy, during the Period of Insurance for the following expenses:
A. Room, Boarding expenses as charged by the Hospital/ Nursing Home
B. Nursing expenses
C. Fees paid to Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists
D. Anesthetist, Blood, Oxygen, Operation Theatre charges, Surgical appliances, Medicines & Drugs, Diagnostic Material and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs. Expenses on hospitalization incurred anywhere in India are covered.

Expenses on hospitalization in Bhutan and Nepal are also covered but Cashless service is not available. Claim settlement will be only in Indian Currency.

2. Duration of Hospitalization
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.

3. Pre Hospitalization
Medical expenses incurred during period up to 30 days prior to hospitalization on disease/ illness/ injury sustained which forms part of illness for which there is valid claim under the Policy will be considered as part of the claim subject to availability of Sum Insured.

4. Post Hospitalization
Relevant medical expenses incurred during period up to 60 days after hospitalization on disease/ illness/ injury sustained which forms part of illness for which there is valid claim under the Policy will be considered as part of the claim subject to availability of Sum Insured.

5. Other Benefits under the Policy

A. Maternity Expenses

This Benefit is admissible only if the expenses are incurred in a Hospital / Nursing Home as an inpatient in India, arising from or traceable to pregnancy, childbirth including normal cesarean section.

A waiting period of 9 months is applicable for payment of any claim relating to normal delivery or cesarean section or abdominal operation for extra uterine pregnancy. The waiting period may be relaxed only in case of delivery, miscarriage or abortion induced by accident or other medical emergency. Baby Care Expenses are payable, for treatment given to the new born child in the hospital as an inpatient for a maximum period of 90 days from the date of its birth and forms the part of Sum Insured.

Claim in respect of delivery for only first two children and/or operations associated therewith will be considered in respect of any one Insured Person covered under the Policy or any renewal thereof. Those Insured Persons who are already having two or more living children will not be eligible for this benefit.

Expenses incurred in connection with voluntary medical termination of pregnancy except natural or accidental termination of pregnancy during the first 12 weeks from the date of conception are not covered.

Pre-natal and post natal expenses incurred only as an inpatient in a Hospital/ Nursing Home only are covered.

Expenses payable under Maternity Expenses benefit shall form part of Sum Insured under the Policy.

The reimbursement under Maternity benefit is limited to actual expenses subject to a maximum of 5% of the Sum Insured.

B. Ambulance Charges
The charges incurred for emergency transport of the patient from place of accident/ illness to the hospital where treatment is taken or incurred for transport of the patient by the hospital where the patient is taken to another hospital for treatment/ diagnostic tests etc. The overall limit under the Policy shall be Rs.1000/- per Policy Period. This forms part of Sum Insured under the Policy.

C. Hospital Cash to Parents
In case of Hospitalization of Children up to Age 12 years Cash allowance of Rs.100/- per day subject to a maximum of Rs.1000/- will be given to account holder, in respect of valid claim is there under the Policy. The overall limit under the Policy shall be Rs.1000/- per Policy period and forms part of Sum Insured under the Policy.

D. Cost of Health check up
The insured shall be entitled for reimbursement of cost of health check-up once at the end of block of every Three Policy years (under this scheme) provided there are no claims reported during the block. The cost so reimbursable shall not exceed 1% of the amount of average Sum Insured during the block of Three Claim Free years. This Provision is applicable only in respect of continuous Insurance without any break.

E. Funeral Expenses
In case of death of any of the insured persons following hospitalization with valid claim under the Policy, Funeral expenses of Rs.1000/- will be paid under the Policy. This amount will be over and above Sum Insured under the Policy.

6. Third Party Administrator (TPA).
Third Party Administrator who is duly licensed by the Insurance Regulatory and Development Authority, and is engaged for the provision of cashless Health Services at the hospitals on their network.

Extensions under the Policy:

Optional Extension Personal Accident Cover:
On payment of additional Premium, Policy can be extended to cover the Account holder, spouse and two dependent children against Death due to Accident. This Cover is not available for Parents of account holders.

Accident anywhere in the world is covered. However, claim settlement will be only in Indian currency

The amount payable under the cover is as per the table below subject to maximum of Sum Insured selected for the family as stated in the Schedule during the Period of Insurance, which shall be same as Sum Insured for the Health cover.



1. Additional Benefits under the Policy

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

Sum Insured: Choice of Sum Insured ranges from Rs 50,000 to Rs 5,00,000 in multiples of Rs 50,000.

Portability:
The insured person will have the option to port the policy to other insurers by applying to such insurer to port the entire policy along with all the members of the family, if any, at least 45 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.

Free Look Period:
The Free Look Period shall be applicable on new individual health insurance policies and not on renewals or at the time of porting/migrating the policy.

date of receipt of the policy document 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 person, 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;

2. Conditions under the Policy
Co-payment: 20% co-pay shall be applicable on each and every claim of Insured above 55 years of age


3. 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