Health Premia Family Floater

Health Premia - Family Health Insurance Plan
A comprehensive health insurance plan that keeps up with your family's lifestyle

SILVER
Cover available upto Rs 7.5 lakhs : Up to Rs 7.5 lakh
Health Check Up : Up to Rs 1,875 per person
Loyalty Bonus : 10% increase in sum insured annually
Maternity benefits : Up to Rs 60,000 /-
Cover starts from : Rs 5 lakhs - Rs 7.5 lakhs
Premium starts from : Rs 12,488 /Yr

GOLD
Cover available upto Rs 50 lakhs : Up to Rs 50 lakh
Health Check Up : Up to Rs 7,500 per person
International coverage : Up to Rs 30 Lacs per person
Maternity benefits : Up to Rs 100,000 /-
Cover starts from : Rs 10 lakhs - Rs 50 lakhs
Premium starts from : Rs 12,488 /Yr

Maternity & New-born coverage
No additional premium for covering a new born baby from day 1 till policy year end

New-age treatment Coverage
Coverage for new-age treatments like laser assisted surgery & more

International Coverage
Insure your health even when you travel abroad under platinum plan

Inbuilt travel insurance
Coverage for loss of checked-in baggage, trip cancellation & more

Hospitalization Coverage
Coverage up to 3cr for you & your insured family members' hospitalization

Health Check-up
Benefit of health check-ups for diagnostic tests from day 1

Hospitalization
IN-PATIENT CARE (HOSPITALISATION)
Get coverage for medical treatment post hospitalization for all insured members

HOSPITAL ACCOMMODATION
Get coverage of room rent up to base sum insured except for suite and above categories.

PRE & POST HOSPITALISATION MEDICAL EXPENSES
The policy will cover pre and post hospitalization expenses as well. The period of the treatment covered is 90 days before you get admitted to the hospital and 180 days after you get discharged from the hospital.

DOMICILIARY HOSPITALISATION
The policy will reimburse you for the medical treatment taken at home on account of unavailability of a hospital bed or the doctor's advice

DAY-CARE TREATMENT COVERED
Your health insurance will cover a host of dental, ENT and other procedures

EMERGENCY AMBULANCE
Get coverage for the ambulance expenses following an emergency to a hospital. These expenses are paid once the in-patient claims are approved

ORGAN TRANSPLANT
Avail coverage for medical expenses incurred on the organ donor's treatment as well

OPD TREATMENT AND DIAGNOSTIC SERVICES
We cover expenses incurred for OPD Treatment and/or Diagnostic Services and/or prescribed medicines for the OPD Treatment taken within India for up to Rs 50,000.( Applicable under Platinum plan)

ALTERNATIVE TREATMENTS
We will indemnify the medical expenses incurred on the insured person's hospitalization for Inpatient Care on treatment taken under Ayurveda, Unani, Siddha and Homeopathy.

Standout Features

PREMIUM WAIVER
Get a free extension of 1 year if the policyholder (who is also an insured) passes away or is diagnosed with any of the specified illnesses

EMERGENCY ASSISTANCE SERVICES
Get coverage for medical evaluation, referral, repatriation etc. when the insured is travelling within India. They must be at a minimum distance of 150 kms. from their residence and the trip must be for less than 90 days

NEW AGE TREATMENT
Treatments like Cyber knife/ Robotics surgery, Laser surgery cover, Weight loss (Bariatric) surgery are covered

MATERNITY BENEFIT
The plan provides you maternity benefits for up to two deliveries. This benefit is available after both you and your spouse have been covered under the policy for two continuous years.

REFILL BENEFIT
In case you have exhausted your Base Sum Insured and Loyalty Additions / Enhanced Loyalty Additions (if any) partially or completely, you are entitled for an additional sum insured equal to the base sum insured for a subsequent claim in the same year. This benefit can be availed for both same and different illnesses.

LOYALTY ADDITIONS
Irrespective of your claim history, you will get an increase of 10% of expiring base Sum Insured every year, subject to maximum of 100% of base Sum Insured.

HEALTH CHECK-UP
You can avail health checkup for Diagnostic Tests purposes from Day 1 for any insured person (including children). You can undergo a health checkup through our service provider on cashless basis. You can choose tests of your choice up to a sub-limit as per the plan chosen.

Add on Features

PERSONAL ACCIDENT COVER
Secure your family's finances against personal accidents

CRITICAL ILLNESS COVER
Get coverage against illnesses like cancer, kidney failure etc. depending on the base sum insured

HOSPITAL CASH
The add-on pays hospital cash for up to 30 days of hospitalization if hospitalized for more than 48 hours

HEALTH COACH
Track your health parameters and get help from the virtual coach to reach your health goals

ENHANCED GEOGRAPHICAL COVER
Now you are entitled to avail international coverage in USA & Canada also.

ENHANCED LOYALTY ADDITIONS
Irrespective of claim history, your sum insured increases by 20% pa; maximum up to 200% of expiring base sum insured

Exclusions

PERMANENT EXCLUSIONS

Investigation & Evaluation

Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.

Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.

Rest Cure, rehabilitation and respite care
Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:

Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.

Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.

Obesity/ Weight Control

Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
Surgery to be conducted is upon the advice of the Doctor.
The surgery/Procedure conducted should be supported by clinical protocols.
The member has to be 18 years of age or older and;
Body Mass Index (BMI);
greater than or equal to 40 or
greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss:
Obesity-related cardiomyopathy
Coronary heart disease
Severe Sleep Apnea
Uncontrolled Type2 Diabetes

Change-of-Gender treatments
Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.

[/B]Cosmetic or plastic Surgery
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.

Hazardous or Adventure sports
Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.

Breach of law
Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.

Excluded Providers
Expenses incurred towards treatment in any Hospital or by any Medical Practitioner or any other provider specifically excluded by Us and disclosed in Our website / notified to the Policyholders are not admissible. However, in case of life threatening situations or following an Accident, expenses up to the stage of stabilization are payable but not the complete claim.

The complete list of excluded providers can be referred to on our website.

Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof.
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.

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

Refractive Error
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 diopters.

Unproven Treatments
Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.

Sterility and Infertility
Expenses related to sterility and infertility. This includes:
Any type of contraception, sterilization
Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
Gestational Surrogacy
Reversal of sterilization

Maternity
Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalization) except ectopic pregnancy;
Expenses towards miscarriage (unless due to an Accident) and lawful medical termination of pregnancy during the Policy Period.

Ancillary Hospital Charges
Charges related to a Hospital stay not expressly mentioned as being covered. This will include charges for admission, discharge, administration, RMO charges, night charges, registration, documentation and filing, surcharges and service charges levied by the Hospital.

Circumcision:
Circumcision unless necessary for the treatment of a disease or necessitated by an Accident.

Conflict & Disaster:
Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.

External Congenital Anomaly:
Screening, counseling or treatment related to external Congenital Anomaly.

Dental/oral treatment:
Treatment, procedures and preventive, diagnostic, restorative, cosmetic services related to disease, disorder and conditions related to natural teeth and gingiva except if required by an Insured Person while Hospitalized due to an Accident.

Hormone Replacement Therapy:
Treatment for any condition / illness which requires hormone replacement therapy.

Multifocal Lens and ambulatory devices such as walkers, crutches, splints, stockings of any kind and also any medical equipment which is subsequently used at home.

Sexually transmitted Infections & diseases (other than HIV / AIDS):
Screening, prevention and treatment for sexually related infection or disease (other than HIV / AIDS).

Sleep disorders:
Treatment for any conditions related to disturbance of normal sleep patterns or behaviors.

Any treatment or medical services received outside the geographical limits of India.

Unrecognized Physician or Hospital:

Treatment or Medical Advice provided by a Medical Practitioner not recognized by the Medical Council of India or by Central Council of Indian Medicine or by Central council of Homeopathy.
Treatment provided by anyone with the same residence as an Insured Person or who is a member of the Insured Person's immediate family or relatives.
Treatment provided by Hospital or health facility that is not recognized by the relevant authorities in India.

Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state as demonstrated by:

Deep coma and unresponsiveness to all forms of stimulation; or
Absent pupillary light reaction; or
Absent oculovestibular and corneal reflexes; or
Complete apnea.

AYUSH Treatment
Any form of AYUSH Treatments, except as mentioned in your policy document.

PERMANENT EXCLUSION FOR PERSONAL ACCIDENT COVER (OPTIONAL)
Suicide or self inflicted Injury, whether the Insured Person is medically sane or insane.

Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.

Service in the armed forces, or any police organization, of any country at war or at peace or service in any force of an international body or participation in any of the naval, military or air force operation during peace time.

Any change of profession after inception of the Policy or any Renewal which results in the enhancement of Our risk, if not accepted and endorsed by Us on the Policy Schedule.

Committing an assault, a criminal offence or any breach of law with criminal intent.

Taking or absorbing, accidentally or otherwise, any intoxicating liquor, drug, narcotic, medicine, sedative or poison, except as prescribed by a Medical Practitioner other than the Policyholder or an Insured Person.

Participation in aviation/marine activities (including crew) other than as a passenger in an aircraft/water craft that is authorized by the relevant regulations to carry such passengers between established airports or ports.

Engaging in or taking part in professional/adventure sports or any hazardous pursuits, speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea diving, polo, snow and ice sports, hunting.

Body or mental infirmity or any Illness except where such condition arises directly as a result of an Accident during the Policy Period. However this exclusion is not applicable to claims made under Permanent Partial Disability clause in your policy document. Read policy wordings for more details.

PERMANENT EXCLUSIONS FOR CRITICAL ILLNESS COVER (OPTIONAL)
AYUSH Treatment:

Any covered Critical Illnesses diagnosed and/or treated by a Medical Practitioner who practices AYUSH Treatment.

Conflict & Disaster:
Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.

External Congenital Anomaly:
Screening, counseling or treatment related to External Congenital Anomaly.

Cosmetic or plastic Surgery
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.

Unproven Treatments
Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.

Hazardous or Adventure sports
Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.

Sterility and Infertility
Expenses related to sterility and infertility. This includes:

Any type of contraception, sterilization
Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
Gestational Surrogacy
Reversal of sterilization

Maternity
Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalization) except ectopic pregnancy;
Expenses towards miscarriage (unless due to an Accident) and lawful medical termination of pregnancy during the Policy Period.

Sexually transmitted Infections & Diseases:
Screening, prevention and treatment for sexually related infection or disease. Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof.

Breach of law
Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.
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.

Unrecognized Physician or Hospital:
Treatment or Medical Advice provided by a Medical Practitioner not recognized by the Medical Council of India or by Central Council of Indian Medicine or by Central council of Homeopathy.

Treatment provided by anyone with the same residence as an Insured Person or who is a member of the Insured Person's immediate family or relatives.

Treatment provided by Hospital or health facility that is not recognized by the relevant authorities in India.

WAITING PERIODS
Pre-existing disease waiting period of 24 months since inception of the policy and continuous renewal. For Critical Illness cover, pre-existing disease waiting period would be 48 months along with a Survival Period exclusion of 30 days for all conditions.
Initial waiting period of 30 days unless the treatment needed is the result of an Accident. For Critical Illness cover, initial waiting period would be 90 days.
Specific waiting period of 12 months, since the inception of the first policy with us, for some listed illnesses, unless the condition is directly caused by Cancer (covered after Initial Waiting Period of 30 days) or an Accident (covered from day 1).
The following benefits will have a waiting period of 36 months since inception of the Policy and subject to continuous renewal:

Weight loss (Bariatric) surgery
Mental disorder treatment
LASER surgery cover
For HIV / AIDS cover, there will be a waiting period of 48 months since inception of the Policy and subject to continuous renewal.