Heartbeat Family Floater

Heartbeat – Family Health Insurance Plan
Our most comprehensive health insurance plan with international emergency coverage

GOLD
Cover Available : Up to Rs 50 lakhs
Health check up : Up to Rs 2,500
Maternity benefits : Up to Rs 1,00,000/-
Loyalty Bonus : 10% increase in sum insured annually

PLATINUM
Cover Available : Up to Rs 1 Cr
Health check up : Up to Rs 5,000
Maternity benefits : Up to Rs 2,00,000/-
Loyalty Bonus : 10% increase in sum insured annually
Cover starts from : Rs 15 lakhs - Rs 1 crore
Premium starts from : Rs 16,414 /Yr

No Room Rent Cap : In case of hospitalization, room rent is covered up to sum insured.

Day Care Treatments
Your health insurance will cover host of dental, ENT procedures & more

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

OPD Consultations
Stay worry-free as we cover OPD treatments under platinum plan

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

Loyalty Bonus
Irrespective of claim history, get 10% more sum insured annually

Hospitalization
IN-PATIENT CARE (HOSPITALISATION)
Get cashless coverage for hospitalization expenses for all insured members at network hospitals

PRE & POST HOSPITALISATION MEDICAL EXPENSES
The policy covers expenses 60 days before hospitalization and 90 days post discharge

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

ORGAN TRANSPLANT
Medical expenses for an organ donor's inpatient treatment for the harvesting of the organ is also covered

OPD TREATMENT AND DIAGNOSTIC TESTS
Get reimbursements for expenses towards medically necessary treatments as an outpatient with a doctor under platinum plan

EMERGENCY AMBULANCE
The policy covers the cost of ambulance. These expenses are paid once we have accepted the inpatient claim

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

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

DIRECT CLAIM SETTLEMENT
There are no third-party agents involved. Get your claims processed painlessly by our customer service team directly

RENEWAL FOR LIFE
Get assured renewal of the policy for life with no extra loadings based on your claim history

INTERNATIONAL COVERAGE
Covers specified illnesses and emergency hospitalization and emergency medical evacuation outside India

LOYALTY BENEFIT
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

MATERNITY & NEWBORN COVERAGE
Avail maternity benefits and no additional premium for covering a new born baby from day 1 till policy year end

ENTRY AGE AND FAMILY COVERAGE
The entry age for adults under this policy can be from 18 to 65 years. The entry age for dependent children is from 91 days to 21 years in a family floater policy. The policy can be taken individually or for the family. The family floater policy is available for husband, wife and a maximum of 4 children.

HEALTH CHECK-UP
You can avail health checkup for Diagnostic Tests purposes post completion of 1st policy year, 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.

SECOND MEDICAL OPINION
Second Medical opinion for listed specified illnesses or a planned surgery or procedure can be obtained under Platinum plan. There is one opinion available per insured person per specified illness/ planned surgery.

REFILL BENEFIT
In case of exhaustion of the base sum insured, get 100% of your base sum insured as a refill for both different and same illness

Add on Features

Optional Benefits:

Hospital Cash
E-Consultation
Personal Accident Cover
Critical Illness Cover
Premium Waiver

If an insured policy holder passes away or is diagnosed with a specified illness during the policy period, then the premium for next year will be waived

Enhanced Geographical Scope for International coverage Extend your hospitalization & emergency medical evacuation cover in US & Canada.

Exclusions
PRE-EXISTING CONDITIONS :
Pre-existing conditions are subject to a waiting period of 24 months of continuous coverage from first policy start date for customers with Gold & Platinum plan and 48 months of continuous coverage from first policy start date for customers with Silver plan.

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.

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.


WAITING PERIODS
Pre-existing disease waiting period of 48 months (silver plan) / 24 months (gold and platinum plans) 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 24 months for persons above 45 years of age, 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).
For mental disorder treatment cover, there will be a waiting period of 36 months since inception of the Policy and subject to continuous renewal.
For HIV / AIDS cover, there will be a waiting period of 48 months since inception of the Policy and subject to continuous renewal.