Pre- Medical screeningThere is no pre acceptance medical screening.
Pre-Existing Diseases / IllnessPre-Existing Disease/ Condition (other than those diseases / conditions for which specific periods have been mentioned under exclusions) will be covered after 11 months of continuous coverage have elapsed, since inception of this policy with the Company.
Policy BenefitsHospitalisation Cover
- In-patient hospitalisation for a minimum of 24 hours.
Expenses covered are:
- Room rent, Boarding and Nursing Expenses @ 1% of sum insured subject to a maximum of Rs.3000/- per day.
- Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees.
- Anaesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, cost of Pacemaker and similar expenses.
- Emergency ambulance charges for transporting the insured person upto a sum of Rs.750/- per hospitalisation and overall limit of Rs.1500/- per policy period.
- Pre-hospitalisation medical expenses upto 30 days prior to the date of admission.
- Post-hospitalisation – a lumpsum calculated at 7% of the hospitalisation expenses (excluding room charges) subject to a maximum of Rs.5,000/-.
HIV positive persons
- Covers HIV positive persons except for opportunistic infections and treatment for HIV / AIDS. The minimum CD 4 count at the time of entry should be 350.
- Upto 25% of sum insured subject to a maximum of Rs.25000/- per occurrence, per year of insurance.
- Any person aged between 18 years and 65 years residing in India. Renewals would be accepted upto 70 years.
- Beyond 70 years renewals would be provided under any other health insurance policy of the company.
- This is a two year policy. The sum insured and sub limits are for each year of insurance and cannot be cumulated or carried forward.
- The premium under the policy can be paid in 2 instalments as indicated.
- The first instalment is payable at the commencement of the policy. The second instalment is payable at the beginning of the second year of the policy. Where a claim is made before such instalment falls due then the same would be recovered from the eligible claim amount.
- The policy would lapse if the instalment is not paid on or before the due date.
- Payment of premium by any mode other than cash for insurance under this policy is eligible for relief under section 80D of the Income Tax Act
- Treatment of disease/sickness/illness contracted by the Insured Person during the first 30days from the commencement date of the policy.
- First two Years exclusions : Cataract, Hysterectomy (abdominal and Vaginal), Dysfunctional Uterine Bleeding (DUB) Fibroid Uterus, Prolapsed Uterus, Myomectomy, Cystectomy, Treatment of Internal Derangement of Knee (other than caused by an accident), Treatment for Joints (other than caused by an accident), other Arthroscopic procedures, Inter-Vertebral Disc Prolapse (other than caused by an accident), Degenerative Vertebral and Disc diseases, Varicose veins and Varicose ulcers, Thyroiditis, Treatment of Goitre, Tympnoplasty, Mastoidectomy Glaucoma. These are not payable irrespective of whether they are Pre-Existing or not.
- First year exclusions : Deviated Nasal Septum, Benign Prostate Hypertrophy, Hernia, Hydrocele, Congenital Internal diseases/defects, Fistula in anus, Piles, Fissure in anus, Sinusitis, and related disorders, Nasal Polyps ,Post trauma non union / mal union, Cholecystectomy, Gall Bladder Calculi and Renal Calculi If any of these are Pre-Existing they will be covered after 24 months of continous insurance with the Company.
- During the first 48 months of continuous operation of this Insurance cover the expenses on Stapedectomy, Bone marrow transplant, Cirrhosis of liver with or without portal Hypertension, Hepatitis, Loss of vision partial / total including Retinopathy, Retinal Detachment, Macular degeneration and Papill Oedema, all types of Cancer, Nephropathy and Chronic Kidney diseases and Implant Removal shall not be payable if these are Pre-Existing at the commencement of this insurance.
- 30% of each and every admissible claim.
- Naturopathy treatment
- Expenses which are purely diagnostic in nature with no positive existence of any disease
- Expenses which are mainly cosmetic in nature
- Call the 24 hour help-line for assistance - 1800 425 2255
- Inform the ID number for easy reference
- In case of planned hospitalisation inform 24 hours prior to admission in the hospital
- In case of emergency hospitalisation information to be given within 24 hours after hospitalisation
- Cashless facility can be availed in all net-work hospitals
- In non-network hospitals payment must be made up-front and then reimbursement will be effected on submission of documents
- No Third Party Administrator; direct in-house claims settlement
- Faster & hassle-free claim settlement
- Cashless hospitalisation
- Network of more than 4600 hospitals across India
- 24x7 Toll- free Helpline
- Free General Physician Consultation over phone. Doctors on duty 24x7. By quoting the policy number, any person can contact our Doctor on the toll free number 1800 425 2255 for medical advices.
- Free Health magazines are issued to policy holders at regular intervals