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In case of Section-I,
i.e., Hospitalization Expenses, the entire family is covered for the
Floater Sum Insured as opted, ie., either one or all members of the family can utilize
the Sum Insured during the policy period.
a. Scope
Of Cover
1) Room, Boarding
expenses as provided by the Hospital/Nursing Home.
2)
Nursing expenses.
3)
Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.
4)
Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical appliances,
Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis,
Chemotherapy, Radiotherapy, Cost of pacemaker, Artificial Limbs and cost of
organs and similar expenses.
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b. Additional covers
1)
Ambulance charges not exceeding Rs.1000/- (Rupees one thousand only) per
Policy period.
2) In case of Hospitalisation of
children below 12 years, a lump sum amount of Rs.1000/- (Rupees one
thousand only) per policy period
towards the out-of-pocket expenses. The payment will be made on the
basis of a declaration from the parent without insisting on any supporting
bill/cash memo.
3) Cost of health check-up : It is allowed at the rate of 1% of the sum insured
after completion of three continuous claim free years under this policy.
4) Pre
& Post Hospitalisation Expenses for first 30 days and 60 days
respectively.
5)
Pre-existing diseases covered after three consecutive continuous claims
free policy years in respect of all diseases provided, there was no
hospitalisation for pre-existing ailment during such three years of
insurance.
6)
Maternity and baby care expenses to be covered up to a limit
of 5% of the S.I. for two children only.
7)
Treatment in Nepal and Bhutan will
also be covered but claim will be paid only in Indian currency.
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c. Other Features
1.
Tax benefit available under Section 80D of IT Act.
2.
The premium will be deducted from Bank a/c. of the
a/c. holder.
3.
The claims will be serviced by TPAs.
4.
Minimum hospitalisation for 24 hours.
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d. Major Exclusions
1.
All diseases/injuries, which are pre-existing when the cover incepts
for the first time. This
exclusion will be deleted after three consecutive continuous claims free
years under this policy in respect of all Pre existing diseases
provided, there was no hospitalisation for pre-existing ailment during such
three years of insurance.
2.
Any hospitalization expenses incurred in the first 30 days from the
commencement date of Insurance cover except in case of Injury arising out
of accident.
3.
During the 1st year of operation of insurance cover the expenses on
treatment of diseases such as Cataract, Benign, Prostatic
Hypertrophy, and Hysterectomy for Hemorrhagic, or Fibromyoma,
Hernia, Hydrocele, congenital internal disease, Fistula
in anus, Piles, Sinusitis and related disorders are not payable. If these
diseases are pre existing it will be covered after three consecutive
continuous claims free policy years.
4.
Circumcision, vaccination or inoculation or change of life or cosmetic
or aesthetic treatment of any description, plastic surgery other than as
may be necessitated due to an accident or as apart of any illness.
5.
Cost of spectacles and contact lenses, hearing aids.
6.
Dental treatment or surgery of any kind unless requiring hospitalization.
7.
Convalescence, general debility, run-down condition or rest cure,
congenital external disease or defects or anomalies, Sterility,
Infertility, Venereal disease, intentional self injury and use of
intoxication drugs/alcohol, AIDS.
8.
Charges incurred at Hospital or Nursing Home primarily for diagnosis
purpose.
9.
Expenses on vitamins and tonics unless forming part of treatment for
injury or diseases as certified by the attending physician.
10.
Expenses in excess of 5% of the Sum Insured as mentioned in the
schedule due to treatment arising from or traceable to pregnancy and child
birth (including Caesarean Section) and allied maternity benefits. No
expenses will be payable for any treatment arising from or traceable to
Voluntary Termination of Pregnancy.
11.
Naturopathy Treatment.
12.
Domiciliary Hospitalization benefits
13.
The benefits including continuity, enjoyed under the previous
Policy/Policies, issued by any other Insurance Company shall not be
available under this Policy.
(N.B.
Company's Liability in respect of all claims admitted during the period of
Insurance shall not exceed the Floater Sum Insured per FAMILY as mentioned
in the schedule).
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