A COMPREHENSIVE HEALTH INSURANCE PLAN

WIDE RANGE OF ANNUAL HEALTH AUTOMATIC

CHECK-UP TAX SAVING
SUM INSURED RECHARGE
FOR ALL INSURED UNDER SECTION 80D
UPTO 75 Lacs UPTO SUM INSURED
MEMBERS

UNLIMITED NO CLAIM
OPD CARE
OPTIONAL COVER
RECHARGE BONUS SUPER
OPTIONAL COVER OPTIONAL COVER
 PLAN BENEFITS
4 Lacs 5/7/10 Lacs 15/20/25/30/40 Lacs 50/60/75 Lacs
PRE-HOSPITALIZATION 30 Days 30 Days 30 Days 30 Days
POST HOSPITALIZATION 60 Days 60 Days 60 Days 60 Days
DAY CARE TREATMENT Yes Yes Yes Yes
Single Private Room Single Private Room
ROOM RENT 1% of SI per day Single Private Room
Upgradable to Next Level Upgradable to Next Level
ICU CHARGES 2% of SI per day No Limit No Limit No Limit
DOCTOR FEES, ETC. No Limit No Limit No Limit No Limit
OTHER MEDICAL CHARGES No Limit No Limit No Limit No Limit
DAILY ALLOWANCE Rs.500 per day up to 5 Days - - -
Upto Rs1500 per Upto Rs2000 per Upto Rs2500 per Upto Rs3000 per
AMBULANCE COVER
hospitalization hospitalization hospitalization hospitalization
DOMICILIARY HOSPITALIZATION Upto 10% of SI Upto 10% of SI Upto 10% of SI Upto 10% of SI
ORGAN DONOR COVER UP TO Rs.50,000 UP TO Rs.1,00,000 UPTO Rs.2,00,000 UPTO Rs.3,00,000
ANNUAL HEALTH CHECK-UP For All Insured Members For All Insured Members For All Insured Members For All Insured Members
MATERNITY COVER - - - Up to Rs.1,00,000
ALTERNATIVE TREATMENT Up to Rs.15000 Up to Rs20,000 Up to Rs. 30,000 Up to Rs. 40,000
SECOND OPINION Yes Yes Yes Yes
NO CLAIM BONUS Up to 50% of SI Up to 50% of SI Up to 50% of SI Up to 50% of SI
RECHARGE OF SUM INSURED Up to SI Up to SI Up to SI Up to SI
CARE ANYWHERE - - - Yes
 POLICY CONDITIONS
Individual Plan
5 Years
MINIMUM ENTRY AGE Family Floater Plan
91 days with at least 1 insured member above 18 Years of Age
Child :24 Years
MAXIMUM ENTRY AGE Adult : No Age limit
RENEWAL Life Long

CO-PAYMENT 20% for customers enrolling in the policy after attaining the Age 61 Years or more

INITIAL WAIT PERIOD 30 Days for all Illness except Accidental injury

NAMED AILMENT WAIT PERIOD 24 Months

PRE-EXISTING DISEASE WAIT PERIOD 48 Months

Individual Plan
Self, Spouse, Son, Daughter, Father, Mother, Brother, Sister, Father-in-law, Mother-in-
law, Grandmother, Grandfather, Grandson, Granddaughter, Uncle, Aunt, Nephew,
PROPOSER- INSURED RELATIONSHIPS
Niece, Employee or any other relationship having an insurable Interest
ALLOWED Family Floater Plan
Self, Spouse, Son, Daughter, Father, Mother, Employee and his/her dependents (
Spouse/children/ Parents) or any other relationship having an insurable interest
KEY TERMS & DEFINITIONS
 BENEFITS
PRE HOSPITALISATION EXPENSES POST HOSPITALISATION EXPENSES

Medical expenses like doctor consultations fee, Medical expenses like doctor consultations fee,
diagnostic or pharmacy that may be required diagnostic or pharmacy that may be required post
before hospitalization are covered under the hospitalization are covered under the following
following conditions. conditions
– Expenses incurred up to 60 Days after date of
– Expenses incurred upto 30 Days prior to date of
discharge .
hospitalization
– All medical expense should be related to disease for
– All medical expense should be related to disease for
which claim has been approved.
which claim has been approved.
 BENEFITS
DAY CARE IN PATIENT CARE
Medical expenses incurred in case of
Growing R&D in healthcare sector, has led to the hospitalization for a minimum period of 24 hrs are
reduction in treatment duration of many ailments . covered.
A treatment that requires Hospitalization for less Expenses like room charges, nursing expenses and
than 24 hours is called a Day Care Procedure
Intensive Care Unit Charges, surgeon's fee,
doctor's fee, anaesthesia, blood, oxygen,
We cover 540+ Day Care Procedures operation theatre charges, etc.

Examples of Day Care procedures are Cataract,

Dialysis, Chemotherapy etc..
 BENEFITS
ROOM RENT CHARGES ICU CHARGES

Cover charges incurred towards room rent We will cover charges incurred towards
charges by Insured member for the ICU charges by Insured member for the
treatment taken by at a hospital treatment taken by you at a hospital
– 1% of SI per day for SI up to Rs.4 Lacs – 2% of SI per day for Sum Insured up to
– Most Economical Single Private Room Rs.4 Lacs
for SI>=5 Lacs – No limit for Sum Insured >=Rs.5 Lakhs
– Option to Upgrade to Next Level for
SI>=15 Lacs
• Option is available if Most Economical
Single Private Room is not available at the
time of admission
• Customer to inform company & seek prior
approval
 BENEFITS
DAILY ALLOWANCE AMBULANCE COVER

A fixed amount is paid for each 24 hours We cover expenses incurred by the Insured
of hospitalization under the following on availing Ambulance services for
condition necessary transportation to the nearest
– Available with policy SI<=4 Lacs Hospital in case of an emergency.
– 24 Hours of hospitalization is required
– The necessity for Ambulance
– Available on reimbursement basis
transportation should be certified by the
– Available for maximum 5 Days in a policy Year
treating Medical Practitioner
 BENEFITS
ORGAN DONOR COVER DOMICILIARY HOSPITALIZATION
Cover medical expenses incurred on donor
for harvesting organ, which will be used in Upto 10% of Sum Insured can be used for
organ transplant surgery of the Insured covering cost of treatment taken by
member Insured Member at home on the advise of
treating Doctor provided
Cover is available under the following – Insured member is not in a situation to be
conditions
moved to a hospital or
– Maximum coverage amount is specified in
Policy Certificate – No Room is available at any of the hospital
– Donor should meet Govt. laws and
– Treatment at home continues for more than 3
regulations
– Donor’s Pre/Post hospitalization medical days
expenses are not covered
– Any amount paid towards donor medical
expenses will reduce the Sum Inured
 BENEFITS
AYUSH BENEFIT MATERNITY COVER
Medical expenses associated with hospitalization
India has a vast AYUSH infrastructure comprising of an insured person for delivery of a child are
of 8 Lakh registered practitioners, 25492 covered under the following conditions
dispensaries & 3601 hospitals – Coverage has a 24 Months Waiting Period
– Available under Family Floater option for all
insured members of age 18 Years or above
In-Patient Hospitalization expenses incurred
– Voluntary termination of pregnancy during first
during AYUSH treatment are covered
12 weeks from the date of conception is not
covered
– Medical expenses towards involuntary
termination of pregnancy are covered
EXCLUSIONS
• Ectopic pregnancy expenses are covered from
basic policy Sum Insured
• Voluntary termination of pregnancy
 BENEFITS
CARE ANYWHERE SECOND OPINION
Covers treatment of 12 specified Critical Illness Covers treatment of 15 specified Critical Illness
anywhere in the world under the following anywhere in the world under the following
conditions conditions
– Available with Sum Insured >=50 Lacs – Available once per year for each specified critical
illness
– Covers In-Patient /Day Care Expenses
List of Specified Critical Illness covered
– Pre/Post Hospitalization expenses are not covered
Benign Brain Tumor/Cancer/End Stage Lung
List of Specified Critical Illness covered Failure/Myocardial Infraction/Coronary Artery Bypass
Benign Brain Tumor/Cancer/Coma/ Coronary Artery Bypass Graft/Heart Valve Replacement/Coma/End Stage Renal
Graft/End Stage Renal Failure/End Stage Lung Disease/End Failure/Stroke/Major Organ Transplant/Paralysis/Motor
Stage Renal Failure/Heart Valve Replacement/Major Neuron Disorder/Multiple Sclerosis/Major Burns/Total
Burns/Major Organ Transplant/Myocardial Blindness
Infraction/Stroke/Total Blindness
 BENEFIT
ANNUAL HEALTH CHECK-UP NO CLAIM BONUS
All Insured members are eligible for annual health Base Policy Sum insured is increased by 10% on
check-up every year under the following Renewal if there is no claim during the previous
policy period subject to following conditions
conditions
– Available from First Year
– No Claim Bonus benefit will not exceed
– Available at company network Labs
50% of Base Policy Sum Insured.
– The increase in Sum Insured under this Bonus
– No Reimbursement will be given if Health Check-
does not increase the sub-limits applicable to
up are taken in a lab other than network labs the policy.
– Pre-defined list of test are covered in the Health – In case of a claim in any policy year, the Sum
Check-up . Insured is reduced by 10% of the expiring policy
sum insured but not lesser than the Sum Insured
applicable in the first policy year.
 NO CLAIM BONUS
ILLUSTRATION

Year 1 Year 2 Year 3 Year 4 Year 5 NCB

10% 10% 10% 10% 10% 50%

Sample Illustration for Policy with 10 Lacs Sum Insured

Year 1 Year 2 Year 3 Year 4 Year 5 NCB

1 Lacs 1 Lacs 1 Lacs 1 Lacs 1 Lacs 5 Lacs
BENEFITS
OPTIONAL COVERS
 OPTIONAL COVER
UNLIMITED AUTOMATIC RECHARGE
Recharge of Sum Insured Unlimited Times
– Recharge amount can be used for future/further claims, not related to the Illness
/ Injury for which the claim has been made during the same Policy year
– Any unutilized Recharge cannot be carried forward to any subsequent Policy Year
– No Claims Bonus and No Claims Bonus Super shall not be considered while
calculating ‘Unlimited Automatic Recharge Amount’
 OPTIONAL COVER
OPD CARE EVERYDAY CARE
Covers expenses related to Doctor Consultation, Covers expenses related to Doctor
Diagnostics and Pharmacy under the following Consultation and Diagnostics under the
conditions following conditions
– Can be claimed on Reimbursement basis – Available on cashless basis
– Doctor Prescription is a must for claiming – Available only on the specially created
Diagnostics and Pharmacy expenses Everyday Network Hospitals
– Claim can be filled maxi. 2 Times in Policy Year – Doctor Consultation coverage will not exceed
Exclusions( Non Exhaustive List) 1% of SI
– Dental treatment like RCT/Teeth Cleaning etc.. – Pharmacy expenses coverage will not exceed
1% of SI
– Cost of Spectacles & Instruments
– 20% Co-payment will be applicable on all
– Food Supplements etc... claims
 OPTIONAL COVER
NO CLAIM BONUS SUPER ( NCB SUPER)
Base Policy Sum insured is increased by 50% on Renewal if there is no claim during the previous policy
period subject to following conditions

– No Claim Bonus SUPER benefit will not exceed 100% of Base Policy Sum Insured .
– The increase in Sum Insured under this Bonus does not increase the sub-limits applicable to the policy.
– In case of a claim in any policy year, the Sum Insured is reduced by 50% of the expiring policy sum
insured but not lesser than the Sum Insured applicable in the first policy year

NCB
Year 1 Year 2
SUPER
50% 50%
100%
NCB+NCB SUPER
ILLUSTRATION