5 CHI
5 CHI
Medical Examination is compulsory for persons more than 50 yrs at entry level, with
recent 2 colour photographs.
Medicals In respect of persons, less than 50 yrs, but with the self declared PED, such proposals
shall be referred to Zonal Doctors for their opinion and their remarks shall be
incorporated in the policy.
Age Proof Age Proof is compulsory for more than 45 yrs.
15 days with refund of Premium, (after deducting Cost of Medical expenses where ever it
Free look Period
is applicable) on Prorata Basis.
Exclusions (3 Time Bound & 18 Permanent Exclusions for Section 1 to 6 and 16
Permanent Exclusions)
Any Disease Contracted 1) 1st 30 days (Accidents Exempted ).
2) First two years, including Congenital Internal Defects / Diseases (24 procedures /
Certain Procedures / Diseases
diseases, if these are Existing while Proposing, then covered after 48 months).
Pre Existing Diseases (PED) 3) 48 months
Allowable Expenses
Non- allopathic Treatment No Provision
Pre Hospitalisations 30 Days Prior to hospitalization.
Post Hospitalisations 60 days after discharge from the hospital
Road Ambulance:
For 5 lakhs Sum Insured - 2k
For 7.5 lakhs Sum Insured - 3k
For 10 lakhs Sum Insured - 3.5k
For 15 lakhs Sum Insured - 4k
Ambulance
For 20 lakhs Sum Insured - 4.5k
For 25 lakhs Sum Insured - 5k
Air Ambulance:
Available for Sum Insured of 7.5 lakhs and above
For 7.5 lakhs Sum Insured & above- 10% of the Basic Sum Insured
Day care Procedures and Limit to Cataract 405 Day Care Procedures with no sub limits
Other excluded expenses 203 Items as per Printed Policy Clause.
100% of Basic Sum Insured without any Extra Premium on exhaustion of Basic Sum
Automatic Restoration of Sum Insured
insured and including Cumulative bonus (if any).
Package Treatments No Restrictions on Package Charges
Room Rent (Incl. of Boarding & Nursing Expenses
Single A/C Room (Actuals)
on Per Day Basis)
ICU
Doctor's Fee Actuals (Subject to insured being admitted into the ward of his / her eligibility only).
Medicine Charges
For Sum Insured of 5 lakhs
Increase in Sum Insured by 50% in first year, subject to maximum of 100%
In the event of Claim - Bonus will be reduced by 50% in the following year and if there is
No Claim Bonus for Every Claim Free Year a claim in succeeding year also the bonus will become zero
For Sum Insured of 7.5 Lakhs & Above
Increase in Sum Insured by 100% in first year, subject to maximum of 100%
In the event of Claim - Bonus will be reduced by 100% in the following year
Expenses of Delivery and New Born Baby is available depending upon Basic Sum
Insured with a waiting period of 36 months from the inception of the policy.
Normal Section - For 5 Lakhs Sum Insured Rs 10K, For 7.5 Lakhs Sum Insured 20K &
For 10 Lakhs Sum Insured & above Rs 25K
Caesarean Section - For 5 Lakhs Sum Insured Rs 15K, For 7.5 Lakhs Sum Insured &
Sec- 2 Delivery & New Born Baby Cover
above 40K
New Born Baby Coverage - For 5 Lakhs Sum Insured- Rs.50,000 & 7.5 Lakhs Sum
Insured & above - Rs.1,00,000
Vaccination Expenses is available up to Rs.1,000 under New Born Baby Coverage
Continuous renewal of the policy, for every block of 3 years, Out Patient Dental &
Ophthalmic treatment is available depending upon the Basic Sum Insured
Sec- 3 O.P. Dental & Ophthalmic
For 5 Lakhs Sum Insured & 7.5 Lakhs - 5K
For 10 Lakhs & above - 10 K
Under Section I, Hospital Cash Benefit is available for each completed day of
hospitalisation based on the Basic Sum Insured, subject to maximum of 7 days per
hospitalisation and up to maximum of 120 days per policy period. This benefit subject to
an excess of first 24 hrs hospitalisation for each and each every claim
Section - 4 Hospital Cash
For 5 Lakhs Sum Insured - Rs.500/- Per Day
For 7.5 & 10 Lakhs Sum Insured - Rs.750/- per day ,
For 15 & 20 Lakhs Sum Insured- Rs.1000/- per day,
For 25 Lakhs Sum Insured - Rs.1500/- per day
For every block of 3 claim free years, Health Check-Up is available depending upon the
Basic Sum Insured
Sec- 5 Health Check-up For 5 lakhs Sum Insured - 5k
For 7.5 & 10 Lakhs Sum Insured - 7.5K
For 15 Lakhs, 20 Lakhs & 25lacs Sum Insured - 12K
Benefit is available with a waiting period of 36 months from the inception of the policy
and with the opinion of two qualified surgeons and with a prior approval from the
company under Cashless benefit only.
The minimum age of the insured at the time of surgery should be above 18 years.
BMI should be more than 40 or above 35 with co-morbidities (like Diabetes and
Sec - 6 Bariatric Surgery
Hypertension) and insured is unable to lose weight through traditional methods like Diet
and Exercises
The maximum limit for the surgery is Rs.250,000 inclusive of Pre & Post Hospitalisation
The limit of coverage is subject to part of the sum insured under Sec. I
Cover is available for the proposer or one insured opted by the proposer, other than
Sec- 7 Accident Death and Permanent Total dependent children and persons more than 70 yrs.
Disablement 100% Death and Permanent Total Disability
Coverage of the benefit is equal or identical to the Sum insured under Sec. I
This should be specifically requested for by the Insured Person
This opinion is given without examining the patient, based only on the medical records
submitted
The second opinion should be only for medical reasons and not for medico-legal
Sec- 8 Option for Second Medical Opinion
purposes
Any liability due to any errors or omission or consequences of any action taken in
reliance of the second opinion provided by the Medical Practitioner is outside the scope
of the policy
Utilizing this facility alone will not amount to making a claim & will not affect NCB
Special Features:
Benefit is available for expenses on medical consultation as an Out Patient incurred in a
Out Patient Medical Consultation
Network Hospital other than Sec.3 up to the limit of Rs.300 per consultation
Benefit is available for a period exceeding 3 days and 10 days for Pyrexia of Unknown
Origin (fever of unknown origin)
Domiciliary Hospitalisation Treatment 1. The condition of the patient is such that he/she is not in a condition to be removed to
a Hospital, or
2. The patient takes treatment at home on account of non-availability of room in a
hospital.
Portability This policy is portable.
Premium Paid by any mode other than cash is eligible for relief under section - 80D of
80 D Benefit
the IT Act.