Writeup on Medi Classic Insurance Policy (Individual w.e.f. 1.4.

2013)
Unique ID # IRDA/NL-HLT/SHAI/P-H/V.II/400/13-14
Hospitalisation Expenses incurred as in-patient for Sickness / Disease / Illness and
Coverage
Accidental Injuries for a minimum period of 24 hrs.
Type of Cover Individuals.
Entry Age 5 months to 65 yrs.
Renewals Life Time.
If the policyholder / insured person is beyond 60 yrs at entry level, then he / she will have
Co-pay to bear 10% of admissible claim amount for each and every claim and renewals
thereafter.
Sum Insured Options in Lakhs 1.5 / 2 / 3 / 4 / 5 / 10 & 15 Lakhs.
One year and Two years option with 30 days, Grace Period to renew the policy. (Renewal
Policy Period & Grace Period during Grace Period - Declaration of Good Health is required). For 2years option, 5 %
discount on premium is allowed.
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 Aadhar & PAN is mandatory, irrespective of the age of primary insured at entry level
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 & 19 Permanent Exclusions)
Any Disease Contracted 1) 1st 30 days (Accidents Exempted ).
2) First two years, including Congenital Internal Defects / Diseases (32 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 (Other than 24 hrs. hospitalization under Non Allopathic treatment - covered up to Rs.25,000/- per Policy
Naturopathy) Period irrespective of Sum Insured.
Pre - Hospitalizations 30 Days Prior to hospitalization.
60 days from the date of discharge. Amount will not exceed 7% of Hospital Bill (Minus
Post - Hospitalizations
Room Rent) or Max of Rs.5000/- Per hospitalization.
Ambulance 750 Per Occurrence / 1500 Policy Year.
101 Day Care Procedures, 100 Day Care Procedures with no sub limits
Day care Procedures and Limit to
For 2 lakhs - 12k both eyes.
Cataract
For 3 / 4 / 5 Lakhs - 20k (1eye) & 30k (2eyes).
For 10 / 15 Lakhs - 30k (1eye) & 40k (2eyes).
Other excluded expenses 203 Items as per Printed Policy Clause.
200% 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 Company's liability in respect of package charges restricted to 80% of such amount.
Room Rent (Incl. of Boarding & Nursing
Upto 2% of Basic Sum Insured subject to Max. of Rs.5000 per day.
Expenses on Per Day Basis)
ICU
Doctor's Fee Actuals (Subject to insured being admitted into the ward of his / her eligibility only).
Medicine Charges
Increase in Sum Insured by 5% every year, subject to maximum of 25%
No Claim Bonus for Every Claim Free Year
In the event of Claim - Bonus will be reduced by 5%.
Upto 1% of Average Sum Insured for every block of 4 claim free yrs, subject to Max of Rs.
Cost of Health Check Up 5000 is payable.
This benefit is available for policies with Sum insured of Rs. 2 Lakhs & above only.
Extra Benefits with additional Premium
Extra Premium 350 + ST of 15% = Rs.403/-
Hospital Cash - Optional Cover - With Cash Benefit of Rs.1000/- for each completed day of hospitalisation, subject to
Extra Premium (5 Months to 65 yrs) Max. of 7 days per hospitalization and upto Max. of 14 days per policy period, excluding
Date of Admission & Date of Discharge.
Extra Premium 580 + ST of 15% = Rs.667/-
Benefit is available with an additional premium, for engaging one attendant immediately
after discharge from the hospital and recommended by the attending physician for a
Patient Care - Optional Cover (for
admissible claim
insured above 60 yrs of age)
Benefit - Payable Rs.400/- per day. Excluding first day, 5 days per hospitalisation and
maximum 14 days per policy period.
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.