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Salient Features (w.e.f 01/11/2009) |
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The Policy can be availed by employers in respect of their employees. Persons in the age group of 3 months to 50 years can be covered under the Policy. Employees can cover their Spuse/dependent children and dependent parents.
In the event of any claim becoming admissible under- this scheme, the company will pay through TPA to the Hospital / Nursing Home or insured person the amount of such expenses as would fall under different heads mentioned below and as are reasonably and necessarily incurred thereof by or on behalf of such insured person.
- Room, Boarding Expenses as provided by the Hospital / nursing home
- Nursing Expenses
- Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees
- Anesthesia, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & brugs, diagnostic Materials and X-ray.
- Dialysis, Chemotherapy. Radiotherapy Cost of Pacemaker, Artificial Limbs & Cost of organs and similar expenses.
- For claims arising out of persons aged more than 35 years, the expenses on following illnesses would be limited to :
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| Hospitalion |
Limits restricted to |
| Cataract |
Actual Expenses or 25% of SI whichever is less. |
| Hernia |
Actual Expenses or 25% of SI whichever is less. |
| Hysterectomy |
Actual Expenses or 25% of SI whichever is less. |
| Major surgery * |
Actual Expenses or 70% of SI whichever is less. |
| Pre c& Post Hospitalization |
Maximum 10% of the sum insured |
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* Major surgeries include cardiac surgeries, brain tumur surgeries, pace maker implantation for sick sinus syndrome, cancer surgeries, kidney transplant andrenal surgeries, hip, knee, joint replacement surgeries.
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G. In addition to the above, the following would apply to claims arising out
of persons aged more than 60 years |
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| EXPENSES ON MAJOR ILLNESSES CHARGED AS TOTAL PACKAGE |
TO BE SETTLED WITH A CO-PAY ON 80:20 BASIS |
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H. |
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| ROOM BOARDING & NURSING EXPENSES |
Restricted to 1% of the sum insured per days or the actual amount whichever is less. This also includes nursing care, RMO Charges, IV Fluids/Blood transfusion/injection administration charges and similar expenses. |
| ICU Expenses |
Restricted to 2% of sun insured per days of the actual amount whichever is less. |
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I. Other Benifits. |
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| Free Health Check-up |
Thorugh TPA expiry of 3 Claims free Years-cost of Health Check up not exceeding 1% of average. Sum Insured for preceding 3 Yrs. |
| No Claim Discount/Bonus |
If it is Renewal. The insured shall be entitled for NCD 5% of premium for every claim free Years(Begining from 16-11-2009) subject to Maximum of 25% of premium 1st Year-5% ♦2nd Year-10% ♦3rd Year-15%♦ 4th Year-20% ♦5th Year-25% |
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(N.B: Company’s Liability in respect of all claims admitted during the period of insurance shall not exceed the Sum Insured per person as mentioned in the schedule) |
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