Summary of Health Insurance Plans

The common features for comfort of a health insurance plan:-

1. 24 hour hospitalization is min required for cashless facility

2. day care treatment- covers 541 diseases (no 24 Hr hospitalization required )

3. room rent – general ward, twin suite, single private, deluxe etc

4. I C U rent- no capping

5. doctor/nursing fee- no limit

6. HOME HOSPITALIZATION /domiciliary treatment – 10%

7 . pre- hospitalization care – 30 days

8. post hospitalization care – 60 days

9 . Organ donor’s medical expenses will be covered

10 . ambulance cover

11 . restoration facility – For sum insured of Rs.3 lakh and above, there is 100% automatic restoration of the sum insured (SI) in case the original is exhausted.

12 . free health check up coupons

13 . The policy provides for one medical second opinion for each major illness diagnosed in one policy period

14 . cumulative/ no claim bonus

15. individual / floater option for family

16 . group policy for corporate

17. pregnancy (it is natural phenomenon and not a disease)

18 . Vaccination of children up to the age of 12 years will be covered up to Rs. 1,000

19. Allopathic and non allopathic- Ayurvedic , homeopathic , Unani and Sidha treatments will also be covered

20. hospitalization cash-For staying in hospital for more than 3 days, some minor expenses are provided on daily basis (if you are employed/ salaried, you get daily allowance)

21. OPD

22. Critical Illness

23. Cashless Facility

24. Tax Benefit Under Sec 80D

25. new born child

26. helicopter facility / Emergency Air Ambulance

27. Multi Year Policy Availability -1,2,3 yrs (Advance premium upto 3 years)

28. Cashless facility in more than 6000 hospitals

29. No medical test required upto age 75 starting from Rs 3 lac SI

30. Option to avail PA (Personal Accidental Policy) along with health insurance in a single policy

31 RECHARGE BENEFIT – It would get activated even when the entire sum insured is not exhausted, and the claim is raised for the same illness. This benefit is applicable for sum insured in the range of Rs.3 lakh and Rs.5 lakh. The recharge amount is in the range of 15% to 30% of sum insured depending on the zone and sum insured opted. Note: Both the restore and recharge can be used up for the same hospitalization.

32 PORTABILITY –
If you want to transfer the policy to another insurer, the plan allows you to do so without losing your accrued benefits after the waiting periods.

33 SUM ASSURED ENHANCEMENT- You can apply for the sum increase at the time of renewal. However, there should not be any claim made on the policy for considering the request.

34 FREE LOOK PERIOD – For any reason, should you decide not to proceed with the policy, you can return the same and request for a refund within 15 days from the date of receipt of the policy document.

Discounts

10% discount on premiums of family members are covered under this policy
10% discount if the insured and the spouse are between 18 years and 25 years old
5% discount on the premiums if the policy is bought online

Co-payment

20% of the claim depending on age and insurer

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

Common Features :-

1 ..accidental cover from day 1 – A 30 days cooling off period for all claims except any arising out of accidental injuries. (cooling off period)

2.. 30days waiting in general

3 ..2yr exclusion for cataract, piles, hernia, kidney stone etc

Arthritis , Osteoarthritis , Osteoporosis , Spinal Disorders, Joint replacement surgery
ENT Disorders & surgeries, Deviation, Sinusitis and related disorders
Cataract
Dilation and Curettage
Piles, Gastric Ulcers
All types of Hernia , Hydrocele
Internal tumors, Skin Tumors , cysts
Kidney Stone , Gall Blader Stone

4.. pre-existing dieases- 4yr waiting

5 … different age slabs have different premiums – so go for 3 yr combo instead of just 1 yr and get discounts

Exclusions :-

1 HIV AIDS

2 cosmetic or dental surgery

3 over dose of alcohol, tobacco, drugs

4 drink & drive

5 treatment of non MBBS doctor

6 riots & war

7 by birth problem

8 non consumable items

What is not covered

All treatments within the first 30 days of cover except any accidental injury.
Expenses arising from HIV or AIDS and related diseases.
Congenital diseases, cosmetic surgery and weight control treatments.
Abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol.
Hospitalization due to war or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind.
Pregnancy, dental treatment, external aids and appliances.
Items of personal comfort and convenience.
Experimental, investigative and unproven treatment devices and pharmacological regimens.

Please refer to the Policy Wording for the complete list of exclusions.

Permanent Exclusions

Intentional self-injury
Mental illness
Cosmetic, aesthetic treatment
Dental surgery
AIDS
Pregnancy, childbirth, miscarriage, and abortion
Congenital disease
Infertility and in vitro fertilization.
Hospitalization out of war, riot, strike and nuclear weapons
Any condition directly or indirectly caused or associated with any sexually transmitted disease
AIDS
Any Treatment arising from or traceable to pregnancy, miscarriage, maternity, abortion or complications of any of these.
Any Dental treatment or surgery unless necessitated due to an injury
Charges incurred in connection with cost of spectacles or contact lenses, routine eye and ear examinations
Any treatment related to sleep disorder etc
Treatment of mental illness, stress , psychiatric or psychological disorders
Any Treatment/surgery for change of sex or gender reassignments including any complication arising out of these treatments
All preventive care, vaccination, including inoculation and immunizations
Treatment received outside India (unless its part of the policy)
Act of self destruction or self inflicted injury , attempted suicide
Any Hospitalization primarily for investigation or diagnosis purpose
Cosmetic and aesthetic treatments

Comply T & C by Govt of India, State Govts, UTS, SEBI, AMFI , RBI, NHB, IRDA, RERA and other authorities. Provide copy of AMFI, NISM, EUIN, IRDA, RERA and other relevant certificates.