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Step 1 – the policyholder chooses the Sum Assured, the policy term and the members covered.
Step 2 – the policyholder can also choose any additional coverage from 5 optional benefits. Critical Illness Rider can also be added by paying an additional premium.
Step 3- If the covered member (s) face any medical contingency and the related expenses are covered by the plan the expenses incurred are paid by the plan.
Step 4 – if the plan matures and no medical contingencies occur, no benefit is paid.
Karim, a non-smoking male aged 35 years, buys the plan for himself for a Sum Assured of Rs.10 lakhs.
Option 1 – Karim suffers an accident and is hospitalized. His total hospital bill comes to Rs.7.5 lakhs. Since the bills are within the Sum Insured, the entire clam is paid by the policy. However, if the medical bills had exceeded Rs.10 lakhs, the company would pay only Rs.10 lakhs.
Option 2 – if the plan matures and Karim doesn’t suffer any medical emergency, no benefit is paid.
|Day care treatments||Covered up to the Sum Insured|
|Post hospitalization||180 days|
|Domiciliary hospitalization||Covered up to the Sum Insured|
|Organ donor expenses||Covered up to the Sum Insured|
|Ambulance cover||Up to Rs.3000 per hospitalization|
|Worldwide Emergency Cover||Covered up to the Sum Insured|
|Health Maintenance Benefits (OPD expenses)||Covered up to Rs.2000|
|Maternity expenses||Normal delivery– lower of actual expenses or Rs.15,000
Cesarean delivery – lower of actual expenses or Rs.25,000
|New born baby cover||Covered up to the maternity benefit limit|
|First year vaccinations||Available|
|Restoration of Sum Assured||Covered once in a policy year|
|Health check-ups||1 check-up annually for adults aged 18 years and above|
|Expert Opinion on Critical Illness||Covered|
|Healthy Rewards||1% of premium paid|
|Age at entry (in completed years)||Policyholder and adults - 18 years
Dependent children – 91 days
|Term of the plan||1 year||3 years|
|Premium paying options||Single pay|
|Sum Assured||Rs.4.5 lakhs||Rs.10 lakhs|
Illnesses suffered during the first 30 days of the plan commencement are not covered.
Critical Illnesses suffered during the first 90 days of the plan commencement are not covered.
Pre-existing illnesses or conditions and maternity related expenses are not covered by the plan in the first 4 years of the policy
Specific illnesses are not covered in the first two years of the plan.
Illnesses or accidents caused due to genetic disorder or stem cell surgery, substance abuse, participation in adventure sports or hazardous activities, criminal acts, attempted suicide, war and hazardous substances, etc. are not covered.
Treatments like dental treatments, cosmetic treatments, artificial life support, weight loss treatments, non-allopathic treatments or due to HIV/AIDS, etc. are not covered.
Below are the sample rates of premium payable by a non-smoking male for different combinations of age and Sum Insured. The policy is taken for 1 year.