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.
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.
Ram, a non-smoking male aged 40 years, buys the plan for himself and his wife for a Sum Assured of Rs.5 lakhs.
Option 1 – Ram suffers from Appendicitis and is hospitalized. His total hospital bill comes to Rs.1.5 lakhs which is paid by the policy.
Option 2 – If the plan matures and Ram or his wife doesn’t suffer any medical emergency, no benefit is paid.
|Day care treatments||141 treatments are covered|
|Pre-hospitalization||30 or 60 days|
|Post hospitalization||60 or 90 days|
|Domiciliary hospitalization||Covered if treatment exceeds 3 days|
|Organ donor expenses||Covered|
|Ambulance cover||Lower of 1% of the Sum Insured or Rs.2000|
|Accidental dental treatments||Up to 100% of hospitalization Sum Insured|
|AYUSH coverage||Covered up to Sum Insured|
|Daily cash for accompanying a minor child||Rs.300/day up to a maximum of Rs.9000|
|Vaccination expenses for post-bite treatments||Up to 100% of hospitalization Sum Insured|
|OPD cover for OPD consultations, diagnostic tests, dental treatments, spectacles, contact lenses, hearing aids, etc.||Lower of 1% of Sum Insured or actual expense up to a maximum of Rs.5000|
|Convalescence benefit||Rs.10,000/member if hospitalization exceeds 10 days|
|Maternity expenses||Normal delivery– lower of actual expenses or Rs.15,000
Cesarean delivery – lower of actual expenses or Rs.25,000 which also includes pre and post-natal expenses of Rs.2000
|New born baby cover||Up to basic Sum Insured till the completion of plan tenure of till the child attains 91 days whichever is earlier|
|Restoration of Sum Assured||Covered as an additional benefit|
|Health check-ups||1 coupon every claim-free year. For family floater 2 coupons are allowed every claim-free year.|
|Value Added Benefits:
|Age at entry (in completed years)||Policyholder and adults - 18 years
Dependent children – 91 days
Dependent children in family floater – 1 day
|Term of the plan||1 year||3 years|
|Premium paying options||Single pay|
|Sum Assured||Rs.3 lakhs||Rs.5 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, OPD coverage and maternity related expenses are not covered by the plan in the first 3 years of the policy
Specific illnesses are not covered in the first year of the plan.
Illnesses or accidents caused due to 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, 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 members covered. The Sum Assured is chosen to be Rs.5 lakhs and the policy is taken for 1 year.
A maximum of 4 children can be covered under the plan.What is the coverage tenure for pre and post hospitalization expenses?
Pre and post hospitalization expenses are covered for 30 days and 60 days respectively. If, however, the insurance company is informed 5 days before hospitalization, the coverage for pre and post hospitalization expenses increase to 60 days and 90 days respectively.When is the cover for accompanying child paid?
If the minor child is aged below 12 years and hospitalization has been beyond 3 days, accompanying child allowance is paid.Is there a grace period?
Yes, a grace period of 30 days is allowed to renew the plan by paying the due premiums.Does the plan cover treatments taken when travelling abroad?
No, treatments taken in India are only covered by the plan.