I. Hospitalisation expenses
1. Room, Boarding and Nursing expenses not exceeding 1% of the Sum Insured or actuals whichever is less.
2. ICU not exceeding 2% of the Sum Insured or actual whichever is less.
3. Expenses incurred for Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.
4. Expenses incurred on Anaesthetic, blood, oxygen, Operation theatre charges, surgical appliances, Medicines & drugs, dialysis,chemotherapy, radiotherapy, cost of artificial limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, orthopaedic implants, infra cardiac valve replacements, vascular stents, relevant laboratory/diagnostic tests, x-ray and similar expenses that are medically necessary and hospitalization expenses (excluding cost of organ) incurred for donor in respect of organ transplant to the insured.
If the insured person opts for a room with rent higher than the entitled category, the charges payable above shall be limited to the charges applicable to the entitled category only. However, this will not apply for Medicines & drugs and implants.
Pre-hospitalisation expenses incurred upto 30 days prior to date of admission and Post-hospitalisation expenses incurred upto 60 days from the date of discharge – actual expenses or 10% of the Sum Insured whichever is less.
Expenses for the following illness restricted to –
a. Cataract, Hernia, Hysterectomy – Actual expenses or 25% of SI whichever is less.
b. Major illness/surgeries – Actual expenses or 70% of SI whichever is less.
c. A co-pay on 80:20 basis applicable for all Major illness charged as a total package.
For list of major illness/surgeries, please see the prospectus or policy document.
II. Day Care Treatment
Certain specified Day Care procedures which require less than 24 hours hospitalization.
III. Family discount of 5% on the total premium if policy is taken for self and any one or more family members viz. spouse or dependent children.
IV. Free Look period of 15 days shall be applicable at the inception of the first policy.
V. Free Medical check-up once at the end of every three underwriting years provided no claims reported during the block and subject to policy renewed without any break. The limit applicable is 1% of the average Sum Insured during the preceding three policy periods.
VI. Premium paid for self, spouse, dependent children and dependent parents are exempt from Income Tax under Section 80-D of the IT act as per rules in force.
For detailed terms and conditions, please see our Prospectus and Policy in our website.