Policy is designed to provide reimbursement of medical expenses incurred within geographical limits of India by the insured person in event of being hospitalised on account of any illness/disease or any injury sustained.
Short period policies are prohibited.
Scope of Cover: Reimbursement of incurred medical expenses, within defined limits, in event of any illness/disease or any accidental bodily injury, at any clinic, hospital and/or Nursing Home as either indoor patient or in the event of Domiciliary Hositalisation as defined in the policy.
A maximum liability thereof would be as laid down under each category, subject to it being necessarily and reasonably incurred.
Definitions:
Hospital/Nursing Home means an institution procedure to correct defect /deformities or repair injuries, diagnosis/cure of disease or provide relief for suffering and prolongation of life.
Domiciliary Hospitalisation means medical treatment provided to the insured patient at his/her home for such illness/disease/injury which in normal course would need hospitalization. This treatment must be taken for a period exceeding three days and the patient must be confined at home due to any of the following circumstances.
Patient’s condition does not permit removal to hospital/nursing home.
Lack of accommodation available at hospital/nursing home.
Patient’s preference for confinement at home and is duly certified/ approved by the attending doctor.
This domiciliary hospitalization does not cover:
Any expenses incurred for pre/post hospitalization.
Any expense related to following ailments/diseases
1)Asthama; (2) Bronchitis; (3) Chronic Nephritis/ Nephrotic Syndrome; (4) Diarrhoea/Dysentry/Gastroenteritis (5) Diabetes Mellitus/Insipidus (6) Epilepsy (7) Hypertension (8) Influenza, Cough & Cold (9) Psychiatric/Psychosomatic disorder (10) Pyrexia of unknown origin – viral fever for less than 10 days. (11) Tonsilitis, Upper Respiratory Tract Infection, Laryngitis, Pharngitis (12) Arthritis, Gout, Rheumatism.
In case of patient certain treatment (like Dialysis, Chemotherapy, Radiotherapy) at the hospital and is discharged on the sam day, these expenses would fall under hospitalization benefits.
One illness would mean continuous period of illness including relapse within 45 days and last date of consultation of treating Medical Practitioner/Hospital. After lapse of 45 days illness will be treated as fresh illness.
The policy also defines Medical Practitioner and Qualified Nurse.
Age Limit: This insurance is available to persons between the age group of 5 to 70 years.
Children between the age group of 3 months to 5 years can be covered provided one of his parents are covered concurrently.
Case of individuals above 70 years benefits stand reduced by 10% between age group of 70 years and by 20% above 75 years of age.
Case of fresh proposal above the age of 70 years Medical Examination and Investigation tests (like ECG/Blood/Urine strip test) are a must, cost for which will have to be borne by the proposer.