Details of medical insurance for the year 2019

These details are only indicative and exact wording and terms will be as per the insurance company document. The following is given for broad understanding of members.

COVERAGE DETAILS 

Family Definition 1+5 (Self + Spouse/ Partner + Dependent Children +2 Dependent Parents/ Parent-in-laws); Option to cover either of 2 Parents or Parent-in-laws i.e. family definition will not exceed 1+5 with maximum 2 parents. Child coverage applicable for maximum 4 children. Only dependent and unmarried children up to the age of 30 years can be covered under this policy. Rests of the members are covered up to the age of 90 years. 

Sum Insured Rs. 10 lacs per family on floater basis

Room Rent Room rent  NO restriction and no limit for ICU per day. All other charges in accordance with the Room Rent restriction.

30 days waiting period is Waived off

1st, 2nd ,3^rd & 4th Year waiting period is Waived off

Age Limit is Waived off

Maternity: Sub Limit on Normal Delivery & C ’Section Delivery INR70,000 applicable for first two children only

Pre & Post Natal expenses expenses will be covered in case of hospitalisation only, within maternity limit. Full policy sum insure shall apply in case of post –natal expenses. 9 month waiting period for maternity applicable for new joiners/New Enrolment in the policy. New born Baby Cover Covered within Family Floater Sum Insured from Day 1on adding the new born. There should not be any additional premium for the new born baby.

Pre-existing Disease covered for all Members without waiting period

Pre & Post Hospitalisation period 30 and 60 days

Domiciliary Hospitalisation Excluded 

Emergency Ambulance charges or Air fare Emergency ambulance charges for air fare restricted to maximum of Rs 10,000 in case of emergency. Air ambulance charges restricted to max Rs 2 lacs. This cover stretcher cases where Air ambulance is not available but commercial air services are available to transport the patient for a life-threatening conditions.

Surgical Treatments for external congenital conditions, which are necessary for survival, are covered under the policy.

20% Co-pay is applicable on each and every claim of parents/ Parent-in-laws &

10% Co-pay is applicable on each and every claim of member pilot, spouse and kids. Co-pay shall not be applicable on capped ailments.

Sub Limit or Capping on any ailment Cataract:  Rs. 30,000/- per eye

Cochlear Implant treatment Restricted to 40% of Sum Insured 

Cyber Knife treatment and stem cell transplantation Covered with 40% Co-pay 

Corporate Buffer Corporate buffer of Rs. 10,00,000/- (Ten Lakhs) with a sub limit of Rs.10,00,000/- per family. Buffer should be availed for all family members without any event restriction and not applicable for capped ailments.

Day Care procedures are covered as per Insurer standard coverage list 

Terrorism Related Hospitalisation is covered

Premium Calculation Pro-Rata basis

Oral chemotherapy Covered for all members

Claim Intimation As per insurer standard terms

Reimbursement claims reporting / submitting period As per insurer standard terms

Waiting Period for any ailment for  new enrollments 3 months 

Special conditions Laparoscopy, Neuro surgery and Prostate Cancer treatment will be payable under the policy without any capping

For new  members/ dependents enrolling policy commencement, following conditions are applicable from the date of joining the policy;

9 months waiting period for maternity

Reduction in sum insured is not allowed for members who have claimed in last year policy. Policy shall be null and void if found by the insurer 

Deletion or replacement of a family members is allowed only in case of demises/ divorce and necessary proof will have to be furnished for the same