Cholamandalam MS Health Individual Healthline Plan Review

Main Highlight of the plan

This plan is available in 3 variants namely Standard, Superior and Advanced.
The plan offers benefits like no-claim bonus, pre and post hospitalization expenses, health and eye check-up benefit, etc.

Scope of cover

Plan	Entry Age	Maximum Number of Members	Sum Insured Range
Standard	Children- 3 months to 26 years Adults- 18 years to 65 years	Members- 7 Maximum Adults – 6 Maximum Children-6	INR 3,00,000 to INR 5,00,000
Superior	Children- 3 months to 26 years Adults- 18 years to 65 years	Members- 7 Maximum Adults – 6 Maximum Children-6	INR 3,50,000 to INR 5,50,000
Advanced	Children- 3 months to 26 years Adults- 18 years to 65 years	Members- 7 Maximum Adults – 6 Maximum Children-6	INR 4,50,000 to INR 10,00,000

Coverage: Benefits & Features

Most Important

ROOM RENT/ ROOM CATEGORY

This plan has limit to cover room expenses is as follows-

For Standard Plan and Superior Plan, Single A/C room up to rent INR 3000 per day is covered.
For Advanced Plan, Single A/C room having rent up to INR 3000 per day for sum insured 4,50,000 and 5,50,000 is covered. However, for the rent for ICU rooms up to maximum of 1% sum insured per day for INR 7,50,000 and INR 10,00,000 is covered.

CO-PAYMENT

This plan has an option to opt for 10% co-pay. This co-pay would not be applicable in case of treatments which already has a co-pay option e.g. outpatient benefits, alternative treatments, etc.

Age based co-pay of 20% is applicable for all individuals above 70 years of age.

NO-CLAIM BENEFITS

All the variants of this plan have no-claim bonus equal to 5% of basic sum insured up to a maximum of 50 % for each unclaimed year. However, the cumulative bonus is reduced by 5% of sum insured once a claim is made.

Note: After any claim, only the cumulative bonus would be reduced at the time of renewal. However, the basic sum insured will not be affected.

Good to have

PRE/POST HOSPITALIZATION

60 days of pre-hospitalization and 90 days of post hospitalization are provided in this plan.

RESTORE BENEFITS

This plan does not offer restore benefit.

HEALTH CHECK-UP

This plan offers health and eye check-up benefit after every two claim free years as follows-

0.5% of the sum insured for Standard Plan.
0.75% of the sum insured for Superior Plan.
1% of the sum insured for the Advanced Plan.

Value Adds

AMBULANCE CHARGES

This plan covers ambulance charges equal to-

INR 1,000 for Standard Plan.
INR 2,000 for Superior Plan.
INR 3,000 for Advanced Plan.

EYE COVER

The Advanced variation of this plan covers eye expenses as mentioned in outpatient benefits.

DOMICILIARY HOSPITALIZATION

The Superior plan covers domiciliary hospitalization equal to 15% of sum insured up to a maximum of INR 70,000.

The Advanced plan covers domiciliary hospitalization equal to 25% of sum insured up to a maximum of INR 1,00,000.

OUTPATIENT BENEFITS

The Advanced variation of this plan covers cost for spectacles, hearing aid and contact lenses equal to 1% of sum insured up to INR 5,000 with 30% co-pay.

This plan covers out-patient expenses for dental treatment as given in dental cover column.

CRITICAL ILLNESS COVERAGE

This plan does not have additional cover for critical illnesses.

ALTERNATIVE PRACTICE

The Advanced variation of this plan offers coverage for in-patient Ayurvedic treatment up to 7.5% of sum insured for some specified illnesses. However, a co-pay of 20% is applicable.

Note: Any treatment by above mentioned practice should be from a government hospital, hospital or an institute recognized by government or accredited by Quality Council of India/ National Accreditation board on health.

DENTAL COVER

The Advanced plan covers dental expenses up to 1% of sum insured up to a maximum of INR 5000.

Note: A waiting period of 3 years and a co-pay of 30% are applicable in this plan.

DAILY CASH

All the variants of this plan have daily cash benefit after choosing shared accommodation as follows: The Standard Plan provides daily cash allowance of INR 250 per day for maximum of 7 days with 1 day deductible.

The Superior Plan provides daily cash allowance of INR 500 per day for insured and of INR 250 per day for accompanying a minor insured for a maximum of 7 days with 1 day deductible.
The Advanced Plan provides daily cash allowance of INR 500 per day for insured and of INR 250 per day for accompanying a minor insured for a maximum of 14 days with 1 day deductible.

ORGAN DONOR COVER

This plan offers coverage for organ donor up to sum insured during organ transplantation.

CONVALESCENCE BENEFIT

This plan does not have any convalescence benefit.

MATERNITY COVER

The Superior and Advanced variation of this plan covers maternity expenses after a waiting period of 5 years.

The Superior Plan covers normal delivery up to INR 15,000 and Caesarean delivery up to INR 25,000.
The Advanced Plan covers normal delivery up to INR 25,000 and Caesarean delivery up to INR 40,000.

Exclusions

A cooling off period of 30 days is applicable on buying a policy for the first year. No claims (other than claims related to an accident) can be made in this cooling off period. There is no cooling off period applicable on renewal of this health insurance policy.

Waiting period of 1 year or 2 years is applicable for specified ailments. Refer to the policy wordings for the list of these specified ailments.
Note: Sub-limits are applicable for treatment of specified illnesses under the Standard and Superior plan. The Advanced plan has no sub-limits.

Waiting period of 4 years is applicable for pre-existing diseases.

PERMANENT EXCLUSIONS

Cosmetic surgery, Lasik eye treatments, drugs or alcohol abuse, genetic disorders, self inflicted injuries, war related injuries, etc are some of the permanent exclusions. For the detailed list of please refer the Cholamandalam MS Health Insurance policy document.