Main Highlight of the plan
- This policy offers basic coverage without any co-pay for all the individuals in the family.
- This policy has two options of sum insured available.
Scope of cover
|
Plan |
Entry Age |
Sum Insured Range |
|
Individual coverage |
Children 3 months to 18
years Adults 18 years to 60
years |
INR
50,000 and INR 75,000 |
Note: Pre-policy health check-up is required above age 45 years and for individuals having adverse medical history irrespective of age.
Coverage: Benefits & Features
Most Important
ROOM RENT/ ROOM CATEGORY
This plan does have limits for coverage of room expenses.
- For normal hospitalization, treatment in general ward of hospital or day care center up to INR 450 per day.
CO-PAYMENT
This plan does not have any co-pay.
NO-CLAIM BENEFITS
This plan offers no-claim bonus equal to 5% of basic sum insured up to a maximum of 30 % is available 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.
SUB-LIMITS
This plan has sub-limits applicable for some specific illnesses and surgeries. Please refer the policy wording for the list of these illnesses.
- After the waiting period of 2 years, diabetes and hyper tension are covered under specified sub-limits. Please refer the policy wording for the sub-limits applicable.
Good to have
PRE/POST HOSPITALIZATION
30 days of pre-hospitalization and 60 days of post hospitalization up to a maximum of 10% of hospitalization expense are provided in this plan.
RESTORE BENEFITS
This plan does not offer restore benefit.
HEALTH CHECK-UP
This plan offers health check-up benefit up to 1% of sum insured every 4 claim free years.
Value Adds
AMBULANCE CHARGES
This plan provides coverage for ambulance expense up to INR 1000 per hospitalization.
EYE COVER
This plan does not cover expenses for eye treatments.
DOMICILIARY HOSPITALIZATION
This plan does not offer coverage for domiciliary expenses.
OUTPATIENT BENEFITS
This plan does not cover out-patient treatment expenses.
CRITICAL ILLNESS COVERAGE
This plan does not offer additional coverage in case of critical illnesses.
ALTERNATIVE PRACTICE
This plan covers non-allopathic treatments (Ayurvedic, Unani and Homeopathic treatments) up to 25% of sum insured.
- Note: The above mentioned non-allopathic treatments should be with government hospital, hospital or institute recognized by government or accredited by Quality Council of India/ National Accreditation board on health.
DENTAL COVER
This plan does not cover expenses on dental treatments.
DAILY CASH
This plan does not offer daily cash allowance.
ORGAN DONOR COVER
This plan offers coverage for medical expenses up to sum insured, on harvesting organ for the insured or for the donor and for transplantation.
CONVALESCENCE BENEFIT
This plan does not have any convalescence benefit.
MATERNITY COVER
This plan does not cover maternity expenses.
Exclusions
A cooling off period of 30 days is applicable on buying heath insurance 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 policy.
Waiting period of 2 years is applicable for specified ailments while that of 4 years for treatments like joint replacement, osteoarthritis, etc. Refer to the policy wordings for the list of these specified ailments.
Waiting period of 4 years is applicable in case of pre-existing illnesses.
Waiting period of 2 years is applicable for pre-existing diseases like diabetes and hypertension.
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 New India Health Insurance policy document.
