1. In-Patient Hospitalization Expenses

The Company undertakes to indemnify Insured person against any disease or Any One Illness or any injury during the Policy Period and if such disease or injury shall require any such Insured Person, upon the advice of a duly qualified physician/ Medical Practitioner to incur in-patient care expenses for medical/surgical treatment at any Hospital/ Nursing Home in India, towards following expenses, subject to the terms, conditions, exclusions and definitions contained herein or endorsed.

I. Room, Boarding expenses

II. Intensive Care Unit bed charges

III. Doctor’s fees

IV. Nursing Expenses

V. Surgical Fees, Operation Theatre Charges, Anesthetist, Anesthesia, Blood, Oxygen and their administration, Physical Therapy

VI. Prescribed Drugs and medicines consumed on the premises

VII. Investigation Services such as Laboratory, X-Ray, Diagnostic tests

VIII. Dressing, Ordinary splints and plaster casts

IX. Cost of Prosthetic and other devices- that are used intra operatively during a Surgical Procedure, if recommended by the attending Medical Practitioner.

2. Pre-Hospitalisation Expenses

The Medical Expenses incurred during the Policy Period, for the period as specified in the Schedule to this Policy immediately before the Insured Person was hospitalised, provided that:

I. Such Medical Expenses were incurred for the same condition for which the Insured Person’s subsequent Hospitalisation was required, and

II. There is a valid claim admissible under Part B 1 (In-patient Hospitalization Expenses) of the Policy.

3. Post-Hospitalisation Expenses

The Medical Expenses incurred during the Policy Period, for the period as specified in the Schedule to this Policy, immediately after the Insured Person was discharged following Hospitalisation, provided that:

I. Such Medical Expenses were incurred for the same condition for which the Insured Person’s earlier Hospitalization was required, and

II. There is a valid claim admissible under Part B 1 (In-patient Hospitalization Expenses) of the Policy.

4. Day Care Procedure/Treatment

The Company will indemnify medical expenses incurred on a treatment towards a Day Care procedure mentioned in the list of Day Care Procedures in the Policy and as available on the Company’s web-site, where the procedure or surgery is taken by the Insured Person as an inpatient for less than 24 hours in a Hospital or standalone day care center but not in the Outpatient department of a Hospital.

5. Loyalty Perk

The Policy provides for auto increase in Sum Insured by 10% on the Sum Insured for every claim free Policy year up to a maximum of 100% of the Sum Insured if the policy is renewed with us without any break or within the Grace period as defined under the Policy.

a) For a Family Floater policy, the loyalty perk shall be available only on floater basis and shall accrue only if no claim has been made in respect of any Insured Person during the expiring Policy Year. The loyalty perk which is accrued during the claim free Policy Year will only be available to those Insured Persons who were insured in such claim free Policy Year and continue to be insured in the subsequent Policy Year.

b) If the Insured Person/s in the expiring Policy are covered on a Floater Basis and the Policy renewal for such Insured Person/s is done by splitting the floater Sum Insured into 2 or more floater / individual covers, then the Loyalty Perk of the expiring Policy shall be apportioned to such renewed Policy/ies in proportion to the Sum Insured under each of the renewed Policy/ies.

c) If the Insured Person/s in the expiring Policy are covered on an Individual basis and thereby enjoy separate Loyalty Perk in the expiring Policy/ies, and such expiring Policy/ies is renewed with the Company on a Floater Basis, then the Loyalty Perk carried forward under such renewed floater Policy would be the least of the Loyalty Perk/s earned under the expiring Policy/ies.

d) Entire loyalty perk will be forfeited if the Policy is not continued / renewed on or before Policy Period End Date or the expiry of the Grace period whichever is later.

e) In case of a claim in the Policy, the renewal of such Policy would not qualify for any fresh Loyalty Perk as well as the existing and/or unutilized Loyalty Perk if any will get reduced by 10% at the time of renewal, in the renewed policy.

6. Preventive Care

The Company will provide below additional benefits which would help in preventing and/or bettering current Health condition/s. The below services will be provided by Us/Our appointed service provider and can be availed anytime during the policy period and there are no restrictions on the number of times the facility can be utilized.

A. First Medical Opinion: A First medical opinion service from our expert panel is available for all Insured Person/s seeking information that will give them confidence in their medical diagnosis and treatment plan. At the request of the Insured Person/s, the company shall arrange for a First Opinion which is subject to the following: i. A First Medical Opinion service provides an unbiased opinion on simple medical queries that have not been taken to a medical expert as of yet. ii. This benefit can be availed only once during the policy Period by the Insured Person iii. The Insured Person is free to choose whether or not to obtain the First Opinion, and if obtained, whether or not to act on the same. iv. The Company does not assume any liability for and shall not be responsible for any actual or alleged errors, omissions or representations made by any Medical Practitioner or in any First Opinion or for any consequences of actions taken or not taken in reliance thereon. v. Any First Opinion provided under the Benefit shall not be valid for any medico-legal purposes.



B. Live Health Talk:

A unique offering where the Insured Person(s) can log in through their unique login ID on the Portal and schedule a live chat with a practicing doctor to discuss health problem.

C. Electronic Medical Record Management (EMRM):

Our Portal provides storage for all your medical documents and reports centrally in one location. With EMRM you may retrieve your medical documents at your convenience through the internet. This facility provides you easy accessibility of the documents anytime and anywhere in a secured way.

D. Fortnightly Newsletters:

Relevant and Crisp Fortnightly Publication for Wellness Awareness would be available for you on the Portal.