Health insurance is a type of cover that pays for the policyholder’s medical bills. It is an agreement between an insurance company and an insured whereby the company will reimburse the insured for expenses incurred for treating bodily injury or illnesses. Health insurance generally provides coverage for hospital stays, medicines and medical treatments.
Under the individual health plan, the insurer will take care of an insured individual’s medical and surgical expenses. The insurer will reimburse the insured individual for expenses relating to hospitalization and medical treatments until the cover limit is reached. The plan covers different kinds of illnesses. The policyholder is given the freedom to set the terms of the policy. Its salient features include cashless hospitalization as well as the insurer taking care of the pre and post hospitalization expenses. Depending on the insurer, you may be eligible for a no claim bonus if you do not make any claims during the tenure of the policy
Any individual between the age of 18 to 65 years (Extended to 70 years) can avail the Individual Mediclaim policy for treatment in India.
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1. The Policy term is one year and is available to any proposer between the age of 18 to 65 years for treatment taken in India. The proposer can also get his family covered (as defined under 2.1).
2. Maximum Entry age for any member, is 65years however, this can be extended upto 70 years. In such case, an additional premium of 10% (including on all future renewals) will be charged on applicable rates, including on Optional PA cover.
3. Sum Insured (SI) available from Rs.1lac to Rs.10lacs.
4. Pre-existing diseases covered after four consecutive renewals.
5. Life long renewals allowed.
6. Family discount of 10% (including on PA cover) if more than one person is covered under the policy.
7. Option of voluntary co-payment of 10% and 20% with corresponding premium discount of 10% and 20% respectively on SI of Rs.2lacs and above. Voluntary co-payment does not apply on PA section.
8. No medical examination for persons upto the age of 55 years.
9. In case of fresh covers, 50% of the Pre-insurance medical check-up cost reimbursable, subject to acceptance of the Proposal.
10. Daily Hospital Cash allowance in case of more than 2 days of continuous hospitalisation.
11. Hospitalisation expenses incurred for donating an organ by the donor (excluding cost of organ) to the insured person, is covered
12. Ambulance charges covered
13. Personal Accident available on optional basis for SI from Rs.2lacs to Rs.10lacs.
14. Free Look Period- A period of 15 days from the date of receipt of the policy to review the terms and conditions of the policy and return the same, if not acceptable.
15. Grace period of 30 days is allowed for payment of renewal premium.
16. Premium adjustment at renewal, for the duration of OMP cover.
17. Discount of 5.5% in premium if TPA services not opted for.
This type of mediclaim is a hospitalisation cover and reimbursement of the medical expenses incurred in respect of covered disease /surgery while the insured was admitted in the hospital as an in patient. The cover also extends to pre- hospitalsation and post- hospitalisation for periods of 30 days and 60 days respectively
The family floater plan, as the name suggests, is a health plan designed to cover you and your family together. Your entire family will be protected under a single plan. Any member of your family can make a claim in case of hospitalization or surgical expenses. One of the benefits of this plan is that if one of the family members falls ill and has to be hospitalized, the un-well member can utilize the total sum insured for treatment. Family floater plans generally cover the individual, spouse and children. In recent times, however, some health insurers are extending the cover to include dependent parents, parents-in-law and siblings.
1. Sum Insured from Rs.2lacs to Rs.20lacs. Existing Insured Persons covered for Rs.1lac Sum Insured may continue with the same. Those existing Insured Persons covered for Sum
Insured of Rs.1.5lacs, may also opt for Sum Insured of Rs.1lac.
2. A floater policy covering the proposer and his / her family under one Sum Insured under one Policy.
3. Maximum Entry Age is 65years for all members. However, this can be extended to 70years subject to conditions.
4. Under Silver and Gold Plans, Pre-acceptance medical check-up is required for persons aged 60 years and above. However, under Diamond Plan, the requirement is for persons aged 55years and above.
5. Term of the Policy is one year and is renewable lifelong.
6. Pre-existing Disease coverage after four consecutive Policy periods.
7. Option of TPA (Cashless facility in network hospitals) and non TPA services.
8. Personal Accident cover as optional cover*
9. Free Look Period
10. Discount of 5.5% in premium if TPA services not opted for (no discount on PA premium).
11. A discount of 5% on premium is allowed, if the Policy is purchased On-line and no Intermediary is involved. This discount is also applicable in case of On-line renewal of Policies, where no Intermediary was involved at any stage- either on the first purchase or in any subsequent renewal thereof.
*Available at the option of the proposer.
Cashless Treatment At Top Hospitals
No Sub-limits on hospital room rents
Up to 150% No Claim Bonus
Income Tax benefits under sec 80(D)
More than 6000+ Hospitals Covered
Covers pre-hospitalisation expenses upto 60 days; post-hospitalisation upto 90 days
Treatment at the Comfort of Home Available