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This benefit in your policy provides you cover against medical expenses that require a minimum of 24 hours hospitalisation. In addition, over 125 day-care procedures are also covered.
The following expenses incurred during hospitalisation are covered, subject to your annual limit:
- Room, Boarding and Nursing expenses as charged by the hospital where the insured availed medical treatment. You are entitled to a single A/C room (room rent capped at 1% of annual limit per day). However for twin share A/C room there is no such cap applicable.
- Intensive Care Unit (ICU) charges
- Fees for Doctor, Surgeon, Anaesthetist, Medical Practitioner, Consultant and Specialist
- Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Cost of Artificial Limbs*
Other Features of this Benefit
Feature
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Description
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| Family floater |
With the family floater option, you can additionally cover your spouse and up to the first three dependant children under the same annual limit.
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| Daycare Treatement Cover |
In addition to hospitalisation, you are also covered for procedures which require less than 24 hours of hospitalisation. These include over 125 listed day care surgeries, Parenteral Chemotherapy, Radiotherapy, Intervention Cardiology, Intervention Radiology, Radio frequency Ablation Treatment, Lithotripsy and Dialysis.
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| Pre & Post Hospitalisation Cover |
Pre hospitalisation expenses up to 30 days prior to hospitalisation and post hospitalisation expenses up to 60 days from the date of discharge are also covered. The pre and post hospitalisation expenses would be covered only in case the expenses incurred are related to the main hospitalisation event.
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| Medical check ups |
A free health checkup will be available to all insured members after the first year once every 2 years. Each member can submit only a single bill in every block of 2 years after the first year. The bills of any one member cannot be aggregated. The cumulative limit for all the members under the policy would be 1% of the annual limit or Rs 5000 whichever is lower. Please contact our call center for further details
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| Ambulance charges |
Up to Rs. 1,000 per policy year subject to acceptance of main hospitalisation claim.
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| No Claim Bonus |
A no claim bonus in the form of an increase in annual limit by 5% of the base annual limit is provided for every claim free year. The maximum increase over the base annual limit will be capped at 25%. In case of a claim, the accumulated no claim bonus will reduce by 10% of the base annual limit in the following year. In no circumstance will this reduction cause the annual limit to go below the base annual limit.
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| Cashless Network Access |
You have an access to an extensive network of hospitals on a cashless basis.
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| Out of network claims |
A co-pay of 20% on the eligible medical expenses will be applicable in case you either
- Stay in single A/c room with a room rent of more than 1% of your annual limit
- Access facilities at hospitals not listed in the chosen network
What happens in an emergency?
In case of emergency hospitalisation related to cardiac and trauma cases, co-pays will not be levied even when hospital is outside your chosen network as long as benefit availed is in a twin sharing room.
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*Payout for artificial limbs would be limited to lower of Rs 25,000 or 10% of the annual limit
ICICI Pru Health Saver UIN 105L087V01
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