Features & Benefits of Hospital Care.

Features of Hospital Care

1. Hospitalisation Benefits (DHCB)

 

• Get a benefit amount if you are hospitalized for more than 24 hours i.e. at least 2 consecutive nights and must be charged for 2 days room expenses.
• The benefit amount is fixed and will be paid irrespective of actual hospitalisation expenses
•  DHCB is payable for hospitalisation up to 90 days per policy year, which includes any days spent in Intensive Care Unit.

 

2. Intensive Care Unit (ICU) benefit

 

• An additional 50% of DHCB amount per day is paid to you if you get admitted to an Intensive Care Unit (ICU), and this amount is paid depending on the plan chosen.
•  The ICU benefit is payable for hospitalisation up to 30 days per policy year, and is paid in addition to DHCB.

 

3. Recuperating benefit

 

• A post-hospitalisation benefit amount in addition to all other amounts will be paid out to ensure that follow-up tests, medicines and consultations go ahead as planned .
• You are eligible for recuperating benefit only on being hospitalized continuously for 5 or more days DHCB.

 

4. Surgery benefit

 

Over and above the hospitalisation expenses, a fixed lump-sum amount is also paid for more than 900 surgical procedures. These surgeries have been classified into four grades, depending on the type and severity. A sample list of surgeries is given below:

For the detailed list of surgeries, Click Here 

5. Benefit amounts at-a-glance

 

You can choose any one plan, from the following four options Each plan has fixed benefit amounts, as shown below:

Waiting period – 90 days except accidental claims.

6. High benefit limits

Hospital Care policy offers you high benefit limits. For instance,under plan A, you can claim up to Rs.4 lakhs for multiple claims, including surgical benefit up to Rs.3 lakhs annually. However, for the entire policy term, you can make multiple claims up to Rs.20 lakhs.

Benefits of Hospital Care

Payout in addition to other plans 

You can claim benefit amount from this policy as well as any other medical insurance policy you may have, since the company only requires submission of photocopies or duplicates of bills and certificates. The lump-sum benefit amount will be paid to you, irrespective of your actual medical expenses.

Cashless hospitalisation

You don't need to make any payment upfront. We shall pay the billed amount directly to the hospital, as settlement of your dues. This facility is available in more than 3000 network hospitals across India.

Multiple claims

Life being uncertain, you may incur medical treatment costs several times. You can make multiple claims during the policy term, so long as the total amount payable does not exceed the benefit limit you are entitled to.

Transparent coverage norms

This policy is very transparent and informs you upfront about benefit payouts, the coverage and exclusions. This helps you plan your finances in the event of an emergency, so that you can concentrate on the treatment.

Guaranteed coverage

Medical eventualities can occur at any time. This policy guarantees you coverage for the entire policy term, so that you enjoy the benefit of the cover, irrespective of any claims made or a change in your health status during the policy term.

Tax benefit

The premium paid by you up to Rs.15,000 p.a. is eligible for tax benefit under Section 80 D, as per prevailing Income Tax laws .

General Exclusions

1. No benefits shall be payable with respect to any period of Hospital Confinement/ICU stay unless the entire confinement / ICU stay and all the Hospital services rendered and performed there had been recommended by a physician and are in accordance with the diagnosis and treatment of the condition for which hospitilisation was required.
2. No benefits shall be paid for the following services, products and conditions:

 

1. pre-existing illness unless stated in the proposal form and specifically accepted by the ompany and endorsed thereon;
2. hospitalisation and / or treatment within the Waiting Period (as stated in clause 6);
3. eye tests, refractive errors of the eyes, refractive  surgery;
4. any dental surgery, extraction of impacted tooth / teeth, orthodontics or orthographic surgery, or Temporo-Mandibular Joint Disorder except as necessitated by an accidental injury;
5. treatment arising from pregnancy which shall include childbirth, infertility, erectile dysfunction or impotency, miscarriage, abortion, sterilization and contraception including any complications relating thereto;
6. treatment for congenital conditions including physical defects present from birth;
7. hospitalisation primarily for investigatory purpose, diagnosis, X-ray examination, general physical or routine medical examination; preventive treatments / medicines, treatments / examinations specifically for weight reduction or gain regardless of whether the same is caused (directly or indirectly) by a medical condition; convalescence, custodial, sanitaria, rehabilitation centre, nature cure clinics or rest care and similar establishments; or private nursing.
8. treatment arising from any geriatric, psycho-geriatric or psychiatric condition, insanity, mental or nervous breakdown or "rest cures";
9. treatment directly or indirectly arising from alcoholism or drug abuse and any injury or sickness which the Life Assured may suffer after he has taken intoxicating liquors or drugs;
10. treatment directly or indirectly arising from or consequent upon war, commando or bomb disposal duties or training, terrorism, invasion, acts of foreign enemies, engagement in hostilities, active military and police duties such as maintenance of civil order, whether war be declared or not, civil war, rebellion, active participation in strikes, riots or civil commotion, revolution, insurrection or military or usurped power or travel by military aircraft or waterborne vessel, and full- time service in any of the armed forces;
11. Acquired Immune Deficiency Syndrome (AIDS) and all illnesses or diseases caused by or related to the Human Immuno-deficiency Virus (HIV);
12. sexually transmitted diseases (STD);
13. cosmetic or plastic surgery except to the extent that such surgery is necessary for the repair of damage caused solely by Accidental Injuries, treatment of xanthelesema, syringoma, acne and alopecia;
14. study and treatment of sleep apnoea;
15. deliberate exposure to exceptional danger (except in an attempt to save human life);
16. nuclear disaster, radioactive contamination and/or release of nuclear or atomic energy; and injuries arising out of or in connection with:
17. military duties of a peace-time nature, namely normal training range work and military exercises;
18. treatment for injury or illness caused by intentionally self-inflicted injuries; or any attempts at suicide while sane or insane;
19. treatment for injury or illness caused by violation or attempted violation of the law or resistance to arrest;
20. treatment for injury or illness caused by professional sports, racing of any kind, scuba diving, aerial sports, activities such as hand-gliding, ballooning, and any other hazardous activities or sports unless agreed by special endorsement;
21. All organ transplant where the Life Assured acts as a donor and all expenses incurred by the donor for such organ transplant;
22. Circumcision unless necessary for treatment of a diseases or necessitated due to an accident;
23. Diagnosis and treatment outside India. However, this exclusion shall not be applicable in the following countries: Australia, Brunei, Canada, Dubai, Hong Kong, Japan, Malaysia, New Zealand, Singapore, Switzerland, UAE, USA, and countries of the European Union. The company may at its discretion review the above list of accepted foreign countries from time to time. Claims documents from outside India are only acceptable in English language unless specifically agreed otherwise, and dully authenticated
24. Failure to seek or follow reasonable medical advice.
25. Ayurvedic, Homeopathy, Unani, naturopathy, reflexology, acupuncture, bone-setting, herbalist treatment, hypnotism, rolfing, massage therapy, aroma therapy or any other treatments other than Allopathy /western medicines.
26. Hospitilisation and treatment of any kind not actually performed, necessary or reasonable, or any kind of elective surgery or treatment which is not medically necessary or any surgical procedure not performed in a hospital.

 

 

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