🏥 Hospitalization

Hospitalisation expenses are covered up to ₹5,00,000 when hospitalised for more than 24 hours as per policy terms and conditions.

👨‍👩‍👧 Family Definition

This policy covers Employee, Spouse, and 4 children up to the sum insured during the policy period.

Example: If you, your spouse or your children require hospitalisation, all of you will be covered up to the total sum insured in the policy, only if dependents have been added to the policy.

🌞 Day Care Treatments

Day care procedures that do not require a 24-hour hospital admission are covered by insurance as long as they are listed under approved day care treatments.

Note: This is insurer dependent.

Example: If you undergo a cataract surgery that takes only a few hours, the expenses will be covered under daycare treatments.

🛏️ Room Rent Limit

Room rent charges are covered up to a Single AC Room for Normal rooms. There is no room category restriction for ICU.

Note: If your insurance covers a certain room rent limit, but you choose a more expensive room, you may have to face a proportionate deduction in your claim. This depends on your insurer's policy terms.

💰 Co-pay

Not applicable/Zero Co-payment.

Co-payment in health insurance means that you share a part of the medical bill with the insurer. You pay a fixed percentage of the approved claim amount, while the insurer covers the rest. However, it does not reduce your total coverage (Sum Insured).

🤰 Maternity

Maternity expenses are covered up to Metro 50000-50000 & For Non-Metro 50000-50000. Coverage is available for the first two children only.

Example: If you deliver a baby through C-Section, the policy will cover the expenses up to ₹50,000.

🍼 Newborn Baby Coverage

Newborn babies are covered from day 1.

Routine checkups or consultations will not be covered.

Note: To avail of a claim, a newborn baby must be added to the policy within 30 days of birth.

Example: If your baby is born and admitted for more than 24 hours, the policy will cover the expenses from day 1.

🤒 Pre-existing Disease

Pre-existing diseases are covered with no waiting period.

Example: If you have a pre-existing disease like diabetes before enrolling in the policy, the expenses related to diabetes will be covered immediately without any waiting period.

⏱️ Pre and Post Hospitalisation

Expenses that are incurred 60 days before admission and 90 days after discharge (pertaining to the main hospitalisation) are covered.

🤱 Pre and Post-Natal Expenses

Pre and post-natal expenses are covered up to ₹5,000 on IPD or OPD basis within the maternity limit.

🚑 Ambulance Coverage

Road ambulance is covered up to ₹2,500 per hospitalization. Air ambulance is covered up to ₹1,00,000 per incident.

Example: If you use a road ambulance to reach the hospital, the policy will cover the charges up to ₹2,500 per hospitalization.

👓 Lasik Surgery

Lasik surgery is covered if the spherical value for each eye being treated is above +/- 6.5D.

Example: If the spherical value for the eye being operated is above +/-6.5D, the policy will cover the expenses for your Lasik surgery.

🦷 Accidental Dental

Accidental Dental treatments are covered in cases of accidents requiring hospitalisation for more than 24 hours, where the treatment is required due to an injury to natural teeth or dental treatment following a trauma/accident.

🧬 Internal Congenital Disease

Conditions that are present at birth and affect the internal organs or systems of the body are covered.

Example: A person born with a heart defect will be covered under this term.

🌿 AYUSH Treatment

We will cover inpatient medical expenses incurred in respect of Insured Person s AYUSH Treatment during the Policy Period up to the Sum Insured provided that
i. The Insured person is Hospitalized for AYUSH Treatment at a Government Recognized AYUSH Hospital or AYUSH Day Care Centre.
ii. This Cover will be provided on reimbursement basis and/or on cashless basis wherever applicable

🧠 Psychiatric Ailments

Psychiatric treatments are covered up to ₹30,000 if the patient is admitted for more than 24 hours.

Example: If you require hospitalisation for a psychiatric ailment, the policy will cover the expenses up to ₹30,000.

💉 Lucentis (Ranibizumab)

Coverage for the cost of the intravitreal injection drug Lucentis (Ranibizumab) is covered up to ₹50,000 (per family).

👁️ Cataract

Coverage for the diagnosis, treatment, and surgery related to cataracts is covered upto Family sum insured.

🔬 Modern Treatments

• 50% Co-Pay for cyberknife treatment/Stem Cell Transplantation.
• Modern Treatment: Covered wherever Medically Indicated either as in patient or as part of day care treatment in a hospital with a 50% copay for below mentioned procedure A. Uterine Artery Embolization and HIFU (High Intensity Focused Ultrasound) , B. Balloon Sinuplasty , C. Deep Brain Stimulation , D. Oral Chemotherapy , E. Immunotherapy - Monoclonal Antibody to be given as injection , F. Intra Vitreal Injections , G. Robotic Surgeries , H. Stereotactic Radio Surgeries , I. Bronchial Thermoplasty , J. Vaporisation of the Prostrate ( Green Laser Treatment or Holmium Laser Treatment) , K. IONM - (lntra Operative Neuro Monitoring) , L. Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.

🌟 Other Special Conditions

• Terrorism: Covered
• Cochlear Implant treatment shall be restricted to 50% of the SI.
• The coverage for treatment of mental illness is also covered upto Rs 30000 within the sum insured.

🧻 Consumables

Single-use items used in medical treatments. E.g., tissue paper, crepe bandage, gown, foot covers, slippers, disposable gloves, sheets, syringes, gowns, and masks.

Example: If your medical bill includes ₹500 for disposable gloves and masks, these expenses will not be covered by the policy.

🚫 Infertility Treatments

Infertility treatments such as IVF and surrogacy will not be covered under the policy.

🌍 Foreign Treatment

Treatments taken outside India are not covered.

Example: If you travel to the USA for a medical treatment, the expenses will not be covered by the policy.

🏠 Homecare Treatment

Homecare treatments that do not require hospitalisation are not covered.

Example: If you receive physiotherapy at home, the policy will not cover the expenses.

🩺 OPD

OPD (Outpatient Department) treatments, including consultations, diagnostic tests, X-rays, observations, and medications, are not covered under the policy unless they require a 24-hour hospitalisation or qualify as daycare treatments.

Example: If you visit a doctor for a consultation and prescription, the expenses will not be covered by the policy.

🦷 Dental

Dental treatments such as cosmetic dentistry, scaling/polishing, orthodontic procedures, and other routine dental care are not covered.

🦴 External Congenital Disease

External congenital diseases are not covered, except in life-threatening situations.

🏠 Domiciliary Hospitalisation

Domiciliary hospitalisation is not covered under the policy.

🚫 Treatment in Blacklisted Hospitals

Expenses incurred at one of the blacklisted hospitals by the insurer will not be covered.