Product (Health Insurance Policy - Senior Citizen)

Salient Features:

  • Entry Age: 61 years to 80 years and taking a Mediclaim Policy for the first time.
  • Sum Insured: Rs.50,000 to Rs 3,00,000
  • A family discount of 5% of the total premium will be allowed comprising the insured and any one or more of the following :

b.Dependent children (ie. Legitimate or legally adopted children)  

  • The Policy will pay to the insured person a Daily Cash Allowance as given below from the third day onwards for the period of hospitalisation in connection with admitted claims subject to a maximum stated below on payment of additional premium as under

Additional Premium Allowance per day Subject to maximum of Rs.150/-Rs.250/-Rs.2,500/-per policy period Rs.300/-Rs.500/-Rs.5,000/-per policy period

Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.

Scope of Cover / Benefits :

Under Construction

Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.

Premium Rates / Chart :

Sum Insured Domiciliary Hospitalisation limit 61-65 yrs 66-70 yrs 71-75 yrs 76-80 yrs
50000 10000 2,950 3,600 4,000 5,000
75000 15000 3,725 4,550 4,950 6,150
100000 20000 4,500 5,500 5,900 7,300
125000 23750 5,350 6,750 7,175 8,850
150000 27250 6,200 8,000 8,450 10,400
175000 31250 6,900 8,675 9,525 11,700
200000 35000 7,600 9,350 10,600 13,000
225000 37500 8,200 10,125 11,525 14,175
250000 40000 8,800 10,900 12,450 15,350
275000 42500 9,350 11,575 13,250 16,325
300000 45000 9,900 12,250 14,050 17,300

At each renewal, the Company will review the rate and loading, if any, will be applicable subject to a maximum of 200% of the expiring premium.

Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.

Note :

  1. Service tax as applicable will be charged extra
  2. For PED of diabetes, hypertension & hyperlipidemia premium will be loaded by 10% each
  3. In the event of adverse claims experience, the company reserves the right to load premium at renewal, the maximum loading shall not exceed 200%
  4. Loading – If three or more claims are lodged during the two immediately preceding policy periods - This loading will be removed after three continuous claim free years. 
    Renewals beyond 80 Yrs will be done at the same premium as 80 Yrs slab

Terms & Conditions :

  1. Every notice or communication regarding hospitalisation or claim to be given or made under this Policy shall be delivered in writing at the address of the TPA office as shown in the Schedule. Other matters relating to the policy may be communicated to the policy issuing office.
  2. The premium payable under this Policy shall be paid in advance. No receipt for Premium shall be valid except on the official form of the company signed by a duly authorised official of the company. The due payment of premium and the observance and fulfilment of the terms, provisions, conditions and endorsements of this Policy by the Insured Person in so far as they relate to anything to be done or complied with by the Insured Person shall be a condition precedent to any liability of the Company to make any payment under this Policy. No waiver of any terms, provisions, conditions and endorsements of this policy shall be valid unless made in writing and signed by an authorised official of the Company.
  3. Upon the happening of any event which may give rise to a claim under this Policy notice with full particulars shall be sent to the TPA named in the schedule immediately and in case of emergency Hospitalisation within 24 hours from the time of Hospitalisation / Domiciliary Hospitalisation.
  4. All supporting documents relating to the claim must be filed with TPA within 7 days from the date of discharge from the hospital. In case of post-hospitalisation, treatment (limited to 60 days), all claim documents should be submitted within 7 days after completion of such treatment.
  5. Note: Waiver of this Condition may be considered in extreme cases of hardship where it is proved to the satisfaction of the Company that under the circumstances in which the insured was placed it was not possible for him or any other person to give such notice or file claim within the prescribed time-limit.

  6. The Insured Person shall obtain and furnish the TPA with all original bills, receipts and other documents upon which a claim is based and shall also give the TPA / Company such additional information and assistance as the TPA / Company may require in dealing with the claim.
  7. Any medical practitioner authorised by the TPA / Company shall be allowed to examine the Insured Person in case of any alleged injury or disease requiring Hospitalisation when and so often as the same may reasonably be required on behalf of the TPA/Company.
  8. The Company shall not be liable to make any payment under this policy in respect of any claim if such claim be in any manner fraudulent or supported by any fraudulent means or device whether  by the Insured Person or by any other person acting on his behalf.
  9. If at the time when any claim arises under this Policy, there is in existence any other insurance (other than Cancer Insurance Policy in collaboration with Indian Cancer Society), whether it be effected by or on behalf of any Insured Person in respect of whom the claim may have arisen covering the same loss, liability, compensation, costs or expenses, the Company shall not be liable to pay or contribute more than its rateable proportion of any loss, liability, compensation costs or expenses. The benefits under this Policy shall be in excess of the benefits available under Cancer Insurance Policy.
  10. Renewal Clause:
    The Company shall renew this Policy if the Insured shall remit the requisite Premium to the Company prior to expiry of the Period of Insurance stated in the Schedule.

    The Company shall be entitled to decline renewal if;

    a)  any fraud, misrepresentation or suppression by the Insured or on his behalf is found either in obtaining insurance or subsequently in relation thereto or,
    b)  the Company has discontinued issue of the Policy, in which event the Insured shall however have the option for renewal under any similar Policy being issued by the Company; provided however, benefits payable shall be subject to the terms contained in such other Policy.

    • If the Insured fails to remit Premium for renewal before expiry of the Period of Insurance, but within 15 days thereafter, admissibility of any claim during the period of subsequent Policy shall be considered in the same manner as under a Policy renewed without break. The Company however shall not be liable for any claim arising out of ailment suffered or hospitalisation commencing in the interim period after expiry of the earlier Policy and prior to date of commencement of subsequent Policy.
    • The Insured may seek enhancement of Sum Insured in writing at or before payment of premium for renewal, which may be granted at the discretion of the Company. However, notwithstanding enhancement, for claims arising in respect of ailment, disease or injury contracted or suffered during a preceding Policy period, liability of the Company shall be only to the extent of the Sum Insured under the Policy in force at the time when it was contracted or suffered

      Upto one month 1/4 th of the annual rate
      Upto three months 1/2 of the annual rate
      Upto six months 3/4th of the annual rate
      Exceeding six months Full annual rate.
  11. If any dispute or difference shall arise as to the quantum to be paid under the policy (liability being otherwise admitted) such difference shall independently of all other questions be referred to the decision of a sole arbitrator to be appointed in writing by the parties or if they cannot agree upon a single arbitrator within 30 days of any party invoking arbitration, the same shall be referred to a panel of three arbitrators, comprising of two arbitrators, one to be appointed by each of the parties to the dispute/difference and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the provisions of the Arbitration and Conciliation Act, 1996.

    It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, if the Company has disputed or not accepted liability under or in respect of this Policy. It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this policy that award by such arbitrator/arbitrators of the amount of the loss or damage shall be first obtained.

  12. If the Company, as per terms and conditions of the policy shall disclaim liability to the Insured for any claim hereunder and if the Insured shall not within 12 calendar months from the date or receipt of the notice of such disclaimer notify the TPA/ Company in writing that he does not accept such disclaimer and intends to recover his claim from the TPA/Company then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.
  13. All medical/surgical treatments under this policy shall have to be taken in India and admissible claims thereof shall be payable in Indian currency.

    Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.

Exclusions :

The company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any Insured Person in connection with or in respect of:

  1. Any pre-existing condition(s) as defined in the policy, until 48 months of continuous coverage of such insured person have elapsed, since inception of his/her first Policy with the Company. Pre-Existing Condition/Disease definition – Any condition, ailment or injury or related condition(s) for which insured person had signs or symptoms, and/or were diagnosed, and/or received medical advice/treatment, within 48 months prior to his/her first policy with the Company.
  2. During the first two years of the operation of the policy, the expenses on treatment of diseases such as Cataract, Benign Prostatic Hyperthrophy, Hysterectomy for Menorrhagia, or Fibromyoma, Hernia, Hydrocele, Congenital internal disease, Fistula in anus, piles, Sinusitis and related disorders, Gall Bladder Stone Removal, Gout & Rheumatism, Calculus Diseases, Joint Replacement due to Degenerative condition and age-related Osteoarthiritis & Osteoporosis are not payable. If these diseases (other than congenital internal disease) are pre-existing at the time of proposal they will not be covered even during subsequent period of renewal. If the insured is aware of the existence of congenital internal disease before inception of policy, the same will be treated as pre-existing.
  3. Injury / disease directly or indirectly caused by or arising from or attributable to invasion, Act of Foreign enemy, War like operations (whether war be declared or not) 
  4. Cost of spectacles and contact lenses, hearing aids.
  5. Dental treatment or surgery of any kind unless necessitated by accident and requiring hospitalisation.
  6. Convalescence, general debility; run-down condition or rest cure, Congenital external disease or defects or anomalies, Sterility, Venereal disease, intentional self injury and use of intoxication drugs / alcohol
  7. All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB -III) or lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.
  8. Charges incurred at Hospital or Nursing Home primarily for diagnosis x-ray or Laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any ailment, sickness or injury, for which confinement is required at a Hospital / Nursing Home
  9. Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician
  10. Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon / materials
  11. Treatment arising from or traceable to pregnancy (including voluntary termination of pregnancy) and childbirth, (including caesarean section)
  12. Naturopathy Treatment, acupressure, acupuncture, experimental and unproven treatments/ therapies.
  13. External and or durable Medical / Non-medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Infusion pump etc. Ambulatory devices i.e., walker, crutches, Belts, Collars, Caps, Splints, Slings, Braces, Stockings, elastocrepe bandages, external orthopaedic pads, sub cutaneous insulin pump, etc., of any kind. Diabetic foot wear, Glucometer / Thermometer, alpha / water bed and similar related items etc., and also any medical equipment, which subsequently used at home etc.
  14. Any kind of Service charges, Surcharges, Admission Fees/Registration Charges levied by the hospital.
Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.