| 8- Family Floater Coverage - Apollo DKV Insurance |
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| Easy Health Individual Health Insurance Plan / Easy Health Family Floater Insurance Plan from Apollo DKV |
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c) Spectacles, Contact Lenses, Hearing Aid
In every third year that an Insured Person is insured without a break under an Easy Health Individual Health Insurance Plan or Easy Health Family Floater Insurance Plan with Us, We will pay up to 50% of the actual cost of either: |
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- One pair of spectacles or contact lenses, or
- A hearing aid, excluding batteries.
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| Provided that: |
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- If the costs claimed are incurred as Outpatient Treatment expenses then these items must be prescribed by a Network EYE/ENT specialised Medical Practitioner, and
- Our maximum liability shall be limited to the amount mentioned in the Schedule of Benefits, and
- Under a Family Floater, Our liability shall be limited to either one pair of spectacles or hearing aid per family.
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| d)E-Opinion in respect of a Critical Illness |
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- If an Insured Person suffers a Critical Illness during the Policy Period, and no previous claim has been made for this benefit in the Policy Period, then at the Insured Person’s request We will arrange a second opinion from a Medical Practitioner selected by the Insured Person from Our panel. The second opinion will be based only on the information and documentation provided to the Medical Practitioner by or on behalf of the Insured Person, and the second opinion will be sent directly to the Insured Person by the Medical Practitioner.
- ii) In opting for this benefit and deciding to obtain an E-opinion, each Insured Person expressly notes and agrees that:
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1.It is entirely for the Insured Person to decide whether to obtain an E-opinion, from which person from Our Panel to take the E-opinion and the use (if any) to which the E-opinion so obtained is put. |
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2.We do not provide an E-opinion or make any representation as to the adequacy or accuracy of the same, the Insured Person’s or any other person’s reliance on the same, or the use to which the E-opinion is put. |
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3.We assume no responsibility for and will not be responsible for any actual or alleged errors, omissions or representations made by any Medical Practitioner or in any E-opinion or for any consequences of any action taken or not taken in reliance thereon. |
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Section. 4 Critical Illness Benefit
Claims made in respect of any of the benefits below will not be subject to the Sum Insured and will not affect either the entitlement to a Cumulative bonus or a health check-up. |
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| If the Schedule shows that the Critical Illness benefit is effective, then We will pay the Critical Illness Sum Insured as a lump sum in addition to Our payment under 1)a), provided that: |
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- The Insured Person is first diagnosed as suffering from a Critical Illness during the Policy Period, and
- The Insured Person survives for at least 30 days following such diagnosis.
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| b)We will not make any payment if: |
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- The Insured Person is first diagnosed as suffering from a Critical Illness within 90 days of the commencement of the Policy Period and the Insured Person has not previously been insured continuously and without interruption under an Easy Health Individual Health Insurance Plan or Easy Health Family Floater Insurance Plan.
- The Insured Person has already made a claim for the same Critical Illness.
- A claim for this benefit has already been made 3 times under this Policy or any other policy issued by Us.
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