| 7- (a) 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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Apollo DKV Insurance Company Limited will provide the insurance cover detailed in the Policy to the Insured Person up to the Sum Insured subject to the terms and conditions of this Policy, Your payment of premium, and Your statements in the Proposal, which is incorporated into the Policy and is the basis of it. |
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| Section. 1 Benefits |
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Claims made in respect of any of the benefits below will be subject to the Sum Insured and will affect both the entitlement to a Cumulative bonus and a health check-up. |
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If any Insured Person suffers an Illness or Accident during the Policy Period that requires that Insured Person’s Hospitalisation as an inpatient, then We will pay: |
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a) In-patient Treatment
The Medical Expenses for: |
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- Room rent, boarding expenses,
- Nursing,
- Intensive care unit,
- A Medical Practitioner,
- Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances,
- Medicines, drugs and consumables,
- Diagnostic procedures,
- The Cost of prosthetic and other devices or equipment if implanted internally during a Surgical Procedure.
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b) Pre-Hospitalisation
The Medical Expenses incurred due to an Illness in the 30 days immediately before the Insured Person was Hospitalised, provided that: |
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- Such Medical Expenses were in fact incurred for the same condition for which the Insured Person’s subsequent Hospitalisation was required, and
- We have accepted an inpatient Hospitalisation claim under Benefit 1a).
- We will pay the Medical Expenses incurred within the 60 days prior to the date of Hospitalisation, if we are provided with the following at least 5 days before the Hospitalisation:
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1. medical documents with all details about the Illness; and
2. the date and the place of the proposed Hospitalisation. |
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c) Post-hospitalisation
The Medical Expenses incurred in the 60 days immediately after the Insured Person was discharged post Hospitalisation provided that: |
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- Such costs are incurred in respect of the same condition for which the Insured Person’s earlier Hospitalisation was required, and
- We have accepted an inpatient Hospitalisation claim under Benefit 1a).
- We will pay the Medical Expenses in the 90 days immediately after the Insured Person was discharged if We were provided with the following at least 5 days before the Hospitalisation:
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1. medical documents with all details about the Illness; and
2. the date and the place of the proposed Hospitalisation. |
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d) Day Care Procedures
The Medical Expenses for a day care procedure or surgery mentioned in the list of Day Care Procedures in this Policy where the procedure or surgery is taken by the Insured Person as an inpatient for less than 24 hours in a Hospital (but not the outpatient department of a Hospital). |
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