| 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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| Section. 5 Renewal Incentives |
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- Cumulative Bonus
- If no claim has been made under the Policy and the Policy is renewed with Us without any break, We will apply a cumulative bonus to the next Policy Year by automatically increasing the Sum Insured for the next Policy Year by 10% of the Sum Insured for this Policy Year. The maximum cumulative bonus shall not exceed 50% of the Sum Insured in any Policy Year.
- In relation to a Family Floater, the cumulative bonus so applied will only be available in respect of claims made by those Insured Persons who were Insured Persons in the claim free Policy Year and continue to be Insured Persons in the subsequent Policy Year.
- If a cumulative bonus has been applied and a claim is made, then in the subsequent Policy Year We will automatically decrease the cumulative bonus by 20% of the Sum Insured in that following Policy Year.
- Health Check-up
If no claim has been made in respect of any benefits and You have maintained an Easy Health Individual Health Insurance Plan or Easy Health Family Floater Insurance Plan with Us for the period of time mentioned in the Schedule of Benefits without any break, then in every subsequent Policy Year We will pay upto the percentage (mentioned in the Schedule of Benefits) of the Sum Insured for this Policy Year or the subsequent Policy Years (whichever is lower) towards the cost of a medical check-up for those Insured Persons who were insured for the number previous Policy Years mentioned in the Schedule.
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| Section. 6 Exclusions |
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- Waiting Periods
- We are not liable for any treatment which begins during waiting periods except if any Insured Person suffers an Accident.
- 30 days Waiting Period
- A waiting period of 30 days (or longer if specified in any benefit) will apply to all claims unless:
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1.The Insured Person has been insured under Easy Health Individual Health Insurance Plan or Easy Health Family Floater Insurance Plan continuously and without any break in the previous Policy Year, or |
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2.If the Insured person renews with Us or transfers from any other insurer and increases the Sum Insured (other than as a result of the application of Benefit 5a) upon renewal with Us), then this exclusion shall only apply in relation to the amount by which the Sum Insured has been increased. |
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Specific Waiting Periods
The Illnesses and treatments listed below will be covered subject to a waiting period of 2 years as long as in the third Policy Year the Insured Person has been insured under an Easy Health Individual Health Insurance Plan or Easy Health Family Floater Insurance Plan continuously and without any break: |
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- Illnesses: arthritis if non infective; calculus diseases of gall bladder and urogenital system; cataract; fissure/fistula in anus, hemorrhoids, pilonidal sinus, gastric and duodenal ulcers; gout and rheumatism; internal tumors, cysts, nodules, polyps including breast lumps (each of any kind unless malignant); osteoarthritis and osteoporosis if age related; polycystic ovarian diseases; sinusitis and related disorders and skin tumors unless malignant.
- Treatments: benign ear, nose and throat (ENT) disorders and surgeries (including but not limited to adenoidectomy, mastoidectomy, tonsillectomy and tympanoplasty); dilatation and curettage (D&C); hysterectomy for menorrhagia or fibromyoma or prolapse of uterus unless necessitated by malignancy; joint replacement; myomectomy for fibroids; surgery of gallbladder and bile duct unless necessitated by malignancy; surgery of genito urinary system unless necessitated by malignancy; surgery of begnin prostatic hypertrophy; surgery of hernia; surgery of hydrocele; surgery for prolapsed inter vertebral disk; surgery of varicose veins and varicose ulcers; surgery on tonsils and sinuses.
- However, a waiting period of 2 years will not apply if the Insured Person was insured continuously and without interruption for at least 2 years under another Indian insurer’s individual health insurance policy for the reimbursement of medical costs for inpatient treatment in a hospital, and he establishes to Our satisfaction that he was unaware of and had not taken any advice or medication for such Illness or treatment.
- If the Insured person renews with Us or transfers from any other insurer and increases the Sum Insured (other than as a result of the application of Benefit 5a) upon renewal with Us), then this exclusion shall only apply in relation to the amount by which the Sum Insured has been increased.
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