|
|
| Apollo DKV : Insure Health India |
|
| 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. |
|
| Section. 1 Benefits |
|
| Claims made in respect of any of the benefits below will be subject to the Sum Insured and will affect the entitlement to Renewal Incentives under Section 2. 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: |
|
| (a) In-patient Hospitalisation |
|
| The Medical Expenses for: |
|
| (i) Room rent and boarding expenses upto the daily amount mentioned in the Schedule of Benefits, |
|
| (ii) Intensive care unit upto the daily amount mentioned in the Schedule of Benefits, |
|
| (iii) Nursing, |
|
| (iv) Medical Practitioner, |
|
| (v) Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, |
|
| (vi) Medicines, drugs and consumables, |
|
| (vii) Diagnostic procedures, |
|
| (viii) The cost of prosthetic and other devices or equipment if implanted internally during a Surgical Procedure. |
|
| Provided that, Our maximum liability for a continuous period of Illness, including relapses within 45 days of the last date of consultation at the Hospital or nursing home where treatment was last taken, or Surgical Procedure shall be limited to the amount mentioned in the Schedule of Benefits. |
|
| (b) Pre-hospitalisation |
|
| If We have accepted a claim under Benefit 1 a), then We will pay the amount specified in the Schedule of Benefits towards pre-hospitalisation expenses for the same Illness for which the Insured Person was Hospitalised. |
|
| (c) Post-hospitalisation |
|
| If We have accepted a claim under Benefit 1 a), then We will pay the amount specified in the Schedule of Benefits towards post-hospitalisation expenses for the same Illness for which the Insured Person was Hospitalised. |
|
| (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. |
|
| (e) Organ Donor |
|
| The Medical Expenses for an organ donor’s treatment for the harvesting of the organ donated, provided that: |
|
| (i) The organ donor is any person in accordance with The Transplantation of Human Organs Act, 1994 (amended) and other applicable laws and rules, |
|
| (ii) The organ donated is for the use of the Insured Person, and |
|
| (iii) We will not pay the donor’s pre- and post-hospitalisation expenses or any other medical treatment for the donor consequent on the harvesting, and |
|
| (iv) We have accepted an In-patient Hospitalisation claim under Benefit 1a). |
|
| (f) Ayush Benefit |
|
| The Medical Expenses for in-patient treatment taken under Ayurveda, Unani, Sidha and Homeopathy will be covered provided that Our maximum liability will be limited to the amounts specified in the Schedule of Benefits and Exclusion 3e)xviii) stands revised for all Insured Persons subject always to the Sum Insured. If We accept any claim under this benefit, then We will not make any payment under allopathic treatment of the same Insured Person for the same Illness or Accident under this policy. |
|
