| Insurance Company |
Apollo Munich Health Insurance |
Apollo Munich Health Insurance |
ICICI Lombard General Insurance |
Star Health & Allied General Insurance |
Max Bupa Health Insurance |
Bajaj Allianz General Insurance |
| Plan Name |
Maxima Plan |
Easy Health Premium Plan |
Health Advantage Plus |
Health Star Gain Insurance |
Heartbeat Platinum Policy |
Tax Gain Plan |
| Entry Age |
Upto 65 years |
Upto 60 years |
Upto 65 years |
5 months to 60 Years. |
At any age |
56 - 75 yrs for Senior Citizen Plan |
| Policy Renewal Upto Age |
Life long |
Life long |
70 years |
|
Life long |
75 years |
| Dental treatment covered |
Yes, Dental treatment is covered for Rs. 1,000/- in a year, subject to treatment taken in a network hospital. |
Yes, Covered upto Rs.5000/- in a year |
OPD expenses cover orthopedic, maternity, pharmacy, dental treatment and other medical expenses incurred on OPD basis. |
This policy covers cost of treatment incurred as an outpatient in any hospital or nursing home. Treatment costs covered even for pre-existing conditions/ diseases, dental expenses, prenatal and post-natal care. |
If any person is taking this policy with Sum Insured Rs. 15, 20 & 50 lacs. Outpatient benefits is covered only upto Rs. 10,000/-, upto Rs. 15,000/- & upto Rs. 20,000/- respectively |
Covered under OPD limit Rs. 12,500/- (for 61-65 yrs only) |
| Sum Insured Maximum |
Rs. 3 Lacs |
Rs. 10 Lacs |
Rs. 3 Lacs |
Rs. 3 Lacs |
SI Rs. 15 Lakhs, SI Rs. 20 Lakhs, & SI Rs. 50 Lakhs |
Rs. 1 Lakh |
| Max Limit for OPD/Dental |
OPD is covered for Rs.10,000/- to Rs.15,000/-(Approx. including consultation fees & Annual health checkup), Dental treatment is limited to Rs. 1,000/- in a year, subject to treatment taken in a network hospital. |
Upto 1% of Sum Insured subject to a maximum of Rs. 5,000 |
Rs. 5,500/- for age slab 61-65 yrs. |
Rs. 3,700/- for age slab 56-60 yrs. |
Rs. 10,000/- Rs. 15,000/- & Rs. 20,000/- |
Dental limit is not mentioned separately under this policy. |
| Premium for 60+ year individual person(including @12.36% S.Tax) in Rs. |
Rs. 27,901/- |
- |
Rs. 20,374/- |
Rs. 15,000/- |
Rs. 76,505/-,
Rs. 88,120/- &
Rs. 98,778/- |
Rs. 20,373/- |
| Remarks/ Special Conditions in the policy |
Out-patient Dental Treatment within specified Network - Any necessary dental treatment taken by an Insured Person from a Network Dentist provided that company will not pay for any dental treatment that comprises cosmetic treatment. The benefit amount is restricted to Rs. 1,000 per Policy Year. |
Out-patient Dental Treatment with Waiting Period of 3 years. Outpatient Dental Treatment : If the policy with the company is renewed for 3 consecutive years without a break, then from the fourth year onwards the company will pay 50% of the reasonable costs of any necessary dental treatment taken from a Network dentist by an Insured Person who has been covered under this policy benefit for the previous 3 Policy Years, provided that:
i) The company's maximum liability shall be limited to the amount specified in the Schedule of Benefits, and
ii) The company will only pay for X-rays, extractions, amalgam or composite fillings, root canal treatments and prescribed drugs for the same, and
iii) The company will not pay for any dental treatment that comprises cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics, orthognathic surgery, jaw alignment or treatment for the temporomandibular (jaw) joint, or upper and lower jaw bone surgery and surgery related to the temporomandibular (jaw) unless necessitated by an acute traumatic injury or cancer. |
This Policy Covers Outpatient Department (OPD) expenses, such as diagnostics tests, dental treatment, medical bills, ambulance charges, etc. The outpatient treatment expenses can be claimed only once a year within a period of 90 days from the start of cover and 30 days from the end of cover. |
This policy covers cost of treatment incurred as an outpatient in any hospital or nursing home. Treatment costs covered even for pre-existing conditions/ diseases, dental expenses, prenatal and post-natal care. |
If any person is taking this policy with Sum Insured Rs. 15, 20 & 50 lacs. Outpatient benefits is covered only upto Rs. 10,000/-, upto Rs. 15,000/- & upto Rs. 20,000/. Exclusion for Dental/ oral treatment are :
Treatment for any dental or oral condition, which includes Surgical Operations for the treatment of bone disease when related to gum disease or damage, or treatment for, or treatment arising from, disorders of the tempromandibular joint. EXCEPTION: However the company will pay for a Surgical Operation undertaken as an In-patient in a Hospital for a continuous minimum period of 24 hours carried out by a Doctor to: (1.) put a natural tooth back into a jaw bone after it is knocked out or dislodged in an Accident (2.) treat irreversible bone disease involving the jaw which cannot be treated in any other way, but not if it is related to gum disease or tooth disease or damage (3.) surgically remove a complicated, buried or impacted tooth root, for example in the case of an impacted wisdom tooth
|
No restrictions of waiting periods to claim under Out patient expenses. Insured can claim for dental procedures & treatment under OPD section!, Cost of Spectacles, dentures, crutches can also be claimed under OPD Section! |
| Compiled by: www.healthinsuranceindia.org |
