| 8- Family Medicare Policy from United India Insurance Company |
|
| SALIENT FEATURES OF THE POLICY |
|
| This policy covers all the members of a family under a single sum insured. |
|
| |
| Eligibility |
Family comprising of Self, Spouse and Dependent Children |
| Age |
Prosper between 18 and 80 years |
| |
Dependent children between the age of 3 months and 18 years provided either or both parents are covered concurrently. However, children above 18 years will cease to be covered if they are employed/self-employed or married. For unmarried and unemployed girls, disabled children without income dependent upon Prosper, the age limit of 18 will not apply. Male child upto 26 years can be covered provided they pursue full-time higher studies and submit Bonafide Certificate from institution. |
|
|
|
Sum Insured: Beginning from Rs.1 lac in multiples of Rs.50,000/- upto Rs.5 Lac and from Rs.5 Lac to Rs.10 Lac in multiples of Rs.1 lac. |
|
Existing Health Policy holders of the Company can also opt for Family Medicare Policy on expiry of their current policy if there has been no claim for the preceding two years in respect of insured persons. |
|
| No Claim Discount / Cumulative Bonus, if any, under existing policy will not be carried forward. |
|
| COVERAGES |
|
Policy covers Hospitalisation Expenses.
Expenses prior to and after hospitalization are also covered. Further details of coverage are given below: |
|
Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatments s detailed in the policy. |
|
Note: Procedures/ treatments usually done in out patient department are not payable under the policy even if converted as an in-patient in the hospital for more than 24 hours or carried out in Day Care Centres. |
|
| Hospitalisation Expenses: |
|
(a)Room/ Boarding/ Nursing Expenses and other expenses as specified in policy upto 1% of sum insured per day. This also includes Nursing Care, RMO Charges, IV Fluids/ Blood Transfusion/ Injection administration charges and the like but does not include cost of materials.
(b)IC Unit upto 2% of Sum Insured per day.
(c)Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees
(d)Anaesthetist, Blood, Oxygen, Operation Theatre Charges, Surgical appliances, Medicine & Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, relevant laboratory diagnostic tests, etc & similar expenses.
(e)All Hospitalisation Expenses (excluding cost of organ, if any) incurred for donor in respect of Organ transplant. |
|
|
| Expenses in respect of the following specified illness will be restricted as detailed below: |
|
| |
| Hospitalisation Benefits |
LIMITS RESTRICTED TO |
(a) Cataract
(b) Hernia
(c) Hysterectomy
(d) Following Specified major surgeries –
i. Cardiac Surgeries
ii. Cancer Surgeries
iii. Brain Tumour Surgeries
iv. Pacemaker implantation for sick sinus syndrome
v. Hip replacement
vi. Knee joint replacement
|
(a) 10% of SI subject to maximum of Rs.25,000/-
(b) 15% of the SI subject to maximum of Rs.30,000/-
(c) 20% of the SI subject to maximum of Rs.50,000/-
(d) 70% of the SI subject to maximum of Rs.4 Lac |
|
|
|
| |
| Pre-Hospitalisation (30 days) & 10% |
Actual expenses subject to maximum of |
| Post-Hospitalisation (60 days) in respect of any illness |
of Sum Insured. |
|
|
|
| In respect of persons above 60 years, 10% deductible will be applied on all admissible claims. |
|
|
|
