| 5- United India's Super Top UP Medicare Policy - Prospectus |
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UNITED INDIA INSURANCE COMPANY LIMITED REGISTERED & HEAD OFFICE: 24, WHITES ROAD, CHENNAI-600014 |
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| E.g. |
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- Existing Policyholder has a sum insured of Rs.5 Lac
- First Inception date of Policy – 1.10.2005 – SI – Rs.4 lacs
- Enhanced to Rs.5 Lac w.e.f. 1.10.2007
- Opts for – 5 lacs Xs 3 Lac from 1.10.2008.
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| Four years during which pre-existing disease will be excluded will be reckoned from dates as under – |
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| 1. |
From 1.10.2005 to 30.9.2009 |
for SI of Rs.1 lac |
| 2. |
From 1.10.2007 to 30.9.2011 |
for SI of Rs.1 lac |
| 3. |
From 1.10.2008 to 30.9.2012 |
for SI of Rs.3 Lac. |
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| Injury / disease directly or indirectly caused by or arising from or attributable to invasion, Act of Foreign enemy, War like operations (whether war be declared or not) |
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(a)Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident.
(b) vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description
(c) plastic surgery other than as may be necessitated due to an accident or as a part of any illness. |
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- Cost of spectacles, contact lenses and hearing aids.
- Dental treatment or surgery of any kind unless requiring hospitalisation.
- Convalescence, general debility; run-down condition or rest cure, Congenital external disease or defects or anomalies, Sterility, Venereal disease, intentional self injury and use of intoxication drugs / alcohol
- All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB - III) or lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.
- Charges incurred at Hospital or Nursing Home primarily for diagnosis
- Expenses on vitamins and tonics unless forming part of treatment.
- Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon / materials
- Treatment arising from or traceable to pregnancy (including voluntary termination of pregnancy) and childbirth (including caesarean section).
- Naturopathy Treatment, acupressure, acupuncture, magnetic and such other therapies.
- External and or durable Medical / Non-medical equipment of any kind used for diagnosis and/or treatment and/or monitoring and/or maintenance and/or support including CPAP, CAPD, Infusion Pump, Oxygen Concentrator etc., Ambulatory devices ie. walker, crutches, Belts, Collars, Caps, Splints, Slings, Braces, Stockings, etc. of any kind, Diabetic footwear, Glucometer/Thermometer and similar related items and also any medical equipment, which are subsequently used at home.
- Any kind of Service charges, Surcharges, Admission Fees/Registration Charges
levied by the hospital.
- All non-Medical expenses of any kind whatsoever.
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| CLAIM PROCEDURE |
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| All claims will be processed and settled by specified Third Party Administrator (TPA) licensed by IRDA. |
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| Intimation of Hospitalisation – to be made immediately to the TPA. |
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| Basically the intimation to the TPA is to be given when the insured persons realise that the expenses are likely to exceed the Threshold Level. |
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| To avail Cashless facility |
Pre-authorisation request to be sent or faxed to TPA immediately on admission. |
| In Reimbursement cases |
Insured to intimate TPA about hospitalisation of insured persons immediately on admission.
Claim bills to be submitted to TPA within 15 days of discharge. |
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| In case of hospitalisation where the expenses are likely to involve both the TPAs of regular Health Policy and Super Top Up Medicare Policy, the intimation/pre-authorisation request with regard to a hospitalisation is to be given to both the TPAs of these Policies. |
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| In the case of a covered hospitalisation, the costs of which were not initially estimated to exceed the Threshold Level but were subsequently found likely to exceed the Threshold Level, the intimation to the named TPA should be submitted along with a copy of intimation made to the Primary Health Policy TPA/Reimbursement Provider immediately on knowing that the Threshold Level is likely to be exceeded. |
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| The payment will be made either to Hospital/Nursing Home in case of Cashless treatment and to the Proposer/insured person in other cases. |
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