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| Senior Citizens Health Insurance (Mediclaim Policy) in India |
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| 6- Senior Citizens Mediclaim Policies - United India Insurance Co. Ltd. |
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| Senior Citizen Policy |
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1 WHEREAS the insured designated in the Schedule hereto has by a proposal and declaration dated as stated in the Schedule which shall be the basis of this Contract and is deemed to be incorporated herein has applied to UNITED INDIA INSURANCE COMPANY (hereinafter called the COMPANY) for the insurance hereinafter set forth in respect of person(s)named in the Schedule hereto (hereinafter called the INSURED PERSON) and has paid premium as consideration for such insurance.
1.1 NOW THIS POLICY WITNESSES that subject to the terms, conditions, exclusions and definitions contained herein or endorsed, or otherwise expressed hereon the Company undertakes that if during the period stated in the Schedule or during the continuance of this policy by renewal any insured person shall contract any disease or suffer from any illness (hereinafter called DISEASE) or sustain any bodily injury through accident (hereinafter called INJURY) and if such disease or injury shall require any such insured Person, upon the advice of a duly qualified Physician/Medical Specialist/Medical practitioner (hereinafter called MEDICAL PRACTITIONER) or of a duly qualified Surgeon (hereinafter called SURGEON) to incur hospitalisation/domiciliary hospitalisation expenses for medical/surgical treatment at any Nursing Home/Hospital in India as herein defined (hereinafter called HOSPITAL) as an inpatient, the Company will pay through TPA to the Hospital / Nursing Home or the Insured Person the amount of such expenses as are reasonably and necessarily incurred in respect thereof by or on behalf of such Insured Person but not exceeding the Sum Insured in aggregate in any one period of insurance stated in the schedule hereto.
1.2 In the event of any claim/s becoming admissible under this scheme, the company will pay through TPA to the Hospital / Nursing Home or the insured person the amount of such expenses as would fall under different heads mentioned below, and as are reasonably and necessarily incurred thereof by or on behalf of such Insured Person, but not exceeding the Sum Insured in aggregate mentioned in the schedule hereto.
A.Room, Boarding and Nursing expenses as provided by the Hospital/Nursing Home not exceeding 1% of the sum insured per day or
the actual amount whichever is less. This also includes nursing care, RMO charges, IV Fluids/Blood transfusion/injection administration
charges and similar expenses.
B.ICU expenses not exceeding 2% of the sum insured per day or actual amount whichever is less.
C.Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees
D.Anaesthesia, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & Drugs, Diagnostic Materials and X-ray,
Dialysis, Chemotherapy, Radiotherapy, Cost of Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like
pacemaker, orthopaedic implants, infra cardiac valve replacements, vascular stents.
E.Hospitalisation expenses (excluding cost of organ) incurred for donor in respect of organ transplant to the insured. The company’s
liability under this head shall not exceed the total SI of the insured under the policy.
ND.: The amount payable under 1.2 C & D above shall be at the rate applicable to the entitled room category. In case Insured opts for a room with rent higher than the entitled category as in 1.2 A above, the charges payable under 1.2 C & D shall be limited to the charges applicable to the entitled category. |
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| Hospitalisation Benefits |
LIMITS per surgery RESTRICTED TO |
| a.Cataract, Hernia |
a.Actual expenses incurred or 25% of th sum insured whichever is less |
| Hysterectomy |
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| b.Major surgeries* |
b.Actual expenses incurred or 70% of th sum insured whichever is less |
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* Major surgeries include cardiac surgeries, brain tumour surgeries, pace maker implantation for sick sinus syndrome, cancer surgeries, hip,
knee, joint replacement surgery.
Pre and Post Hospitalisation expenses payable in respect of each hospitalisation shall be the actual expenses incurred subject to a maximum of
10% of the Sum Insured
The above limits specified are applicable per hospitalisation / surgery. |
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(N.B: Company's Liability in respect of all claims admitted during the period of insurance shall not exceed the Sum Insured per person as mentioned in the schedule) |
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| 2 DEFINITIONS: |
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2.1 HOSPITAL / NURSING HOME means any institution in India established for indoor care and treatment of sickness and injuries and which Either
(a) has been registered as a Hospital or Nursing Home with the local authorities and is under the supervision of a registered and qualified Medical Practitioner.
Or
(b) Should comply with minimum criteria as under:i) It should have at least 15 inpatient beds.
ii) Fully equipped operation theatre of its own wherever surgical operations are carried out.
iii) Fully qualified Nursing Staff under its employment round the clock.
iv) Fully qualified Doctor (s) should be in-charge round the clock. |
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