Health Insurance Comparison

8/8/2019 Health Insurance Comparison

1/25

2- National Insurance Co. Ltd.Product Varistha Mediclaim for Senior CitizensSalient Features :

This policy has been designed to cater to the needs of our Senior Citizens. It covers Hospitalization and Domiciliary Hospitalization Expenses under Section I as well as expenses for treatment of Critical Illnesses ,if opted for, under Sect

ion II. Diseases covered under Critical Illnesses are as under:

Coronary Artery SurgeryCancerRenal Failure i.e. Failure for both kidneysStrokeMultiple SclerosisMajor Organ Transplants like kidney, Lung, Pancreas or Bone marrowParalysis and blindness at extra premiumCritical Illness cover is an optional cover under the policy. Persons who will not opt for critical illness cover are entitled to Hospitalization and Domiciliary hospitalization expenses cover for those diseases categorized above as critic

al illness but up to the limit of Sum Insured under Section I i.e. under Hospitalization and Domiciliary Hospitalization Expenses and the claim for those diseases will be paid on reimbursement basis or as cashless hospitalization. Person opting for Critical Illness cover may opt for claim either under Section I or Section II(if not hospitalized) or under both sections for those diseases categorized above as Critical Illnesses but claim under Section I will be paid either on reimbursement basis or as cashless hospitalization if it is otherwise admissible.If in any policy year a critical illness is diagnosed and claim paid thereafter, in subsequent renewals the person may avail cover both under Section I & II but with the exclusion, both under Section I & II, of that particular critical illness which has been diagnosed and claim paid in the preceding policy year.Sum Insured: Sum Insured is fixed per person.Under Hospitalization & Domiciliary Hospitalization Cover sum Insured is Rs.1,00

,000/- and under Critical Illness cover Sum Insured is Rs.2,00,000/-.

Age Group: For fresh entry in to the scheme-60 years to 80 years. However, forrenewal, age limit will be extended up to 90 years in which case the premium of76-80 age band will be loaded by 10% up to 85 years and 20% up to 90 years of age.

Preacceptance Medical Check up: No Medical Check up is required if the insuredwas covered under any Health Insurance Policy of National Insurance Company orother Insurance companies uninterruptedly for preceding three years. Other persons have to undergo medical check up at their own cost for Blood/Urine Sugar, Blood Pressure, Echo-cardiography and eye check up including retinoscopy.

Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.

Scope of Cover / Benefits :

Section I- Hospitalization and Domiciliary Hospitalization Expenses Cover:In the event of any claim/s becoming admissible under this section, the Companywill pay to the Insured person the amount of such expenses as would fall under different heads mentioned below and as are reasonably and necessarily incurred hereof by or on behalf of such Insured Person but not exceeding the Sum Insured inaggregate mentioned in the Schedule hereto.

Hospitalisation Benefits LimitsA (i)Room, Boarding expenses a provided by the Hospital/Nursing Home


2/25

(ii) If admitted in IC Unit i)Up to 1% of Sum Insured per day

ii)Up to 2% of Sum Insured per dayOverall limit:25% of the S.I. per illness/injuryB Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses Up to 25% of Sum Insured per illness/ InjuryC Anesthesia, Blood, Oxygen, OT charges, Surgical appliances (any disposab

le surgical consumables subject to upper limit of 7% of Sum Insured), Medicines,drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, costof pacemaker, artificial limbs, Cost of stent & implants Up to 50% of SumInsured per illness/Injury1)Company's overall liability in respect of claims arising due to Cataract is Rs.10,000/- and that of Benign Prostatic Hyperplasia is Rs 20,000/- only.2)Company's liability in respect of all claims admitted during the period of Insurance shall not exceed the Sum Insured for the person as mentioned in the Schedule.3)Liability of the company under Domiciliary Hospitalization clause is limited to 20% of the Sum Insured under Section I and within the overall limit of sum Insured under section I.

4)Hospitalization expenses of person donating an organ during the course of organ transplant will also be payable subject to the sub limits under C above applicable to the insured person within the overall sum insured of the insured person.5)Ambulance charges up to a maximum limit of Rs.Rs.1000/- in a policy year willbe reimbursed.


Premium Rates/ Chart :

Sum Insured

Premium

60-65 years

66-70 years

71-75 years

76-80 years

Mediclaim

1,00,000

4180

5196

5568

6890


3/25

Critical Illness

2,00,000

2007

2130

2200

2288

TOTAL

6187

7326

7768

9178

For fresh entrants to National Insurance above premium will be loaded by 10%.Under Mediclaim Section(Section I), if the insured intends to cover pre-existingdiseases of Hypertension and/or Diabetes from the inception of the policy he/she has to pay additional premium @10% for either hypertension or diabetes & 20% for hypertension & diabetes for first year of the policy. However, if a fresh entrant suffers from blood pressure/hypertension and/or diabetes and opts for Critical Illness cover, the same may be covered at additional premium @10% for either hypertension or diabetes & 20% for hypertension & diabetes provided no organ o

f the proposer is affected in consequence of blood pressure and/ or diabetes. Ifthe medical report indicates occurrence of any such consequential complication,those proposals will be declined.Loading for preexisting Diabetes and/or Hypertension to be applied on Total Premium for first year and on Critical Illness Premium only from 2nd year onwards.

At the time of taking this policy, if a person suffers from any of the terminaldiseases referred under Critical Illness cover mentioned below, that particulardisease will never be covered under Section II of this policy even on payment ofadditional premium.Cover for Paralysis and Blindness under Critical Illness:Paralysis and Blindness may be covered under Critical Illness by loading the Critical Illness premium by 15% in each case or 25% in case of both covers together.

Under Group Policy, if the incurred claim ratio of the group exceeds 70% then the renewal premium will be loaded on 70% as if basis i.e. if the incurred claim ratio of any policy year exceeds 70% renewal premium will be loaded in such a waythat the incurred claim ratio of expiring policy becomes 70%.

Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.Terms & Conditions :

Upon the happening of any event, which may give rise to a claim under this polic

y notice with full particulars shall be sent to the Company within 7 days from the date of Injury/Hospitalization/Domiciliary Hospitalization.Claim must be filed within 30 days from date of discharge from the Hospital.Note


4/25

: Waiver of this condition may be considered in extreme cases of hardship whereit is proved to the satisfaction of the Company that under the circumstances inwhich the Insured was placed it was not possible for him or any other person togive such notice or file claim within the prescribed time limit.All medical surgical treatment under this policy shall have to be taken in Indiaand admissible claims thereof shall be payable in Indian currency.Any Medical Practitioner authorized by the Company shall be allowed to examine t

he Insured person in case of any alleged injury or disease requiring hospitalization when and so often as the same may reasonably be required on behalf of the Company.If at the time when any claim arises under this policy there is in existence anyother insurance (other than Cancer Insurance Society) whether it be effected byor on behalf of any insured person in respect of whom the claim may have arisencovering the same loss, liability, compensation, costs or expenses the Companyshall not be liable to pay or contribute more than its ratable proportion of anyloss, liability, compensation, costs or expenses. The benefits under this policy shall be in excess of the benefits available under the Cancer Insurance Policy.ENTIRE CONTRACT: the policy, proposal form, prospectus and declaration given by

the insured shall constitute the complete contract of insurance. Only insurer may alter the terms and conditions of this policy/ contract. Any alteration that may be made by the insurer shall only be evidenced by a duly signed and sealed endorsement on the policy.COMMUNICATION: Every notice or communication to be given or made under this policy shall be delivered in writing at the address of the policy issuing office / Third Party Administrator as shown in the Schedule.PAYMENT OF PREMIUM: The premium payable under this policy shall be paid in advance. No receipt for premium shall be valid except on the official form of the Company signed by a duly authorized official of the company. The due payment of premium and the observance and fulfilment of the terms, provisions, conditions andendorsements of this policy by the Insured Person in so far as they relate to anything to be done or complied with by the Insured Person shall be condition prec

edent to any liability of the Company to make any payment under this policy. Nowaiver of any terms, provisions, conditions and endorsements of this policy shall be valid, unless made in writing and signed by an authorised official of the Company.NOTICE OF CLAIM: Immediate notice of claim with particulars relating to Policy Number, ID Card No., Name of insured person in respect of whom claim is made, Nature of disease / illness / injury and Name and Address of the attending medicalpractitioner / Hospital/Nursing Home etc. should be given to the Company / TPA while taking treatment in the Hospital / Nursing Home by Fax, Email. Such noticeshould be given within 48 hours of admission or before discharge from Hospital /Nursing Home, whichever is earlier, unless waived in writing by the Company.CLAIM DOCUMENTS: Final claim along with hospital receipted original Bills/Cash memos/reports, claim form and list of documents as listed below should be submitted to the Company / TPA within 7 (seven) days of discharge from the Hospital / Nursing Home.Original bills, receipts and discharge certificate / card from the hospitalMedical history of the patient recorded by the Hospital.Original Cash-memo from the hospital (s) / chemist (s) supported by proper prescription.Original receipt, pathological and other test reports from a pathologist / radiologist including film etc supported by the note from attending medical practitioner / surgeon demanding such tests.Attending Consultants / Anaesthetists / Specialist certificates regarding diagnosis and bill / receipts etc.Surgeons original certificate stating diagnosis and nature of operation performed

along with bills / receipts etc.Any other information required by TPA / Insurance Company.All documents must be duly attested by the insured person.


5/25

FRAUD / MISREPRESENTATION / CONCEALMENT: The Company shall not be liable to makeany payment under this policy in respect of any claim, if such claim be in anymanner (intentionally or recklessly or otherwise) misrepresented or concealed orinvolve any non disclosure of material facts or making false statements or submitting fake bills whether by the Insured Person or Institution / Organization onhis behalf. Such action shall render this policy null and void and all claims h

ereunder shall be forfeited. Company may take suitable legal action against theInsured Person / Institution / Organization as per Law.

Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.Exclusions :

The Company shall not be liable to make any payment under this Policy in respectof any expenses whatsoever incurred by any person in connection with or in respect of:1 All diseases/injuries which are pre existing when the cover incepts for the first time. However, those diseases will be covered after one claim free year unde

r this policy. Cost of treatment towards dialysis, chemotherapy & radiotherapy for diseases existing prior to the commencement of this policy is excluded from the scope of cover of this policy even after one claim free year.Only two preexisting diseases (Diabetes and/or Hypertension) will be coveredfrom the inception of the policy provided the company receives additional premium for covering these preexisting diseases and mentions the same in the schedule.. However, any ailment already manifested or being treated and attributable todiabetes and/or hypertension or consequences thereof at the time of inception ofinsurance will not be covered even on payment of additional premium for covering diabetes and/or hypertension.2 Any disease other than those stated in Clause 4.3, contracted by the Insured Person during the first 30 days from the commencement date of the policy. This condition 2 shall not however apply in case of the Insured Person having been cove

red under this Scheme or group insurance scheme with any one of the Indian Insurance Companies for a continuous period of preceding 12 months without any break.3 During the first one year of the operation of the policy the expenses incurredon treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Disease, Fistula in anus, Chronic fissure in anus, Piles, Pilonidal Sinus, Sinusitis, Stone disease of any site, Benign Lumps/growths in any part of the body, CSOM(Chronic Suppurative Otitis Media), joints replacements of any kind unless arising out of accident, surgical treatment of Tonsils, Adenoids and deviated nasal septums and related disorders are not payable. If these diseases (other than Congenital Internal Disease/Defects) are pre-existing at the time of proposal, theywill be covered only after one claim free year as mentioned in column 4.1 above.If the Insured is aware of the existence of Congenital Internal Disease/Defectbefore inception of the policy, the same will be treated as pre-existing.

4 Injury or disease directly or indirectly caused by or arising from or attributable to War Invasion Act of Foreign Enemy Warlike operations (whether war be declared or not).5 Vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to as accident or as part of any illness.

6 The cost of spectacles and contact lenses, hearing aids.7 Any Dental treatment or surgery which is a corrective, cosmetic or aesthetic p

rocedure, including wear and tear, unless arising from accidental injury and which requires hospitalization for treatment.8 Convalescence, general debility, `Run Down condition or rest cure, congenital e


6/25

xternal disease or defects or anomalies, sterility, venereal disease, intentional self-injury and use of intoxicating drugs / alcohol, rehabilitation therapy inany form.9 All expenses arising out of any condition directly or indirectly caused to orassociated with Human T-Cell Lymphotrophic Virus Type III (HTLB-III) or Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or variations Deficiency Syndrome or any Syndrome or condition of a similar kind commonly referred to

as AIDS.10 Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-Rayor laboratory examinations or other diagnostic studies not consistent with norincidental to the diagnosis and treatment of positive existence or presence of any ailment, sickness or injury for which confinement is required at a Hospital /Nursing Home.11 Expenses on vitamins and tonics unless forming part of treatment for injuryor disease as certified by the attending physician.12 Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials.13 Treatment arising from or traceable to pregnancy childbirth including caesarean section.

14 Naturopathy treatment


1 - Bajaj Allianz General Insurance Co. Ltd.Product : Silver Health Policy (Health Cover for Seniors)Salient Features :

Eligibility : Age from 46 years to 75 yearsAge at entry restricted to 70 years.Cost of pre-acceptance medical tests are reimburse. However if the proposal is accepted the company.5% family discount available.SI from 50,000 to 5,00,000 can be opted from 46 yrs to 70 yrs.5% cumulative Bonus for every claim free years .Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.Scope of Cover / Benefits :

The policy covers hospitalization expenses and an amount equivalent to 3% of admissible hospitalization expenses in respect of any and all pre and post hospitalization expensesCovers ambulance charges in an emergency subject to a limit of Rs.1000/-Pre-existing illnesses are covered from the second year of the policy.The Companys liability an case of any pre-existing illness form the second year of the policy would be restricted to 50% of the limit of indemnity in a policy year.The policy has lifetime indemnity limit of three times the limit of indemnity specified in the earliest senior citizen plan, if the policy is renewed continuously.Cashless facility ; with Silver health plan, the member has access to the cashles facility at various network of over 2400 hospitals across India ( Subject toexclusion and conditions)

The member can opt for hospital besides the empanelled ones. In which case the expenses, incurred by him/her shall be reimbursed within 14 working days from submission of all the documents.


7/25

20% of co-payment of the admissible claims to be paid by the member if treatmentis taken in a hospital other than a network hospital.Health checkup in designated Bajaj Allianze Diagnostic centers at the end of continuous four claim-free yearsIncome tax benefit on the premium paid as per section 80 D of the Income Tax Actas per existing IT law.Note: Please refer to the policy documents for the complete Insurance Policy sub

ject to the insurance Company.Premium Rate / Chart :

SI /AGE AGE (in years)46-50 51-55 56-60 61-65 66-7050000 1995 2495 3824 4780 7170100000 2993 3742 5736 7170 10755150000 3741 4677 7170 8963 13444200000 4646 5846 8963 11203 16805300000 5845 7308 11203 14004 21006400000 8767 10962 16805 18905 24199500000 10959 13155 21006 23632 29039

* Service Tax as applicable


All diseases / injuries existing at the time of proposing this insuranceAny disease contracted during the first 30 days of commencement of policyCertain diseases such as hernia, piles, cataract, benign prostatic hypertrophy,hysterectomy shall be covered after a waiting period of 1 yearNon-allopathic medicineAll expenses arising from AIDS and related disordersPre-acceptance medical tests at the cost of the proposer. However if the proposa

l is accepted the company will reimburse the cost of medical tests. (only for fresh proposals)Cosmetic, aesthetic or related treatmentUse of Intoxicating drugs, alcoholJoint replacement surgery (other than due to accidents shall have a waiting period of four years)Treatment of any mental illness or psychiatric illnessNote: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.Exclusions :

All diseases / injuries existing at the time of proposing this insuranceAny disease contracted during the first 30 days of commencement of policyCertain diseases such as hernia, piles, cataract, benign prostatic hypertrophy,hysterectomy shall be covered after a waiting period of 1 yearNon-allopathic medicineAll expenses arising from AIDS and related disordersPre-acceptance medical tests at the cost of the proposer. However if the proposal is accepted the company will reimburse the cost of medical tests. (only for fresh proposals)Cosmetic, aesthetic or related treatmentUse of Intoxicating drugs, alcoholJoint replacement surgery (other than due to accidents shall have a waiting period of four years)Treatment of any mental illness or psychiatric illness



8/25

3- Oriental Insurance Co. Ltd.Product (Senior Citizen Specified Diseases Insurance)Salient Features:

Exclusively designed for Citizens aged 60 years and aboveMinimum sum insured that can be selected is Rs 100,000/- and higher sum insuredcan be selected in multiples of Rs 100,000/- upto a maximum sum insured of Rs. 5,00,000/-.Policy is available for Sum Insured 1 lakh,2 lakhs,3 lakhs,4 lakhs & 5 lakhs.Covers specified diseases only.Compulsory co-payment of 20% on admissible claim amount.Discount in premium for opting Voluntary Co-payment.No claim discount in premium.Loading for new entrants.Benefit of continuity extended if already insured with any mediclaim policy of the Company.

TPA service available.Cashless Service through TPA only and limited to Rs. 1 lakh.This insurance policy is issued for a period of one year.This Policy is available to any Indian citizen who is aged 60 years and above and for hospitalisation in India only.

The proposer has to submit any of the following documents as age proof:(a) Birth Certificate(b) Matriculation Certificate(c) School Leaving Certificate(d) Photo Voter Identity Card(e) Driving Licence(f) PAN Card

(g) Passport

The Policy reimburses the payment of hospitalisation and / or domiciliary hospitalisation expenses for the specified diseases contracted or injury sustained bythe insured persons. The settlement of the claim will be done by the TPA eitherto the network hospital or to the insured.



Only the following Specified Diseases / illness/ injury are covered under the policy and the maximum liability of the Company in respect thereof shall be as follows:Sr. No. Name of Disease Maximum Limit of Liability per illness (including domiciliary hospitalisation benefit, if any)1. Accidental Injury 100% of Sum Insured2. Knee Replacement 70% of Sum Insured3. Cardio Vascular Diseases 50% of Sum Insured4. Chronic Renal Failure 50% of Sum Insured5. Cancer 50% of Sum Insured6. Hepato-Biliary Disorders 50% of Sum Insured7. Chronic Obstructive Lung Diseases 20% of Sum Insured8. Stroke 20% of Sum Insured

9. Benign Prostrate 15% of Sum Insured10. Orthopaedic Diseases 15% of Sum Insured11. Ophthalmic Diseases 10% of Sum Insured


9/25

Note: Companys Liability in respect of all claims admitted during the Period of insurance shall not exceed the Sum Insured per Person mentioned in the Policy / Schedule.

REASONABLE & NECESSARY EXPENSES UPTO THE FOLLOWING limits ARE PAYABLE / REIMBURSABLE UNDER THE POLICY, FOR the Specified Diseases / illness/ injury only, WITHINTHE OVERALL LIMIT AS SPECIFED ABOVE:

Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home not exceeding 1% of the Sum Insured per day.I.C. Unit expenses not exceeding 2% of the Sum Insured per day.

(Stay in the Room and the stay in I.C.U., if required, should not exceed total number of days of admission in the hospital).

Ambulance Services Charges per illness by registered ambulance Actual Expenses or Rs 1000/- whichever is less shall be reimbursable in case patient has to be shifted from residence to hospital in case of admission in Emergency Ward / I.C.U. Or from one Hospital / Nursing home to another Hospital / Nursing Homefor hospitalisation.Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.

Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost ofProsthetic devices implanted during surgical procedure like pacemaker, Relevant Laboratory / Diagnostic test, X-Ray etc..Note: Only reasonable and necessary expenses based on the severity (minor / medium / major) of the Specified Diseases / illness/ injury will be payable under the policy but not exceeding the maximum limit irrespective of the expenses incurred by the insured.


Premium Rates / Chart :

Age Group Sum Insured (in Rs.)100000 200000 300000 400000 500000Premium (in Rs.)61-65 4500 8700 12400 16100 1970066-70 4800 9100 13100 16900 2070071-75 5700 11400 16300 21500 2610076-80 6100 12000 17100 22700 27600Above 80 6400 12600 18100 23800 29000Premium will be loaded by 10% for new entrants.


ENTIRE CONTRACT: The policy, proposal form, prospectus and declaration given bythe insured shall constitute the complete contract of insurance. Only insurer may alter the terms and conditions of this policy / contract. Any alteration thatmay be made by the insurer shall only be evidenced by a duly signed and sealed endorsement on the policy.COMMUNICATION: Every notice or communication to be given or made under this policy shall be delivered in writing at the address of the policy issuing office / Third Party Administrator as shown in the Schedule.PAYMENT OF PREMIUM: The premium payable under this policy shall be paid in advance. No receipt for premium shall be valid except on the official form of the Com

pany signed by a duly authorized official of the company. The due payment of premium and the observance and fulfillment of the terms, provisions, conditions andendorsements of this policy by the Insured Person in so far as they relate to a


10/25

nything to be done or complied with by the Insured Person shall be condition precedent to any liability of the Company to make any payment under this policy. Nowaiver of any terms, provisions, conditions and endorsements of this policy shall be valid, unless made in writing and signed by an authorized official of theCompany.The policy shall be deemed to be void ab-inito (since its inception) if the payment instrument is dishonoured for any reasons whatsoever and under this circumst

ance the Company shall not admit any liability whatsoever under this policy.NOTICE OF CLAIM: Immediate notice of claim with particulars relating to Policy Number, ID Card No., Name of insured person in respect of whom claim is made, Nature of disease / illness / injury and Name and Address of the attending medicalpractitioner / Hospital/ Nursing Home etc. should be given to the Company / TPAwhile taking treatment in the Hospital / Nursing Home by Fax, Email. Such noticeshould be given within 48 hours of admission or before discharge from Hospital/ Nursing Home, whichever is earlier, unless waived in writing by the Company.CLAIM DOCUMENTS: Final claim along with hospital receipted original Bills/ Cashmemos / reports, claim form and list of documents as listed below should be submitted to the Company / TPA within 7 (seven) days of discharge from the Hospital/ Nursing Home.

a. Original bills, receipts and discharge certificate / card from the hospital.b. Medical history of the patient recorded by the Hospital.C. Original Cash-memo from the hospital (s) / chemist (s) supported by proper

prescription.d. Original receipt, pathological and other test reports from a pathologist /

radiologist including film etc supported by the note from attending medicalpractitioner / surgeon demanding such tests.

e. Attending Consultants / Anaesthetists / Specialist certificates regardingdiagnosis and bill / receipts etc.

f. Surgeons original certificate stating diagnosis and nature of operation performed along with bills / receipts etc.g. Any other information required by TPA / Insurance Company.

All documents must be duly attested by the insured person.

In case of post hospitalisation treatment (limited to 60 days) all supporting claim papers / documents are listed above should also be submitted within 7 (seven) days after completion of such treatment (upto 60 days or actual period which ever is less) to the Company / T.P.A. In addition insured should also provide theCompany / TPA such additional information and assistance as the Company / TPA may require in dealing with the claim.

NOTE: Waiver of the condition may be considered in extreme cases of hardship where it is proved to the satisfaction of the Company that under the circumstancesin which the insured was placed it was not possible for him or any other personon behalf of the insured to give such notice or file claim within the prescribedtime limit. Otherwise Company / TPA has a right to reject the claim.

PROCEDURE FOR AVAILING CASHLESS ACCESS SERVICES IN NETWORK HOSPITAL / NURSING HOME:i) Claim in respect of Cashless Access Services shall be through the TPA provided admission is in a listed hospital in the agreed list of the networked Hospitals / Nursing Homes and is subject to pre admission authorization. The TPA shall,upon getting the related medical details / relevant information from the insuredperson / network Hospital / Nursing Home, verify that the person is eligible toclaim under the policy and after satisfying itself shall issue a pre-authorisation letter / guarantee of payment letter to the Hospital / Nursing Home mentioning the sum guaranteed as payable, also the ailment for which the person is seeki

ng to be admitted as in- patient.

ii) The TPA reserves the right to deny pre-authorisation in case the hospital /


11/25

insured person is unable to provide the relevant information / medical details as required by the TPA. In such circumstances denial of Cashless Access should inno way be construed as denial of claim and /or deficiency of service. The insured person may obtain the treatment as per his / her treating doctors advice and later on submit the full claim papers to the TPA for reimbursement within 7 daysof the discharge from Hospital / Nursing Home.

iii) In case any information available to the TPA / Company which makes the claim inadmissible or doubtful requiring investigations, the authorisation of cashless facility shall be withdrawn. However this shall be done by the TPA before thepatient is discharged from the Hospital.

NON ADMISSION OF CLAIM:A (I): Where the policy is being serviced by TPA, it shall repudiate the claim if not covered / not payable under the policy. The TPA shall mention the reasonsfor repudiation in writing to the insured person. The insured person may approach the policy issuing office of the Company for any grievance relating to the claim. The Companys decision in this regard shall be final and binding on TPA.

A (II): Where the policy is serviced by the Company and in case of repudiation of the claim, insured may approach the concerned Regional Office of the Company for redressal of any grievance relating to the claim.

B: In case claim is repudiated by the Company as per A (1) & A (II) the insuredperson may approach the Chief Manager Grievance Cell of the Companys Regd. Officesituated at A-25/27, Asaf Ali Road, New Delhi-110002.

C: The Central Government has established office of the Insurance Ombudsman forredressal of grievances and the insured may approach the Insurance Ombudsman forredressal of his grievance. The insured may visit the site of http://www.ombudsmanindia.org/ for details.

Any medical practitioner authorized by the TPA/ Company shall be allowed to examine the Insured Person with / without prior notice in case of any alleged injuryof Disease requiring Hospitalisation when and so often as the same may reasonable be required on behalf of the TPA / Company.FRAUD / MISREPRESENTATION / CONCEALMENT: The Company shall not be liable to makeany payment under this policy in respect of any claim, if such claim be in anymanner (intentionally or recklessly or otherwise) misrepresented or concealed orinvolve any non disclosure of material facts or making false statements or submitting fake bills whether by the Insured Person or Institution / Organization onhis behalf. Such action shall render this policy null and void and all claims hereunder shall be forfeited. Company may take suitable legal action against theInsured Person / Institution / Organization as per Law.CONTRIBUTION: If at the time when any claim arises under this policy, there is in existence any other insurance (other than Cancer Insurance Policy in collaboration with Indian Cancer Society) whether it be effected by or on behalf of any Insured Person in respect of whom the claim may have arisen covering the same loss, liability, compensation, costs or expenses, the company shall not be liable to pay or contribute more than its rateable proportion of any loss, liability, compensation, costs or expenses. The benefits under this policy shall however be in excess of the benefits available under Cancer Insurance Policy.CANCELLATION CLAUSE: Company may at any time, cancel this Policy by sending theInsured 30 days notice be registered letter at the Insureds last known address and in such an event the Company shall refund to the Insured a pro-rata premium for un-expired Period of Insurance. (such cancellation by the company may be for reasons such as intentional misrepresentation / malicious suppression of facts in

tended to misleading the insurance company about the acceptability of the proposal, lodging a fraudulent claim and such other intentional acts of the insured /beneficiaries under the policy). The Company shall, however, remain liable for a


12/25

ny claim which arose prior to the date of cancellation. The Insured may at any time cancel this policy and in such event the Company shall allow refund of premium at Companys short period rate only (table given here below) provided no claimhas occurred during the policy period up to date of cancellation.

Period on Risk Rate of premium to bechargedUpto 1 Month 1/4th of the annual rate

Upto 3 Months of the annual rateUpto 6 Months 3/4th of the annual rateExceeding 6 months Full annual rate

ARBITRATION CLAUSE: If any dispute or difference shall arise as to the quantum to be paid under the policy (liability being otherwise admitted) such differenceshall independently of all other questions be referred to the decision of a solearbitrator to be appointed in writing by the parties or if they cannot agree upon a single shall be referred to a panel of three arbitrators, comprising of twoarbitrators, one to be appointed by each of the parties to the dispute/ difference and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the provisions of the Arbit

ration and Conciliation Act, 1996.It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, if the Company has disputed or not accepted liability under or in respect of this policy.

It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this policy that award by such arbitrator/ arbitrators of the amount of the loss or damage shall be first obtained.

DISCLAIMER OF CLAIM: It is also hereby further expressly agreed and declared that if the TPA/ Company shall disclaim liability in writing to the Insured for any claim hereunder and such claim shall not within 12 calendar months from the date of such disclaimer have been made the subject matter of a suit in a court of

law, then the claim shall for all purposes be deemed to have been abandoned andshall not thereafter be recoverable hereunder.PAYMENT OF CLAIM: The policy covers illness, disease or accidental bodily injurysustained by the insured person during the policy period any where in India andall medical / surgical treatment under this policy shall have to be taken in India and admissible claims thereof shall be payable in Indian currency without any interest thereof.a) Payment of claim shall be made through TPA to the Hospital / Nursing Homeor to the Insured Person in case policy is serviced through TPA.b) In non TPA case the claim shall be paid to the insured person by the Company.


Exclusions :

The Company shall not be liable to make any payment under this policy in respectof any expenses whatsoever incurred by any Insured Person in connection with orin respect of:

Any disease / health condition / illness / ailment or any condition arising therefrom other than those specified in the policy as covered.Pre-existing health condition or disease or ailment / injuries: Any ailment / disease / injuries / health condition which are pre-existing (treated / untreated,

declared / not declared in the proposal form), when the cover incepts for the first time are excluded upto 2 (two) years of this policy being in force continuously.


13/25

For the purpose of applying this condition, the date of inception of the Mediclaim policy taken from the Company shall be considered, provided the renewals havebeen continuous and without any break in period.

This exclusion shall also apply to any complications arising from pre existing ailments / diseases / injuries. Such complications shall be considered as a partof the pre existing health condition or disease. To illustrate if a person is s

uffering from hypertension or diabetes or both hypertension and diabetes at thetime of taking the policy, then policy shall be subject to following exclusions.

Diabetes Hypertension Diabetes & HypertensionDiabetic Retinopathy Cerebro Vascular accident Diabetic RetinopathyDiabetic Nephropathy HypertensiveNephropathy Diabetic NephropathyDiabetic Foot /wound Internal Bleed/ Haemorrhages Diabetic FootDiabetic Angiopathy Coronary Artery Disease Diabetic AngiopathyDiabetic Neuropathy Diabetic NeuropathyHyper / Hypoglycaemic shocks Hyper / Hypoglycaemic shocks

Coronary Artery DiseaseCerebro Vascular accident

Hypertension NephropathyInternal Bleeds/ HaemorrhagesAny disease covered under the policy other than those stated in clause 4.4, contracted by the Insured person during the first 30 (Thirty) days from the commencement date of the policy except treatment for accidental injuries.The expenses on treatment of following ailments / diseases / surgeries for firsttwo policy years are not payable.i

Non infective Arthritis.

ii

Cataract.

iii

Surgery of benign prostatic hypertrophy.

iv

Surgery of gallbladder and bile duct excluding malignancy.

v

Surgery of genito urinary system excluding malignancy.

vi

Gout and Rheumatism.

vii

Calculus diseases.

viii

Joint Replacement due to Degenerative condition.

ix


14/25

Age related osteoarthritis and Osteoporosis.

If the continuity of the renewal is not maintained with the Company then subsequent cover shall be treated as fresh policy and clauses 2, 3, 4 shall apply afresh unless agreed by the Company and suitable endorsement is passed on the policy.

Injury or disease directly or indirectly caused by or arising from or attributab

le to War, Invasion, Act of Foreign Enemy, War like operations (whether war be declared or not) or by nuclear weapons / materials.Circumcision (unless necessary for treatment of a disease included hereunder oras may be necessitated due to any accident), vaccination, inoculation or changeof life or cosmetic or of aesthetic treatment of any description, hair transplant, plastic surgery other than as may be necessitated due to an accident or as apart of any illness / disease.Surgery for correction of eye sight, cost of spectacles, contact lenses, hearingaids etc.Convalescence, general debility. run down condition or rest cure, congenital external diseases or defects or anomalies, sterility, any fertility, sub- fertilityor assisted conception procedure, venereal diseases, intentional self- injury/ s

uicide, all psychiatric conception procedure, venereal diseases, intentional self- injury/ suicide, all psychiatric and psychosomatic disorders and diseases / accident due to and or use, misuse or abuse of drugs / alcohol or use of intoxicating substances or such abuse or addiction etc.All expenses arising out of any condition directly or indirectly caused by, or associated with Human T-cell Lymphotropic Virus Type III (HTLD- III) or Lymohadinopathy Associated Virus (LAV) or the Mutants Derivative or Variations DeficiencySyndrome or any Syndrome or condition of similar kind commonly referred to as AIDS, HIV and its complications including sexually transmitted diseases.Expenses incurred at Hospital or Nursing Home primarily for evalution / diagnostic purposes which is not followed by active treatment for the ailment during thehospitalised period.Expenses on vitamins, tonics, mineral water and allied items unless forming part

of treatment for injury or disease as certified by the attending physician.Naturopathy treatment, unproven procedure or treatment, experimental or alternative medicine and related treatment including acupressure, acupuncture, magneticand such other therapies etc.Expenses incurred for investigation or treatment irrelevant to the diseases diagnosed during hospitalisation or primary reasons for admission. Private nursing charges, Referral fee to family doctors, Out station consultants / Surgeons feesetc.External and / or durable Medical / Non medical equipment like Ambulatory devices i.e. Walker, Crutches, Belts, Collars, Caps, Splints, Slings, Braces, Stockingetc of any kind, CPAP, CAPD, Infusion pump, Diabetic foot wear, Glucometer/ Thermometer, nebuliser and similar related items etc and also any medical equipmentwhich is subsequently used at home etc.All non medical expenses including Personal comfort and convenience items or services such as telephone, television, Aya / barber or beauty services, diet charges, baby food, cosmetics, napkins, toiletry items etc., guest services and similar incidental expenses or services etc.Change of treatment from one system of medicine to another unless necessitated and agreed / allowed by the TPA / Company.Treatment of obesity or condition arising therefrom (including morbid obesity) and any other weight control programme, services or supplies etc.Any treatment required arising from Insureds participation in any hazardous activity such as scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing, other allied similar activities etc.Any treatment received in convalescent home, convalescent hospital, health hydro

, nature care clinic or similar establishments.Any stay in the hospital for any domestic reason or where no active regular medical treatment is given by the specialist / physician.


15/25

Out Patient Diagnostic, Medical or Surgical procedures or treatments, non-prescribed drugs and medical supplies.Massages, Steam bathing, Shirodhara and like treatment under Ayurvedic treatment.Any kind of Service charges, Surcharges, Admission fees / Registration charges,File Charges etc levied by the hospital.Doctors home visit charges, Attendant / Nursing charges during pre and post hospi

talisation period.Treatment which is continued before hospitalization and continued even after discharge for an ailment / disease / injury other than the one for which hospitalisation claim is made / admissible.Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.

4 - Star Health & Allied Insurance Co LtdProduct Senior Citizen Red Carpet

Salient Features :

No pre-insurance Medical test is required.Minimum sum insured Rs.100,000/- and Maximum sum insured Rs.200,000/-For people aged between 60 and 69 yearsGuaranteed renewals beyond 69 yearsNo pre-insurance medical test requiredTreatment at network hospitals onlyAll pre-existing diseases are covered from first year,except those for which treatment or advice was recommended by or received during the immediately preceding12 months from the date of proposalDisease for which treatment or advice was recommended by or received during theimmediately preceding 12 months from the date of proposal will be covered from s

econd year onwardsNote: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.Scope of Cover / Benefits :

Hospitalization Cover: In-patient hospitalization expenses for a minimum of 24 hours.Includes room rent and boarding @1% of sumICU expenses per day @ 2% of sum insuredNursing expensesSurgeon's fees,consultant's fees,Anesthetist's and specialist's fees,per illness@ 25% of sum insuredCost of blood,oxygen,pacemakerCost of drugs and diagnostic tests @ 50% of sum insured per hospitalizationTreatment for Cardiovascular Diseases / Cerebrovascular Accident/ Cancer and breakage of Bones : upto Rs.75,000/- where the sum insured is Rs.1,00,000/- and upto Rs.1,50,000/- where the sum insured is Rs.2,00,000/-Cataract (both eyes included), up to Rs.15,000/-Renal Complications : upto Rs.75,000/- where the sum insured is Rs.1,00,000/- and upto Rs.1,50,000/- where the sum insured is Rs.2,00,000/-All other Major Surgeries : upto Rs.60,000/- where the sum insured is Rs.1,00,000/- and upto Rs.1,20,000/- where the sum insured is Rs.2,00,000/-Emergency Ambulance Charges for transporting thhe Insured Person to the [email protected]/- per Hospitalisation and Rs.1200/- per Policy periodPremium paid by cheque or credit card is eligible for relief as provided under Section 80 D of the Income Tax Act.

Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.Premium Rates / Chart :


16/25

Policy Premium- Including Service Tax

Sum Insured (Rs.) Premium (Rs.)1,00,000 4,9082,00,000 9,326A discount of 10% of the above premium will be allowed if the proposer produces

the following documents to the satisfaction of the company:a) Stress Thallium Report*b) BP Report*c) Sugar (blood & urine)*d) Blood Urea & Creatinine*e) Self-declaration or Certification that surgeries related to Heart/Brain/Cancer has/have not been done in the past.

* The tests should have been taken not before 45 days from the date of the proposal.

Note: Please refer to the policy documents for the complete Insurance Policy sub

ject to the insurance Company.Terms & Conditions :

Every notice or communication to be given or made under this policy shall be delivered in writing at the address as shown in the schedule.The premium payable under this policy shall be payable in advance. No receipt ofpremium shall be valid except on the official form of the company signed by a duly authorized official of the company. The due payment of premium and the observance of fulfillment of the terms, provision, conditions and endorsements of this policy by the Insured Person, in so far as they relate to anything to be doneor complied with by the Insured Person, shall be a condition precedent to any liability of the Company to make any payment under this policy. No waiver of any terms, provisions, conditions, and endorsements of this policy shall be valid unl

ess made in writing and signed by an authorized official of the Company.Upon the happening of any event, which may give rise to a claim under this policy, notice with full particulars shall be sent to the Company within 24 hours from the date of Death, injury, Hospitalization.Claim must be filed with 15 days from the date of discharge from the Hospital.

Note: this is a condition precedent to admission of liability under the policy.

The Insured Person shall obtain and furnish the Company with all original bills,receipts and other documents upon which a claim is based and shall also give the Company such additional information and assistance as the Company may requirein dealing with the claim.All claims under this policy shall be payable in Indian currency. All medical/surgical treatments under this policy shall have to be taken in India.Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.Exclusions :

Treatments currently availed or availed during the previous 12 months from dateof proposalAny expenses incurred for treatment of illness/disease/sickness contracted by the insured person during the first 30 days from the commencement date of the policyFirst Two-year exclusions: Hernia, Piles, Hydrocele, Congenital Internal disease/ defect, Sinusitis, Gall Stone/Renal Stone removal and Benign Prostrate Hypertr

ophyTwo-Year Exclusions:Hysterectomy,Cataract,Joint/Knee Replacement surgery (otherthan caused by an accident), Prolapsed Intervertebral Discs,Varicose Veins,Ulcer


17/25


18/25

Appendicectomy 16000/-Cholecystectomy 18000/-Prostate 18000/-Hemia-Inguinal 16000/-Hernia- Ventral / Incisional 20000/-Septoplasty 9000/-Haemarrhoidcctomy 8000/-

Fissurectomy 9000/-Fistulectomy 10000/-Angiography 12000/-Tonsillectomy 7000/-Tympanoplasty 13000/-Kidney stone/ lithotripsy 13000/-Arthoscopy 10000/-PID-Disectomy 31000/-Mastectomy (Radical) 36000/-Exploratory Laprotomy 18000/-Actual pre-hospitalisation medical charges of up to 30 days period immediately before the insureds admission to hospital for that illness, subject to maximum 5%

of hospital bill.

Actual post-hospitalisation medical charges of up to 60 days period immediatelyafter the insureds discharge from a hospital for that illness or injury, subjectto maximum of 10% of hospital bill.Expenses incurred for Ayurvedic/Homeopathic/Unani Treatment subject to a maximumlimit of 25% of the sum insured per illness, provided the treatment is taken ina Government Hospital.Ambulance charges, subject to a maximum of Rs. 1000/-Hospitalisation Expenses (excluding cost of organ) incurred on the donor duringthe course of organ transplant to the Insured. The Companys liability towards expenses incurred on the donor and the Insured recipient together shall not exceedthe sum insured of the latter

ote: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.

Premium Rates/ Chart :

Sum insured (Rs.) Premium (in Rs.)60-65 yrs 66-70 yrs 71-75 yrs 76-80 yrs

1,00,000 3850 4250 4700 51501,50,000 5720 6310 6980 7650Loading for renewal between age of 81- 85 yrs. 10% of the highest age band of 76-80 yrs.

Loading for renewal between age of 86- 90 yrs. 20% of the highest age band of 76-80 yrs.

Additional Premium for covering Pre- existing- 10% of basic premium for each Condition i.e. Hypertension & Diabetes mellitus Condition.From the inception of the policy.

Discount for opting for voluntary excess of Rs. 10,000/- -10%Discount in case spouse is covered - 10%


Terms & Conditions :


19/25

Contract: The proposal form, declaration, pre acceptance Health check-up and thepolicy issued shall constitute the complete contract of insurance.Communication: Every notice or communication to be given or made under this Policy other than that relating to the claim shall be delivered in writing at the address of the policy issuing office as shown in the schedule. The claim shall bereported to the TPA appointed for providing claim services as per the procedurementioned in the guidelines circulated by the TPA to the policyholders. In case

TPA services are not availed then claim shall be reported to the policy issuingoffice only.Premium Payment: The premium payable under this policy shall be paid in full andin advance. No receipt for premium shall be valid except on the official form of the company signed by a duly authorized official of the Company. The due payment of premium and the observance and fulfillment of the terms, provisions, conditions and endorsements of this policy by the Insured Person in so far as they relate to anything to be done or complied with by the Insured Person shall be a condition precedent to admission of any liability by the Company to make any payment under the Policy. No waiver of any terms, provisions, conditions and endorsement of this policy shall be valid unless made in writing and signed by an authorized official of the Company.

Physical Examination: Any Medical Practitioner authorized by the TPA / Company shall be allowed to examine the Insured Person in case of any alleged disease/ illness/ injury requiring Hospitalization. Non co-operation by the Insured Personwill result into rejection of his/her claimFraud, Misrepresentation, Concealment: The policy shall be null and void and nobenefits shall be payable in the event of misrepresentation, misdescription or nondisclosure of any material fact/ particulars if such claim be in any manner fraudulent or supported by any fraudulent means or device whether by the Insured Person or by any other person acting on his/her behalf.Contribution: If at the time when any claim arises under this policy, there is in existence any other insurance (other than Cancer Insurance Policy in collaboration with Indian Cancer Society/ Cancer Patient Aid Association), whether it beeffected by or on behalf of any Insured Person in respect of whom the claim may

have arisen covering the same loss, liability, compensation, costs or expenses,the Company shall not be liable to pay or contribute more than its ratable proportion of any loss, liability, compensation, costs or expenses. The benefits under this Policy shall be in excess of the benefits available under Cancer Insurance Policy as indicated above.Cancellation Clause: The Company may at any time cancel this Policy by sending the Insured 30 days notice by registered letter at the Insureds last known addressand in such event the Company shall refund to the Insured a pro-rata premium for un-expired Period of Insurance. The Company shall however, remain liable for any claim, which arose prior to the date of cancellation. The Insured may at anytime cancel this Policy and in such event the Company shall allow refund of premium at Companys short period scale of rate only (table given here below) providedno claim has occurred up to the date of cancellation.Period On Risk Rate of Premium To be ChargedUp to one-month 1/4th of the annual rateUp to three months of the annual rateUp to six months 3/4th of the annual rateExceeding six months Full annual rate

Free Look Period: The insured additionally to have 10days free look period to cancel the policy and premium is returned without interest.Disclaimer of Claim: If the TPA/ Company shall disclaim liability to the Insuredfor any claim hereunder and if the insured shall not, within 12 calendar monthsfrom the date or receipt of the notice of such disclaimer, notify the TPA/ Company in writing that he does not accept such disclaimer and intends to recover hi

s claim from the Company, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.All medical/surgical treatment under this policy shall have to be taken in India


20/25

.Cumulative Bonus: The Cumulative bonus (CB) is allowed when a policy is renewedafter a claim free year at the rate of 5% of the expiring sum insured. CB will be limited to a maximum of 30%. Renewals from other companies will not be eligible for Cumulative Bonus and will be treated as fresh insurance.In the event of claim, entire Cumulative Bonus will be withdrawn at the time ofrenewal, irrespective of the claim amount.


Exclusions :

The Company shall not be liable to make any payment under this policy in respectof:

Pre-existing diseases/condition: All diseases/ injuries, which are pre-existingwhen the cover incepts for the first time. However, they will be covered on completion of 18 claim free months of insurance.

Dialysis, Chemotherapy & Radiotherapy for diseases, including Critical Illnesses, existing prior to commencement of this policy are excluded even after two- claim free years.Pre-existing conditions of Diabetes mellitus and Hypertension are covered from inception of the policy but only on payment of additional premium. However, any ailment attributable to Diabetes mellitus or Hypertension, which has already manifested at the time of inception of insurance, will not be covered even on payment of additional premium for covering Diabetes mellitus and / or Hypertension.30-day Exclusion: No claim will be payable in respect of any disease contractedby the Insured person during first 30 days from the commencement date of the policy. This exclusion will not apply if the policy is renewed without any break. The exclusion does not apply to treatment for accidental injuries.Writing period for specified diseases/ ailments/ conditions: No claim will be pa

yable in respect of the following Diseases/Conditions contracted during the waiting periods specified below, starting from the first day of inception of the coverfor the first time.Sr. No Name of Disease/Ailment/Surgery not covered for1 Any skin disorder 18 months2 All internal & external benign tumors, cysts, polyps of any kind, including benign breast lumps 18 months3 Benign Ear, Nose, Throat disorders 18 months4 Benign Prostate Hypertrophy 18 months5 Cataract & age related eye ailments 18 months6 Diabetes melitus 18 months7 Gastric/Duodenal Ulcer 18 months8 Gout & Rheumatism 18 months9 Hernia of all types 18 months10 Hydrocele 18 months11 Hypertension 18 months12 Hysterectomy for Menorrhagia/ Fibromyoma, Myomectomy and Prolapse of uterus 18 months13 Non Infective Arthritis 18 months14 Piles, Fissure and Fistula in Anus 18 months15 Pilonidal Sinus, Sinusitis and related disorders 18 months16 Prolapse Inter Vertebral Disc unless arising from accident 18 months17 Stone in Gall Bladder & Bile duct 18 months18 Stones in Urinary Systems 18 months

19 Unknown Congenital internal disease/defects 18 months20 Varicose Veins and Varicose Ulcers 18 months21 Age related Osteoarthritis & Osteoporosis 48 months


21/25

22 Joint Replacements due to Degenerative Condition 48 monthsThese diseases/conditions are covered on expiry of the duration shown against each, provided the policy is continuously renewed with the Company without any break.

Permanent Exclusions:Any medical expenses incurred for or arising out of:

War, Invasion, Act of foreign enemy, War like operations, Nuclear weapons, Ionising Radiation, contamination by Radioactive material nuclear fuel or nuclear waste.Circumcision, cosmetic or aesthetic treatment, plastic surgery unless required to treat any injury or illness.Vaccination & Inoculation.Cost of braces, equipment or external prosthetic devices, non-durable implants,eyeglasses, Cost of spectacles and contact lenses, hearing aids including cochlear implants and durable medical equipments.All types of Dental treatments except arising out of an accident.Convalescence, general debility. Run-down condition or rest cure. Obesity treatmen

t and its complications, congenital external disease/ defects or anomalies, treatment relating to all psychiatric and psychosomatic disorders, dementia, Alzheimers disease, infertility, sterility, use of intoxicating drugs/alcohol, use of tobacco leading to cancer.Bodily injury or sickness due to willful or deliberate exposure to danger (except in an attempt to save a human life), intentional self-inflicted injury, attempted suicide and arising out of non-adherence to any medical advice.Treatment of any Bodily injury sustained whilst or as a result of active participation in hazardous sports of any kind.Treatment of any Bodily injury sustained whilst or as a result of participatingin any criminal actSexually transmitted diseases, any condition directly or indirectly caused due to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB-III) or Lymp

hotropathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred toas AIDS.Diagnostics, X-Ray or Laboratory examination not consistent with or incidental to the diagnosis of positive existence and treatment of any ailment, sickness orinjury, for which confinement is required at a Hospital/Nursing Home.Vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any of these including caesarean section, except abdominal operation for extra uterine pregnancy (Ectopic Pregnancy), which is proved bysubmission of Ultra Sonographic Report and Certification by Gynaecologist thatit is life threatening one if left untreated.Any Naturopathy Treatment.Instruments used in treatment of Sleep Apnea Syndrome (C.P.A.P.) and ContinuousPeritoneal Ambulatory Dialysis (C.P.A.D.) and Oxygen Concentrator for BronchialAsthmatic condition.Genetic disorders and stem cell implantation / Surgery.Any Domiciliary Hospitalization/ Treatment.Treatment taken outside India.Experimental and Unproven treatment (not recognized by Indian Medical Council).Change of treatment from one system of medicine to another unless recommended bythe Consultant / Hospital under whom the treatment is taken.All non-medical expenses including convenience items for personal comfort such as telephone, television, Ayah, Private Nursing/ Barber or beauty services, diet

charges, baby food, cosmetics, tissue paper, diapers, sanitary pads, toiletry items and similar incidental expenses.Service charges or any other charges levied by hospital, except registration/adm


22/25

ission chargesNote: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.

6- UNITED INDIA INSURANCE COMPANY LIMITEDProduct (Senior Citizen Specified Diseases Insurance)Salient Features:

Entry Age: 61 years to 80 years and taking a Mediclaim Policy for the first time.Sum Insured: Rs.50,000 to Rs 3,00,000A family discount of 5% of the total premium will be allowed comprising the insured and any one or more of the following :

a.Spouse,b.Dependent children (ie. Legitimate or legally adopted children)

The Policy will pay to the insured person a Daily Cash Allowance as given belowfrom the third day onwards for the period of hospitalisation in connection withadmitted claims subject to a maximum stated below on payment of additional premium as underAdditional Premium Allowance per day Subject to maximum of Rs.150/-Rs.250/-Rs.2,500/-per policy period Rs.300/-Rs.500/-Rs.5,000/-per policy period



Under Construction


Premium Rates / Chart :

HEALTH INSURANCE POLICY- SILVER- PREMIUMSum Insured Domiciliary Hospitalisation limit 61-65 yrs 66-70 yrs 71-75 yrs 76-80 yrs50000 10000 1918 2285 2882 444575000 15000 2778 3303 4162 6408100000 20000 3715 4417 5568 8613125000 23750 4598 5471 6946 10940150000 27250 5480 6525 8324 13263175000 31250 6306 7519 9634 15503200000 35000 7133 8517 10942 17743225000 37500 7906 9454 12182 19895250000 40000 8677 10390 13422 22048275000 42500 9448 11327 14662 24203300000 45000 10221 12264 15902 26355At each renewal, the Company will review the rate and loading, if any, will be applicable subject to a maximum of 200% of the expiring premium.

Note: Please refer to the policy documents for the complete Insurance Policy sub

ject to the insurance Company.Terms & Conditions :


23/25

Every notice or communication regarding hospitalisation or claim to be given ormade under this Policy shall be delivered in writing at the address of the TPA office as shown in the Schedule. Other matters relating to the policy may be communicated to the policy issuing office.The premium payable under this Policy shall be paid in advance. No receipt for Premium shall be valid except on the official form of the company signed by a duly authorised official of the company. The due payment of premium and the observa

nce and fulfilment of the terms, provisions, conditions and endorsements of thisPolicy by the Insured Person in so far as they relate to anything to be done orcomplied with by the Insured Person shall be a condition precedent to any liability of the Company to make any payment under this Policy. No waiver of any terms, provisions, conditions and endorsements of this policy shall be valid unlessmade in writing and signed by an authorised official of the Company.Upon the happening of any event which may give rise to a claim under this Policynotice with full particulars shall be sent to the TPA named in the schedule immediately and in case of emergency Hospitalisation within 24 hours from the timeof Hospitalisation / Domiciliary Hospitalisation.All supporting documents relating to the claim must be filed with TPA within 7 days from the date of discharge from the hospital. In case of post-hospitalisatio

n, treatment (limited to 60 days), all claim documents should be submitted within 7 days after completion of such treatment.Note: Waiver of this Condition may be considered in extreme cases of hardship where it is proved to the satisfaction of the Company that under the circumstancesin which the insured was placed it was not possible for him or any other personto give such notice or file claim within the prescribed time-limit.

The Insured Person shall obtain and furnish the TPA with all original bills, receipts and other documents upon which a claim is based and shall also give the TPA / Company such additional information and assistance as the TPA / Company mayrequire in dealing with the claim.Any medical practitioner authorised by the TPA / Company shall be allowed to examine the Insured Person in case of any alleged injury or disease requiring Hospi

talisation when and so often as the same may reasonably be required on behalf ofthe TPA/Company.The Company shall not be liable to make any payment under this policy in respectof any claim if such claim be in any manner fraudulent or supported by any fraudulent means or device whether by the Insured Person or by any other person acting on his behalf.If at the time when any claim arises under this Policy, there is in existence any other insurance (other than Cancer Insurance Policy in collaboration with Indian Cancer Society), whether it be effected by or on behalf of any Insured Personin respect of whom the claim may have arisen covering the same loss, liability,compensation, costs or expenses, the Company shall not be liable to pay or contribute more than its rateable proportion of any loss, liability, compensation costs or expenses. The benefits under this Policy shall be in excess of the benefits available under Cancer Insurance Policy.Renewal Clause:The Company shall renew this Policy if the Insured shall remit the requisite Premium to the Company prior to expiry of the Period of Insurance stated in the Schedule.

The Company shall be entitled to decline renewal if;a) any fraud, misrepresentation or suppression by the Insured or on his behalfis found either in obtaining insurance or subsequently in relation thereto or,b) the Company has discontinued issue of the Policy, in which event the Insuredshall however have the option for renewal under any similar Policy being issuedby the Company; provided however, benefits payable shall be subject to the term

s contained in such other Policy.

If the Insured fails to remit Premium for renewal before expiry of the Period of


24/25

Insurance, but within 15 days thereafter, admissibility of any claim during theperiod of subsequent Policy shall be considered in the same manner as under a Policy renewed without break. The Company however shall not be liable for any claim arising out of ailment suffered or hospitalisation commencing in the interimperiod after expiry of the earlier Policy and prior to date of commencement of subsequent Policy.The Insured may seek enhancement of Sum Insured in writing at or before payment

of premium for renewal, which may be granted at the discretion of the Company. However, notwithstanding enhancement, for claims arising in respect of ailment, disease or injury contracted or suffered during a preceding Policy period, liability of the Company shall be only to the extent of the Sum Insured under the Policy in force at the time when it was contracted or suffered

PERIOD ON RISK RATE OF PREMIUM TO BE CHARGED.Upto one month 1/4 th of the annual rateUpto three months 1/2 of the annual rateUpto six months 3/4th of the annual rateExceeding six months Full annual rate.If any dispute or difference shall arise as to the quantum to be paid under the

policy (liability being otherwise admitted) such difference shall independentlyof all other questions be referred to the decision of a sole arbitrator to be appointed in writing by the parties or if they cannot agree upon a single arbitrator within 30 days of any party invoking arbitration, the same shall be referredto a panel of three arbitrators, comprising of two arbitrators, one to be appointed by each of the parties to the dispute/difference and the third arbitrator tobe appointed by such two arbitrators and arbitration shall be conducted under and in accordance with the provisions of the Arbitration and Conciliation Act, 1996.It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, if the Company has disputed or not accepted liability under or in respect of this Policy. It is hereby expresslystipulated and declared that it shall be a condition precedent to any right of a

ction or suit upon this policy that award by such arbitrator/arbitrators of theamount of the loss or damage shall be first obtained.

If the Company, as per terms and conditions of the policy shall disclaim liability to the Insured for any claim hereunder and if the Insured shall not within 12calendar months from the date or receipt of the notice of such disclaimer notify the TPA/ Company in writing that he does not accept such disclaimer and intends to recover his claim from the TPA/Company then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.All medical/surgical treatments under this policy shall have to be taken in India and admissible claims thereof shall be payable in Indian currency.

Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.Exclusions :

The company shall not be liable to make any payment under this policy in respectof any expenses whatsoever incurred by any Insured Person in connection with orin respect of:

Any pre-existing condition(s) as defined in the policy, until 48 months of continuous coverage of such insured person have elapsed, since inception of his/her first Policy with the Company. Pre-Existing Condition/Disease definition Any condition, ailment or injury or related condition(s) for which insured person had si

gns or symptoms, and/or were diagnosed, and/or received medical advice/treatment, within 48 months prior to his/her first policy with the Company.During the first two years of the operation of the policy, the expenses on treat


25/25

ment of diseases such as Cataract, Benign Prostatic Hyperthrophy, Hysterectomy for Menorrhagia, or Fibromyoma, Hernia, Hydrocele, Congenital internal disease, Fistula in anus, piles, Sinusitis and related disorders, Gall Bladder Stone Removal, Gout & Rheumatism, Calculus Diseases, Joint Replacement due to Degenerativecondition and age-related Osteoarthiritis & Osteoporosis are not payable. If these diseases (other than congenital internal disease) are pre-existing at the time of proposal they will not be covered even during subsequent period of renewal.

If the insured is aware of the existence of congenital internal disease beforeinception of policy, the same will be treated as pre-existing.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)Cost of spectacles and contact lenses, hearing aids.Dental treatment or surgery of any kind unless necessitated by accident and requiring hospitalisation.Convalescence, general debility; run-down condition or rest cure, Congenital external disease or defects or anomalies, Sterility, Venereal disease, intentionalself injury and use of intoxication drugs / alcoholAll expenses arising out of any condition directly or indirectly caused to or as

sociated 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 x-ray or Laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any ailment, sickness or injury, for which confinement is required at a Hospital / Nursing HomeExpenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physicianInjury or Disease directly or indirectly caused by or contributed to by nuclearweapon / materials

Treatment arising from or traceable to pregnancy (including voluntary termination of pregnancy) and childbirth, (including caesarean section)Naturopathy Treatment, acupressure, acupuncture, experimental and unproven treatments/ therapies.External and or durable Medical / Non-medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Infusion pump etc. Ambulatory devices i.e., walker, crutches, Belts, Collars, Caps, Splints, Slings, Braces, Stockings, elastocrepe bandages, external orthopaedic pads, sub cutaneous insulin pump, etc., of any kind. Diabetic foot wear, Glucometer / Thermometer, alpha / water bed and similar related items etc., and also any medical equipment, which subsequently used at home etc.Any kind of Service charges, Surcharges, Admission Fees/Registration Charges levied by the hospital.Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.

Health Insurance Comparison

Documents

Transcript of Health Insurance Comparison