Blog Single

i. Room Rent charges up to Single Private AC room;
ii. Intensive Care Unit Charges;
iii. Qualified Nurse charges;
iv. Medical Practitioner’s Fees;
v. Anaesthesia, blood, oxygen, operation theatre charges, medicines, drugs and consumables (other than those specified in the list of excluded expenses (non-medical) in Annexure II.
vi. Surgical appliances and prosthetic devices recommended in writing by the attending Medical Practitioner and that are used intra operatively during a Surgical Procedure.
Cost of investigative tests or prescribed diagnostic procedures directly related to the Injury/Illness for which the Insured Person is hospitalized

Upto SI

-Expenses incurred on nursing care at home are excluded from the scope of pre hospitalization expenses.

Upto SI

-We will also consider Post-Hospitalization Medical Expenses incurred on Physiotherapy if the treating Medical Practitioner advises such Physiotherapy in writing and the same is Medically Necessary Treatment.

-We will also cover Medical Expenses incurred for procedures including but not limited to
1. intravenous chemotherapy,
2. radiotherapy,
3. hemodialysis or any other therapeutic procedure,

which requires a period of specialized observation or medical care after completion of the procedure.

-Expenses associated with automation machine for peritoneal dialysis shall not be payable

-The Domiciliary Hospitalization has commenced on the written advice of a medical practitioner and continues for at least 3 consecutive days

–the following treatment is not covered following medical conditions:
Asthma, Bronchitis, Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharyngitis, Cough and Cold, Influenza,
Arthritis, Gout and Rheumatism,
Chronic Nephritis and Nephritic Syndrome,
Diarrhoea and all type of Dysenteries including Gastroenteritis,
Diabetes Mellitus and Insupidus, Epilepsy,
Hypertension,
Pyrexia of unknown origin.
-pre
-post

– No pre or post
– no screening cost
– any other medical expenses due to harvesting
-cost of acquisition of organ
– expenses for organ transportation / preservation
– expenses occurred as donor
– any medical condition consequent due to harvesting

– to transfer the Insured Person to the nearest Hospital from the place of Accident/Illness with adequate emergency facilities for the provision of Emergency Care
– To the nearest Hospital with higher medical facilities which is prepared to admit the Insured Person and provide the necessary medical services if such medical services cannot satisfactorily be provided at a Hospital where the Insured Person is situated, and only if that transportation has been prescribed in writing by a Medical Practitioner and is for Medically Necessary Treatment.

-From a Hospital to the nearest diagnostic center during the course of Hospitalization for advanced diagnostic treatment in circumstances where such facility is not available in the existing Hospital.

-Any expenses in relation to transportation of the Insured Person from Hospital to the Insured Person’s residence while transferring an Insured Person after he/she has been discharged from the Hospital are not payable under this Benefit.

Upto SI

– Will not reduce
– If unlimited SI is taken Cumulative bonus is not added

– 20% only in claim free period
-Maternity
-Daily Hospital cash
-Global

– Its guaranteed SI
– Not applicable if unlimited SI is opted
– If person chooses to opt out of this all accumulated benefits will be zero
– All conditions of Guaranteed Cumulative bonus are applicable
– The power booster is not available on Consumable / claim protector add on

– Cover Against inflation
-The percentage increase will be only applicable to SI
– If person opt out at renewal all additions would be forfeited
– Claim Protector ( Consumables )/ Reset Benefit/ Pre- hospitalization/ Post – Hospitalization

Upto Rs 5L/ Upto Rs 5L

We will cover the Medical Expenses incurred in respect of In Patient Hospitalization of the Surrogate mother appointed by the “Intending Couple”/”Intending woman” for complications arising out of pregnancy and post-partum delivery complications during the Policy Period, up to a maximum limit of Rs. 5 Lakhs and subject to the following conditions:

i. Initial waiting period of 30 days will be applicable
ii. This benefit is applicable for all female Insured Persons who have opted for 3 years’ policy term
iii. The maximum coverage available for a surrogate mother is a period of thirty-six (36) continuous months after the surrogacy procedure has been successful
iv. Any expenses incurred on delivery of the new born (either via normal delivery or caesarean section) are excluded from the scope of this cover
v. This coverage shall only be available if all the provisions as specified in The Surrogacy Regulation Act (2021), and all the rules and regulations made thereunder are fulfilled
vi. The terms and conditions of In-patient Treatment shall apply


We will cover the Medical Expenses incurred in respect of Hospitalization of the Oocyte donor appointed by the “Intending Couple”/”Intending woman” for complications arising due to oocyte retrieval during the Policy Period, up to the annual sum insured subject to maximum limit of Rs.5 Lakhs and subject to the following conditions:
i. This cover shall be available only for a period of twelve months (12 months) after the oocyte retrieval procedure has been successful
ii. This benefit is applicable to all or any female insured person
iii. Any expenses incurred on delivery of the new born (either via normal delivery or caesarean section) are excluded from the scope of this cover
iv. This coverage shall only be available if all the provisions as specified in The Assisted Reproductive Technology (Regulation) Act, 2021, and all the rules and regulations made thereunder are fulfilled
v. The terms and conditions of In-patient Treatment shall apply.

-Coverage up to Unlimited Sum Insured for any one claim in the lifetime of the policy.
-Coverage will cease once a claim is made under this cover and will not be available for subsequent renewals
– Applicable to IPD , Day care Treatment , IPD AAYUSH
– After Utilization of infinite claim the Total SI would be reduced to zero for that year
– Optional cover Voluntary co-payment or Voluntary deductibles are applicable

– Not available for worldwide cover , I{D surrogate mothers/ Oocyte or policies with unlimited SI


-Cover will have to be opted in first 2 Policy years since the date of joining. of single year policy than opt this cover at the time of policy inception or the first renewal
If policy tenure is 2or 3 years the cover is opted at time of policy inception.
– One Opted can be opted out at renewal , if opted out it cannot be opted again

-Pre and post is not covered

Over and above SI

Applicable on
Basic Cover 1 in-patient Treatment or
Basic Cover 2 Daycare Procedures /Treatments or
Basic Cover 6. in-patient AYUSH Hospitalization

i. the diseases/illnesses/conditions has been declared by the Insured Person and accepted by Us, or
ii. the diseases/illnesses/conditions has been detected during Pre-policy medical examination and have been accepted by Us.
iii.Theabovereducedwaitingperiodof30daysshallbe applicable only for specified Insured Persons who have opted and paid additional premium as specified in the policy schedule.
iv.This cover will be available only during inception of the policy and only for the Annual Sum Insured chosen at the time of Policy Inception.
v. Deletion of this Optional cover shall not be permitted upon subsequent policy renewals.
Vi.This reduced waiting period of 30 days shall not be applicable for claims made under Optional Cover 9. Worldwide Cover.

1. Asthma is a Chronic condition that affects the airways (bronchi) of the lungs, causing them to constrict (become narrow) when exposed to certain triggers which results in the symptoms of wheezing, coughing, tight chest and shortness of breath.
2. Hypertension is the term used to describe a persistent elevated blood pressure, commonly referred to as high blood pressure, and if this chronic disease is not treated appropriately, is a major risk factor for heart disease, stroke, kidney disease and even eye diseases.
3. Hyperlipidemia is a chronic disease that refers to an elevated level of lipids (fats), including cholesterol and triglycerides, in the blood and if not treated appropriately, it is a major risk factor for increased risks of heart disease, heart attacks, strokes and other incidents of disease.
4. Diabetes mellitus is a chronic, progressive disease in which impaired insulin production leads to high blood glucose (sugar) levels, and without good self-management and proper treatment, the increased glucose (sugar) in the blood affects and damages every organ in the body, which causes serious health consequences.
5. Obesity where Obesity means abnormal or excessive fat accumulation that presents risk to the health (Body Mass Index i.e. BMI is less than or equal to 39.99. This BMI limit will be modified in case of co-morbidities.)
6. Coronary Artery Disease with PTCA done prior to 1 year:
i. Coronary artery disease is the buildup of lipid-rich plaque in the arteries that supply oxygen-rich blood to the heart. Plaque causes a narrowing or
ii. blockage that could result in a heart attack.
iii. PTCA (Coronary Angioplasty) is defined as percutaneous coronary intervention by way of balloon angioplasty with or without stenting for treatment
iv. ofthenarrowingorblockageofminimum50%ofoneor more major coronary arteries. The intervention must be determined to be medically necessary by a cardiologist and supported by a coronary angiogram (CAG).
v. Coronary arteries herein refer to left main stem, left anterior descending, circumflex and right coronary artery.
vi. Diagnostic angiography or investigation procedures without angioplasty / stent insertion are excluded from the scope of this definition.

The Reset Benefit/Pre-Hospitalisation medical expenses/ Post hospitalization medical expenses will not be applicable for this Section.

– List Item 1 are covered( over and above SI)
-Only applicable on India
– guaranteed cumulative bonus/ inflation protector / reset benefit is not available

-upto SI max Rs 5L (Over and above SI )
– Same has to be prescribed by medical practitioner during hospitalization or 30 days after that
– Purchase has to be done within 30 days of medical recommendation
– only on claim IPD/ Day care/ AAYUSH

1. CPAP Machine
2. Ventilator
3. Wheelchair
4. Prosthetic device 5. Suction Machine 6. Commode Chairs 7. Infusion pump
8. Continuous Passive motion devices in case of Knee Replacement
9. Oxygen concentrator

– Reset benefit/ Pre-Hospitalisation medical expenses/ Post hospitalization medical expenses will not be applicable for this Section.

– maternity cover and new born baby cover is taken is opted and claim accepted
–1% of base SI per newly born child, max upto ₹10,000( over and above the maternity limit)

The Reset Benefit/Pre-Hospitalisation medical expenses/ Post hospitalization medical expenses will not be applicable for this Section.

– It is for a life threatening emergency health conditions of the Insured Person which requires immediate and rapid ambulance transportation from the place where the Insured Person is situated at the time of requiring Emergency Care to a hospital provided that the transportation is for Medically Necessary Treatment, is certified in writing by a Medical Practitioner, and Domestic Road Ambulance services cannot be provided.
– This cover is limited to transportation from the area of emergency to the nearest Hospital only

– We will not cover:
a. Any transportation from one Hospital to another;
b. Any transportation of the Insured Person from Hospital to the Insured Person’s residence after he/she has been discharged from the Hospital
c. Any transportation or Air Ambulance expenses incurred outside the geographical scope of India.
– We shall not be liable if Medically Necessary Treatment can be provided at the Hospital where the Insured Person is situated at the time of requiring Emergency Care.

The Reset Benefit/Pre-Hospitalisation medical expenses/ Post hospitalization medical expenses will not be applicable for this Section.

Upto 65 Yrs of age for adults only

1. Accidental death – during policy period or within 12 months from date of occurrence of such accident / injury which occurred during policy period
2. Permanent Total Disability
3. Permanent Partial disability

The Reset Benefit/Pre-Hospitalisation medical expenses/ Post hospitalization medical expenses will not be applicable for this Section.

– Waiting period of 90 days
– survival Period 0
– Can be claimed in a policy only once in a lifetime
– Claim is not admissible if critical illness is cause of PED
– Applicable upto adult member of 50 years
– multiple illness max liability is SI max upto 50 Lakhs

1. Cancer of Specified Severity
2. Myocardial Infarction (First Heart Attack of Specified Severity)
3. Coronary Artery Disease
4. Open Chest CABG
5. Open Heart Replacement or Repair of Heart Valves
6. Surgery to Aorta
7. Stroke resulting in Permanent Symptoms
8. Kidney Failure requiring Regular Dialysis
9. Aplastic Anaemia
10. End Stage Lung Disease
11. End Stage Liver Failure
12. Coma of Specified Severity
13. Third Degree Burns
14. Major organ /bone marrow transplant
15. Multiple Sclerosis with Persisting Symptoms
16. Fulminant Hepatitis
17. Motor Neuron Disease with Permanent Symptoms
18. Primary Pulmonary Hypertension 19. Terminal Illness
20. Bacterial Meningitis

–Max age of coverage is 65 Years who Is RI of India

– 2 years waiting period ( no waiting in case of accident)

– Any new family member addition would have waiting period of 2 years

–Coverage if

–The coverage is available for 45 consecutive days from the date of travel in a single trip and 90 days in a cumulative basis as a whole in a Policy Year. Any expenses incurred beyond 45 days from date of travel shall not be covered in any case

– The expenses covered under this benefit will be limited to Inpatient Hospitalization Expenses and Daycare Procedures/Treatment Expenses.

– Out- patient Treatment or any other Basic Covers/Optional Covers under this Policy shall not be covered under Worldwide cover.

-In case of planned hospitalization, prior intimation at least 7 days in advance of the travel and due approval from Us will be necessary.

-Any Additional Sum Insured as available under Guaranteed Cumulative Bonus/Power Booster / Inflation Protector (if any) will not be available for worldwide cover and Hospitalization/day care expenses incurred will be covered only up to the Annual Sum Insured under the Policy.

Maternity Benefit, Infinite Care, Reset benefit, and Claim Protector will not be available for worldwide cover.

12 months

– Can be chosen at inception

– optional cover for period 2 continuous policy year

The Reset Benefit/Pre-Hospitalisation medical expenses/ Post hospitalization medical expenses will not be applicable for this Section.

– Person is hospitalized for10 day or more
– Payable once per policy year

The Reset Benefit/Pre-Hospitalisation medical expenses/ Post hospitalization medical expenses will not be applicable for this Section.

– Qualified nurse employed with hospital at only if you have taken IPD
– And is certified by medical practitioner
– Maximum duration of benefit is 10 days

The Reset Benefit/Pre-Hospitalisation medical expenses/ Post hospitalization medical expenses will not be applicable for this Section.

– if hospitalizations extends beyond 5 consecutive days
– Economy class air ticket/ Railway ticket from place of origin tor place of residence
– Immediate family member means – Spouse / Children/ Parents/ Parents in law

The Reset Benefit/Pre-Hospitalisation medical expenses/ Post hospitalization medical expenses will not be applicable for this Section.

– only to 1 immediate family member
– Medical practitioner certifies that the insured member require hospitalization of min 3 days maximum of 10 days

The Reset Benefit/Pre-Hospitalisation medical expenses/ Post hospitalization medical expenses will not be applicable for this Section.

– If treatment is taken from networked hospital
– 20% co pay if non network hospital

–Cover for Accidental Emergencies only
-worldwide coverage is not applicable
-all waiting periods applicable

i. Provides declaration upon Policy Issuance and subsequent renewals that they are based abroad in entirety for the Policy Year
ii. Provides proof of overseas residence for the upcoming year upon each renewal to continue availing the discount
iii. Possesses and provides other relevant identity proof documents as mandated for Citizenship of India
iv. Has an Indian bank account for premium/claims payment.

Endometriosis

Hysterectomy

Dysfunctional uterine bleeding

Dilatation and curettage

Benign prostatic hypertrophy

Hernia of all types and Hydrocele

Fistulae in anus
,Fissure in anus

Hemorrhoids

All types of sinuses

Any types of gastric or duodenal ulcers

Gout and Rheumatism

Non Infective Arthritis and other form arthritis

Prolapse inter Vertebral Disc and Spinal Diseases including spondylitis/spondylosis unless arising from Accident

Dialysis required for Chronic Renal Failure.

Surgery for any skin ailment,