Plan:Mediclaim Type:Individual

 Description > Benefits > How it works > Exclusions

Locations
 

Description:

Mediclaim Insurance Policy is a cover, which takes care of medical expenses following Hospitalization/Domiciliary Hospitalization of the Insured in respect of the following situations:

(A) In case of a sudden illness

(B) In case of an accident

(C) In case of any surgery which is required in respect of any disease which has arisen during the policy period.

 
 

Benefits:
General
Entry Age Minimum 5 yrs
Entry Age Maximum 60 yrs
Individual Policy Yes
Group Policy No
Underwriter Government Public Sector Unit (PSU)/Corporation
Plan Name Mediclaim Policy
Mandatory Requirement for Policy Cover Medical Report for Age > 45
Coverage Details
Floater Available No
Cover while in India Yes
Cover while travel abroad No
What does Policy Cover( See Details Below)
Yearly Health Checks After 4 renewals 1% of Sum Insured
Doctor Visits No
Specialist Doctor Visits No
Prescription Drugs Only if hospitalized
Hospitalization Yes
Pre- Hospitalization Yes
Post Hospitalization Yes
Day care Expenses No
Domiciliary Hospitalization Yes(*6)
Accident  
Emergency Care  
Pre-existing Diseases No
Hospitalization Abroad No
Network
Network of Doctors to Visit Free to Choose any Doctor
Network of Hospitals to visit Listed Hospital Available in Policy Document
Option to Choose out of Network Doctor  
Choose out of Network Hospital Yes. But No Cashless Admission
Claim Settlement
Who settles Claim TPA defined by Underwriter
Process for Claim in Network Outlined by Policy Document
Process for Claim for out of Network Pay & Claim Re-imbursement
Other Services
Cashless Admission Within Network
Ambulance  
Emergency Hot Line  
Toll free numbers within India Available in Policy Doc.
Toll free numbers when abroad No
 
 
 
What the policy Covers?

This cover is a hospitalization cover and reimburses the medical expenses incurred in respect of covered disease /surgery while the insured was admitted in the hospital as an in-patient. The cover also extends to pre- hospitalsation and post- hospitalization for periods of 30 days and 60 days respectively

 
 

Exclusions:

  1. Any pre-existing disease, any expense incurred during first 30 days of cover except injury due to accident.
  2. Treatment arising from or traceable to pregnancy, childbirth, including caesarean.
  3. Treatment for Cataracts.
  4. Benign prostatic hypertrophy, Hysterectomy
  5. Menorrhagia or Fibromyoma, Hernia, Fistula of anus, Piles, Sinusitis, Asthma, Bronchitis.
  6. All Psychiatric or Psychosomatic disorders are excluded from the scope of the cover.
  7. Congenital external disease, sterility, venereal disease, intentional self-injury, use of drugs, alcohol, rest cure etc.
  8. AIDS
  9. Charges primarily for diagnostic, laboratory examinations, and not related to any treatment in hospital. So also for vitamins and tonics unless prescribed for treatment.
  10. Dental treatment not requiring hospitalization. .
  11. Naturopathy treatment.