The policy covers hospitalization expenses reasonably and necessarily incurred for treatment of illness/disease or injury contracted/sustained by the insured persons during the policy period, Provided Period of the Hospitalization exceeds 24 hrs except those which are listed in Day care treatment. The Insurer will either provide a cashless treatment or reimbursement of medical expenses for injuries or illnesses covered under the policy.
Scope of Cover
The policy covers expenses towards diseases / ailments and accidents incurred as an in-patient in a Hospital (Allopathic, Ayurvedic and Homeopathic) which will include:
Room, Boarding and Operation Theatre charges
Fees of Surgeon, Anesthetist, Nurses, Specialists
The cost of diagnostic tests, medicines, blood, oxygen, appliances like pacemaker, artificial limbs and organs etc.
Key Features
Hospitalization expenses incurred in India only are covered.
Any number of claims can be made until the Sum assured is exhausted.
Cumulative bonus available for every claim-free year.
Free look period and policy portability
All relevant expenses incurred 30 days before and 60 days after hospitalization are reimbursable (for which a claim is payable).
Any expenses incurred by the Insured towards hospitalization for any disease contracted by the insured during the first 30 days from the date of commencement of the policy, is not payable.
Pre-existing diseases are excluded under Standard Medi claim Policy for the first four years.
Pre-existing Condition means any injury which existed prior to the effective date of the insurance policy. It also means any sickness or symptoms, which existed prior to the effective date of insurance, whether or not the insured person had knowledge that the symptoms were related to the sickness.
First year Policy Exclusions: Expenses incurred on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy, Menorrhagia, Fibromyoma, Hernia, Congenital internal diseases, Fistula in anus, sinusitis and related disorders, Gout and Rheumatism, Calculus diseases, Joint replacement due to degenerative condition and age related Osteoarthritis & Osteoporosis.
Some policies exclude some of the diseases/ procedures for a period longer than 1 year like Knee Replacement/ Hip Replacement for 4 years.
Types of Medi claim Policies
1.The Individual Health Insurance plan :
offers cover only for the insured individual.
2.Family floater insurance Policy:
Covers multiple members of the same family under a single Premium which include the primary insured, his spouse and children. However, there are some Insurers who even allow coverage for parents, siblings and other relatives under the same policy.
Free look Period: The policyholder can review the terms and conditions of the policy and decide whether or not to continue with the policy within a period of 15 days . If there is any disagreement with the terms, the policyholder can cancel the policy by stating the reason for cancellation. Upon cancellation within the free look period, the Insurer will refund the money obtained for the Premium charges. Certain deductions such as proportionate Premium for the period of cover, charges incurred by the company for medical examinations, stamp duty charges, etc. may apply during the return of Premium.
Portability
This is the right accorded to an individual health insurance policy holder (including family cover) to transfer the credit gained by the insured for pre-existing conditions and time bound Exclusions if the policyholder chooses to switch from one Insurer to another Insurer, provided the previous policy has been maintained without any break.
Tax benefits
Tax benefits are available on the Premiums paid under Section 80D of the Income Tax Act, 1961.
All pre-existing conditions are covered at the end of 4 years from the purchase date. However, following are the Exclusions before the waiting period.
Pre-existing medical conditions
Alternative therapies
Does not cover therapies such as magnetic therapy, naturopathy, acupressure, and other treatments.
Lifestyle related conditions
Cosmetic treatments
Dental treatments unless requiring Hospitalization.
Pregnancy and childbirth.
Diagnostic expenses
Laboratory tests that are routinely conducted are not covered under health policies. If the tests yield a positive result for any illness or injury that requires hospitalization however are covered.
Cost of spectacles and contact lenses, hearing aids.
Injuries caused due to suicide attempt
Injuries that are caused due to any kind of self-harm or suicide attempt are not covered under the Policy.