Summary
Good Features
Missing Features
Pricing
Insurer Performance
Product Benefits
In Patient Hospitalisation
ICU Room Rent Limit | No Limit |
Room Rent Limit | No Limit |
Pre & Post Hospitalisation
Pre Hosipitalization Expenses covered | 60 Days |
Post Hosipitalization Expenses covered | 180 Days |
Day Care Treatment
Financial Limit | No Limit |
No. of treatments covered | All are covered |
Organ Donor
Expenses covered upto | Sum Insured |
Domiciliary Treatment
Expenses covered upto | Sum Insured |
No. of illnesses NOT covered | 12 |
Modern Treatment
Financial Limit | No Limit |
Bonus
Max Bonus | 100% |
Reduction in bonus post claim | No |
% of Bonus added every year | 50% |
Super Bonus
Max Bonus | 500% (Add-on) |
Reduction in bonus post claim | No (Add-on) |
% of Bonus added every year | 100% (Add-on) |
Restoration Benefit
No. of times refill can be applied | Unlimited |
Claim in which refill of cover can be applied | Subsequent claims |
When does restoration trigger ? | Full exhaustion of Sum Insured & Bonus |
Illness for which refill will be eligible | Related and unrelated illness |
Non-Medical Expenses Cover (Consumables Cover)
Limit on Non Medical Expenses | No limit (Add-on) |
Cover on Non Medical Expenses | Available (Add-on) |
Additional Features
Alternate Medicine (AYUSH) | Sum Insured |
Worldwide Coverage | Not Available |
Animal Bite Vaccination | Not Available |
Daily Cash Allowance | Not Available |
Discount on Renewal | Available (Upto 30%) |
Free Health CheckUps | Once a year |
Out patient consultation benefits | Available (Add-on) |
Maternity Benefits
Available with in a different plan Joy Tomorrow (2 years Maternity Waiting period) | Rs. 50,000 cover for Maternity, Pre & Post Natal Expenses |
Limits
Cataract treatment expenses covered up to | Sum Insured |
Joint replacement surgery expenses covered up to | Sum Insured |
Pre-existing Disease Waiting Period | 36 months (Add-on can reduce to 24/12 months) |
Specified Treatment Waiting Period | 24 months |
Initial Waiting Period | 30 Days |
Co-payment | No co-payment |
Deductible | No Deductible |
Add-Ons
Instant Cover ★ RecommendedClaim can be made for hospitalization related to Diabetes, Hypertension, Hyperlipidemia & Asthma after initial wait period of 30 days.
Reduction in PED ★ Recommended
Reduce pre-existing disease waiting period to 1 or 2 years (from the default 3 years).
Note:This rider does not reduce specific illness waiting period.
Unlimited Care ★ Recommended
Get full coverage with no limit on any single claim for the lifetime of the policy
Instant Cover Advanced
Claim can be made for hospitalization related to Diabetes, Hypertension,Obesity, Chronic Obstructive Pulmonary Disease ( COPD), Coronary Artery Disease with PTCA done prior to 1 year, Hyperlipidemia & Asthma after initial wait period of 30 days
Annual Health Check Up
Once for all insured every policy year
OPD Care
- 4 General Physician (physical) consultations
- 4 Specialist consultations (choose from 14 specialists)
- Maximum reimbursement: Rs. 500 per consultation.
Be-Fit Benefit
Unlimited visits to fitness centers can be availed by insured members aged above 12 years.
Claim Shield Plus
Non-payable items will be covered (as per list I, II, III, IV of Annexure I)
NCB Shield
The accrued No Claim Bonus remains unaffected if you make a claim
Inflation Shield
At the time of renewal, the sum insured amount is raised each year by the Consumer Price Index (CPI) inflation rate
Discounts
Aggregrate Discount : Get a discount on your insurance premium when you agree to pay a certain aggregate deductible amount.Deductible Amount Options : Rs.25,000, Rs.50,000, & Rs.1,00,000
Exclusions
1. Hormone replacement therapy2. Prosthesis or external equipment of any kind
3. Hair loss treatment, wigs, hair replacement, etc.
4. Brain-related issues due to substance abuse (unless prescribed)
5. Life support for someone declared brain dead or in vegetative state
Insurer Performance
% of claims settled in less than 30 days Speed of settling valid claims | Not Available |
Claim Settlement Ratio (No. of claims) % of the claims received were paid | 95.20% |
Claim Rejection Ratio % of claims rejected & repudiated by the insurer | 3.10% |
Amount Settlement Ratio % of the claim amount received was paid | 87.97% |
% of Complaints received on overall claims % customers dissatisfied with claims | 0.47% |
Incurred Claim Ratio % of premium collected was paid out as claims (ideal : 70-90%) | 66.30% |
No. of Cashless Hospitals | 11,400+ |
Taxes
GST : ZEROIncome Tax Benefits (Old Tax Regime) : Under Section 80D, premium paid for Health Insurance is tax exempted. Limit is upto Rs. 25,000