Summary
Good Features
Missing Features
Pricing
Insurer Performanceā
Product Benefits
In Patient Hospitalisation
ICU Room Rent Limit | No Limit |
Room Rent Limit | No Limit (Add-on) |
Pre & PostĀ Hospitalisation
Pre Hosipitalization Expenses coveredĀ | 90 Days |
Post Hosipitalization Expenses coveredĀ | 180 Days |
Day Care Treatment
Financial Limit | No Limit |
No. of treatments covered | All are covered |
Organ Donor
Expenses covered upto | Sum Insured |
DomiciliaryĀ Treatment
Expenses covered upto | Sum Insured |
No. of illnesses NOTĀ covered | 13 |
ModernĀ Treatment
Financial Limit | No Limit |
BonusĀ
Max Bonus | 1500% |
Reduction inĀ bonus postĀ claim | No (Bonus applies irrespective of claims) |
% of Bonus added every year | 100% |
Super BonusĀ
Max Bonus | Not Available |
Reduction inĀ bonus postĀ claim | Not Available |
% of Bonus added every year | Not Available |
Restoration BenefitĀ
No. of times refill can be applied | Unlimited |
Claim in which refill of cover can be applied | Subsequent claims |
When doesĀ restoration trigger ? | Partial exhaustion of Sum Insured |
Illness for which refill will beĀ eligible | Related and unrelated illness |
Non-Medical Expenses CoverĀ (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 2.5% |
Free Health CheckUps | Once a year (for Adults) |
Out patient consultation benefits | Not Available |
Maternity Benefits
Available in a difference Plan Sarvah UttamĀ (3 years waiting period for Maternity, covers for 2 deliveries)Ā | 20% of Sum Insured or Max Rs. 5 Lacs cover for Maternity |
Limits
Cataract treatment expenses covered up to | Sum Insured |
Joint replacement surgery expenses covered up to | Sum Insured |
Pre-existing Disease Waiting Period | No Waiting Period |
Specified Treatment Waiting Period | No Waiting Period |
Initial Waiting Period | 30 Days |
Co-payment | 10%/20%/30% (Add-on) |
Deductible | Multiple OptionsĀ (Add-on) |
Add-Ons
Surplus Benefit ā RecommendedAdditional 100% of sum insured, available from day one for 1st claim only, in each policy year.Ā
Coverage for Non Medical Items & Durable Medical Equipment ā Recommended
CNM : Covers listed 68 Non-Medical Items up to the Sum inured (in case of In-patient Hospitalization and/or Day Care Treatment).
DMC : Covers total listed 10 equipment, the expenses towards the cost of buying / renting durable medical equipment covered up to Rs.1 Lac in case.
Air Ambulance
Get up to sum insured or maximum 10 lacs over and above sum insured.
Room Rent Modification
To Any Room or Twin Sharing
Deductible
Multiple Options
Discounts
AggregateĀ Discount :Ā Get a discount on your insurance premium when you agree to pay a certain aggregate deductible amount.ĀExclusions
1.Ā Multifocal lens costs for undergoing cataract treatment2. Expenses associated with organ donor screening or organ transplant surgery involving organs not harvested from a human body
3. External or durable equipment for diagnosis or treatment
4. Dental or gum treatment is excluded, unless it involves irreversible jaw bone disease and is specifically covered under the policy
Insurer Performance
% of claims settled in less than 30 days Speed of settling valid claims | 98.70%ā |
Claim Settlement Ratio (No. of claims) % of the claims received were paid | 93.10% |
Claim Rejection Ratio % of claims rejected & repudiated by the insurer | 6.24% |
AmountĀ Settlement Ratio % of the claim amount received was paid | 66.77% |
% of Complaints received on overall claims % customers dissatisfiedĀ with claims | 0.25% |
Incurred Claim Ratio % of premium collected was paid out as claims (ideal : 70-90%) | 75.45% |
No. of Cashless Hospitals | 15,000+ |
Taxes
GST : ZEROIncome Tax Benefits (Old Tax Regime)Ā : Under Section 80D,Ā premium paid for Health InsuranceĀ is tax exempted. Limit is upto Rs. 25,000