Family Health Optima Insurance Plan

This policy provides benefits only on a Floater basis.

Any person aged between 18 and 65 years can avail this policy. Dependent children are covered from the 16th day onwards up to 25 years.

This policy provides wide coverage to family members including self, spouse, dependent children (maximum 3), parents and parents-in-law.

Hospitalisation expenses incurred for a period of more than 24 hours on account of  illness, injury or accidents are covered.

In addition to in-patient hospitalisation, the medical expenses incurred up to 60 days before the date of admission to the hospital are also covered.

Post-hospitalisation medical expenses up to 90 days from the date of discharge from the hospital are covered.

Expenses incurred on occupying a shared accommodation by the insured person are covered up to the limits mentioned in the policy clause.

Ambulance charges for the transportation of insured person by private ambulance are covered up to Rs. 750/- per hospitalisation and Rs. 1500/- per policy period.

Air ambulance expenses are covered up to 10% of the Sum Insured for the entire policy period.

Upon exhaustion of the limit of coverage during the policy period, 100% of the Sum Insured will be restored 3 times in the same policy year.

For Sum Insured options Rs. 3,00,000/- and above, Cumulative Bonus is available at 25% of the expiring Sum Insured in the second year and additional 10% of the expiring Sum Insured for the subsequent years. The maximum allowable bonus shall not exceed 100%

If the insured person meets with a Road Traffic Accident resulting in an in-patient hospitalisation, then the Sum Insured shall be increased by 25% subject to a maximum of Rs.5,00,000/-.

The Company will reimburse medical expenses incurred on Assisted Reproduction Treatment, where indicated, for sub-fertility 1. Waiting period of 36 months from the date of first inception of this policy is applicable. 2. Maximum liability of the Company for such treatment shall be limited to Rs.1 lakh for sum insured of Rs.5 lakh and Rs.2 lakhs for sum insured of Rs.10 lakhs and above for every block of 36 months.

Cover starts from 16th day after birth and subject to a limit of 10% of the Sum Insured or Rupees Fifty Thousand, whichever is less, provided the mother is insured under the policy for a continuous period of 12 months without break. Note : Exclusions No.1(Code Excl 01), Exclusion No.2(Code Excl 02), Exclusion No.3(Code Excl 03) and the above sublimit will not apply for treatment related to Congenital Internal disease/defects for the new born.

Expenses incurred for the treatment under Ayurveda, Unani, Siddha and Homeopathy systems of medicines in AYUSH hospitals are covered.

Expenses incurred towards the transportation of the insured person from the treating hospital to another hospital for treatment are covered as per the limits mentioned in the policy clause.

The air transportation expenses incurred up to Rs. 5000/- are payable for an immediate family member to travel to the hospital in case of hospitalisation of the insured person for life-threatening emergency times, at the place away from insured’s usual place of residence.

The Insured person can avail a Second Medical Opinion from a Doctor in the Company’s network of medical practitioners.

Modern treatment expenses are payable up to the limits mentioned in the policy clause.

Available up to the limits.

Medical treatments and surgical procedures that require less than 24 hours of hospitalisation due to technological advancements are covered.

Expenses incurred for domiciliary hospitalisation, including AYUSH on the advice of a medical practitioner for a period exceeding three days are covered.

Expenses incurred for organ transplantation are covered up to a limit of 10% of the Sum Insured subject to the maximum of Rs. 1,00,000/- whichever is less.

The expenses incurred for the repatriation of mortal remains of the insured person are covered up to Rs. 5,000/- per policy period.

Expenses incurred for Cataract treatment are covered up to the limits mentioned in the policy clause.

If the treatment is undergone in a hospital suggested by the Company, then a lump-sum of 1% of the Sum Insured subject to a maximum of Rs. 5,000/- per policy period is payable.

Health check-up expenses incurred at Network Hospitals are covered up to the specified limits for every claim-free year.

This policy is subjected to co-payment of 20% of each and every claim amount for fresh as well as renewal policies for insured persons whose age at the time of entry is 61 year and above.

Premium can be paid Quarterly and Half Yearly. Premium can also be paid Annually and Biennially (once in 2 years). Note: If Instalment Facility is opted for 2 year term policies, the full premium applicable for 2 year terms should be paid in quarterly or half yearly within the expiry of the first year.

5% discount for filling the lifestyle and habits related questionnaire at the inception of this policy.