Health Assure Insurance

This policy can be availed either on an Individual or Floater basis.

Any person aged between 91 days and 75 years can avail this policy on an Individual basis.

Any person aged between 18 and 75 years can avail this policy. Under the Floater basis, a maximum of up to three dependent children aged between 16 days and 17 years are covered.

No pre-medical check-up is required to avail this policy. However, those who declare adverse medical history may be subjected to pre-medical check-up at Company’s cost.

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 incurred up to 180 days from the date of discharge from the hospital are covered.

Room, boarding and nursing expenses incurred during in-patient hospitalisation are covered up to 1% of the Sum Insured per day for Rs. 5 lakh Sum Insured; any room (except suite or above category) for Rs. 10/15/20/25 lakh Sum Insured options; and any room for Rs. 50/75/100/200 lakh Sum Insured options.

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

If there is an admissible claim under the policy, then non-medical items specified in this policy will become payable.

This policy covers ambulance charges for admission in hospital, for shifting from one hospitals to another for better medical treatment and from hospital to residence (if it is in the same city).

Air ambulance expenses are covered up to 10% of the Sum Insured per policy year, provided the situation requires an immediate hospitalisation of the insured person and ground transportation cannot be provided.

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

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

Expenses incurred for modern treatments such as Oral Chemotherapy, Intra Vitreal injections, Robotic Surgeries, etc. are covered up to the Sum Insured.

In-patient hospitalisation expenses incurred for organ transplantation from the Donor to the recipient insured person are payable provided the claim for transplantation is payable. In addition, the expenses incurred by the Donor, (if any) for the complications that necessitate a Redo Surgery / ICU admission will be covered.

Expenses incurred for Rehabilitation and Pain Management are covered up to the specified sub-limit or maximum up to 20% of the Sum Insured whichever is less, per policy year.

Expenses incurred for the treatment under Ayurveda, Unani, Sidha and Homeopathy systems of medicines in AYUSH hospitals are covered up to the Sum Insured.

The air transportation expenses incurred up to Rs. 10,000/- 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 expenses incurred for the repatriation of mortal remains of the insured person are covered up to Rs. 15,000/- in a policy year.

Expenses incurred for In Utero Fetal surgeries and procedures mentioned in this policy are covered with a waiting period. Note: The above-mentioned waiting periods will not apply for the treatment related to congenital Internal disease/defects for the Unborn.

In the event of hospitalisation in Valuable Service Provider, then a lump-sum of 1% of the Sum Insured subject to a maximum of Rs. 5,000/- per policy period is provided.

Cumulative bonus is provided at 25% of the Sum Insured for each claim-free year subject to a maximum of 100% of the Sum Insured.

Insured person can avail premium discount if he/she choose any of the deductibles as mentioned in this policy.

If the insured person purchases or renews the policy at 61 years of age or above, then he/she is subjected to the co-payment of 10% for each and every claim amount.

Health check-up expenses are covered up to the specified limits for each policy year irrespective of the claim.

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

Wellness program designed to motivate and encourage the healthy lifestyle of the insured person through various wellness activities. In addition, the earned wellness points can be utilised for availing renewal discounts up to a maximum of 20%.

1. For Pre-Existing Diseases (3 year term) – 30 months 2. For Pre-Existing Diseases (1 and 2 year term) – 36 months 3. For Specific Diseases/Procedures – 24 months Initial Waiting Period – 30 days

The policy premium can be paid on a quarterly or half-yearly basis. It can also be paid on an annual, biennial (once in 2 years) and triennial (once in 3 years) basis. This facility is not available for long-term (2 & 3 year term) options.