Paripoorna Mediclaim Ayush Bima

Policy Highlights

Exclusive for CGHS Beneficiaries – Serving and retired CGHS members along with their family members can be covered.

1. Family Floater Option – Covers up to 6 family members under one policy, including spouse, children, parents, and parents-in-law.

2. Mid-term Inclusion of Newborn & Spouse – Newly married spouse and newborn baby can be added mid-term by paying pro-rata premium (CGHS membership to be provided).

3. Floater Sum Insured Options – ₹10 lakh or ₹20 lakh.

4. Comprehensive Hospitalization Cover – Covers room rent, ICU, doctor’s fees, medicines, diagnostics, surgeries, dialysis, chemotherapy, etc.

5. Room Rent & ICU Limits – Room Rent up to 1% of SI per day; ICU up to 2% of SI per day.

6. Pre-Hospitalization Expenses – Up to 30 days prior to hospitalization.

7. Post-Hospitalization Expenses – Up to 60 days from date of discharge.

8. 100% AYUSH Coverage – Covers Ayurveda, Yoga, Naturopathy, Unani, Siddha & Homeopathy up to 100% of SI (in-patient only).

9. Claims are payable only if in-patient hospitalization exceeds 24 hours, except for approved day-care procedures.

10. Day Care Procedures – Modern treatments requiring less than 24-hour hospitalization are covered (as per Annexure I).

11. Ambulance Expenses – Emergency ambulance charges covered up to 0.5% of SI per event.

12. Cataract Cover – ₹1 lakh per eye for ₹10L SI and ₹1.5 lakh per eye for ₹20L SI.

13. Congenital Disease – Covered after 24 months of continuous coverage.

14. Modern Treatment Cover – 25% of SI (inbuilt).

15. Modern Treatment Rider – Optional cover up to 100% of SI with additional 15% premium.

16. Flexible Co-Pay Options – 70:30 or 50:50 between insurer and insured.

17. Family Discount – 5% (2 members), 10% (3 members), 15% (more than 3 members).

Additional Benefits

1. Cumulative Bonus – 10% of SI for every claim-free year up to maximum 100%.

2. Cashless Hospitalization – Available at network hospitals through TPA.

3. Lifetime Renewability – No age limit for renewal.

4. Waiting Periods – First 30 days; 90 days for Diabetes & Hypertension; 24 months for specified illnesses.

5. Waiver of Pre-Existing Disease (PED) – May be considered on submission of Good Health Certificate with no hospitalization in past 24 months.

6. Pre-Existing Disease Definition – Any illness diagnosed or treated within 24 months prior to policy start.

7. Planned Hospitalization requires prior TPA/NIA intimation. Emergency cases to be intimated within 24 hours.

8. Policy Renewal & Continuity – 30 days grace period allowed for continuity benefits (no claims during grace period).

Note: For complete details of coverage, terms and conditions, refer to the Paripoorna Mediclaim Ayush Bima Policy Clause and Prospectus.