Senior Citizen Mediclaim Policy

Health Insurance Policy

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Salient features of the Policy

1.0 COVERAGE:The Policy covers reimbursement of Hospitalization Expenses for Illness/ Injury sustained.

2.0 SCOPE OF COVER: HOSPITALIZATION EXPENSES
In the event of a claim becoming admissible, the Company will pay the expenses listed below that are Reasonable and Customary, and Medically Necessary incurred by or on behalf of such Insured Person but not exceeding, in aggregate, the Sum Insured mentioned in the Schedule.

2.1.0

Hospitalization Benefits	Limits
(i) Room, Boarding expenses charged by the Hospital/Nursing Home (ii) If admitted in ICU	Up to 1% of Sum Insured per day Up to 2% of Sum Insured per day Overall limit: 25% of the Sum Insured.
Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses	Overall limit 25% of Sum Insured
Anesthesia, Blood, Oxygen, OT charges, Surgical appliances, Medicines, Drugs, Diagnostic material and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs, Cost of Stents and Implants	Overall limit 50% of Sum Insured

2.1.1Claims in respect of the following Illness / Surgery, will be subject to the following limits:

Name of Illness/Operation	Maximum Charges Inclusive of Room/ICU/OT Charges/ Surgeons, Anesthetist, doctor's fees, medicines, internal appliances and other charges incurred during hospitalization period
Cataract with imported foldable lens	10000/-
Hysterectomy	22000/-
Appendicectomy	16000/-
Cholecystectomy	18000/-
Prostate	18000/-
Hemia-Inguinal	16000/-
Hernia- Ventral/Incisional	20000/-
Septoplasty	9000/-
Haemorrhoidectomy	8000/-
Fissurectomy	9000/-
Fistulectomy	10000/-
Angiography	12000/-
Tonsillectomy	7000/-
Tympanoplasty	13000/-
Kidney stone/lithotripsy	13000/-
Arthoscopy	10000/-
PID-Disectomy	31000/-
Mastectomy(Radical)	36000/-
Exploratory Laprotomy	18000/-

2.2Actual Pre-Hospitalization Medical Expenses of up to 30 days, subject to maximum 5% of hospital bill.

2.3Actual Post-Hospitalization Medical Expenses of up to 60 days, subject to maximum of 10% of hospital bill.

2.4 Expense incurred for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy system of medicines are covered 100% of Sum insured.

2.5Ambulance charges, subject to a maximum of INR 1000/-

2.6Hospitalization Expenses (excluding cost of organ) incurred on the donor during the course of organ transplant to the Insured. The Companys liability towards expenses incurred on the donor and the Insured recipient together shall not exceed the sum insured of the latter.

Sum Insured (INR)	60-65	66-70	71-75	76-80	81-85	86 and above
Sum Insured (INR)	60-65	66-70	71-75	76-80	81-85	86 and above	100000	4043	4463	4935	5408	5948	6489
150000	6006	6626	7329	8033	8836	9639