Standard Group Janata Mediclaim
Health Insurance Policy
Health Insurance Policy
1.0 COVERAGE:The Policy covers reimbursement of Hospitalisation Expenses for Illness/ Injury sustained.
2.0Cost of treatment taken in General Ward of the Hospital/ Day-Care Centre per day maximum charges INR 450/-.
2.1Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses.
2.2Surgeon, Anaesthetist, Medical Practitioner, Consultants’ Specialist fees.
2.3Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like pacemaker, Relevant Laboratory/Diagnostic test, X-Ray etc.
2.4Pre-Hospitalisation medical Expenses up to 30 days.
2.5Post-Hospitalisation medical Expenses up to 60 days, subject to maximum of 10% of hospital bill.
2.6 AYUSH:Expenses incurred for Ayurvedic/Homeopathic/Unani Treatment are admissible up to 25% of the Sum Insured provided the treatment for Illness or Injury, is taken in a Government Hospital or in any institute recognized by Government and /or accredited by Quality Council Of India / National Accreditation Board on Health, excluding centers for spas, massage and health rejuvenation procedures.
2.7Ambulances services – actual expenses for transportation of patient (insured) or INR 1000/- whichever is less in case patient has to be shifted from residence to Hospital for admission in Emergency Ward or ICU or from one Hospital to another Hospital by fully equipped ambulance for better medical facilities.
2.8Hospitalisation expenses (excluding cost of organ) incurred on the donor during the course of organ transplant to the Insured person. The Company’s liability towards expenses incurred on the donor and the Insured recipient shall not exceed the sum insured of the Insured person receiving the organ.
2.9The total amount payable under this policy during the period of insurance will in no case exceed the Sum Insured and will be subject to the limits shown in the following schedule or actual whichever is less.
2.10 SCHEDULE OF PAYMENT FOR SPECIFIED DISEAES
|Name of Illness/Operation||Maximum Charges Inclusive of Room/ICU/ OT Charges / Surgeons, Anesthetist, doctors’ fees, medicines, internal appliances and other charges incurred during Hospitalization period|
|Cataract with imported foldable lens||10800/-|
|Angioplasty (imported stent single)||Actual or Sum Insured whichever is less|
|CABG||Actual or Sum Insured whichever is less|
|Total Knee replacement||Actual or Sum Insured whichever is less|
|Total hip replacement||Actual or Sum Insured whichever is less|
|Exploratory Laprotomy||13500/- to 27000/-|
Actual expenses for Other Surgeries/Hospitalisation or given hereunder whichever is less:
PER DAY CHARGES
|Room Rent (inclusive of nursing / treatment charges)||450/-|
|Minor Surgery (as defined) / Day care Room Rent per day||450/-|
|Operation Theatre Charges||1260/-|
|Operation Theatre Charges||1764/-|
|Operation Theatre Charges||2520/-|
SUPRA MAJOR SURGERY
|Operation Theatre Charges||5040/-|
|ICU Charges (per day with all intensive care infrastructure & facilities)||1800/-|
|Ventilator Charges (Per day)||450/-|
|Visit Charges (Per day irrespective of number of visits)||360/-|