Standard Group Janata Mediclaim

Salient features of the 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/OperationMaximum 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 lens10800/-
Hysterectomy22500/-
Appendicectomy16200/-
Cholecystectomy18000/-
TURP18000/-
Hemia-Inguinal16200/-
Hernia- Ventral/Incisional19800/-
Septoplasty9000/--
Haemorrhoidectomy8100/-
Fissurectomy9000/-
Fistulectomy10800/-
Angiography12000/-
Angioplasty (imported stent single)Actual or Sum Insured whichever is less
CABGActual or Sum Insured whichever is less
Total Knee replacementActual or Sum Insured whichever is less
Total hip replacementActual or Sum Insured whichever is less
Tonsillectomy7200/-
Tympanoplasty13500/-
Kidney stone/lithotripsy13500/-
Arthoscopy10800/-
PID-Disectomy31500/-
Mastectomy(Radical)36000/-
Exploratory Laprotomy13500/- 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 day450/-
Operation Theatre Charges1260/-
Anesthesia630/-
Anesthetist Fees945/-
Surgeon fees3150/-

INTERMEDIATE SURGERY

Room Rent450/-
Operation Theatre Charges1764/-
Anesthesia882/-
Anesthetist Fees1323/-
Surgeon fees4410/-

MAJOR SURGERY

Room Rent450/-
Operation Theatre Charges2520/-
Anesthesia1260/-
Anesthetist Fees1890/-
Surgeon fees6300/-

SUPRA MAJOR SURGERY

Room Rent450/-
Operation Theatre Charges5040/-
Anesthesia2520/-
Anesthetist Fees3780/-
Surgeon fees12600/-
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/-