Tertiary Care Insurance(Individual) (Cashless Facility Available)

SALIENT FEATURES OF THE POLICY

1.0 The Policy covers reimbursement of Hospitalisation/Domiciliary Hospitalisation expenses for nine major ailments suffered by the insured person as defined herein below:

1. Nephritis of any Aetiology plus Bacterial renal failure requiring Kidney Transplantation or Dialysis
2. Cerebral or Vascular Strokes
3. Open and Close Heart Surgery (inclusive of C.A.B.G)
4. Malignancy disease which are confirmed on Histopathological report
5. Encephalitis (Viral)
6. Neuro Surgery
7. Total Replacement of joints
8. Liver disorder (Hepatitis B & C) associated with complications like Cirrhosis of liver
9. Grievous Injury including multiple fracture of long bones, head Injury leading to unconsciousness, burns of more than 40%, Injury requiring artificial ventilator support plus Vertebral Column Injury

And if such condition shall require any such Insured Person, upon the advice of a duly qualified Medical Practitioner / Medical Surgeon to incur

a) Hospitalisation expenses for medical/surgical treatment at any Hospital in India as herein defined (herein defined) as an Inpatient OR

b) On Domiciliary treatment in India under Domiciliary Hospitalisation (herein defined), the Company will pay to the Insured Person the amount of such expenses as are Reasonable and Customary, and Medically Necessary incurred in respect thereof by or on behalf of such Insured Person.

 1.1 In the event of any claim becoming admissible under this scheme, the company will pay to the Insured person the amount of such expenses as would fall under different heads mentioned below, and as are Reasonable and Customary, and Medically Necessary incurred thereof by or on behalf of such Insured Person.

A) Room, Boarding Expenses as provided by the Hospital which includes Registration & Admission Fees.

B) Nursing Expenses.

C) Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees

D) Anesthesia, Blood, Oxygen, Operation Theater Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & Cost of Organs and similar expenses.

E) Reasonable expenses incurred for ambulance within city limits at the time of admission and discharge only.

F) Pre-Hospitalisation Medical Expenses

G) Post-Hospitalisation Medical Expenses

N.B.Company’s Liability in respect of all claims admitted during the period of insurance shall not exceed the Sum Insured (with Cumulative Bonus) per person per annum to be reckoned from the date of inception of the risk as mentioned in the schedule.

1.2 This insurance scheme also provides for Cumulative Bonus.

1.3 Hospitalisation expenses, which are Reasonable and Customary, and Medically Necessarily incurred on person donating the organ to the insured person during the course of organ transplant operation subject to limits available during the policy period.