United India Family Medicare 2014 Health Insurance Plan

Entry age

Minimum age – 18 years

Maximum age – 80 years

Children between the ages of 3 months and 18 years will be covered if the parents are covered.

Coverage

The following will be covered under this policy:

• Hospital expenses:

• Room, boarding and nursing expenses – not exceeding 1% of the sum insured or the actual expense, whichever is less

• ICU expenses – not exceeding 2% of the sum insured or the actual expense, whichever is less

• Surgeon, anaesthetist, medical practitioner, consultant and specialist’s fees.

• Expenses incurred on anaesthetic, blood, oxygen, OT charges, surgical appliances, medicines, drugs, chemotherapy, dialysis, radiotherapy, etc.

• Day care treatment

• Ayush treatment

• Pre-hospitalisation expenses up to 30 days prior to hospitalisation.

• Post-hospitalisation expenses up to 60 days after discharge.

• Cashless facilities at more than 7000 hospitals across India.

• Ambulance charges up to Rs.2,500 maximum per policy period.

• Hospital cash benefit Rs.250 or Rs.500 per day subject to maximum of Rs.2,000 or Rs.5,000 per hospitalisation.

Payment mode

Either the amount is reimbursed or the cashless payment option is available in network hospitals

Renewal

The policy can be renewed throughout the lifetime of the life insured. You get 30 days grace period to renew the policy.

Free look period

You can return the policy in within 15 days from the date of receipt of the policy.

No claim discount

No claim discount of 3% is available after 3 continuous claim free years and it is subject to a maximum of 15%.

Expenses of health check-up will be reimburses once at the end of every 3 continuous years of no claim period.

Cancellation

The company can cancel the policy on grounds of fraud, non-disclosure and misrepresentation by sending 15 days written notice.

Claim

The insurer can settle the claim within 15 days from the receipt of the necessary documents.

Tax benefits

Payments made towards this policy in any mode other than cash is eligible for deduction from taxable income under section 80D of the Income Tax Act.

Other benefits

• Free medical check-up once at the end of the term provided no claims were reported during that term.

• Cashless facility

• No claim discount

• Tax benefit

Waiting period

• Pre-existing diseases will be covered after 48 months.

• Any diseases that were contracted within 30 days of taking the policy will have a waiting period to be covered.

• Two year waiting period for:

1. Cataract

2. Benign prostatic hypertrophy

3. Hysterectomy

4. Hernia

5. Hydrocele

6. Congenital internal disease

7. Fistula

8. Piles

9. Sinusitis

10. Gall bladder stone removal

11. Gout and rheumatism

12. Calculus disorder

• Four year waiting period for:

1. Joint replacement arising due to degenerative condition

2. Age related osteoporosis and osteoarthritis

Exclusions

The following conditions or diseases will be excluded under this policy:

• Treatment outside India

• Injuries arising out of war

• Circumcision

• Spectacles

• Hearing aids

• Dental treatment

• HIV, AIDS and STDs

• Hospitalisation for diagnostic purposes

• Vitamins and tonic unless they are prescribed for a treatment

• Pregnancy

• Experimental treatment

• External medical equipment

• Treating genetic disorder with stem cell therapy

• ARMD, RFQMR and EECP treatment

• Non-medical expenses

• Service charge, admission fee and registration charges

• Change of system of treatment or medicine