What are the covers?

Hospitalization

• Reimbursement of expenses incurred at hospital including- Room/Nursing/Operation Theatre/Specialist/Doctors/Drugs/Pathology etc
  
• Minimum 24hrs as Inpatient
  

Day Care Treatment

Hospitalization as an Inpatient for treatment or procedures that require less than 24 hrs of hospitalization due to advancement of technology.

Pre – Existing Diseases

Covered from 3rd year of the policy, after 24 months of continuous cover under this policy

Pre-Post Hospitalization

60 days prior to hospitalization & 90 days post hospitalization including Day Care Critical Illness Cover (Reimbursement) Additional Amount equivalent to opted Sum Insured for 9 listed

Critical Illnesses

• On renewal of this particular Insured, double SI is not available for the same Critical Illness. The same will be however available for the remaining illnesses.

• Additional SI for hospitalization due to Accident

• When Sum Insured is exhausted due to previous claim, by any member, the policy will reinstate the Sum Insured for any subsequent hospitalization due to accident. Reinstatement will be upto the expenses incurred on that claim or SI opted under the Policy, whichever is lower Reinstatement is available only once during an Annual Policy & can be availed by any member

Maternity Cover

Maximum 5% of SI or 25,000 for Normal Delivery & maximum 10% of SI for C-Section or actual, whichever is lower Maximum two events during the lifetime & for first two children only Waiting period of 48 months for continuous cover for the female member who makes the claim

New born baby cover

Medical expenses of the new born baby as an inpatient upto 90days within maternity limit Vaccination Charges are also payable upto 90days

Vale Added

All Value Added covers are available upto Sum Insured specified under each cover. Limits under each cover is available separately for each Insured and available for each instance of Hospitalization/Day Care Claim which becomes payable. Total benefit including all value added benefits cannot exceed the opted Sum Insured

Donor Expenses

Reimbursement of Hospitalization Expenses (excluding Pre-Post) of the donor upto the limit of SI opted Cost of organ is not covered Donated organ for the use of Insured Person only

Hospital Cash

Payment of Rs 1000 per day for a maximum of 7 days in case of hospitalization exceeding 3 days continuously. (Coverage is from day 4 to day 11)

Ambulance Charges

Maximum of Rs 1500 per hospitalization

 Recovery Benefit

Lump Sum of Rs 10,000 when hospitalization is for a continuous period of 10 days

Expenses on accompanying person

Reimbursement of expenses for an accompanying person upto maximum of Rs 500 per day Maximum 5 days where hospitalization exceeds 3 days. (Cover starts from day 4 to day 8)

What are the Features?

Sum Insure option

Minimum 3lacs

Maximum 10 lacs

Multiples of 1 lac

Family Floater

Family Floater option

available for maximum 4 persons Self+ lawfully wedded spouse+2 dependant children upto age 18 yrs Children above 18 yrs will be moved to an individual policy with continuation benefits but without any CB

Policy Period Option

1 yr 2 yr Incase of two yr policies, fresh limits upto the full Sum Insured will be applicable again for the 2nd yr

Family discount

10% for covering more than 2 members of the family, maximum 6 members are eligible for this discount Not Applicable on floater option

L&T group employee discount

10% discount for all L&T group company employees. Employee must be the proposer

Cumulative Bonus

5% increase in Si for each claim free renewal Maximum Accumulation of 50% CB reduces to 0% in case of a claim For 2 yr policies CB will be accumulated & awarded at the time of renewal

Income Tax Benefit

Under Section 80D (if paid by cheque or Credit Card0 Premium for Self, Spouse, Children & Parents is eligible for exemptions

2 yr Health Checkup

At end of every 2 yr irrespective of claim history For Insured above 45yrs Conducted at company network diagnostic centre Results of this checkup have no impact on renewal terms or premium

Co-payment

25% of payable claim amount for each and every claim for all insured persons above 70yrs Grace Period 15 days from date of expiry of policy with continuity benefits Fresh cover starts beyond 15 days

Cancellation

May be requested in writing. Return will be on Short Period Scale Cancellation from Company side will be in case of fraud, non-disclosure or misrepresentation without any refund

Free-Look Cancellation

A period of 15 days is available from the date of receipt of Policy Documents to review of the policy. Customer can request for cancellation giving reasons For such cases company will refund the premium the premium after deducting the medical expense cost, stamp duty & pro rated premium if the risk has already commenced

Who can be covered?

Entry Age

3 months (91 days) along with at least one parent in the same policy 3 months to 18 yrs under a floater as a Dependant Child 18-65 yrs as a proposer

Renewal Age Eligibility

Lifetime Cover Children under a floater on turning 19 yrs will be renewed under an Individual Policy with continuity benefits

Who can be covered

Self + lawful Spouse + max 2 dependant Children upto 18 yrs in a floater Parents can be covered under family floater as self & Spouse Siblings & Parents- in-laws & blood relatives can be covered on individual basis

EXCLUSIONS

Temporary

First 30 days excluding accidents 2 years(24 months): Cataract, Hysterectomy, Knee/Joint Replacement (except those caused by accident), Varicose Veins, ulcer, hernia, stones(urinary, biliary), Hydrocele, Congenital Internal, Fistula, Piles, Sinus, Deviated Nasal Septum Diabetes & related complications Hypertension & related complications Any Pre-existing Diseases Four years (48 months): Maternity & all related complications except ectopic pregnancy which may lead to life threatening conditions will be considered under basic hospitalization cover

PERMANENT

Domiciliary Hospitalization Circumcision unless necessary for treatment of disease, illness or injury, or due to accident Genetic Disorder Dental Treatment, Impotency, HIV treatment Out patient treatment other than falling under pre-post Cost of instruments that are not used intra-operatively Dyslexia, behavioral problems Cosmetic treatments unless falling under a part of accidents or burns Non-allopathic treatment Non-medical expenses like diabetic footwear, glucometer Service charge other than service tax

To understand the nuances of different types of policies and its price, feel free to seek the help of InsuranceMall to select the right products based on your need. Or you can directly call them on +91-22-30503050

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