FAQs in relation to COVID-19 cover under retail Health Insurance policies

• Hospital Daily Cash: A certain amount (as per the plan chosen) will be paid for each and every completed day of hospitalisation, if such hospitalisation is atleast for a minimum of 3 consecutive days and subject to maximum of 10 consecutive days.
• Convalescence Benefit: A benefit amount of `10,000 per insured once during the policy period will be paid in case of hospitalisation arising out of any injury or illness as covered under the policy, for a period of consecutive 10 days or more.

OPTIONAL COVER 2

• Outpatient Treatment Cover: Reimbursement for the medical expenses incurred as an Outpatient (OPD).
• Maternity Benefit: Reimbursement for medical expenses incurred for delivery, including a cesarean section, during hospitalisation or lawful medical termination of pregnancy during the policy period. The waiting period for maternity cover is 3 years. The cover shall be limited to 2 deliveries / terminations during the period of insurance. Pre - natal and Post - natal expenses shall be covered under this benefit. This cover is applicable only for floater plan having Self and Spouse in the same policy.
• New Born Baby Cover: The new born child can be covered under this policy during hospitalisation for a maximum period upto 91 days from the date of birth of the child. This cover will be provided only if maternity cover is opted.
• Wellness and Preventive Healthcare: All the expenses pertaining to routine health check - ups and for other wellness and fitness activities taken by you will be reimbursed.

OPTIONAL COVER 3

• Critical Illness Cover: The customer can opt for Critical Illness Cover covering specified Critical Illnesses / medical procedures like Cancer of Specified Severity, First Heart Attack - of Specified Severity, Open Chest Cabg, Stroke Resulting in Permanent Symptoms, Permanent Paralysis of Limbs,Kidney Failure Requiring Regular Dialysis, Major Organ / Bone Marrow Transplant, Multiple Sclerosis with Persisting Symptoms, Open Heart Replacement or Repair of Heart Valves, Coma of specified severity. A benefit amount is paid up on the diagnosis of the chosen critical illness.
• Donor Expenses: Reimbursement up to `50,000 for such medical expenses as incurred by the organ donor for undergoing any organ transplant surgery for your use.

For the first 2 years, some diseases like cataract, hernia, stone in the urinary system and others will not be covered.

Exclusions valid for the first 2 years

• Treatment of the following diseases/illness/ailments
• Cataract #
• Benign prostatic hypertrophy
• Myomectomy, hysterectomy unless because of malignancy
• Hernia and hydrocele
• Fissures and/or fistula in anus, hemorrhoids/piles
• Joint replacement, unless due to accident
• Sinusitis and related disorders
• Stone in the urinary and biliary systems
• Dilatation and curettage, endometriosis
• All types of skin and all internal tumours/cysts/nodules/polyps of any kind, including breast lumps, unless malignant
• Dialysis required for chronic renal failure
• Surgery on tonsils, adenoids and sinuses
• Gastric and duodenal erosions and ulcers
• Deviated nasal septum
• Varicose veins/varicose ulcers

If the policy is renewed with us for two consecutive years, the above diseases / illness / ailments will be covered from the third year.

# Any claim for cataract treatment shall not exceed ` 20,000 per eye, during each policy year after 2 years from the policy start date.

## 4 years for sum insured up to ` 2 lakhs.

Pre-existing diseases, non-allopathic treatments and some other expenses are permanently excluded from being covered.

Permanent exclusions

• Any illness/ disease/ injury/ pre-existing disease before the inception of the policy. However, this exclusion ceases to apply if the policy is renewed with the company for two consecutive years for sum insured of `3, 4, 5, 7, 10 lakhs and ` 2 lakhs if the policy is renewed for 4 consecutive years
• Non-allopathic treatment, pregnancy and childbirth related complications, cosmetic, aesthetic and obesity related treatment
• Expenses arising from HIV or AIDS and related diseases, use or misuse of liquor, intoxicating substances or drugs as well as intentional self-injuryWar, civil war or breach of law
• Naturopathy treatment, acupressure, acupuncture, magnetic and other such therapies
• Treatment taken outside the country
• Any expenses arising out of domiciliary treatment
• It’s always a good idea to be aware of what is excluded from your policy; so make sure you read the Policy Wordings