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

• Convalescence Benefit: In the event that the insured hospitalised is for a minimum period of 10 consecutive days, due to any Injury or Illness as covered under the policy, we shall pay a benefit amount equal to the sum insured specified against this optional benefit.

OPTIONAL COVER 2

• Personal Accident Cover: We will pay you/nominee a benefit amount equal to the sum insured specified against this optional benefit, upon the unfortunate event of Accidental Death or Permanent Total Disablement resulting from an accident.
• Temporary Total Disablement (TTD) Rehabilitation Cover: We shall pay you a benefit amount as stated in policy schedule on a weekly basis up to a maximum of 10 weeks for rehabilitation upon the unfortunate event of Temporary Total Disablement resulting from an Accident.
• Rehabilitation is a treatment or treatments designed to facilitate the process of recovery from injury, illness, or disease to as normal a condition as possible. Only the rehabilitation services provided by a certified practitioner will be considered.
• Repatriation of Remains: We shall reimburse to the nominee/legal heir of the insured, upto the Sum Insured as specified against this optional cover, the costs of transporting the remains of the insured back to the place of residence or, up to an equivalent amount, for burial or cremation in the city where death has occurred.

OPTIONAL COVER 3

• Critical Illness Cover: We shall pay a lump-sum amount upto the extent of cover opted on your first diagnosis of such Critical Illnesses, subject to your intimation of the same within 30 days of such diagnosis.
• No claim will be payable under this cover if you are first diagnosed as suffering from any of these Critical Illnesses within 90 days of the start date of the first policy with us. This cover can be availed only once during your lifetime.
• Once a claim becomes payable under any of the Critical Illness covered, the cover would terminate and this cover will not be offered on any subsequent renewal of policy.

Co-payment

We are not liable to pay 20% of admissible claim amount above the deductible applicable under the policy, for insured above 60 years of age. This does not apply if insured is 60 years of age or below. However, this condition will not be applicable if you were aged 45 years or below at the time of buying this policy first time and have renewed it continuously after that. No co-pay will be applicable for optional covers, if any.

First 30 days waiting period

Any diseases contracted and declared during first 30 days of period of insurance start date except those arising out of accidents. This exclusion shall cease to apply from first renewal of the policy with us. This will not be applicable if the insured person(s) is/are insured continuously and without interruption for at least 1 year under any other health insurance plan with an Indian non-life insurer as per guidelines on portability issued by the insurance regulator.

Pre-existing disease waiting period

Any pre-existing condition(s) declared by you and accepted by us, shall not be covered until 24 months of your continuous coverage, since inception of this policy.

First 2 year exclusions

For medical diseases/ conditions and treatment/procedure mentioned below, a waiting period of 2 years will be applicable unless required due to occurrence of cancer.

• ENT: Sinusitis, deviated nasal septum
• Gynaecological: Fibroids (fibromyoma), endometriosis, prolapsed uterus, polycystic ovarian disorder (PCOD)
• Orthopaedic: Arthritis, gout and rheumatism, osteoarthritis and osteoporosis, spinal or vertebral disorders
• Gastrointestinal: Calculus diseases of gall bladder including cholecystitis, esophageal varices, pancreatitis, fissure/fistula in anus, hemorrhoids, pilonidal sinus, piles, ulcer and erosion, gastro esophageal reflux disorder (GERD), perineal abscesses, perianal abscesses
• Uro-genital: Calculus diseases of Urogenital system, for example: kidney stone, urinary bladder stone etc., benign enlargement of prostate, chronic kidney disease
• Eye: Cataract
• Other general conditions (Applicable to all organ systems/ organs/ disciplines whether or not described above): Internal tumors, cysts, nodules, polyps, skin tumors, lumps, all types of internal congenital anomalies/illnesses/defects

Permanent exclusions

• Any illness/disease/injury pre-existing before the inception of the policy for the first 2 years. Such waiting period shall reduce if the insured has been covered under a similar policy before opting for this policy, subject however to portability regulations
• Medical expenses incurred during the first 30 days of inception of the policy, except those arising out of accidents. This exclusion doesn’t apply for subsequent renewals without a break
• Expenses attributable to self - inflicted injury (resulting from suicide, attempted suicide)
• Injury or diseases directly or indirectly attributable to war, invasion, act of foreign enemy, war like operations
• Expenses arising out of or attributable to alcohol or drug use / misuse / abuse
• Cost of spectacles/contact lenses, dental treatment
• Medical expenses incurred for treatment of AIDS
• Treatment arising from or traceable to pregnancy (this exclusion does not apply to ectopic pregnancy proved by diagnostic means and is certified to be life threatening by the medical practitioner) and childbirth, miscarriage, abortion and its consequences congenital disease
• Tests and treatment relating to infertility and in-vitro fertilisation