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The policy covers reimbursement of Hospitalization/Domiciliary Hospitalization expenses for illness/diseases of injury sustained. In the event of any claim becoming dismissible under this scheme, the company will pay to the insured person the amount of such expenses would fall under different heads mentioned below, and as are reasonable and necessarily incurred thereof by or on behalf of such insured person, but not exceeding the sum insured in aggregate in any one period of insurance stated in the schedule hereto. (N.B. Company’s Liability in respect of all claims admitted during the period of insurance shall not exceed the Sum Insured per person mentioned in the schedule).
This insurance scheme also provides for: ‘Hospital/Nursing Home’ means any institution in India established for indoor care and treatment of sickness and injuries and which Either Should comply with minimum criteria as under: (N.B.* In case ‘C’ town condition of number of beds be reduced to 10).

Domiciliary Hospitalisation Benefit
Medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a hospital/nursing home but actually taken whilst confined at home in India under any of the following circumstances namely, Subject however that domiciliary hospitalization benefits shall not cover:
Expenses incurred for pre and post hospital treatment and expenses incurred for treatment for any of the following diseases: Note:
When treatment such as Dialysis, Chemotherapy, Radiotherapy etc. if taken in the Hospital/Nursing Home and the Insured is Discharged on the same day, the treatment will be considered to be taken under Hospitalization Benefit section. Liability of the company under this clause is restricted as stated in the schedule attached hereto.

Any one illness will be deemed to mean continuous period of illness and includes relapse within 45 days from the date of last consultation with the Hospital/Nursing Home where treatment may have been taken. Occurrence of same illness after a lapse of 45 days as stated above will be considered as fresh illness for the purpose of this policy.

The company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any Insured Person in connection with or in respect of.

Age Limit
All diseases/injuries which are pre–existing when the cover incepts for the first time.
Any diseases other than stated clause 4.3 contracted by the Insured Person during the first 30 days from the commencement date of the policy.

The exclusion shall not however, apply if in the opinion of Panel of Medical Practitioners constituted by the company for the purpose, the insured Person could not have known of the existence of the Disease or any symptoms or complaints thereof at the time of making then proposal for insurance to the Company This condition 4.2 shall not however apply in case of the insured person having been covered under this scheme or group insurance scheme with any of the Indian Insurance Companies for a continuous period of 12 months without any break.

During the first year of the operation of insurance cover, the expenses on treatment of diseases such Cataract, Benign Prostates Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Diseases, Fistula–in–ano, Piles, Sinusitis and related disorders are not payable. Injury or disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, Warlike operations (whether war be declared or not). Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or changes of life or cosmetic or aesthetic treatment for any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness. This insurance is available to person between the age of 5 years and 75 years Children between the age of 3 months and 5 years of age can be covered provided one or both parents are covered concurrently.

Family Discount
A discount of 10% in the total premium be allowed comprising the insured and any one or more of the following: Cumulative Bonus
Sum insured under the policy shall be progressively increased by 5% in respect of each claim free year of insurance, subject to maximum accumulation of 10 claims free years of insurance. In case of a claim under the policy in respect of insured person who has earned the cumulative bonus the increased percentage will be reduced by 10% of sum insured at the next renewal. However, basic sum insured will be maintained and will not be reduced

For cumulative Bonus and Health Check up provisions as aforesaid.

Both Health Check up and cumulative bonus provisions are applicable where period of insurance as stated in the schedule attached hereto has commenced not later than a week after the expiry of last Mediclaim Insurance Policy, although Renewal is subject to medical check – up. Cumulative Bonus as accrued to the credit of the same policy holder will be added to sum insured under this policy.

Renewal of insurance cover
A further period of 7 days from the date of expiry will be permissible in exceptional cases subject to Health Certificate from Medical Practitioner.

Any diseases contracted during the period of 7 days extension will be excluded from the date of renewal in addition to other diseases excluded in the expiring policy, whereas other benefits mentioned above in item II (a) (b) (c) will be permissible. This is only a gist of the salient features for your information. For further details and conditions please contact:

Hutoxi P. Dadachanji
A 207 Gera Park.
Boat Club Rd.,
Pune 411001
Tel: 6125673