Salient Feature
Hospitalization for illness, disease or accident, whether including surgery or not, imposes heavy financial burden on individuals, families, employers and welfare bodies.
Scope Of Cover
Mediclaim insurance policy has been devised under the aegis of the Government of India.
The policy provides the following benefits.
1) Reimbursement of hospitalisation expenses which are reasonably and necessarily incurred, Under the following heads:
a) Room, boarding expenses as provided by the hospital/nursing home.
b) Nursing expenses.
c) Fees of surgeon, anesthetist, medical practitioner, consultant and specialist.
d) Expenses on account of anesthesia, blood, oxygen, operation theatre charges, surgical Appliances, medicines and drugs, diagnostic material, X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs and cost of organs and similar expenses.
2) Introduction of Sub-Limits:
The following provisions have been introduced:
a). Room, Board and Nursing Expenses as provided by the Hospital /Nursing Home- Room
Rent limit : 1 % of the Sum Insured per day subject to maximum of Rs.5000./-. I.C. Unit
expenses : 2 % of Sum Insured per day subject to maximum of Rs. 10,000/-. Over all
limits under this head : 25% of S.I. per illness.
b). Surgeon, Anesthetist, Medical Practitioner, Consultants Special fees - maximum limits per illness -
25% of S.I.
c). Anesthesia, Blood, Oxygen, OT charges, Surgical appliance, Medicines, drugs, Diagnostic Material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs and cost of stent and implant. Maximum limit per illness - 50% of Sum Insured.
d). Ambulance services - 1% of the sum insured subject to maximum of Rs 1000/- provided registered ambulance is used for shifting patient from residence to hospital if admitted to ICU or emergency ward OR from one hospital to another subject to sub-limits under ‘c’ above.
e). Hospitalization expenses of person donating an organ during the course of organ transplant will also be payable subject to the sub-limits under ‘c’ above.
3) Premium paid for the policy towards self, spouse, dependent children and dependent parents are exempt from Income Tax under Sec. 80D of the l.T. Act.
4) Cost of Health Check Up and Cumulative Bonus -
Benefits will accrue only if the Policy is a renewal of ‘National’.
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