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United India Medical Insurance |
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We Cover
Expenses incurred by the insured for hospitalization for illness / diseases or injury sustained (domiciliary hospitalization also payable as per policy). These include Hospital charges ( Room, Boarding & Operation theatre ) fees for surgeon, Anesthetist Nursing, specialist etc., diagnostic tests, cost of medicines, blood, oxygen etc., cost of appliances like pacemaker, artificial limbs etc.,
Who can be Insured?
• Any person in the age group of 5 to 75 years Children between 3 months and 5 years can be covered only along with parent/s.
• Institutions (Government or Private) for their employees
• Clubs / association for their members in the said age group.
• Group schemes for homogenous groups of more than 50 persons.
Insured against what risk ?
Illness / disease, accidental injury sustained leading to one or more of class of expenses listed above.
Other Benefits
• Domiciliary hospitalisation benefits can be excluded under group mediclaim policy and a premium discount can be availed
• Exemption under income tax (80D of Income Tax Act) for Premium paid by cheque
• A discount of 10% of total premium for coverage of family under a single policy.
What will Policy Pay ?
• Actual hospitalisation expenses of various types listed above subject to a maximum of Rs. 15,000/- to Rs. 5,00,000/- depending upon the sum insured chosen at the inception of the policy ( sum insured is maximum liability under the policy.)
• Actual domiciliary hospitalisation expenses limited to Rs. 3,000/- to Rs. 50,000/- depending on the sum insured chosen at inception.
• Cost of health check up reimbursable at the end of 4 continuously claim free underwriting years limited to 1% of Average sum insured of 4 claim free years
• The sum insured will be increased by 5 % cumulative bonus for every claim free year. If there is a claim in a policy with cumulative bonus 10% of the sum insured will be reduced from the earned bonus.
N.B. Maternity expenses incurred in Hospital / Nursing Home as in-patient subject to limit of sum insured or Rs. 50,000/- whichever is lower on payment of extra premium and policy being extended to cover maternity benefits. This benefit is only available in group policies.
All terms, benefits, conditions of cover are subject to the definitions of various terms under policy.
What will policy not pay ?
• Broadly there would be no claim under policy under following circumstances
DOMICILLARY HOSPITALISATION: Pre and post hospitalisation treatment, treatment of Asthma, Chronic Nephritis and Nephritis Syndrome, Gastro-enteritis, diabetes mellitus and insipidus, epilepsy, hypertension, influenza, cough and cold, all psychiatric or psychosomatic disorder, pyrexia of unknown origin for less than 10 days, tonsilitis and URTI, arthritis, rheumatism ( the list is not exhaustive) Any treatment relating to any illness / disease already in existence at the time of proposal
• Any disease / injury during first 30 days of commencement of policy. ( accidental injury is not an exclusion )
• During first year of cover of cataract, Benign prostatic Hypertrophy, Hysterectomy for menorrhagia on fibromyoma, Hernia, Hydrocele, Congenital internal disease, Fistula in anus, sinusitis and related disorder.
• Any pre-existing disease / illness is not covered during renewal also.
• Vaccination, inoculation circumcision or change of life or cosmetic or aesthetic treatment, plastic surgery, unless dental treatment unless requiring hospitalisation necessitated due to accident or as a part of any illness.
• Cost of spectacles, contact lenses, hearing aids.
• Convalescence, general debility, "run-down" conditions sterility, venereal disease, intentional self-injury use of intoxicants
• Any variation of deficiency syndrome or AIDS.
• Hospital / nursing home charges not consistent with or incidental to the diagnosis and treatment : Vitamins, tonics not forming part of any treatment.
• Any treatment related to pregnancy, child birth and voluntary medical termination of pregnancy during the first 12 weeks of pregnancy
• Nuclear perils and war group of perils
• Naturo pathy treatment.
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