1. TYPES OF POLICIES
 INDIVIDUAL POLICY
 FAMILY PACKAGE POLICY
 FAMILY FLOATER POLICY
 TOP UP/EXCESS POLICIES
 GROUP HEALTH INSURANCE POLICY

2. SCOPE OF COVER
Hospitalisation Expenses
Pre & Post Hospitalisation Expenses
Domiciliary Hospitalisation Expenses
Ambulance Charges
Hospital Daily Cash
Maternity Cover
Domiciliary Treatment Charges

3. Critical Illness cover
Reimbursement of cost of medical check
up
Reinstatement /restoraton of sum insured
after a claim
Cumulative Bonus/No claim Bonus

4. EXCLUSIONS
Pre-existing conditions until 48 months of
continuous coverage have elapsed
Circumcision
Vaccination, inoculation, change of life,
cosmetic or aesthetic treatment
Cost of spectacles, contact lenses and
hearing aids

5. Dental treatment
Convalescence, general debility,
congenital external disease or defects,
sterility, venereal disease, intententional
self injury, use of intoxicating
drugs/alcohol.
Treatment for Human T-cell
Lymphotrophic virus type III or condition
similar kind referred to as AIDS.

6. Expenses for diagnosis, x-ray or
laboratory examinations or other
diagnostic studies not consistent with
treatment or positive existence of
ailment.
Injury or disease caused by nuclear
weapon/materials
External and or durable
medical/nonmedical equipment

7. Service charges, surcharges,
admission/registration fees
All Non-medical expenses

8. LIMITATIONS
Hospital should have minimum 10 beds,
Operation theatre, fully qualified Doctor
& nurses in class “c” towns and 15 beds
in other towns & cities or
Should have been registered as
Hospital/Nursing Home with the local
authorities.

9. ▀ Room, Boarding & Nursing expenses are
reimbursable upto the limit prescribed.
▀ Waiting period of 30 days (except for
accident)
▀ Waiting period for specified diseases
▀ Limits applicable for specified diseases
▀ Co-payment

10. ▀ Reasonable Expenses clause
▀ PPN Hospitals

11.  Gather full information on insurance covers
available
 Select the insurance cover which is suitable for
you
 Give correct information as asked for in the
proposal form
 Invariably register nominees name in the
proposal form
 Examine the policy when received and if the
terms and conditions are not acceptable,
return the policy to the insurer within Free Look
period of 15 days.

12. If a claim is to be lodged --
 Give intimation to the insurer or TPA atleast 24 hours
prior to admission in the hospital for availing cashless
facility or
 Immediately on admission if cashless facility is not
required
 Keep in mind the limitations in the policy especially in
regard to room charges, etc. at the time of admission
 After discharge from hospital, submit all relevant
papers to TPA for reimbursement in a week’s time.
Papers relating to post hospitalization expenses can
be submitted later on.


13.  Don’t buy health insurance covers through unreliable
sources though such covers may be cost effective and
may be with easy terms
 Don’t under-estimate the importance of the questions in
the proposal forms and refrain from furnishing correct
answers
 Do not suppress any information that are required to be
provided
 Do not neglect payment of renewal premium in time.
 Avoid delay in intimating of claim or submitting claim
papers.