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Some of the Medical Insurance PoliciesLooking for medical insurance? Mediclaim is probably the only one that
rings a bell. But there happens to be more on offer.
Scheme: Personal accident
insurance for students
Insurer: National Insurance Company Coverage: Against accidents caused by any motor vehicle or train resulting in permanent partial/ total disablement or death. Cost: Premium of Rs 142 per year. Age: Between 5 - 70 years. Amount:
Insurer: National Insurance Company Coverage: Expenses incurred for treatment of diseases such as cataract, benign, prostatic hypertrophy, hysterectomy for menorrhagia or fibro myoma, hernia, hydrocele, congenitial internal diseases, fistula in anus, piles, sinusitis, aids, dental treatment or surgery of any kind unless requiring hospitalisation. Cost: Rs 5,000 per person. Age: Between 5 - 70 years. Children between 3 months and 5 years can be covered provided one or both parents are also covered. Amount: Reimbursement of hospitalisation expenses for illness/ diseases or injury sustained for a sum not exceeding Rs 5,000 per person. Scheme: Personal accident
insurance Scheme: Raj Rajeshwari
Mahila Kalyan Bima Yojana Scheme: Mediclaim
insurance Scheme: Critical illness
insurance policy Scheme: Ashadeep Scheme: Cancer
insurance Scheme: Long-term
hospitalisation scheme
Insurance Family Schemes? Couple Schemes?
Jeevan Saathi
Children Schemes?
Jeevan Balya
Jeevan Kishor
Jeevan Chhaya
Individual Schemes?
Jeevan Vishwas :
Bal Vidya :
Nav Prabhat :
Pension Schemes? Special Schemes?
Mortgage Redemption:
Bhavishya Jeevan:
New Jana Raksha:
Double Endowment:
Fixed Term (Marriage) Endowment/Educational Annuity:
Convertible Whole Life:
Money Back Plan:
Jeevan Surabhi:
Jeevan Sathi:
Jeevan Chhaya:
Jeevan Mitra:
Jeevan Shree:
Asha Deep II:
Jeevan Aadhar:
Jeevan Suraksha:
Jeevan Sanchay:
Jeevan Sneha:
Term Assurance?
Convertible Term Assurance Plan:
Bima Sandesh:
Bima Kiran:
Multiple Benefits?
Jeevan Griha
Jeevan Surabhi
Medical Insurance? Expenses incurred by the insured for domiciliary hospitalisation and hospitalisation for illness / diseases or injury sustained. These include Hospital charges ( Room & Boarding theatre ) fees for surgeon, Anaesthetist Nursing, specialist etc., diagnostic tests, cost of medicines, blood, oxygen etc., cost of appliances like pacemaker, artificial limbs etc., INSURED AGAINST WHAT RISKS ? Illness / disease, accidental injury sustained leading to one or more of class of expenses listed above. WHO CAN TAKE THE POLICY ? 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. Domiciliary hospitalisation benefits can be excluded with GIC's approval and a premium discount 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 WHAT WILL POLICY PAY AND HOW MUCH? Actual hospitalisation expenses of various types listed above subject to a maximum of Rs. 15,000/- to Rs. 3,00,000/- 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. 45,000/- 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 item No. 1 on above or Rs. 50,000/- whichever is lower on payment of extra premium and policy being limited to cover maternity benefits. 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 of pregnancy .Nuclear perils and war group of perils naturo pathy treatment.
100 % of the premium paid upto Rs.10000/- (Rs.15000/- for senior citizen)is deductible from What is insured ? Any motor vehicle, private car, goods carrying/ Passenger vehicle, motor cycle (including a side car) when used in a public place. Insured against what risks? Insured’s legal liability, as per Motor Vehicle Act, arising out of accident caused by or arising out of the use of the vehicle anywhere in India. Such liability as above in respect of injury ( fatal or non fatal) to any third party and damage to any third party property . Who can insure? Owners and /or financier of the vehicle having insurable interest in it. What will policy pay and how much? Subject to limit of liability laid down in the Motor Vehicle Act, the policy pays the insured’s legal liability for death/disability for third party. Loss or damage to third party property; liability for claimant’s cost is also met. All costs and expenses incurred with company’s written consent In case of death of the Insured/Person entitled to indemnity for a liability incurred under this policy, his personal representative will be indemnified as in the case of the insured, if he observed all conditions as insured himself. When will policy not pay? Contractual liability. When vehicle is used outside the geographical area; when used contrary to limitation as to use; driven by a person other than the driver stated in driver’s clause War perils, nuclear perils and drunken driving Claims arising out of and in the course of employment of a person in the employment of the insured. Property-Commercial Insurance?
Perils Covered
Who can insure ?
House owners, office establishments, hoteliers, and shopkeepers.
In these policies, interest of banks and financial institutions can also be covered. What will policy pay and how much? The policy pays for the actual cost of repairs, replacement and reinstatement of the item lost/damaged. However, the market value of the item lost and adequacy of the sum insured will govern the settlement. Where buildings, plant and machinery are covered on Reinstatement Value basis, "the cost when new"of the building, plant and machinery erected on the same site would be the basis. What will policy not pay? Loss or damage
Due to Theft during or after the occurrence of any insured peril Overseas Travel Insurance?
Policy covers expenses incurred towards medical treatment for accident / disease sustained during overseas trips and loss of passport also covered under this policy. WHO CAN INSURE ? Persons going abroad on business & holiday. INSURED AGAINST WHAT ? Medical expenses and repatriation - In-flight personal accident benefit - Loss of passport. WHAT WILL POLICY PAY AND HOW MUCH ? Usually, ( EXCLUDING USA & CANADA) AGE LIMIT: 6 months to 60 years. On the basis of medical examination, this can be extended up to 70 and 75 years at the discretion of the company. TRIP LIMIT: 180 days any one trip plus additional time but not exceeding 365 days on any one trip COVERAGE LIMIT DEDUCTABLE Medical expenses and Repatriation US $ 50,000 US $ 100 In flight personal accident Benefit US $ 10,000 NIL (c) Loss of passport US $ 150 US $ 30 PLAN - B BUSINESS & HOLIDAY (INCLUDING USA & CANADA) AGE LIMIT: 6 months to 40 years. On the basis of medical examination, this can be extended upto 70 and 75 at the discretion of the company. TRIP LIMIT: 180 days any one trip plus additional time but not exceeding 365 days on any one trip COVERAGE LIMIT DEDUCTABLE (a) Medical expenses and Repatriation US $ 1,00,000 US $ 100 In flight personal accident benefit US $ 10,000 NIL (c) Loss of passport US $ 150 US $ 30 Check for proper amount before getting insured. WHAT WILL POLICY NOT PAY? Any diseases existing / treated prior to one year of commencement of risk whether declared or not. For children aged 5 and under treatment relating to :-Mumps, chicken pox, measles, German measles, spina bifida, whooping cough, Diphtheria, Poliomyelitis, menimaitis and scarlet fever. Involving travel against medical advise, travel for treatment, terminal prognosis / awaiting special treatment. Cosmetic surgery, pregnancy related costs, AIDS. War perils, nuclear perils. Suicide or attempted suicide. Benefits recoverable under any other policy like motor, WC or public assistance scheme. Examination / treatment in India or expenses incurred outside country of study / postings(This does not prejudice emergency evacuation on medical grounds) OVERSEAS MEDICLAIM INSURANCE (Corporate Frequent Traveller) WHAT IS INSURED ? Policy covers expenses incurred towards medical treatment for accident / disease sustained during overseas trips and loss of passport also covered under this policy. WHO CAN INSURE ? Business establishments for their executives who makes frequent trips to overseas INSURED AGAINST WHAT ? Medical expenses and repatriation In-flight personal accident benefit Loss of passport. WHAT WILL POLICY PAY AND HOW MUCH ? Usually ,AGE LIMIT: 18 years to 60 years. On the basis of medical examination this can be increased to 70 years, subject to loading of premium TRIP LIMIT: 30 days for any one trip COVERAGE LIMIT DEDUCTABLE (a) Medical expenses and Repatriation US $ 1,00,000 US $ 100 (b) In flight personal accident benefit US $ 10,000 NIL (c) Loss of passport US $ 150 US $ 30 WHAT WILL POLICY NOT PAY? Any diseases existing / treated prior to one year of commencement of risk whether declared or not. For children aged 5 and under treatment relating to :-Mumps, chicken Pox, measles, German measles, spina bifida, whooping cough, Diphtheria, Poliomyelitis, menimaitis and scarlet fever. Involving travel against medical advise, travel for treatment, terminal prognosis / awaiting special treatment. Cosmetic surgery, pregnancy related costs, AIDS. War perils, nuclear perils. Suicide or attempted suicide. Benefits recoverable under any other policy like motor, WC or public assistance scheme. Examination / treatment in India or expenses incurred outside country of study / postings(This does not prejudice emergency evacuation on medical grounds) Check for proper terms before getting insured. Baggage Insurance? It covers accompanied baggage (not dealers’ stock or travellers’ samples) during a specified journey (including Air travel) suitcase, trunk etc. containing the baggage and additions during the journey when declared specifically can also be covered. INSURED AGAINST WHAT RISKS? The policy provides cover against loss or damage to accompanied personal baggage due to fire, riot and strike, terrorist activity or theft or accident during the course of journey including stoppages en route anywhere in India. WHO CAN TAKE INSURANCE? Insured and insured’s family members in respect of their baggage as specified above. WHAT WILL POLICY PAY AND HOW MUCH? The policy pays for the contents of the baggage damaged/lost due to any of the perils stated above on a strict basis of indemnity. WHEN WILL POLICY NOT PAY? The policy does not cover loss or damage to articles of consumable nature, cash, securities, jewellery, precious stones, furs, watches etc. to any property conveyed/transported by a carrier under receipt due to depreciation, wear and tear, consequential loss, legal liability, theft from unsecured car due to war perils, nuclear perils, moth, vermin or while cleaning, repairing. What is insured ? Physical loss to an individual due to an accidental injury ( including fatal) Insured against what risks? Death or disablement from accidental bodily injury ( anywhere in the world). Who can insure ? Any individual or group of individuals ( through employer, association, and institution) aged between 12 and 70. Subject to medical examination at 70, a person can be covered up to 80. What will policy pay and how much? When an accidental injury being the sole and direct cause results ( within 12 calendar months) in: Death 100 % of Sum Insured Permanent Total Disablement 100 % of Sum Insured Loss of two limbs/ Two eyes or one limb and one eye 100 % of Sum Insured Loss of one limb or one eye 50 % of Sum Insured Permanent Partial Disablement Varying % of Sum Insured as per policy Temporary Total Disablement 1 % of Capital Sum Insured per week , Subject to a maximum of Rs 3000 per week On payment of extra premium, medical expenses incurred up to 25 % of claim or 10 % of Sum Insured can be covered. Policy also pays for education fund for children (2) of deceased insured and expenses of carriage of dead body of insured from accident site ( as per details in policy) There is a provision for increase of Sum Insured by 5 % for each completed claim free year of insurance ( maximum of 50 % ) What will policy not pay? Compensation under more than one clause for same period of disability - Any payment after admission of a claim for 50 % / 100 % of Capital Sum Insured - Any claim in the same period of insurance exceeding the Capital Sum Insured - Suicide, attempt there at, VD, criminal breach of law, influence of liquor/drugs - Pregnancy related claim - War and nuclear perils. What is insured? Expenses incurred due to postponement / stoppage / cancellation of marriage Insured's own property / leased to him for which he is liable at the venue Legal Liability / Third party Property at the venue Who can Insure ? Any person arranging marriage function Insured against what risk ? Loss of expenses incurred due to postponement / stoppage / cancellation of marriage due to: The impossibility of groom / bride due to stranding train / bus non - availability of road conveyance, local law and order problem. Accidental Death of a close relative of groom / bride Police action (other than child marriage or any criminal act) Damage to building and contents due to: Fire and allied perils causing damage to marriage hall and contents there on Burglary of valuables Third party liability What policy will pay and how much? Actual expenses incurred, securities/ departures/ Advances Actual loss of property due to insured peril at the venue/ Legal Liability / Third Property as per the act The above indemnity will be subject to the sum insured available under each section and condition of average. What will policy not pay? The company will not be liable for any loss / damage arising out of Dispute between the marriage partners / parties Criminal acts, violation of law, child marriage, marriage under Duress Willful negligence, misconduct , insolvency, impersonation, influence of intoxicating liquor / drugs Loss or damage to fragile articles Theft, damage by public authority or under it's order, subterranean fire, damage to electrical apparatus due to self heating / sort circuiting. Damage involving the insured or any family members or employee as principal accessory in case of burglary Fines, penalties, levies imposed by Government. War and war like perils Nuclear group of perils Radioactivity Wear and tare, Consequential loss of any kind. Property-Residential Insurance? What is insured ? This package cover offers protection against loss or damage to the following: Building and its contents Domestic appliances like TV, VCR, Refrigerator, Washing Machine, Grinder A/C, Computer, Pump set etc., Baggage Jewellery and Valuables Persons against accident Who can Insure ? Any householder exposed to the above contingencies Insured against what risks ? Building:- Fire, Lightning, Act of god perils, Riot & Strike, explosion of domestic gas Contents:- Fire, Lightning, Act of god perils, Riot & Strike, explosion of domestic gas, Burglary and House breaking. Domestic appliances:- Mechanical & electrical breakdown Jewellery & valuables : - All risks Baggage : All risks Personal Accident: Accidental injury causing death/permanent total disablement (Policy is available with different range of fixed sum insured on package premium) What will policy pay and how much ? Actual extent of loss/damage to the property up to sum insured under respective section Sum insured is the limit of maximum liability under respective section. No condition of average(under insurance) clause applicable. In case of personal accident Sum insured will be paid for death or permanent total disability What will policy not pay? Loss or damage due to : War and war like perils - Wear and tear, consequential loss - Nuclear group of perils - Gross and willful negligence of the insured - Violation of policy conditions - Loss/damage/where the insurd's family or insured's employee acted as principal/accessory - Intentional act/self injury/influence of drug/intoxication |
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