Cover Period:

Principal Insured, Insured Spouse, Parents  

[80 minus Age at entry]

[70 minus Age at entry], if AHC benefit is triggered and the policy is not continued by payment of premium after expiry of AHC period.

Insured Children
[25 minus Age at entry]

Initial Daily Benefit (i.e. the level of Hospital Cash Benefit (HCB) at inception):

The benefits under this plan are payable in terms of Applicable Daily Benefit (ADB): Applicable Daily Benefit means the amount of Hospital Cash Benefit in a Policy Year reckoned as follows:

• During the first three years of cover starting from the Effective Date of Cover in respect of an Insured, the Applicable Daily Benefit shall be equal to the Initial Daily Benefit (i.e. the level of Hospital Cash Benefit) chosen by the Principal Insured.
• After the third year of cover, the Applicable Daily Benefit of the previous Policy Year shall be increased by way of ‘Auto Step Up Benefit’ and ‘No Claim Benefit’. And the resulting amount shall be the Applicable Daily Benefit for that Policy Year.

Benefits payable on inpatient hospitalisation during the Cover Period:

Hospital Cash Benefit (HCB):If any of the Insured(s) is hospitalised due to Accidental Body Injury or Sickness and the stay in hospital exceeds a continuous period of 24 hours, then for any continuous period of 24 hours or part thereof(after having completed the 24 hours), provided any such part stay exceeds a continuous period of 4 hours in a non-ICU ward/room of a hospital, an amount equal to the Applicable Daily Benefit (ADB)available under the policy during that policy year shall be payable, regardless of actual costs of treatment, subject to Benefit Limits and Conditions mentioned. If any of the Insured(s) is required to stay in an Intensive Care Unit of a hospital, two times the Applicable Daily Benefit will be payable subject to Benefit Limits and Conditions mentioned. During a period of 24 continuous hours (i.e. one day) of Hospitalisation, if the said Hospitalisation included stay in an Intensive Care Unit as well as in any other inpatient (non-Intensive Care Unit) ward of the Hospital, the Corporation shall pay benefits as if the admission was to the Intensive Care Unit provided that the period of Hospitalisation in the Intensive Care Unit was at least 4 continuous hours.

Major Surgical Benefit (MSB):In the event of an Insured, due to medical necessity, undergoing one of the surgeries listed in Major Surgical Benefit Annexure, in a hospital due to Accidental Bodily Injury or Sickness, the respective benefit percentage of the Major Surgical Benefit Sum Assured, as specified against each of the eligible surgeries mentioned in Major Surgical Benefit Annexure, shall be payable subject to Benefit Limits and Conditions mentioned. The Major Surgical Benefit Sum Assured is equal to 100 (one hundred) times the Applicable Daily Benefit for that Policy Year in respect of each Insured. 5 Hospital Cash Benefit will be paid over and above the lump sum Major Surgical Benefit based on the length of stay in the hospital.

In addition, the following benefits shall also be available under Major Surgical Benefit:

Ambulance Benefit: In the event that a Major Surgical Benefit is payable and emergency transportation costs by an ambulance have been incurred, an additional lump sum of `1,000 will be payable in lieu of ambulance expenses.

Premium Waiver Benefit: In the event that a Major Surgical Benefit falling under Category 1 or Category 2 is payable in respect of any Insured, the total one year premium in respect of the Policy including Rider Premium (if opted for), from the date of installment premium due coinciding with or next following the date of the Surgery will be waived. In case of multiple MSB claims (in respect of multiple/same Insured) falling under Category 1 or Category 2 in the same Policy year, premium waiver benefit will be available only once during the policy year.

Major Surgical Benefit Restoration: In the event that 100% of Major Surgical Benefit Sum Assured is exhausted in a policy year in respect of an Insured due to the previous Major Surgical Benefit claims in that policy year, the next Major Surgical Benefit claim (i.e. in case of any specified surgeries as mentioned in the Major Surgical Benefit Annexure) in that policy year, post exhaustion of Sum Assured, will be covered, subject to:

• The subsequent Major Surgical Benefit claim should be for a different category/bucket (For e.g. Cardiovascular System, Digestive System etc.) than any of the previous Major Surgical Benefit claims in that policy year.
• The subsequent Major Surgical Benefit claim should not be arising from or due to the previous Major Surgical Benefit claims in that policy year.
• The subsequent Major Surgical Benefit claim should be for a different procedure (For e.g. CABG, Pancreatolithotomy etc.) than any of the previous Major Surgical Benefit claims in that policy year.

Day Care Procedure Benefit: In the event of an Insured, due to medical necessity undergoing any specified Day Care Procedure mentioned in the Day Care Procedure Benefit Annexure, in a Hospital or Day Care Centre due to Accidental Bodily Injury or Sickness, a lump sum amount equal to 5 (five) times the Applicable Daily Benefit shall be payable, regardless of the actual costs incurred subject to Benefit Limits and Conditions mentioned.

Other Surgical Benefit: In the event of an Insured, due to medical necessity, undergoing any Surgery not listed under Major Surgical Benefit or Day Care Procedure Benefit causing the Insured’s Hospitalization to exceed continuous period of 24 hours then, a daily benefit equal to 2.5 (two and half) times the Applicable Daily Benefit shall be payable regardless of the actual costs incurred for each continuous period of 24 hours or part thereof provided any such part stay exceeds a continuous period of 4 hours of Hospitalization, subject to Benefit Limits and Conditions mentioned. Hospital Cash Benefit will be paid over and above the Other Surgical Benefit based on the length of stay in the hospital.

Medical Management Benefit: In the event of an Insured undergoing inpatient hospitalization, due to the following major medical conditions, a lump-sum of 2.5 times of Applicable Daily Benefit shall be payable regardless of the actual cost incurred, subject to Benefit Limits and Conditions mentioned.

• Dengue
• Malaria
• Pneumonia
• Pulmonary Tuberculosis
• Viral Hepatitis A Hospital Cash Benefit will be paid over and above the Medical Management Benefit based on the length of stay in the hospital.

Extended Hospitalization Benefit : In the event of an Insured undergoing a single period of continuous inpatient hospitalization in excess of 30 days due to Accidental Body Injury or Sickness, a lumpsum of 10 times of Applicable Daily Benefit shall be payable regardless of the actual cost incurred, subject to Benefit Limits and Conditions mentioned. Extended Hospitalization benefit would be payable in addition to any applicable Hospital Cash Benefit, Major Surgical Benefit, Other Surgical Benefit or Day Care Benefit payable for the same event of inpatient hospitalization.

Other Benefits:

Auto Step Up Benefit: Under this benefit, an amount equal to 15% of Initial Daily Benefit shall be added to the Applicable Daily Benefit of the previous policy year. Such increase in the Applicable Daily Benefit shall be effected at the end of every third policy 7 anniversary during the Cover Period and shall continue to be added until Applicable Daily Benefit attains a maximum amount of 1.5 times the Initial Daily Benefit. Thereafter this amount in each Policy year in future shall remain at that maximum level attained i.e. no addition shall be made under this benefit. In case of all the Insured(s) covered at inception, the date on which Auto Step up Benefit is effected may be same. However, in respect of any Insured(s) joining subsequently, the date on which Auto Step up Benefit is effected may be different as the third policy anniversary shall be construed from ‘Effective Date of Cover’ of the respective Insured. In case the Auto Health Cover Benefit is triggered in respect of an Insured as detailed in Para 3.IV. below, Auto Step Up Benefit shall not be applicable. On expiry of Auto Health Cover Period, the conditions applicable for Auto Step Up Benefit shall be as specified  (Auto Health Cover Benefit).

No Claim Benefit: In the event of every three claim free policy years, an amount equal to 5% (five percent) of the Initial Daily Benefit shall be added to the Applicable Daily Benefit at the end of the third claim free year; where, ‘Claim free policy years’ shall be construed in respect of the policy as a whole, that is, there are no claims in respect of any of the Insured(s) covered under the policy during the immediate previous three years. There shall be no maximum limit for this benefit throughout the cover period.

• Hence, even if any additional member is included after the Date of Commencement of Policy, the date of accrual of No Claim Benefit in respect of such additional member shall coincide with that of PI (i.e. No Claim Benefit shall be added for that additional Insured member from the policy anniversary on which ‘No Claim Benefit’ is added in respect of Principal Insured). Hence, No Claim Benefit in respect of any such additional member may accrue even after a minimum period of one year from Effective Date of Cover and before completion of three policy years from his/her joining the policy.Therefore, the No Claim Benefit for Principal Insured and additional members will accrue concurrently irrespective of their date of joining the policy.
• On death of original PI, in case the Auto Health Cover Benefit is triggered/not triggered in respect of any of the Insured, No Claim Benefit (i.e. in respect of all the Insured members) shall be added in the event of three claim free policy years from the Date of Expiry of AHC period in respect of the Insured member for which AHC period expires in the last.

Health Check-up Benefit: In addition to various benefits payable on hospitalization mentioned in Para 1. above, Health Check-up Benefit is also payable in respect of each of the Insured. Under this benefit, an amount equal to the actual expenses incurred but not exceeding 8 One half of Applicable Daily Benefit shall be payable in respect of each Insured towards Health Check-up expenses once in every 3 policy years provided he/she undergoes Health Check-up and shares a copy of the medical report and the medical bills.

Death Benefit:

• On death of an Insured person other than the Principal Insured: The policy will continue in respect of other Insured(s) and premium payable in respect of the deceased Insured shall cease from the instalment premium due date coinciding with or next following the date of death of the Insured.
• On death of Original Principal Insured: Auto Health Cover (AHC) Benefit (wherein the premiums payable under the Base Policy shall be waived for Auto Health Cover Period) as detailed below shall be available to the other Insured(s) covered under this policy and the policy shall continue. Auto Health Cover (AHC) Benefit shall be available to each of the eligible Insureds, as per terms and conditions mentioned in Para A below. If any of the Insured(s) do(es) not satisfy trigger condition for AHC Benefit, then the condition as specified shall apply.

Auto Health Cover (AHC) Benefit: In case of death of original Principal Insured, the policy shall continue with new PI along with other eligible surviving Insured(s) without any payment of premiums from the policy anniversary coinciding with or next following the date of death of the Principal Insured, for a further period of 15 years or up to specified age in respect of each of the Insureds, whichever is earlier, provided they are eligible for this AHC Benefit.

The period for which AHC Benefit shall be applicable in respect of each of the eligible Insureds shall be denoted as “Auto Health Cover (AHC) Period”. The applicable Auto Health Cover Period for each eligible Insured shall be as detailed below:

• For Insured Child(ren): AHC Period shall be a period of 15 years or till the policy anniversary on which the Insured Child is 25 years, whichever is earlier.
• For Insured Spouse/Insured Parent(s): AHC Period shall be a period of 15 years or till the policy anniversary on which the age of Insured Spouse/Parents is 70 years, whichever is earlier.

Maturity Benefit: No benefits are payable at the end of the Cover Period and the Policy shall stand terminated.