Medi Premier

benefits

Section I

Section II

Specified Major
Illnessess

Exclusions
The policy has two sections:

Section I: Offers protection against unexpected health issues.

Section II: Ensures a lumpsum payment of 50% of the sum insured when certain disorders are diagnosed.

• Hospitalisation cover – in-patient hospitalisation expenses are covered which includes room rent at 2% of Sum Insured subject to a
maximum of Rs.4,000/-.
• Boarding and nursing expenses.
• Surgeon’s fees, Consultant’s fees, Anesthetist’s fees.
• Cost of blood, oxygen, diagnostic expenses, cost of pace-makers, artificial limbs, etc.
• Cost of medicines and drugs.
• Emergency ambulance charges for transporting the insured patient at Rs.750/- per hospitalisation and Rs.1500/-per policy period.
• Pre-hospitalisation expenses upto 30 days prior to date of admission into the hospital.
• A lump sum calculated at 7% of the specified hospitalisation expenses payable towards Post-hospitalisation, subject to a maximum of
Rs.5000/-.

• Lump-Sum Compensation is provided for 50% of sum insured under Section II in addition to payment of hospitalisation under Section I
• Such hospitalisation expenses would be paid only till the date of diagnosis of the Major Illness
• On entitlement for payment of lump-sum under this section, all further benefits under the policy of insurance shall cease and the policy
automatically terminates
• Only one lump sum payment will be made during the Insured Person’s lifetime regardless of the number of the Major illness incapacities
treatments suffered by the Insured Person
• Survival Period - To become eligible for lump sum compensation, the diagnosis should be 90 days from the commencement date of the
policy. In case of detection of major illness, the insured person must survive beyond 30 successive days from such date of detection to be
eligible for a claim under this policy.

• Stroke
• Renal Failure
• Cancer

• Expenses incurred for treatment of any illness/ disease/ condition, which is pre-existing at the time of commencement of insurance.
• Any expenses incurred for treatment of illness/ disease/ sickness contracted by the Insured Person during the first 30 days from the
commencement of the policy.
• First Year Exclusions – Hernia, Piles, Hydrocele, Congenital Internal disease/ defect, Sinusitis, Gall Stone / Renal Stone removal / treatm
• Two Years Exclusions – Hysterectomy, Cataract, Joint Replacement Surgery, Prolapsed Intervertebral Disc, Varicose veins / ulcers.
• Naturopathy treatment.
• Expenses, which are purely diagnostic in nature with no positive existence of any disease.
• Expenses that are cosmetic in nature.
• Expenses incurred for treatment by systems of medicines other than Allopathic shall be limited to 25% of Sum Insured, subject to a
maximum of Rs.25000/-in the entire policy period.
Coverage Offered
for Specific
Conditions

Diabetes Benefits

Special Features

Pre-Acceptance
Medical screening

Exclusions
• Eyes: Diabetic Retinopathy requiring laser treatment.
• Kidneys: Diabetic Nephropathy leading to chronic renal failure.
• Feet: Diabetic foot ulcer requiring micro-vascular surgical correction.
• The policy covers the cost of treatment up to the limit provided.

• Hospitalization Cover.
• Boarding and room charges at 2% of the sum insured subject to a maximum of Rs.2500 per day in Class A cities and
Rs.1250 per day in other locations.
• Nursing expenses.
• Surgeon's fees, Consultant's fees and/or Anesthetist fees.
• Cost of blood, oxygen, diagnostic expenses.
• Cost of medicines and drugs.

• Hospitalization expenses on donor of kidney for renal transplant surgery are payable subject to availability of sum insured.
• Post-renal complications on the insured person covered.
• Second transplant following failure of the first transplant covered.

All applicants will have to undergo a pre-acceptance medical screening at company nominated center

• Patients who have already developed complications of Diabetic Retinopathy and/or Diabetic Nephropathy leading to
Chronic Renal failure and/or Diabetic foot ulcer.
• Expenses on treatment of Diabetes Mellitus Type II (A detailed list of exclusions is available in the policy conditions
document).
Family Health Optima
Benefits

Additional Benefits

Pre - and Post

Hospitalisation cover

Discount

Exclusions
• Hospitalisation Cover: This would protect the insured person for in-patient hospitalisation expenses for a minimum of
24 hours. These expenses include room boarding expenses to a maximum of Rs.1500 per day in Class A cities, Rs.750/- in
Class B cities or Rs.500/- in other locations.
• Nursing expenses.
• Surgeon's fees, Consultant's fees, Anesthetist and Specialist fees.
• Cost of blood, oxygen, diagnostic expenses, cost of pace makers etc.
• Cost of medicines and drugs.
• Emergency ambulance charges for transporting the covered patient to the hospital up-to a sum of Rs.750/- per
hospitalization and overall limit of Rs.1500/- per policy period.

The sum insured floats among the family members insured. In other words there is no need to take insurance for each
member separately for separate sum insured. Thus there is considerable premium saving

Pre-hospitalisation Medical expenses up to 30 days prior to the date of admission or post-hospitalisation calculated at 7%
of the hospitalisation expenses (excluding room rent) subject to a maximum of Rs.5000 is payable.

A discount of 10% on Premium is allowed on renewal of the policy if there is no claim in the immediately preceding year of
the policy. This discount is not cumulative.

• Expenses incurred for treatment of any illness/ disease/ condition, which is pre-existing at the time of commencement of
insurance.
• Any expenses incurred for treatment of illness/ disease/ sickness contracted by the Insured Person during the first 30
days from the commencement of the policy.
• First Year exclusions – Hernia, Piles, Hydrocele, Congenital Internal disease/ defect, Sinusitis, Gall Stone / Renal Stone
removal / treatment.
• Second Year Exclusions – Hysterectomy for Menorrhagia or Fibromyoma, Cataract, Knee Replacement Surgery (other
than caused by an accident), Joint Replacement Surgery (other than caused by an accident), Prolapsed Intervertebral Disc
(other than caused by an accident), Varicose veins / ulcers.
• Naturopathy treatment.
• Expenses, which are purely diagnostic in nature with no positive existence of any disease.
• Expenses those are mainly cosmetic in nature.
• Expenses incurred for treatment of diseases/illness/accidental injuries by systems of medicines other than Allopathic.
• Expenses incurred for treatment of congenital disease/defects/anomalies.
• For a detailed list of exclusions please refer policy conditions.
Major Product
Features

The Benefits

EXCLUSIONS
• For people aged between 60 and 69 years.
• Guaranteed renewals beyond 69 years.
• No pre-insurance medical test is required.
• Treatment at network hospitals only.
• All pre-existing diseases are covered, except those for which treatment or advice was recommended by or received during the
immediately preceding 12 months from the date of proposal. Conditions apply.

• Hospitalization Cover: In-patient hospitalization expenses for a minimum of 24 hours. Includes room rent and boarding @ 1% of
sum insured.
• ICU expenses per day @ 2% of sum insured.
• Nursing expenses.
• Fees for Doctor / Surgeon / Consultant / Anesthetist per illness @ 25% of sum insured.
• Cost of Blood, Oxygen, Pacemaker.
• Cost of Drugs and Diagnostic tests @ 50% of sum insured per hospitalization.
• Treatments for Cardiovascular Diseases / Cerebrovascular Accident / Cancer and Breakage of Bones : upto Rs.75,000/- where the
sum insured is Rs.1,00,000/- and upto Rs.1,50,000/- where the sum insured is Rs.2,00,000/-.
• Cataract (both eyes included), up to Rs.15,000/-.
• Renal Complications : upto Rs.75,000/- where the sum insured is Rs.1,00,000/- and upto Rs.1,50,000/- where the sum insured is
Rs.2,00,000/-.
• All other Major Surgeries : upto Rs.60,000/- where the sum insured is Rs.1,00,000/- and upto Rs.1,20,000/- where the sum
insured is Rs.2,00,000/-.
• Emergency Ambulance Charges for transporting thhe Insured Person to the Hospital @Rs.600/- per Hospitalisation and Rs.1200/-
per Policy period.
• A lump sum calculated at 7% of the hospitalization expenses is payable towards post-hospitalization, subject to a maximum of
Rs.5000/- per occurrence as per the policy.

• Treatments currently availed or availed during the previous 12 months from date of proposal.
• Any expenses incurred for treatment of illness / disease / sickness contracted by the Insured person during the first 30 days from
the commencement of the policy.
• First year exclusions : Hernia, Piles, Hydrocele, Congenital Internal disease / defect, Sinusitis, Gall Stone / Renal Stone removal
and Benign Prostrate Hypertrophy.
• Two years exclusions: Hysterectomy, Cataract, Joint / Knee replacement surgery (other than caused by an accident), prolapsed
intervertebral discs, varicose veins/ulcers.