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HEALTH GAIN INSURANCE

HEALTH GAIN INSURANCE. Major Product Features. Flat premium of only Rs. 15,000/- including service tax Coverage for both inpatient and outpatient treatment Policy can be given for both individual and family floater basis.

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HEALTH GAIN INSURANCE

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  1. HEALTH GAIN INSURANCE

  2. Major Product Features.. • Flat premium of only Rs. 15,000/- including service tax • Coverage for both inpatient and outpatient treatment • Policy can be given for both individual and family floater basis. • Any unutilised amount under outpatient benefit can be carried forward to the next one year Coverages.. • Section – I • Hospitalization Expenses incurred as an inpatient for • Sickness/Illness/Diseases • Accidental injuries • Section – II • Hospitalization Expenses incurred at any Hospital / Nursing Home as an outpatient.

  3. Family Size.. • Proposer • Spouse • Dependent Children Age Limits.. • 5 Months – 65 Yrs • Life long Renewal • Dependent Children can be covered only with any one of their Parents

  4. Pre - Insurance Medical Test • For persons with adverse medical history and • For all persons above 50 years, acceptance subject to Medical Examination at Company’s Cost. Sum Insured.. • Minimum Sum Insured - Rs. 1,00,000/- • Maximum Sum Insured - Rs. 5,00,000/- • The following Sum Insured options are available • Rs. 1,00,000/- • Rs. 2,00,000/- • Rs. 3,00,000/- • Rs. 4,00,000/- • Rs. 5,00,000/-

  5. Allowable Expenses… Section - I • Room rent & boarding charges as follows • Class A Cities – 2% of the Sum Insured subject to a maximum of Rs. 5,000/- per day (Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkatta, Mumbai including Thane, Pune, New Delhi and Secunderabad) • Class B Cities – 1% of the Sum Insured subject to a maximum of Rs. 3,000/- per day (Baroda, Coimbatore , Surat, Meerut and all State Capitals other than those falling under Class A) • Class C Cities – 1 % of the Sum Insured subject to a maximum of Rs. 1,000/- per day (Other Cities) • Nursing charges

  6. Allowable Expenses… Section - I • Anesthesia, Blood, Oxygen,Operation Theatre charges, medicines and drugs, diagnostic materials, cost of pace maker • Emergency Ambulance charges to go to Hospital for treatment @ Rs 750/- per hospitalisation upto maximum of Rs 1,500/- per policy period • Pre-hospitalization expenses incurred 30 days prior to the date of hospitalization • Post hospitalization expenses on a lump-sum basis @ 7% of the actual hospitalization expenses (excluding room rent and hospital registration charges), subject to a maximum of Rs 5,000/-

  7. Sub limits…

  8. Day Care Treatment.. Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time limit will not apply for • taken in the Hospital / Nursing Home and the Insured is discharged on the same day. • No limits for the above Day care procedures except Cataract surgery

  9. Allowable Expenses… Section - II • Medical expenses incurred at any Hospital / Nursing Home as an Out Patient. • Maternity expenses as Out Patient • Dental treatment as Out Patient • Unutilised benefit under this section can be carried forwarded to the next year on renewal • The maximum period of such carry over shall be limited to one immediately succeeding year only.

  10. Limit of Outpatient benefits for individual IP – Inpatient NA – Not Available

  11. Limit of Outpatient benefits for family floater A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available (policy cannot be given)

  12. Limit of Outpatient benefits for family floater A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available policy cannot be given

  13. Renewal Discount.. • Renewal Discount on Basic Premium is allowed on renewal for every Claim Free Year as per chart • It is not Cumulative No Claim Discount for Individual basis

  14. No Claim Discount for Family Floater basis

  15. No Claim Discount for Family Floater basis

  16. Other Benefits: • Benefits under Section 80-D of the IT Act • Cashless Service without intervention of TPA • Direct Tie up with hospitals on an All India Basis Exclusions.. • 48 months exclusion for Pre Existing Diseases (as per GIC council) • Any Disease contracted during first 30 days • First Year Exclusions • Benign prostate hypertrophy • Hernia, Hydrocele, Fistula in Anus, Piles • Sinusitis • Renal stone and Gall stone removal • Congenital internal disease/defect

  17. Exclusions.. • First Two Years Exclusions • Cataract • hysterectomy following menorrhia or fibromyoma • Knee Replacement Surgery • Joint Replacement Surgery • Prolapse of intervertibral • Vericose veins/ulcers • Naturopathy Treatment • Expenses incurred on Non Allopathic Treatment.

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