WHAT IS FLEXICARE GROUP INSURANCE POLICY?
In day to day lives, we are exposed to many risks associated with accidents, illnesses, surgery and travel and with the ever increasing costs associated with hospitalization, it can mean a drain on the precious savings. Not anymore. With the ManipalCigna FlexiCare Group Insurance Policy, one can provide employees, members of any affinity group the optimum cover they require.
It offers easy protection against listed perils, events, ailments, risks, with a full range of benefits available on standalone basis (i.e. a single cover can be opted to design a group protection) or in combination (i.e. bundle of multiple covers from same or different segment like accident, illness, surgery, travel etc.).
We, at ManipalCigna, also understand the importance of simple and small changes in lifestyle that enables well-being. That’s where our health and wellness solutions come into picture. This is holistically designed based on multiple parameters of health and wellness. It's fast, it's accessible & it's easy to use. Choose cover from wellness package to add to the core cover and a customized group protection solution is ready.
WHO CAN BUY THE GROUP FLEXICARE POLICY?
A Corporate can purchase this policy for their Employees and Dependents, or groups / associations with commonality of purpose can purchase this policy for their members and dependents. Affinity groups for example would include Cooperative Society, Bank / Mutual Fund customer group and holders of the same credit card etc.
WHO IS THE POLICY HOLDER?
The Policy is issued in the name of the Company / Employer / Affinity Group, so the Company / Affinity Group is therefore the owner of the Policy and is known as the Policy Holder. The Policy then states that all benefits are paid to the Employees / Group members, who are therefore the Insured Persons.
WHAT IS THE TERM OF THE POLICY?
The policy is issued for a term of 1 year*.
Short period cover: For Accident Section only, Policy can be issued for a term less than one year to provide coverage to specific events or specified period.
On-duty Cover: For Group Personal Accident Section only, Policy can be issued for restricted time period of the day e.g. Work duty hours only etc.
*(Term more than 1 year is available only for Credit Linked Policy).
CAN WE COVER FOREIGN NATIONALS WORKING IN INDIA IN THE GROUP POLICY?
Proposal acceptability will be subject to underwriting approach, group demographics, risk parameters and other attributes including company underwriting guidelines.
CAN A NRI TAKE THIS GROUP POLICY?
Proposal acceptability will be subject to underwriting approach, group demographics, risk parameters and other attributes including company underwriting guidelines.
HOW MANY MINIMUM NUMBER OF MEMBERS ARE REQUIRED TO FORM A GROUP FOR ISSUANCE OF A POLICY?
Minimum number of members required to issue a group policy is 7.
IS NOMINATION COMPULSORY IN THIS POLICY?
Nomination is a right conferred on the insurance holder to appoint a person to receive the policy monies in the event of his or her death. You can change your nomination any time before the date of policy termination. Nomination is required for valid discharge of claim.
ARE MEDICAL TESTS REQUIRED PRIOR TO COVER?
Medical tests may be required subject to underwriting approach and assessment designed depending on group demographics, policy type, age, health status of the persons and other parameters.
CAN A GROUP HOLDER PLACE THE INSURED PERSONS ON DIFFERENT LEVELS OF COVER?
Yes, the policy allows Companies / Affinity group to tailor make different benefit structures for Employees / Group members, which will result in different benefit tables as per group on the policy schedule.
WHAT DO YOU MEAN BY CASHLESS HOSPITALIZATION?
Under cashless hospitalization the insured patient does not have to settle the hospitalization expenses at the time of discharge from the hospital apart from the non-admissible expenses. Cashless facility is only available at our network hospital wherein bills will get settled down by ManipalCigna.
CAN THE POLICY BE PURCHASED / RENEWED ONLINE?
To purchase/renew the policy, please get in touch with us at 1800-102-4462 or visit any of our branches. For more details log on to our website www.manipalcigna.com
WHEN WILL THE INSURANCE COVER END?
Cover under the policy for any particular insured person shall automatically terminate on the earliest happening of the following events:
i. Premiums owed under the Policy is not received within the Grace Period
ii. Non-Indian Nationals returning to their country of domicile
iii. There is misrepresentation, fraud, non-disclosure of material fact
iv. On death of the insured person
v. Insured Person ceases to be a member of the group
vi. Cover will end for spouse or any unmarried partners
vii. If an employee/ member gets divorced or the unmarried partners no longer live together or a civil/ contractual partnership is dissolved, then the spouse or unmarried, civil/contractual partner will no longer be considered as a Dependent for the purposes of this Policy.
WHO IS A MEDICAL PRACTITIONER?
Medical Practitioner means a person who holds a valid registration from the Medical Council of any State or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within its scope and jurisdiction of license.
IS THERE A TAX BENEFIT AVAILABLE IN THE POLICY?
Tax benefit is applicable for Contributory policy (where insured member pays premium towards the policy) for Mediclaim, Surgery related covers.
WILL I GET A DISCOUNT ON RENEWAL IF NO CLAIM IS MADE DURING THE YEAR?
There will be no renewal discount for a claim free year under the policy.
IF I FORGET TO RENEW THE POLICY ON TIME, CAN I GET THE CONTINUITY BENEFITS?
Renewal within 30 days of grace period from policy expiry date is permissible, and policy will be considered as continuous for the purpose of waiting period.
For renewals after 30 days of grace period, new proposal form needs to be submitted and same will be treated as fresh proposal.
For instalment premium policy, revival period applicable is 15 days.
Note: Wherever Premiums are not received within the grace/revival period, the Policy will be terminated and all claims that fall beyond such instalment due date shall not be covered as part of the policy.
CAN MEMBERS BE ADDED/DELETED IN-BETWEEN POLICY YEARS?
Any person (Employee/Group Member) may be added to policy as an insured person during the policy period provided that the application of cover has been accepted by us, additional premium, on pro-rata basis in respect of such member has been received by us and we have issued an endorsement confirming the addition.
Any Insured Person who is covered under the Policy may be deleted upon request by policy holder during the policy period. Refund of premium can be made on pro-rata basis, provided that no claim is paid / outstanding in respect of that insured person or his/her dependents.
WHAT SUM INSURED CAN BE OPTED?
We offer a wide range of Sum Insured options (depending on the type of cover) from ₹ 500 up to ₹ 5 Cr.
DO I GET A MEMBER CARD?
Issuance on member health card will be subject to cover type, policy type, business approach and claims process designed for a particular group/channel partner.
IF I RESIGN OR AM TERMINATED FROM EMPLOYMENT OR LEAVE THE AFFINITY GROUP WHAT HAPPENS TO COVERAGE FOR ME AND MY FAMILY?
Upon resignation or termination from employment or on leaving the group, you and your covered spouse/family member will have the option of continuing coverage on a direct-pay basis under the closest similar retail plan option available. You must contact ManipalCigna Customer Service at 1800-102-4462 or nearest branch to place your request.
CAN I COVER FAMILY MEMBER RESIDING IN ANOTHER CITY UNDER ONE PLAN?
Yes, you can cover your family residing in India under one policy. Your group insurance policy can be used all across India.
The relationships which may be covered under the Policy are - The Employee’s/member’s Spouse, parents, children, sibling, parent-in-laws, sibling-in-laws*, grandparents, grandchildren, son in law, daughter in law, uncle, aunt, niece and nephew, etc. (with insurable interest).
*Brother-in-laws & Sister-in-laws
WHAT IS THE MINIMUM AND MAXIMUM AGE OF ENTRY OR EXIT IN THE POLICY?
There is no minimum or maximum Age for entry in to the Policy, however it can be specified for a group (as per requirement).
WHAT KIND OF DOCUMENTATION IS REQUIRED TO ISSUE A POLICY?
The best part of this policy is that it has a simple documentation process. All you need to submit is a quote request sheet, client information details, member details and filled proposal form with relevant information and attach a cheque or demand draft or other payment modes for requisite premium.
IS TERRORISM AND NATURAL CALAMITIES COVERED IN THE POLICY?
Yes, we cover terrorism and natural calamities under this policy.
WHAT DO YOU MEAN BY EXCLUSION?
Exclusions mean specified coverage, hazards, services, conditions, and the like that are not provided for (covered) under a particular health insurance contract.
WHAT IS DISEASE CATEGORY SUB-LIMIT?
Disease category sub-limit covers medical expenses towards distinct illness/injury (as per WHO list) up to the limit selected for that particular disease category. There is no restriction on the number of claims made in the current policy year provided it does not exceed the specified limit.
WHAT ARE CONTRIBUTORY AND NONCONTRIBUTORY POLICIES?
Contributory policy means that the premium for such policy is paid by the insured himself/herself.
Non-contributory policy means premium for such group is paid by the employer / group admin.
IS DEDUCTIBLE AND CO-PAYMENT SIMILAR?
Deductible is the amount beyond which all admissible claims will be settled by the insurer. Deductible option can be selected on annual aggregate or per claim basis.
Co-pay is a fixed percentage of the admissible claim amount that insured person will pay each time a claim is made during the policy year.
IF I HAVE QUESTIONS OR NEED ASSISTANCE, WHO SHOULD I CONTACT?
For any query or assistance, you can contact us with the details through:
Our Website: www.manipalcigna.com
E-mail: servicesupport@manipalcigna.com
Toll Free: 1800-102-4462
WHAT IS AN ACCIDENT?
Accident means a sudden, unforeseen and involuntary event caused by external, visible and violent means.
Examples of Accidents can be as follows:
• Motor Vehicle Accidents (MVA's), irrespective of whether you are the Driver, Passenger or Pedestrian
• Injuries on Duty (Accidents whilst performing your business duties),
• Animal attacks (to be specifically opted for cover)
• Sporting Injuries (to be specifically opted for cover)
• Home-based Injuries eg. Fall from stairs, drowning (suicide not covered)
• Injuries sustained as a result of a natural calamity, terrorism.
WHY YOU NEED AN ACCIDENT COVER?
Every day we hear or witness accidents. Accident can happen to anyone. Buying insurance is protection against uncertainty of life which may lead to emotional and financial loss to family, loss of income/ job due to permanent disability, increase in financial expenses due to medical treatment and dipping into savings.
WHAT EVENTS OR PERILS ARE COVERED IN ACCIDENT SEGMENT UNDER THIS POLICY?
Scope of Accident includes to: Any Accident except Adventure Sports, Adventure Sports, Recreational Sports (Excluding professional and Semi-Professional Sports), Professional & Semi Professional Sports, Accident in a Common Carrier (Flight, Bus, Train, Rented Cab, Rented Bike, Ship/ Cruise, Any mode of Transport), Accident in a Personal (2 Wheeler, Personal Car), Road Accident (as pedestrian), Accident at Workplace/School/College/Recreation Centre, Accident due to Stampede, Accident due to AOG (Natural Disasters - Earthquake , Floods , Forest Fire , Land Slide), Accident due to Electrocution, Accidental Poisoning/ Choking/ Drowning, Accidental Burns & Scalds (Any/Chemical Burns/Cooking/House-fire/Firecracker), Accidental Animal Attack (Domestic/ Wild), Accidental Insect/Reptile/Bird Attack, Assault, Accidents cover for Worldwide emergency (including or excluding Adventure Sports)
ARE ILLNESSES COVERED UNDER THIS SEGMENT?
The policy provides cover towards injuries due to accident along with a range of choice for groups. Illnesses are covered under Mediclaim segment.
WHAT COVERS ARE AVAILABLE UNDER ACCIDENT SEGMENT?
The policy provides coverage towards accidental hospitalization, death, disability, broken bones, coma, support items, ambulance, AYUSH cover, funeral expenses, home nursing, loss of income, EMI protection, medical appliances, out-patient expenses, evacuation, repatriation, family & dependent related benefits etc.
The covers can be selected on indemnity, benefit or daily cash basis (as applicable).
IS OUTPATIENT AND PHYSIOTHERAPY TREATMENT COVERED?
Yes, accidental out-patient cover and physiotherapy is available for selection under Accident segment.
WILL PRE & POST HOSPITALIZATION EXPENSES BE COVERED?
Yes, pre & post hospitalization expenses are available as a choice to be opted under Accidental hospitalization cover.
IS THERE A DAILY CASH BENEFIT AVAILABLE UNDER ACCIDENT COVER?
Daily, Weekly, Monthly cash benefit is available under: Accident Hospital Cash, Broken Bones Cash, Accidental Coma Cash, Accidental Dependent Children Cash, Disappearance Cash, Accident Education Fund Cash, Accident Home Nursing Cash, Accidental Loss of Earning Cash, Accident Parent Cash, Accidental Permanent Partial Disablement Cash, Accidental Permanent Total Disablement Cash, Accidental Temporary Total Disablement Cash and Accident Spouse Cash.
WHAT IS COMMON CARRIER?
Common Carrier means transportation which is available as a public service and operated by an entity in the business of transporting people for hire, as a public service. Example - bus, train, air plane, ship etc.
WHAT IS ACCIDENTAL CARE AT HOME SERVICES?
Home care services includes one or more choice (as per selection):
• Physiotherapy at home, as prescribed by the treating Medical Practitioner,
• Nursing attendant at home, as prescribed by the treating Medical Practitioner,
• Stroma care, colostomy, tube feeding at home, as prescribed by the treating Medical Practitioner
• Doctor visits at home
• Delivery of Medically prescribed medicine at home
• Health Check at home
• Vaccination at home, prescribed by the treating Medical Practitioner
• Custodial or personal care (like bathing, dressing, or using the bathroom)
WHAT IS DISAPPEARANCE BENEFIT?
If an Insured Person disappears due to accident followed by a forced landing, stranding, sinking or wrecking of a conveyance during the Policy Period and is legally declared dead (declared death in absentia or legal presumption of death), we will pay the specified sum insured subject to a period of at least 7 years has been completed since the date of the Insured Person’s disappearance.
IF CLAIM HAS OCCURRED DURING THE GRACE PERIOD WILL IT BE PAID?
If claims occur during the grace period, it will not be covered.
WHAT IS EMI PROTECTION?
If during the policy year, the Insured Person suffers an Injury due to an accident, caused by an event/ peril covered under the policy and that Injury results in Death, Permanent Total Disablement, Permanent Partial Disablement, Temporary Total Disablement, Hospitalisation or Coma of the Insured Person and the event completely prevents the Insured Person from performing duty that pertains to his/ her employment or engaging in occupation for a minimum period of one month. In such an event, We will pay the cash benefit in commensuration with the Insured Person’s contribution in EMI of the existing insurance linked loan account, up to the limit as specified in the policy schedule.
WHAT ARE INCLUDED IN ACCIDENTAL COMPLIMENTARY TREATMENT COVER?
Complimentary treatment includes (choice of one or more) of Physiotherapy, Acupuncture and Acupressure, Chiropody and Chiropractic, Osteopathy, Homeopathy, Ayurveda.
IF THE POLICY INCLUDES COMMON BENEFITS (EG. HOSPITAL CASH BENEFIT) OPTED IN BOTH ACCIDENT AND MEDICLAIN SECTION, WILL CLAIM BE PAYABLE UNDER BOTH THE POLICY?
If common benefits are opted under both the plans, claim trigger will be on the basis of the nature of event taking place (e.g. for accidental injury claim will be paid from Accident policy and for illness covered illness claim will be paid under Mediclaim section).
WHAT IS LIGAMENT TEAR COVER?
If during the policy year, the Insured Person suffers an Injury due to an accident, caused by an event/ peril covered under the policy that results in ligament tear, We will pay the medical expenses, up to the limit as specified in the Policy Schedule/Certificate of Insurance.
WHAT IS MODIFICATION ALLOWANCE COVER/BENEFIT?
If during the Policy Year, the Insured Person suffers an Injury due to an Accident caused by an event/ peril covered under the policy that results in the Permanent Total Disablement or Permanent Partial Disablement which necessarily requires to modify his/her vehicle or make modifications in his/her house to adjust to the disablement, We will pay the Sum Insured as specified in the Policy Schedule/ Certificate of Insurance.
The cover is available on Indemnity and/or Benefit basis.
WHAT IS PERSONAL BELONGING COVER?
The cover provides for cost of replacement of personal belongings up to the limit as specified in the Policy Schedule/ Certificate of Insurance, if during the Policy Year, the Insured Person suffers an Injury due to an Accident, caused by an event/ peril covered under the policy results in damage of one or more Personal belongings.
Personal belongings for the purpose of this section means items such as clothes and other articles of personal nature likely to be worn or carried and includes mobile phones, credit or debit cards, jewellery, lens, glasses, watches, laptops. It does not include any goods or samples carried in connections with any trade or business, theft or burglary of the personal belonging, money as physical cash.
WHAT IS PERSONAL PROTECTIVE QUIPMENT COVER?
The cover provides for the costs of Personal Protective Equipment damaged in the accident up to the Sum Insured as specified in the Policy Schedule/ Certificate of Insurance, subject to the Insured Person suffering an Injury due to an Accident, caused by an event/ peril covered under the policy.
For the purpose of this Benefit, Personal Protective Equipment means any equipment that controls or mitigates a risk to a person's health and safety. Personal Protective Equipment includes safety goggles, high visibility vests, work kneepads, tool vests to replace tool belts, safety boots, ear plugs or earmuffs, face masks, respirators, lead aprons and over the shoulder tool belts.
WHAT IS ACCIDENT SPOUSE BENEFIT?
If during the Policy Year, the Insured Person suffers an Injury due to an Accident, caused by an event/ peril covered under the policy and that Injury solely and directly results in the Permanent Total Disablement, Permanent Partial Disablement or death of the Insured Person within 365 days from the date of the Accident, We will pay the Sum Insured as specified in the Policy Schedule/ Certificate of Insurance, in respect of the widowed Spouse of the Insured Person, irrespective of whether the Spouse is an Insured Person under this Policy.
WHAT KIND OF BENEFITS MY SPOUSE AND CHILDREN ARE ENTITLED ON DEATH OR PERMANENT DISABILITY?
On death or permanent disability of the primary insured, spouse and children are entitled to get 100% of the sum insured opted. In addition, any eligible optional benefit will be paid on fulfillment of specified conditions.
WHAT IS ACCIDENTAL EMERGENCY EVACUATION?
For emergency, arising out of an accident, if adequate medical facilities are not available locally, we will provide the specified amount (on benefit or indemnity basis, as opted) towards arrangement for an emergency evacuation of the insured person to the nearest available medical care facility, within India, under this cover.
DOES THIS POLICY COVER ADVENTURE SPORTS?
Accident section offers cover towards perils/events under:
Adventure Sports, Recreational Sports (Excluding professional and Semi-Professional Sports) and Professional & Semi Professional Sports
On suffering an accidental injury resulting in accidental death or disability or other listed outcomes, while engaged in sports carried out in accordance with the guidelines, codes of good and safe practices laid down by a governing authority, then we will pay the amount as opted under applicable covers.
List of type of covers are mentioned in the policy wording available on our website download section.
HOW TO CLAIM UNDER ACCIDENT?
You can notify us either at the call center or in writing within 10 days from the date of occurrence of such accident. We will assist you with the submission of the documents required and the process will be completed within 30 days of the receipt of last necessary document.
IS CASHLESS OR REIMBURSEMENT FACILITY AVAILABLE UNDER ACCIDNT PLAN?
Claims will be settled on re-imbursement basis paying fixed or indemnity amount as applicable depending on the benefit/cover opted.
Cashless facility will be available for covers with payout basis as indemnity.
CAN I MAKE MULTIPLE CLAIMS UNDER THE POLICY?
Yes, multiple claims can be paid subject to maximum of 100% of sum insured opted.
DOES THE POLICY COVER NATURAL DEATH?
The accident section covers accidental death or disability or other eventualities (as listed) solely resulting due to accident during the policy period.
WILL THE POLICY COVER ME ANYWHERE IN THE WORLD?
The geographical scope of this Policy applies to events limited to India except Accidental Death or unless specified under this Policy in a particular Benefit or definition. However, all admitted or payable claims shall be settled in India in Indian rupees.
IS THE EDUCATION FUND BENEFIT PAYABLE ONLY IF THE DEPENDENT CHILDREN ARE INSURED IN ACCIDENT PLAN?
Policy provides Education fund benefit (if opted) to the dependent child/nominee or appointee (as applicable) in an event of claim under Permanent Total Disablement. It is not necessary that children are to be covered under the policy.
WHAT IS ON-DUTY COVER?
The employer/affinity group, for a reduced premium can choose an on-duty cover where policy is restricted for a time period of the day i.e. Work duty hours only.
DOES THE COVER DIFFER FOR DIFFERENT AGE GROUP?
No, the cover does not change with change in the age group. However, at the time of customizing the group cover, policy holder can choose to have separate policies with different covers as per age bands or create separate groups under single master policy with different table of benefits.
WHAT IS MEDICLAIM?
Mediclaim covers a defined group of people, for example employees of an organization, members of a society or professional association or an affinity group. This section has been designed to provide medical coverage to members of the group in the event of hospitalization due to illness, injury and other listed medical eventualities. This plan offers a comprehensive protection a range of multiple options to choose as per the need of the group.
WHY TO CHOOSE MEDICLAIM COVER?
It offers a set of covers including hospitalization, pre and post, AYUSH In-patient, ambulance, care at home, cost of support items, family and dependent related benefits, EMI protection, home nursing, hospice and palliative care, loss of earning, modification allowance, out-patient treatment, disablement, rehabilitation, emergency evacuation and more.
All these covers are available with a combination of sub-limit, sub-options, co-pays, deductible to allow design a group protection solution as per the need of the group.
WHAT PERILS/EVENTS ARE COVERED UNDER MEDICLAIM?
Perils/events covered under mediclaim includes all illness/ injury, Maternity (including Pre-post Natal, birthing classes, assisted delivery etc.); New Born; Birth Control Procedure; Infertility Treatments; Specific Disease (All listed, unless restricted to any one or more category or disease)
o Critical Illness (36 CIs)
o Cancer of specific severity
o Cancer
- Carcinoma -in-situ
- Early Stage Cancer
- Major Cancer
o Cardiac, Encephalitis, Diabetes & Hypertension, Kidney Failure, Stroke & Paralysis, Lung Disease, Liver Disease;
Infections
o Vector-borne
- Dengue Fever
- Malaria
- Chikungunya
- Others (West Nile Virus, Eastern Equine Encephalitis, Japanese Encephalitis, Rift Valley Fever, Lyme Disease, Bubonic plague, Rocky Mountain Spotted Fever, Tularemia (Rabbit Fever), Typhus (Flea-Borne, Endemic), Zika Virus Disease etc.)
o Water-borne:
- Typhoid fever
- Cholera
- Hepatitis
-Others (Dysentery, Guinea worm disease, etc.)
o Viral Fever (Smallpox, measles, mumps, rubella, chicken pox, and shingles, Hepatitis, Polio, rabies, Ebola and Hanta fever, Severe acute respiratory syndrome (SARS), dengue fever, Zika, and Epstein-Barr, etc.)
o Jaundice
Dental (Emergency/ Class I/ Class II/ Class III)
Vision & Refractive Error Correction beyond +/-5
Worldwide emergency illness
Worldwide Critical Illness (elective) (36 CIs unless restricted to any one or more)
Sexually Transmitted Diseases (including HIV/AIDS)
WHAT EXPENSES ARE COVERED UNDER HOSPITALIZATION?
It covers Medical Expenses towards room charges, ICU/CCU/HDU, operation theatre, doctor fees, specialist fees, surgeon fees, anesthetist’s fees, radiologist, pathologist fees, nursing charges, medicines, diagnostic tests, medical and/or surgical appliances.
Day Care and/ or Domiciliary Treatment will be covered under the Benefit if opted.
WILL MEDICAL EXPENSES BEFORE AND AFTER HOSPITALIZATION BE COVERED?
We will cover medical expenses of an insured person which are incurred pre and/or post hospitalization, provided the cover has been opted.
Please note Pre & Post medical expenses claims should be related to the same illness / condition for which insured was admitted in the hospital.
IS HOME NURSING AND DOMICILIARY TREATMENT SIMILAR?
No, Domiciliary treatment covers treatment taken at home due to lack of accommodation in the hospital/nursing home or the patient’s condition being such that he/she cannot be shifted to the hospital.
In Home Nursing a qualified nurse is arranged by the hospital to give nursing services to insured person at home because he/she is significantly facing problem to cope up with the activities of daily living i.e. washing, dressing, toileting, feeding etc. Home Nursing is an optional cover under the Policy.
WHAT ALL ARE COVERED UNDER AYUSH INPATIENT HOSPITALISATION COVER?
AYUSH includes Ayurveda, Yoga, Unani, Siddha and also Homeopathy. It will cover medically necessary treatment taken during In-patient Hospitalisation for an illness or injury within policy period. Sub limit, co-pay, deductible options are also available.
WHAT IS BENEFIT OF DIAGNOSIS?
The benefit covers expenses towards diagnosis provided that the illness which the Insured Person is suffering from, occurs or first manifests itself during the Policy Period as a first incidence and the Insured Person survives for at least the survival period, specified under the Policy, from the date of diagnosis of the Illness. Upon Our admission of the first claim under this Section in respect of an Insured Person in any Policy Period, the cover under this Section shall automatically terminate in respect of that insured person.
WHAT IS A FAMILY COUNSELLING BENEFIT?
If during the policy year, the Insured Person suffers an Illness/ Injury due to an accident, caused by an event/ peril covered under the policy and that Illness/ Injury solely and directly results in Permanent Total Disablement or Permanent Partial Disablement of the Insured Person or the Insured Person is diagnosed with a Critical Illness or a Terminal Illness causing mental trauma to any or all Immediate Family Members of the Insured Person, the cover pays the expenses up to the limit as specified in the Policy Schedule / Certificate of Insurance towards the psychiatric counselling of the Immediate Family Members of Insured Person provided the family members receive such counselling on an out-patient basis in a Hospital.
WHAT HAPPENS WHEN I UNDERGO A TREATMENT/ SURGERY AND GET DISCHARGED THE SAME DAY?
Day care procedures cover medically necessary treatment or surgery undertaken for illness / conditions which require less than 24 hours of hospitalization. We cover all Day care procedures up to full sum insured opted.
WILL AMBULANCE COST GET COVERED UNDER THIS PLAN?
Yes, road and/or air ambulance cover is available. The cover is available on indemnity / benefit basis (as opted) covering expenses towards transportation of the insured person by a registered ambulance provider to a hospital for treatment of illness or injury, or by a medically equipped aircraft which can offer medical care in flight and should have medical equipment’s vital to monitoring and treating the Insured Person.
ARE MATERNITY / NEW BORN BABY EXPENSES COVERED IN THIS PLAN?
Yes, these are covered under the list of perils/events. Maternity expenses (including Pre-post Natal, birthing classes, assisted delivery etc.) and New born expenses are covered subject to sub-limits, sub-options, co-pays, deductible (as opted) and waiting period and exclusions (if applicable).
IS OUT-PATIENT TREATMENT COVERED?
Medical expenses incurred towards treatment on an out-patient basis are covered up to the Sum Insured selected. Any one or combination of the following can be opted under the cover:
i. Consultations with Medical Practitioners & Specialist
ii. Prescribed Medicines, Drugs, Dressings
iii. Diagnostic tests
WHAT IS HOSPITAL DAILY CASH BENEFIT?
This cover provides Daily, Weekly, Monthly Cash option under:
Hospital cash, Coma cash, Dependent children cash, Education fund cash, Home nursing cash, Hospice & palliative care cash, Loss of earning cash, Parent cash, Permanent partial disablement cash, Permanent total disablement cash, Temporary total disablement cash and Spouse cash.
Number of days available from 1 day to 365 days and coverage from Rs. 50 to 50 lacs per frequency.
WHAT IS CRITICAL ILLNESS (36 Cis)?
Critical Illness shall mean Illnesses listed below or as customized for a Policy and specified under the Policy Schedule/ Certificate of Insurance.
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WHAT IS LOSS OF EARNING BENEFIT?
If during the Policy Year, the Insured Person suffers an Illness/ Injury due to an Accident, caused by an event/ peril covered under the policy and that Illness/ Injury solely and directly results in Hospitalisation, Permanent Total Disablement, Permanent Partial Disablement, Temporary Total Disablement or Coma, as an effect, the Insured Person is disabled from engaging in his/her primary occupation and loses his/her source of income generation as a consequence thereof, We will pay the Sum Insured as per the limit as specified in the Policy Schedule/Certificate of Insurance.
WHAT IS EMERGENCY EVACUATION COVER?
Emergency evacuation cover takes care of expenses towards medical evacuation of the insured to a nearest facility within India capable of providing adequate care not available locally. To avail the benefit pre-authorization is required. Transportation can be through medically equipped aircraft, commercial airline, train or Ambulance depending upon the medical needs and available transportation service.
WHAT IS RE-TRAINING EXPENSES BENEFIT?
We will pay the expenses up to the limit as specified in the Policy Schedule/ Certificate of Insurance towards the costs actually incurred to re-train the Insured Person for an alternative occupation either in the business of the Policyholder or elsewhere provided the Insured Person suffers an Illness/ Injury due to an Accident, caused by an event/ peril covered under the policy and that Illness/ Injury solely and directly results in Permanent Total Disablement, Permanent Partial Disablement or mental disability of the Insured Person, however the Insured Person is capable to take up an alternate occupation which requires training.
WHAT IS SURGERY OR SURGICAL PROCEDURE?
Surgery or Surgical Procedure means manual and / or operative procedure (s) required for treatment of an illness or injury, correction of deformities and defects, diagnosis and cure of diseases, relief from suffering and prolongation of life, performed in a hospital or day care centre by a medical practitioner.
WHAT PERILS/EVENTS/AILMENTS/RISKS ARE COVERED UNDER SURGERY SECTION?
List of perils/events/ailments/risks includes: All Surgery; All Day Care Surgery; Nervous system; Endocrine; Cardiovascular; Eye; Dental; ENT; Respiratory; Lymphatic; Urinary; Muscle or soft tissue; Skin; GI/mouth; Reproductive; Bone, cartilage and joint; Bariatric Surgery; Emergency Surgery; Diagnostic surgery; Organ Transplant; Cancer; Any other disease or body system specific (defined for a group).
WHAT IS SURGICAL BENEFIT?
If during the Policy Year, the Insured Person suffers an Illness/ Injury due to an Accident and that Illness/ Injury solely and directly requires the Hospitalisation of the Insured Person to undergo a Surgical Procedure, covered under the Policy, we will pay the Sum Insured as specified in the Policy Schedule / Certificate of Insurance.
WHAT IS SURGICAL CASH BENEFIT?
If during the Policy Year, the Insured Person suffers an Illness/ Injury due to an Accident and that Illness/ Injury solely and directly results in the Hospitalisation of the Insured Person to undergo a Surgical Procedure, covered under the policy, we will pay the cash benefit, up to the limit for each continuous and completed period of Hospitalisation as specified in the Policy Schedule/ Certificate of Insurance.
WHAT SERVICES ARE INCLUDED UNDER SURGERY CARE AT HOME?
Home care services include (any one or more, as opted):
• Physiotherapy at home, as prescribed by the treating Medical Practitioner,
• Nursing attendant at home, as prescribed by the treating Medical Practitioner,
• Stroma care, colostomy, tube feeding at home, as prescribed by the treating Medical Practitioner
• Doctor visits at home
• Delivery of Medically prescribed medicine at home
• Health Check at home
• Vaccination at home, prescribed by the treating Medical Practitioner
• Custodial or personal care (like bathing, dressing, or using the bathroom)
WHAT IS SURGERY EDUCATION FUND CASH?
We will pay the cash benefit as specified in the Policy Schedule/ Certificate of Insurance, in respect of the tuition fees paid towards the Dependent Child’s education for the Policy Period, irrespective of whether the child (children) is an Insured Person under this Policy subject to the Insured Person suffering an Illness/ Injury due to an Accident and that Illness/ Injury solely and directly results in the Hospitalisation of the Insured Person to undergo a Surgical Procedure, covered under the policy, and that Illness/ Injury solely and directly results in the Permanent Total Disablement of the Insured Person.
WHAT IS SURGERY FAMILY TRANSPORTATION ALLOWANCE?
We will pay the Sum Insured as specified in the Policy Schedule / Certificate of Insurance, towards transportation of any one Immediate Family Member of the Insured Person to the place of Hospitalization of the Insured Person provided the Insured suffers an Illness/ Injury due to an Accident and that Illness/ Injury results in the Hospitalisation of the Insured to undergo a Surgical Procedure, covered under the policy, in a Hospital which is situated at a distance of at least 100 kilometers from his actual place of residence. The attending Medical Practitioner has to recommend the personal attendance of an Immediate Family Member.
The cover is available on indemnity and/or benefit basis.
WHAT IS SURGERY FOLLOW UP MEDICAL TRIP?
If during the Policy Year, the Insured Person suffers an Illness/ Injury due to an Accident and that Illness/ Injury results in the Hospitalisation of the Insured Person to undergo a Surgical Procedure, covered under the policy, and that Illness results in severe trauma and/or advised amputation that requires follow up treatment to be taken outside the territorial limits of the city of residence, We will pay the Sum Insured as specified in the Policy Schedule/Certificate of Insurance towards travelling, boarding & lodging of the Insured Person.
The cover is available on indemnity and/or benefit basis.
WHAT IS SURGERY HOSPICE & PALLIATIVE CARE?
If during the Policy Year, the Insured Person suffers an Illness/ Injury due to an Accident and that Illness/ Injury results in the Hospitalisation of the Insured Person to undergo a Surgical Procedure, covered under the Policy and he/she is subsequently declared as terminally ill with a life expectancy of less than six (6) months from the date of such diagnosis, and medical treatment can no longer be expected to cure the condition provided the same is certified by the treating Medical Practitioner, We will pay the cash benefit towards palliative care or hospice care for Hospitalization, Day Care Treatment or OPD treatment of the Insured Person.
The cover is available on indemnity and/or benefit and/or daily cash basis.
WHAT IS SURGERY MEDICAL APPLIANCES?
Surgical medical appliances cover asthma pumps, blood glucose monitors, surgical stockings, CPAP devices, hearing aids, spinal supports, knee braces, crutches, wheel chair, walker, walking stick, nebulizer, catheter, thermometer, BP monitor, infusion pump, digital foetal monitor or conduct the daily activities through artificial limb/prosthetic device. We will pay the Sum Insured as specified in the Policy Schedule/ Certificate of Insurance.
The cover is available provided the Insured Person suffers an Illness/ Injury due to an Accident and that Illness/ Injury solely and directly results in the Hospitalisation of the Insured Person to undergo a Surgical Procedure, covered under the Policy and Post Surgery the Insured Person is advised by the treating medical practitioner to use medical appliances.
The cover is available on indemnity and/or benefit basis.
WHAT IS SURGERY MEDICAL SECOND OPINION COVER?
If during the Policy Year, the Insured Person is diagnosed with a Critical Illness, Permanent Total Disablement, Permanent Partial Disablement or Temporary Total Disablement and advised a Surgery by a Medical Practitioner, then the Insured Person may choose to secure a second opinion from a Specialist for such treatment. We will pay the consultation fees of the specialist, up to the limit as specified under the Policy Schedule/ Certificate of Insurance.
The cover is available on indemnity basis.
WHAT IS SURGERY MEDICAL SECOND OPINION BENEFIT?
If during the Policy Year, the Insured Person is diagnosed with a Critical Illness, Permanent Total Disablement, Permanent Partial Disablement or Temporary Total Disablement and advised a Surgery by a Medical Practitioner, then the Insured Person may choose to secure a second opinion from a Specialist for such treatment, from Our network of Medical Practitioners for such treatment. Such opinion from Our network of Medical Practitioners shall be directly sent to the Insured Person. This benefit can be availed only once, by each Insured Person during the lifetime of the Policy for a particular Critical Illness, Permanent Total Disablement, Permanent Partial Disablement or Temporary Total Disablement.
WHAT IS DOMESTIC TRAVEL?
Domestic travel means travel within the same country.
Safeguard you from financial crisis during an emergency while you are traveling anywhere in India. The purpose of any plan is to ensure peace of mind to the traveler when they leave home for a holiday or on business.
WHAT COVERS ARE AVAILABLE IN DOMESTIC TRAVEL?
Domestic travel includes choice of multiple covers from Accidental death - during travel, while engaged in sports, in common carrier; Accidental hospitalization; Out-patient cover; Bounced hotel; Compassionate visit; Cruise interruption; Baggage delay; Emergency accommodation; Medical evacuation; Flight cancellation; Flight delay; Hijack distress; Loss of electronic items; Loss of personal documents; Overbooked flight; Disability; Loss of baggage; Trip cancellation & interruption; Trip delay; Return of minor child; Gold equipment cover to Home to home cover.
One can select single or combination of multiple covers as per need of the group to design a comprehensive travel policy.
WHAT IS TRAVEL ACCIDENTAL DEATH?
If the insured person meets with an accident during the trip and the injury results in the death of the insured within 365 days from the date of accident, the cover provides payment of sum insured as mentioned in the policy schedule and certificate of insurance. On payment of claim, all covers under the policy will terminate for the insured person.
WHAT IS TRAVEL ACCIDENTAL DEATH – COMMON CARRIER?
If the insured person meets with an accident during the trip while traveling in a common carrier and the injury results in the death of the insured within 365 days from the date of accident, the cover provides payment of sum insured as mentioned in the policy schedule and certificate of insurance. On payment of claim, all covers under the policy will terminate for the insured person.
Common carrier is explained in Generic FAQ section.
WHAT EXPENSES ARE COVERED UNDER TRAVEL ACCIDENTAL OUT PATIENT COVER?
It covers medically necessary expenses towards:
i. Consultations with Medical practitioners and specialist;
ii. Prescribed medicines, drugs and dressings;
iii. Diagnostics tests such as laboratory test, radiology and pathology, MRI, CAT scan and PET scan.
WHAT IS ALTERNATE EMPLOYEE / SUBSTITUTE EMPLOYEE EXPENSES COVER?
If a claim has been accepted by Us (with respect to Travel benefits) towards the Injury, Illness of an Insured Person where that Illness or Injury (if applicable) has resulted in the Insured Person’s return to Place of Origin or death before the completion of work assignment as per the travel itinerary stated in his/her main travel booking , We will pay the Sum Insured, as specified in the Policy Schedule / Certificate of Insurance, towards Emergency Medical Evacuation or Repatriation of Mortal Remains, in case of death of the Insured Person and expenses necessarily incurred by the Policyholder for sending an employee with similar qualifications and experience to complete the business assignment.
The cover is available on indemnity and/or benefit basis.
WHAT IS TRAVEL COMPASSIONATE VISIT COVER?
- We will pay the amount incurred by any one Immediate Family Member for return tickets in economy class on a Common Carrier to visit the Insured Person, and expenses for the duration of the stay in the Hospital up to the limit as specified in the Policy Schedule /Certificate of Insurance, provided the Insured Person is Hospitalized for more than seven (7) consecutive days in a Place of Visit whilst on a Trip, and no adult Immediate Family Member is present.
- We will pay the amount incurred by the Insured Person for obtaining return tickets in economy class on a Common Carrier to his usual place of residence to visit the Immediate Family Member up to the limit as specified in the Policy Schedule/Certificate of Insurance provided if an Immediate Family Member of the Insured Person is Hospitalized in Place of Origin for more than seven (7) consecutive days or in the event of their death, whilst the Insured Person is in a Place of Visit on a Trip.
For both the events medical practitioner to certify that the person suffering is not fit to travel and he/she would benefit from the visit.
IS MISSED PORT DEPARTURE EXPENSES COVERED?
Yes, we will pay the Sum Insured for cost incurred towards any alternate accommodation booking and travel booking in reaching the next Port at which the Common Carrier shall dock for the same Cruise subject to the Insured Person’s failure to arrive at the first Port of departure in time to board the Common Carrier on which he/she has booked to travel on a Cruise, caused as a result of any of the below events occurring whilst the Insured Person is travelling to the Common Carrier’s first Port of departure.
a) The breakdown of a scheduled Common Carrier on which the Insured Person is travelling;
b) An Accident or breakdown of the vehicle in which the Insured Person is travelling;
c) An Accident or breakdown on a motorway or thoroughfare, occurring ahead of the Common Carrier or any vehicle on which the Insured Person is travelling,
d) Any strike, industrial action or Inclement Weather conditions affecting the scheduled Common Carrier or any vehicle on which the Insured Person is travelling.
The cover is available on indemnity and benefit basis.
IS THERE A COVER FOR UNUSED/PARTLY USED TRIP?
Yes, the policy pays the cost of any on-shore excursions booked in advance forming a part of the Trip, which such Insured Person was unable to utilize and which are not recoverable from any other source, subject to the insured person suffering an illness/injury whilst on a Cruise, which causes the Insured Person to be confined/quarantined by a Medical Practitioner to his/her own cabin/medical ward on board the Common Carrier.
IS THERE A TRIP INTERRUPTION BENEFIT?
The policy covers cost towards any alternate travel bookings in reaching the next Port at which the Common Carrier shall dock for the same Cruise, in the event of the Insured person requiring Hospitalization on dry land due to any unexpected Injury or Illness of a temporary nature.
The cover is available on indemnity and/or benefit basis.
WILL BAGGAGE DELAY BE COVERED?
In the event of delay in scheduled arrival of the Checked-in Baggage whilst on a Trip and whilst it is in the custody of the Common Carrier, we will pay the cost incurred towards emergency purchases of toiletries, medication and clothing up to the limit as specified in the Policy Schedule/Certificate of Insurance OR the expenses incurred by the Insured Person towards transportation for recovering the Checked-in Baggage from the Common Carrier.
The cover is applicable only at the Intended Destinations, and is limited to the period commencing from the time the Checked-in Baggage is entrusted to the Common Carrier and return of the Insured Person back to the Place of Origin, or any other Port in India along with all halts and via destinations included in the travel booking. The cover is available on indemnity and/or benefit and/or regular cash.
WILL EMERGENCY ACCOMODATION EXPENSES BE COVERED?
Yes, if an Insured Person's intended place of accommodation, in the Place of visit, is rendered uninhabitable due to fire, flood, earthquake, storm, hurricane, explosion, or outbreak of major infectious Illnesses, we will pay the difference in costs towards any alternate accommodation booking made by the Insured Person, up to the limit, specified in the Policy Schedule/ Certificate of Insurance.
The cover is available on indemnity and/or benefit basis.
WILL EMERGENCY MEDICAL EXPENSES BE COVERED?
Yes, on the occurrence of any Illness contracted or Injury sustained by an Insured Person due to an Accident in a Place of visit, whilst on a Trip, which requires Emergency Care, We will pay
1.In-patient treatment and/or Day Care treatment expenses in a local Hospital at the place the Insured Person is staying at the time of occurrence of an Insured Event.
2. Medical Expenses towards room charges, ICU/CCU/HDU, operation theatre, doctor fees, specialist fees, surgeon fees, anesthetist’s fees, radiologist, pathologist fees, nursing charges, medicines, diagnostic tests, medical and/or surgical appliances, surface ambulance charges, Blood storage & processing charges. The cover is available on indemnity and/or benefit and/or regular cash.
WHAT IS COVERED UNDER HIJACK DISTRESS?
In the event that a Common Carrier in which the Insured Person is traveling, whilst on a Trip, is hijacked for more than the number of hours specified as eligibility in the Policy Schedule / Certificate of Insurance, we will pay the Sum Insured as specified in the Policy Schedule / Certificate of Insurance towards the Insured Person. The cover is available on benefit and/or cash basis.
WHAT IS HOME TO HOME COVER?
If the Insured suffers an Injury due to an accident during the Period of Insurance, whilst on the way from his/her place of residence to the Port in Place of Origin to board a Common Carrier for the purpose of commencement of a Trip, or whilst on the way back to his/her place of residence from the Port in Place of Origin upon arrival from the Place of visit, and that Injury solely and directly results in death or disablement of the Insured Person which is of the nature specified in the table of benefits in terms and conditions within 90 days from the date of such accident, the Company shall pay the percentage of the Sum Insured as specified in policy.
WILL LOSS OF ELECTRONIC ITEMS, MOBILE, LAPTOP BE COVERED?
i. In the event of theft of the Insured Person’s Electronic items / equipment / gadget in the Place of visit whilst on a Trip, we will pay the Market Value of such Electronic items/ equipment / gadget, up to the limit specified in the Policy Schedule / Certificate of Insurance.
For the purpose of this Benefit, “Electronic item/ equipment / gadget” shall mean camera, tablet, music player, e-readers, GPS devices, iron, smart suitcase, pocket sized washing machine, portable Wi-Fi, hotspot or power bank, travel drone, smart phone gimbal, travel vacuum, Bluetooth speaker, flash light, video recording sun glasses, hi-tech foot warmers, smart phone breathalyser, compact air pollution monitor, germ eliminating travel wand, owned and declared by the Insured person.
ii. In the event of theft of the Insured Person’s Laptop in the Place of visit whilst on a Trip, We will pay the Market Value of such Laptop, up to the limit as specified in the Policy Schedule / Certificate of Insurance.
For the purpose of this Benefit, “Laptop” shall mean a laptop computer, or any handheld tablet computers excluding any accessories or attachments that come as standard equipment with such devices.
iii. In the event of theft of the Insured Person’s Mobile Phone in the Place of visit whilst on a Trip, we will pay the Market Value of such Mobile Phone, up to the limit as specified in the Policy Schedule / Certificate of Insurance.
For the purpose of this Benefit, “Mobile Phone” shall mean any handheld mobile phone excluding any accessories or attachments that come as standard equipment with such devices.
WHAT ALL ARE COVERED UNDER LOSS OF PERSONAL EFFECTS / BELONGINGS?
We will pay the Market value of items, if an Insured Person suffers any act of Mugging whilst on a Trip in the Place of visit and any property or valuable is stolen by way of mugging, provided that the Mugging is reported to the police in the applicable jurisdiction within 24 hours of Mugging, and a written police report is furnished to the Company.
WHAT IS COVERED UNDER WEARABLE DEVICES BENEFIT?
We will pay the Market Value of such wearable device, up to the limit specified in the Policy Schedule / Certificate of Insurance in the event of Theft of the Insured Person’s wearable devices in the Place of visit whilst on a Trip. For the purpose of this Benefit, “wearable device” shall mean health device, smart watch, GPS wrist phones, wearable charging cable, fitness trackers, e-alarm, owned and declared by the Insured person.
This Benefit shall be payable subject to the following:
• Such Theft is required to be reported to the Police having jurisdiction at the place of loss within 24 hours of the occurrence of the incident, and a written report being obtained for the same.
• The Company is provided with the original invoice/receipt evidencing the proof of purchase and ownership of such item, or document evidencing the authorized custody of the same, if such item is provided by his/her employer/business organization.
• The Company is satisfied that the Insured Person took reasonable care to protect his/her item and did not in any way exposed it to the Theft.
IS TRAVLE LOAN COVERED UNDER THIS POLICY?
Travel loan secure is only applicable to loan/credit linked policies. If the Insured Person has procured a Loan Amount from any Financial Institution for the purpose of the Trip, and the same is declared to the Company and specified in the Policy Schedule/ Certificate of Insurance, we will pay the Outstanding Loan Amount of the Loan Amount specified in the Policy Schedule/ Certificate of Insurance, upon Accidental Death or Permanent Total Disablement of the Insured Person.
Notwithstanding anything to the contrary contained under this Policy, in case of loan/ credit linked policies where this Benefit is opted, the Company will make any amounts payable under this Benefit to the Financial Institution specified in the Policy Certificate, to the extent of the Outstanding Loan Amount, as the case may be or as agreed per the applicable loan agreement, provided that a valid deed of assignment under Section 38 of the Insurance Act 1938 is provided to the Company in favour of such Financial Institution.
WHAT IS GOLF HOLE IN ONE COVER?
We will pay the expenses incurred in celebration of achieving the “hole-in-one” by the Insured Person, up to the limit, as specified in the Policy Schedule / Certificate of Insurance, in the event of an Insured Person being declared winner for a “hole-in-one” at any nationally recognized 18-hole golf course in a Place of visit whilst on a Trip. This Benefit shall be payable subject to the following:
Insured Person must provide the Company with a written confirmation from the golf course supervisor that the hole-in-one was achieved along with the receipts for the cost of such celebrations on the date of accomplishment at the golf course.
WHAT IS WELLNESS COVER?
Wellness cover includes a range of options from dental, vision, alternative care, impaired life care, out-patient care to weight and disease management, condition management, diagnostic tests, healthy living program, wellness services, premium waiver, bonus and more.
Wellness cover is available as optional cover only with one or more of covers under Accident, Mediclaim, Surgery and Travel segment. For Wellness covers, Sum Insured will be mandatory if covers are offered on Indemnity basis. However, if the cover is offered on Network as Service, Sum Insured shall not be mandatory.
WHAT IS ALTERNATIVE CARE?
Alternative Treatments include (one or more of the items listed):
i. Physiotherapy,
ii. Acupuncture and Acupressure
iii. Chiropody and Chiropractic
iv. Osteopathy,
v. Homeopathy
vi. Ayurveda.
WHAT IS IMPAIRED LIFE CARE?
If the Insured Person is diagnosed with Cancer, HIV/AIDS, Chronic Kidney failure, Tuberculosis, Disability or suffers Stroke, Paralytic attack, Menopause, post-partum psychosis, we will pay the charges towards psychological counselling of the Insured Person with a specialist, on an Out-patient basis, at a Hospital or a recognized unit.
WHAT IS MENTAL CARE?
If the Insured Person is diagnosed with a Mental illness, Stress, Anxiety, Depression or a medical condition impacting mental health, we will pay for expenses incurred towards medically necessary out-patient treatment/ program, including Specialist consultations that are prescribed by a Medical Practitioner, where the intention of the treatment/program is to offer care to the Insured Person towards mental Illness.
WHAT IS HEALTH COACHING?
We will pay the charges for expenses incurred towards specialist consultations for Diet and Nutrition management, Physical and Mental health management.
The benefit will be payable up to the limits as specified in the Policy Schedule/Certificate of Insurance.
WHAT IS FITNESS PROGRAM & TRACKING?
We will track the fitness program or/and activities of the Insured Person through fitness tracking devices and/ or applications.
Fitness Rewards may be rewarded on completion of each level.
Each earned reward point will be valued at 1 Rupee. Accumulated reward points can be redeemed in the following ways –
- A discount in premium from 1st Renewal of the Policy.
- Equivalent value of OPD, if opted for, anytime during the policy.
- Equivalent value of non-payables, co-pay, deductible limit, if opted for, anytime during the policy.
- Purchasing fitness devices/ gadgets.
WHAT IS FITNESS CARE?
If the Insured Person enrolls into any of the fitness activities mentioned below, we will pay the membership fees, program fees, enrolment fees, registration fees, trainer fees, fitness instrument and gadgets & associated costs, with respect to the Insured person.
Fitness activities:
• Yoga
• Zumba
• Dance
• Aerobics
• Fitness group (Cycling group, Running group)
• Fitness club eg. Swimming club, Tennis club, Badminton club etc.
• Meditation
• Spiritual therapy
The benefit is payable provided the Insured Person enroll in a recognized center, registered with appropriate authority and the activity is not done in professional capacity.
WHAT IS WEIGHT & DISEASE MANAGEMENT?
We will pay the charges for expenses incurred towards Medically Necessary treatment/ program, including Specialist consultation, that are prescribed by Medical Practitioners with an intention to manage weight or any specific illness of the Insured Person.
WHAT IS SMOKE, TOBACCO, DRUGS, ALCOHOL MANAGEMENT?
We will pay the charges for expenses incurred towards Medically Necessary treatment/ program, including Specialist consultations which is prescribed by a Medical Practitioner with an intention to manage Smoke, Tobacco, Drugs, Alcohol addiction of the Insured Person.
WHAT IS A HEALTHY LIVING PROGRAM?
Our Healthy Living Reward Program encourages the Insured Persons to regularly assess their health status and engage in activities which aid in improving their overall well-being. Any one or a combination of the following activities will be offered under the program.
• Enrollment into Wellness Program
• Health Risk Assessment (HRA)
• Targeted Risk Assessment (TRA)
• Online Lifestyle Management Program (LMP)
• Chronic Condition Management Programs
• Participating in ManipalCigna Sponsored Programs and Worksite or Online/Offline Health Initiatives
• Health Check Up
Healthy Reward Points may be awarded on enrollment in the policy or completing various programs.
Each earned reward point will be valued at 1 Rupee. Accumulated reward points can be redeemed in the following ways (Select any one or more)
- A discount in premium from 1st Renewal of the Policy.
- Equivalent value of OPD, if opted for, anytime during the policy.
- Equivalent value for non-payable/ co-pay/ deductible limit, if opted for, anytime during the policy.
Any unutilized Healthy Reward Points at the end of a Policy Year will be carried forward to the next Policy Year at renewal and will lapse at the end of the Grace Period if the coverage is not Renewed with Us.
IS THERE A BONUS IN THE POLICY?
We will add a Cumulative Bonus (if cover opted) as a percentage (specified in the Policy Schedule/ Certificate of Insurance) of the Base Sum Insured at the end of the Policy Year if the Policy is Renewed with Us.
CAN I OPT FOR A MEDICAL SECOND OPINION?
Yes and if opted, We will provide the Insured person the choice to avail a medical second opinion for an Insured person who is diagnosed with a Critical illness, Terminal illness or suffers Permanent Total Disablement, Permanent Partial Disablement, Temporary Total Disablement, life-threatening and life altering diagnosis during the policy year.
The benefit will be payable up to the limits as specified in the Policy Schedule/Certificate of Insurance.