A plan which restores your Sum Insured when you need it the most. Instant addition of 100% Basic Sum insured on complete or partial utilisation of your existing policy Sum Insured Cumulative Benefit if applicable during the policy year. This total amount (Basic Sum Insured, Cumulative Benefit and Restore Sum Insured) will be available to all Insured Persons for all claims under in-patient benefit during the current policy year.

Normally, 10% cumulative bonus will be applied on the base sum insured for next policy year under the policy after every claim-free policy year, provided that the policy is renewed with the insurer without a break. The maximum cumulative bonus shall not exceed 100% of the Sum Insured in any policy year. If a cumulative bonus has been applied and a claim is made, then in the subsequent policy year, the insurer will automatically decrease the cumulative bonus by 10% of the sum insured. There will be no impact on the in-patient Sum Insured, only the accrued cumulative bonus will be decreased.

The old generation plans provide 30/60 days cover but in the new generation plans 60/180 days cover is provided.

Up to a certain limit subject to hospitalisation

Covered up to Sum Insured.

Based on the results of your medical tests and key health parameters such as BMI, BP, HbA1c and cholesterol, the insurer will offer you incentives for staying healthy.

• Renewal premium discounts of up to 25% for management of health conditions.

• Reimbursement up to 25% of renewal premium towards your medical expenses (like a consultation charges, medicines and drugs, diagnostic expenses,acidental expenses and other miscellaneous charges not covered under any medical insurance).

If opted and/or mentioned on the policy schedule that a co-payment is effective in an admissible claim, the insurer shall bear the co share amount which is normally 10-20% as per the policy condition of the eligible claim amount payable under the policy and his liability, if any, shall only be in excess of that sum and would be subject to the Sum Insured.

Cashless Settlement- Most of the claims for IPD is settled cashless if the insurer opts for the network hospital. The process is seamless and hassle-free where one is entitled to cashless treatment for an amount within the eligible SA of the Policy. The Process for settlement of Mediclaims can be divided into two parts which are;

•        Planned Hospitalisation

•        Unplanned Hospitalisation

• Once everything is to the satisfaction of TPA you would get discharged from the hospital after paying the amount you are required to pay, if any.

• Get the claim form filled from the Treating Doctor and submit with The TPA.

• Once approval is received one can get admitted and get the treatment without paying anything (should be within the scope of Policy)

• During the treatment your bill might exceed the initial approved amount, thus you have to send request through hospital alongwith the interim bill for enhancement of the claimed amount to be utilised for the treatment.

• At the time of discharge, the final bill has to be submitted to the TPA for the clearance of the claim. At the time of final approval information on deductions or the expenses in the bill not within the scope of the policy is also shared by the TPA. The said amount has to be paid by the insured to the hospital.

• Once everything is to the satisfaction of TPA you would get discharged from the hospital after paying the amount you are required to pay, if any.
  

• In case of an emergency at the time of admission you would require to pay some amount. To initiate approval from TPA get a claim form duly filled by treating doctor and submits to the TPA.

• Keep a close watch on the initial approval as you might have to resolve the queries raised by TPA, once approval is received, the hospital accounts department should be informed.

• During the treatment your bill might exceed the approved amount so you have to send requests through hospital along with the interim bill for enhancement of the amount.

• At the time of discharge, the final bill has to be submitted to the TPA for the clearance of the claim. At the time of final approval information on deductions or the expenses in the bill not within the scope of the policy is also shared by the TPA. The said amount has to be paid by the insured to the hospital.

• Once everything is of satisfaction to TPA you would get discharged from the hospital after paying the amount you are required to pay over and the above the initial amount deposited by you. However, anything excess would be refunded by the hospital to you at the time of discharge. 

• Get all the papers of the expenses incurred pre and post hospitalisation such as Bills of OPD prescription, Original Reports, bills of medication, Diagnostic bills etc 30/60 or 60/180 (as the terms offered in your policy)days prior and after the admission. Your claim in such category cannot exceed the Sum Assured limit of the Policy after the consuming during the Hospitalisation.

• The original Papers along with the claim  form and cancelled cheque  have to be submitted with the Insurance Company or TPA

• Insurance Company takes around 2-4 working days to respond in case of any  queries

• Get the queries responded at the earliest.

• With the satisfaction of the TPA the claim is processed and paid in 7-10 working days.

• With satisfaction of the TPA, the approval is sent of the sanctioned amount and transfer of approved amount to the account is done in around  3-4 days.

• Claim Process for Reimbursement of claim incase of Non Network hospital

• Get all the papers like Bills of OPD prescription, Original Reports ,bills of Medication, Diagnostic bills, discharge summary, Final Bill with payment receipt of hospital, etc collected

• The original Papers alongwith the claim  form and cancelled cheque  have to be submitted with the Insurance Company or TPA

• Insurance Company takes around 2-4 working days to respond if there are queries

• Get the queries responded at the earliest with satisfaction of the TPA the approval is sent of the sanctioned amount and transfer of approved amount to the account is done in around 3-4 days