This document summarizes various types of health insurance policies including Mediclaim, Group Mediclaim, Cancer Patients Aid Association policy, Critical Illness Insurance, Overseas Medical policy, and Corporate Frequent Travellers policy. It outlines what is covered and excluded in each policy type, such as reimbursement of hospitalization expenses, waiting periods, claim limits, and eligibility.

1. Expenses incurred under following heads are
payable :
 Room, Boarding expenses in Hospital
 Nursing expenses
 Specialist fees ( surgeon, Anesthetist)
 Operation Theatre charges & surgical
appliances, Blood, Oxygen etc
 Medicines and Drugs exp
HEALTH INSURANCE
Reimbursement of Hospitalization/ domiciliary
hospitalization expenses for illness/ disease or
accidental injury cover under policy.

2.  Expenses on hospitalization for a minimum period of
24 hours are admissible.
 Following types of specific treatment are exempted
from min.24 hours stay in hospital :
-Dialysis, chemotherapy, Radiotherapy,
Eye surgery, Dental surgery, lithotripsy etc.
 The criteria has to be satisfied by a hospital/ nursing
A) Registration with local authorities
b) Operation theatre
c) doctors and nursing staff round the clock

3. Special Features of Mediclaim
policy
 The costs “ Artificial limbs” are payable under
Mediclaim policy.
 Relevant medical expenses incurred during the period
of 60 days after hospitalization and 30 days prior to
hospitalization are treated as part of the claim.
 ‘Tonsilitis’ diseases is excluded under Domiciliary
Hospitalization benefit.
 Epilepsy disease is not excluded during the first year
of operation of policy.

4. Exclusions :
 Under medicalim policy any disease contracted by the
insured during the first 30 days from the
commenceement of policy is excluded
 All pre-existing diseases are not cover incepts for the
first time.
 ‘Hernia’ disease is excluded during the first year of
operation of mediclaim policy.
 Cataract, fibromyoma, Hydrocele, Fistuala in anus,
Piles, Sinusitis and related disorders also not covered
during first year of operation policy.

5.  Cost of spectacles, contact lenses & hearing machine
 Dental treatment & cosmetic surgery (but it is
payable if necessitated due to an accident)
 Expenses on vitamins and tonics are excluded unless
forming part of treatment.
 Voluntary termination of pregnancy, caesarian
section & childbirth.
 Naturopathy treatment.

6. • Cumulative bonus : The sum insured is
increased by 5% for each claim free year of
insurance subject to maximum 10 years.
 Cost of Health checkup :
Reimbursement of medical check up once in
every 4 years subject to no claim preferred.
 Age Limit : Between the ages of 5 yrs to 80 years.
 Sum insured and premium :
The sum insured is decided by the insured. S.I. is
usually available from Rs.15,000 to Rs.5,00,000.
 Tax benefit is available under section 80-D of income
Tax Act.

7.  Family discount: 5% discount in the total premium
is allowed to a family comprising the insured and
a) spouse, b) dependent children
c) Dependent parents.
 Proposal Form : Following information are required
in proposal form-
a) Average Monthly income
b) Past diseases and treatment
c) Income tax Pan

8. GROUP MEDICLAIM POLICY
 A group Mediclaim is available to any group, subject to
the following :
a) The group has a centrl administration point.
b) The prescribed number of persons are covered.
 Group policy is issued in the name of Group/
association/ Institution/ corporate body called insured.
 The coverage under the policy is the same as under
individual Mediclaim policy with the following
differences :

9.  Cumulative bonus & health check up expenses are
not payable.
 Group discount in the premium is available.
(cumulative bonus not available)
 Renewal premium is subject to Bonus/malus clause
 Maternity benefit extension is available at extra prem.
1) A waiting period of 9 months is applicable
for payment off a Maternity claim.
2) Maternity extension is payable only for first
two children.
3) Pre-natal expenses prior to hospitalization
is not payable.

10.  This policy is granted to members of the Cancer
Patients Aid Association (CPAA).
 The premium is payable to CPAA as part of he
membership fee.
 No claim is payable if the insured contracts cancer
within a period of 30 days from the date of becoming
a member of CPAA.
 The sum insured is increased by 5% for each
completed year of policy in force prior to claim.
 Differences as to the claim are to be referred to
committee set up by CPAA and the insurance co.
Cancer Patients Aid Association Policy

11. Critical Illness Insurance
 A critical illness shall means selected diseases by
Insured as like Cancer, Paralysis, Parkinson’s Disease
etc.
 Tuberculosis is not specified.
 Any critical illness discovered with 90 days of the
inception date of the policy is not covered.

12. Overseas Medical policy
 Overseas Medical Policy can be granted
to Indian Resident undertaking bonafide trips for
following purposes :
a) Business & Official purposes
b) Holiday
c) Employment
d) Studies
 Age : For adult upto 70 years beyond 70 years is
granted at extra premium.
For children age of 6 months to 5 years are
covered.

13.  Period of insurance : Insurance is valid from the
first day of insurance or date and time of
departure from India whichever is later and
expires on the last day of the number of days
specified in the policy or on return to India
whichever is earlier.
 Extension of the period of insurance automatic, for
the period not exceeding 7 days and without extra.

14. Risks covered under Policy : (6 Sections)
 A) Medical expenses
 B) Personal Accident
 C) Loss of checked baggage
 D) Delay of checked Baggage
 E) Loss of passport
 F) Personal liability

15.  Cosmetic surgery necessary as a result of a covered
accident is not excluded under policy.
 Dental services for immediate relief of dental pain
only is not paid upto the full limit of cover under
policy
 Permanent partial Disablement is not covered under
Personal Accident section.
 Emergency purchase of replacement items is paid if
there is delay or more than 12 hours in delivery of
Baggage

16. •
 Under loss of checked baggage, the claim of following
items is not payable :
a) Binolculars,. B) Sun-glasses c) Antiques
 Policy does not operate beyond a period of 180 days
continuous absence.
 Under Personal Accident section of the policy,
deductible does not apply.

17. Corporate Frequent Travellers Policy
 Corporate Frequent Travellers policy is grangted to
a) Officials of companies registered under the Companies Act.
b) Partners of registered firms.
 The duration of any one trip under annual policy not to exceed
60 days.
 Under world-wide travel Plan, the deposit premium is equal to
premium of at least 500 days.
 Employees above 60 years of age have to submit the prescribed
Medical report.
 Personal Liability is not covered for Employment & study
purpose policy.