| Name of policy |
Mediclaim insurance policy |
Sampoorna arogya bima policy |
Parivaar- Mediclaim for family |
Varistha bima |
| Types of policy |
Individiual/family |
Individual/family policy |
Family floater policy- single premium |
For senior citizens |
| Eligibility/Requirement |
| Entry age limit |
3 months - 59 years |
3months - 59 years |
3 months- 60 years |
60 years - 80 years |
| Min -Max sum assured limit |
Rs 50000 - 500000 |
Rs 25000-500000 |
Rs. 200000 - 500000 |
100000- 200000 |
| Expense covered per illness |
| Room rent |
up to 1% of S.I,
<=5000 per day
ICU - 2 % of S.I
<=10000 per day |
up to 1% of S.I
<=5000 per day
ICU - 2 % of S.I
<= 10000 per day |
up to 1% of S.I per day
ICU - 2 % of S.I per day
|
up to 1% of S.I per day
ICU - 2 % of S.I per day
|
| Doctor,surgeon fees etc. |
upto 25% of S.I |
upto 25% of S.I |
Actual |
upto 25% of S.I |
Medical, O.T. charges etc. &
Medical Exp. Relating to person donating organ |
upto 50% of S.I |
upto 50% of S.I |
Actual and Limit of 7% of S.I for any disposable surgical consumables |
upto 50% of S.I |
| Package Hospt. Expenses |
Not indicated |
80% of S. I unless full break-up given |
Total Expenses Incurred
for ony one illness is
limited to 50% of the
sum insured per person |
Limit for Cataract Rs. 10000 &
Benign Prostatic Hyperthropathy Rs 20000 |
| Pre- hospitalzation Expenses |
Upto 30days |
Upto 30days |
upto 15 days |
Upto 30days |
| Post- hospitalzation Expenses |
Upto 60 days |
Upto 60 days |
upto 30 days |
Upto 60 days |
| Other benefits |
| Family Discount |
10 % on total premium, Yes |
10 % on total premium, Yes |
Nil |
Nil |
| Cumulative Bonus |
10% of S.I claim free yrs max 50% |
10% of S.I claim free yrs max 60% |
Nil |
5%-S.I upto 10 claim free yrs |
| Emergency Ambulance Charges |
1% of S.I Max. Rs. 1000 |
Upto Rs. 1000 |
Not Indicated |
Upto Rs. 1000 |
| Policy Extention |
Geographical & Abroad |
Nepal, Bhutan approval required |
Not Indicated |
Not Indicated |
| Anyone illness |
relapse with 105 days |
relapse with 45 days |
relapse with 45 days |
relapse with 45 days |
| IT deduction if paid by cheque |
Max. Limit as per Section 80D |
Max. Limit as per Section 80D |
Max. Limit as per Section 80D |
Max. Limit as per Section 80D |
| Critical Illness cover |
Not Available |
Not Available |
Not Available |
Available |
| TPA - cash less facility |
Available |
Available |
Available |
Available |
| "Reimbursement of cost of health check-up" |
"1% of Avg. S.I, once every block of 4 claim free years" |
"1% of Avg. S.I, once every block of 4 claim free years" |
Nil |
"2% of Avg. S.I, once every block of underwriting 3 yrs" |
| Waiting Period or Exclusions |
| "During 1st 30 days Except for Accidental & Emergency cases" |
"All illness / sickness other than 4.1, 4.2, 4.3" |
"All illness / sickness other than 4.1, 4.2, 4.3" |
"All illness / sickness other than 4.1, 4.2, 4.3" |
"All illness / sickness other than 4.1, 4.2, 4.3" |
| "4.1 During 1st Yr" |
"Benign, ENT disorders & surgeries like Tonsilectomy / Andenoidectomy / Mastoidectomy / Typanoplasty" |
Nil |
Nil |
Cataract, Benign Prostatic Hyperthropathy, Hysterectomy, Hernia, Hydrocele, Congenital Internal Diseases, Chronic Fissures in anus, Fitsula in Anul, Piles, Pilonidal Sinus, Sinusitis, stone disease of any site, Benign Lumps/ growth in any part of the body, CSOM ( Chronic Suppurative Otitis Media) , Joint replacements, of any kind unless arising out of accident, Surgical treatment of Tonsils, Adenoids and deviated nasal septums and related disorders. |
| " 4.2 During 2nd Yr" |
"Cataract, Benign Prostatic Hyperthropathy, Hysterectomy, Hernia, Hydrocele, Congenital Internal Diseases, Fissures/fitsula in Anul, Piles, Sinusitis and related disorders, Polycystic ovarian diseases, Non- infective arthritis, undiscended testis, surgery of gall bladder & bile duct excluding malignancy, surgery of Genitourinary system excluding maligancy, Pilonidal Sinus, Gout & Rheumatism, Hypertension, Diabetes, Calculus disease, Surgery for prolapsed intervertebral disc unless arising from accident, surgery of varicose veins" |
"Cataract, Benign Prostatic Hyperthropathy, Hysterectomy, Hernia, Hydrocele, Congenital Internal Diseases/defects, Fitsula in Anul, Piles, Arthrtis,Gout & Rheumatism, Joint replacements, Sinusitis, Gall bladder stone , Kidney stone and related disorders" |
Cataract, Benign Prostatic Hyperthropathy, Hysterectomy, Hernia, Hydrocele, Congenital Internal Diseases, Chronic Fissures in anus, Fitsula in Anul, Piles, Pilonidal Sinus, Sinusitis, stone disease of any site, Benign Lumps/ growth in any part of the body, CSOM ( Chronic Suppurative Otitis Media) , Joint replacements, of any kind unless arising out of accident, Surgical treatment of Tonsils, Adenoids and deviated nasal septums and related disorders. |
Nil |
| Pre-existing Disease 4.3 |
upto 4 continuos claim free yrs |
upto 3 continuos claim free yrs |
upto 4 continuos claim free yrs |
upto one claim free years |
| Heart and circulatory disorders |
upto 4 continuos claim free yrs |
upto 5 continuos claim free yrs |
upto 4 continuos claim free yrs |
upto 1 claim free years |
| Diabities if pre-existing |
upto 4 continuos claim free yrs |
upto 3 continuos claim free yrs |
"can be covered from inception * less10 % of addm. Claim/ 25 for both" |
"can be covered from inception * (excluding any ailment already manifested )" |
| Hypertenstion if pre-existing |
upto 4 continuos claim free yrs |
upto 3 continuos claim free yrs |
"can be covered from inception * less10 % of addm. Claim/ 25 for both" |
"can be covered from inception * (excluding any ailment already manifested )" |
| Pre-existing knee joint problem |
upto 4 continuos claim free yrs |
upto 3 continuos claim free yrs |
upto 4 continuos claim free yrs |
|
| "Joint Replacement due to degenerative condition, Age related osteoarthritis" |
first 4 yrs of the policy |
first 2 yrs of the policy |
first 2 yrs of the policy |
first 1 yr of the policy |
| Medical Requirement : |
| "Blood / Urine Sugar, Blood Pressure, ECG, Eco-cardiography and eye -check-up including retinoscopy + MDs Report" |
"No Medical test : 1. For persons < 50 Yrs 2. Renewal of 3 yrs old policy"
Must for person above 50 years |
"No Medical test : 1. For persons < 50 Yrs 2. Renewal of 3 yrs old policy"
Must for person above 50 years |
Not indicated
Not indicated |
"No Medical test : 1. For renewal policy of preceeding 3 yrs of National "
Must for person above 60 Yrs |
