United india Insurance

HEALTH INSURANCE POLICIES OF UNITED INDIA INSURANCE CO.LTD cover the reasonable & necessary expenses incurred by the Insured due to DEASEASE & INJURY, if such Diseases & Injury requires hospitalization upon advice of duly qualified Medical Practitioner as an INPATIENT during the period stated in the schedule or during the continuance of the policy by Renewal, the Insurance Company will pay through TPA to the hospital or to the Insured person but not exceeding the S I as specified and governed by the term, conditions and exclusion therein contained or otherwise expressed in the said policy.

. Covered expenses includes Room & Boarding charges, ICU charges, Surgeon/Medical Practitioner/Consultant & Specialist charges, Drugs & Medicines, Operation Theater & hospital Miscellaneous services such as laboratory, X ray, Diagnostic test etc., Pre &post hospitalization expenses. Relevant Medical expenses incurred during Pre -30days & Post-60days will be considered as part of claim

Expenses of hospitalization for minimum period of 24 hours are admissible. But, expenses incurred on hospitalization or other diagnostic studies or Procedure/Treatment is usually done as Outpatient department are not payable even if this is converted as an Inpatient in the hospital for more than 24 hours.

However this time limit is not applicable to specific treatments i.e. day care treatment for stitching of wounds, close reduction & application of POP casts, Dialysis, Chemotherapy, Radiotherapy, Arthroscopy, Cataract, ENT surgery, Angiographies, Lithotripsy(Kidney stone removal), D & C etc

There are three types of Health policies

• Mediclaim
• Individual Health Insurance
• Family Floater Policy

Individual Medical policy

A health insurance policy of aged above 61 & which is in force since 2006-2007 by renewal without any break. Restrictions & discounts are not applicable. This policy attracts NCB but NCB will be withdrawn on renewal after the admissible claim

Individual Health Insurance

A health insurance policy for all the age group. This policy is further divided into three groups

• Platinum - Age of entry is 0.3months to 35 years & eligible Sum Insure is Rs 50,000/- to Rs 10,00,000/-
• Gold - Age of entry should be between 36- 60 years of age & eligible Sum Insure is 50,000/- to Rs 5,00,000/-
• Senior Citizen - Insured age is above 61 years & eligible Sum Insured is Rs 50,000/- to Rs 3,00,000

Individual Health Insurance, cover the whole family consists of Self, Spouse, Children & dependent parents individually but not exceeding to the Sum Insured Individually. Individual Health Insurance, cover the whole family consists of Self, Spouse, Children & dependent parents individually but not exceeding to the Sum Insured Individually.

Expenses per hospitalization/Surgery will be restricted as detailed below:

• Room/Boarding & Nursing expenses -Actual amount or 1% of Sum Insured per day, whichever is less
• ICU expenses -- Actual expense or 2% of Sum Insured per day, whichever is less
• Pre 30 days & Post 60 days of Hospitalization --Actual Expenses or 10% of sum Insured whichever is less
• Hernia -- Hysterectomy- Actual expenses or 25 % of Sum Insured whichever is less
• Major Surgeries -- Actual expenses or 70% of the Sum Insured whichever is less
• For the age above 61years —20% Co Pay is applicable on all admissible claim

Note: Major Surgeries include Cardiac Surgeries, Brain Tumor Surgeries, Pace maker Implantation for sick Sinus Syndrome, Cancer surgeries, Hip/Knee/Joint replacement Surgeries.

IMPORTANT EXCLUSION: Pre Existing Disease for which Insured Person had signs or symptoms, and or were diagnosed and or received medical advice/treatment is excluded until 48 months of Continuous coverage of such insured person.

Note: For PED of Diabetes, Hypertension & Hyperlipidemia premium will be loaded by 10% each

During the first TWO years of the policy, the expenses on treatment of disease such as Cataract, Hysterectomy, Hernia Hydrcele, Removal of Kidney & Gall Bladder stone, Joint Replacement etc as stated in the Exclusion Part of Terms & condition are not payable. However if the insured is aware of the same & under medication for that disease, same will be treated as Pre Existing disease & PED condition are applicable

Family Floater policy, a health Insurance policy to the whole family consists of Self, Spouse & Dependent Children up to the age of 25 years under the Single Sum Insured i.e. Any one member or sum of all the member of the policy can claim during the policy period subject to Terms & Condition, Exclusions as stated in Individual Health Insurance but not exceeding to the Sum Insured.

Family Floater policy, a health Insurance policy to the whole family consists of Self, Spouse & Dependent Children up to the age of 25 years under the Single Sum Insured i.e. Any one member or sum of all the member of the policy can claim during the policy period subject to Terms & Condition, Exclusions as stated in Individual Health Insurance but not exceeding to the Sum Insured.

Expenses per hospitalization/Surgery will be restricted as detailed below:

• Cataract – 10% 0f the Sum Insured or Rs 25,000/- whichever is less
• Hernia – 15% of Sum Insure or Rs 30,000/- whichever is less
• Hysterectomy --20% of the Sum Insured Major Surgeries
• major Surgeries --70 % of the Sum Insured or Rs 4Lacs whichever is less red or Rs 50,000/- whichever is less
• Aged above 60 years -- Co-pay of 10% by the insure on all admissible claims

Pre-acceptance health checkup such as:

• Physical examination including Blood Pressure with ECG
• Glycosylated Hemoglobin
• Serum Creatinine & Urea.
• Stress Test unless contraindicate & its reports are required to insured person whose age is above 45 years & who has adverse medical history

Loading on applicable premium at renewal based on admissible claim

• Claim up to 25 % of S I -25%
• Claims up to 26-50 % of S I- 50%
• Claims up to 51-75 % of the S I – 75 % .
• SClaims 75-90 % of S I – 100%
• Above 90 % of S I – 150 %.

This loading will be removed after 3 continues claim free years