Provides a fixed amount for each continuous and completed period of 24 hours that the Insured Person is Hospitalized due to an accidental bodily injury or illness first occurring or manifesting during the policy period.
Main features of Hospital Daily Cash Policy
Daily Cash Options (in Rs): Normal : 250/ 500/ 750/ 1000/ 1500/ 2500/ 5000 ICU : Twice the normal hospitalization amount
Policy tenure : 1 year / 2years/ 3 years
Maximum Benefit period per year (in days) – 15/30/60/90/180
Waiting Period – 30 days
Pre-existing disease waiting period – 48 months
What it Covers
We will pay the amount as specified in the schedule as Hospital Daily Cash, for each continuous and completed period of 24 hours, up to the benefit period per year, that the Insured Person is Hospitalised during the policy period due to an illness or accidental bodily injury.
In case of each continuous and completed period of 24 hours of hospitalization within the Intensive Care Unit (ICU), We will pay twice the benefit amount as specified in the schedule as Hospital Daily Cash.
Other Benefits -
Day Care Surgeries – We will pay the One day Daily Cash benefit as mentioned in the schedule, for the Day care surgeries as listed in Annexure – “List of Day Care Procedures” of the policy document.
Modern Treatment Methods and Advancement in Technologies - We will pay the Daily cash benefit for each day of hospitalization or One day Daily Cash benefit (depending upon the nature of procedure), up to the benefit period specified in the policy schedule, during the policy period for the following procedures (wherever medically indicated):
Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
Balloon Sinuplasty
Deep Brain stimulation
Oral chemotherapy
Immunotherapy- Monoclonal Antibody to be given as injection
Intra vitreal injections
Robotic surgeries
Stereotactic radio surgeries
Bronchial Thermoplastic
Vaporization of the prostrate (Green laser treatment or holmium laser treatment)
IONM - (Intra Operative Neuro Monitoring)
Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions to be covered.
Note: The benefit period as specified in the policy schedule is cumulative of all hospitalizations, whether single or multiple, occurring in each policy year.
Waiting Period
Pre-existing Diseases:- Any claim for hospitalization relating to a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 48 months of continuous coverage after the date of inception of the first policy with insurer.
30-day waiting period:- Any claim for hospitalization relating to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident.
Specified disease/procedure waiting period:–
Any claim for hospitalization relating to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 24/48 months of continuous coverage after the date of inception of the first policy with us. This exclusion shall not be applicable for claims arising due to an accident.
In case of enhancement of Daily Cash Limit/ benefit period in subsequent renewals, the exclusion shall apply afresh to the extent of Daily Cash Limit/ benefit period increase.
If any of the specified disease/procedure falls under the waiting period specified for pre-Existing diseases, then the longer of the two waiting periods shall apply.
The waiting period for listed conditions shall apply even if contracted after the policy or declared and accepted without a specific exclusion.
If the Insured Person is continuously covered without any break as defined under the applicable norms on portability stipulated by IRDAI, then waiting period for the same would be reduced to the extent of prior coverage.
List of specific diseases/ procedures excluded under the first 24 months of policy with us:
Benign ENT disorders
Tonsillectomy
Adenoidectomy s
Mastoidectomy
Tympanoplasty
Hysterectomy
All internal and external benign tumors, cysts, polyps of any kind, including benign breast lumps
Benign prostate hypertrophy
Cataract and age related eye ailments
Gastric/ Duodenal Ulcer
Gout and Rheumatism
Hernia of all types
Hydrocele
Non Infective Arthritis
Piles, Fissures and Fistula in anus
Pilonidal sinus, Sinusitis and related disorders
Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident
Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy.
Varicose Veins and Varicose Ulcers
Internal Congenital Anomalies
List of specific diseases/ procedures excluded under the first 48 months of policy with us:
Treatment for joint replacement unless arising from accident
Age-related Osteoarthritis & Osteoporosis
Major Exclusions
We will not pay for any claim caused by, based on, arising out of or attributable to any of the following:
Refractive Error: Any claim if the hospitalization relates to treatment for correction of eyesight due to refractive error less than 7.5 dioptres.
Any claim of hospitalization for Dental treatment or other dental examination and/or tests not incidental to the treatment or diagnosis of an injury, sickness or disease.
Sterility and Infertility – Any claim for hospitalization relating to sterility and infertility. This includes:
Any type of contraception, sterilization
Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
Gestational Surrogacy
Reversal of sterilization
Maternity -Any claim for hospitalisation relating to -
Childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;
Miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.
Sleep disorder, Parkinson and Alzheimer’s disease, general debility or exhaustion (“run-down condition”); or growth hormone therapy.
Venereal disease, sexually transmitted disease or illness except for HIV/AIDS.
Change of Gender – Any claim relating to hospitalization of treatment, including surgical management, to change characteristics of the body to those of the opposite sex.
Circumcisions unless required as a part of treatment of an illness or injury.
Intentional self-injury, suicide or attempted suicide.
War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense.
Breach of Law – Any claim for hospitalisation if treatment arises from or is consequent upon You/ any insured person committing or attempting to commit a breach of law with criminal intent.
Treatment of alcoholism, drug or substance abuse or any addictive condition and consequences thereof.
Hazardous or Adventure Sports: Any claim if the hospitalisation is necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.
Participation in a naval, military, air force or law enforcement operation.
Any sporting risk in so far as they involve, the training or participation in competitions of professional or semi-professional sportsmen or women or riding or driving in any form of race or competition.
Unproven Treatments – Any claim for hospitalisation relating to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.
Investigation, Prevention & Evaluation - Any claim if admission in hospital is primarily for diagnostics, preventive and evaluation purposes which are not related or not incidental to the current diagnosis and treatment.
Narcotics used by the Insured Person unless taken as prescribed by a registered Medical Practitioner.
Any external congenital anomaly or external birth defects.
Cancellation
IFFCO-Tokio may cancel the policy on grounds of fraud, moral hazard or misrepresentation or non-cooperation by the Policy holder by sending 15 (fifteen) days’ notice under recorded delivery to the Policy holder at his/her last known address and in such event, IFFCO-Tokio will return to the Policy holder, except in case of fraud or illegality on Policy holder’s part, the premium paid less the pro rata portion thereof for the period the Policy has been in force.
