Individual Health Protector Policy Insurance

Imagine how the lack of a Mediclaim policy could rattle your easy-going life and strain your finances, in the event of a critical illness. To help you stay prepared for any such eventuality, we offer you the opportunity to opt for a Critical Illness Cover on payment of a little extra amount. The following are the medical conditions that have been identified as critical ailments, under our individual health protector plan: -

• Cancer of specified severity.

• Coma of specified severity.

• Major Organ/Bone Marrow Transplant.

• Stroke Resulting in Permanent Symptoms.

• First Heart Attack - of specified severity.

• Motor neuron disease with permanent symptoms.

• Open Chest CABG.

• Permanent Paralysis of Limbs.

• Open Heart Replacement or Repair of Heart Valves.

• Kidney Failure Requiring Regular Dialysis.

• Multiple sclerosis with persisting symptoms.

Following are the exclusions in case of which our company will not be able to compensate your claims:

• Frenuloplasty, Circumcision, Preputial Dilatation, Preputioplastyand Removal of SMEGMA.
• Expenses incurred on diagnostics that do not tally with the treatment for the ailment for which you or your family member has been admitted to the nursing home or hospital. Expenses on account of admission to the hospital mainly for diagnostic purposes without any positive existence of ailment/sickness /injury/disease and there is no further indication of any treatment being administered. Disease or injury directly or indirectly caused due to nuclear materials or weapons.
• Behavioural, Mental and Psychiatric ailments.
• Vaccination or Inoculation (other than post-bite treatment and for medical treatment for therapeutic reasons).
• Cosmetic or plastic surgery (other than necessary as a result of an illness or an accident).
• Unless necessitated due to accidental injuries warranting hospitalization, dental treatment or surgery are not payable. (Dental implants are not payable).
• Cost of Nutritional Supplements, hearing aids, infusion pump, spectacles and contact lens, Continuous Ambulatory Peritoneal Dialysis [CAPD], walkers and crutches, Cochlear implants, wheelchairs, CPAP, BIPAP and other such similar aids and procedures and associated expenses for hospitalization.
• Congenital External Defects /Anomalies and Conditions.
• Biologicals, Oral Chemotherapy, and Immunotherapy, other than when given as an in-patient, indicated clinically and warranted due to hospitalization.
• Expenses incurred on Rotational Field Quantum Magnetic Resonance Therapy, Deep Brain Stimulation, Photodynamic therapy, High Intensity Focused Ultrasound, Balloon Sinoplasty, Enhanced External Counter Pulsation, Low-level laser therapy, Uterine Fibroid Therapy and related therapies, Embolisation, Chelation therapy, Hyperbaric Oxygen Therapy, VAX-D, and other such therapies similar to those mentioned herein.
• Deliberate injury to oneself.
• Expenses incurred on tonics and vitamins unless they are a part of the treatment and have been certified by the attending physician of the hospital where the treatment is being performed.
• Expenses that come up due to any condition indirectly or directly caused due to or associated with Human T-cell Lympho Trophic Virus type III (HTLV-III) or Lymphadenopathy Associated Virus (LAV) or HIV / AIDS. However, it is being clarified that patients who are tested HIV positive (Human Immune Deficiency Virus) shall be eligible for expenses borne for treatment. Expenses are not allowed for opportunistic infections and for treatment of HIV/AIDS, given that during the initial start of coverage under this policy, their CD4 count is more than 350.
• Substance abuse, consumption of intoxicating substances, smoking, drugs/alcohol, and tobacco chewing.
• Treatment is arising from or traceable to family planning, pregnancy, miscarriage childbirth, abortion and complications due to any of these conditions (other than ectopic pregnancy).
• Treatment for Assisted Conception, Sub-Fertility, and or other associated complications caused due to the same conditions.
• Surgical or Medical treatment of the genetic and endocrine disorder and Sleep apnoea, Expenses incurred for Bariatric Surgery or weight management services comprising of surgical procedures for medical treatment of obesity.
• Medical conditions caused directly or indirectly or attributable to the act of a foreign enemy, war, warlike operations or invasion, whether there is a war declaration or not).
• The run-down condition, Nutritional deficiency state, convalescence, rest cure or general debility.
• Experimental, Untested, Unproven and Unconventional therapies.
• Expenses incurred on Refractive Error Correction treatments such as Lasik Laser, treatment for disorders of eye requiring intravitreal injections and other related complications.
• Hospital registration charges, record charges, telephone charges, admission charges, or any other such charges.
• Chondrocyte Implantation, Intraarticular injection therapy, Stem cell Therapy, and Procedures using Platelet Rich Plasma.

Cancellation

You may cancel the cashless Mediclaim policy through written notice. To do this send the written notice within 30 days to us using the standard method of registered post. A refund will be issued using the following scale as a measure.

Your cashless Mediclaim Policy may be canceled by us, on the grounds of moral hazard or misrepresentation/fraud/non-cooperation from your side. For this process, we will send a 30 (thirty) days’ notice using a registered post to your last known address. The only thing that you will be entitled to, in such a case is a pro-rata refund of premium for the unexpired period that remained of the Mediclaim policy. This would be with respect to such insured person(s) for the likes of whom there has been no claim.

Download Forms

• Day Care Procedures_5.pdf
• Health Cashless Request Form_5.pdf
• Health Claim Form_2.pdf
• Health Protector Policy Proposal Form.pdf
• Health Protector Policy Wording.pdf
• KYC Form_3.pdf
• List of excluded Hospitals.pdf
• List of Network Hospitals.pdf
• List of Non Payable Items_5.pdf
• Individual Health Protector Brochure.pdf