Swasthya Raksha Bima

Swasthya Raksha Bima is the affordable health insurance plan for people located in smaller cities and non-metro towns.

Features

• Affordable health insurance plan for people living in smaller towns and cities.
• Covers Pre-Hospitalization and Post Hospitalization expenses for 30 days
• Ambulance services charges limited to Rs 750 or actual whichever is less
• 35% co pay if the Insured person takes treatment in Zone A
• Domiciliary hospitalization covered up to a max sub-limit of 20% of sum insured
• Daily allowance Rs 150/- per day
• Covers hospitalization expenses of person donating the organ
• Emergency assistance services covered such as medical evacuation and emergency cash coordination
• The policy is for persons between the age of 18 years and 65 years

What it covers?

Following hospitalisation expenses are covered under the policy:

• Room, Boarding and Nursing Expense as provided in the Hospital/Nursing Home subject to following limits.
  • Sub limit per day for normal Room expenses:1% of the Sum Insured
  • Sub limit per day for Intensive Care/Therapeutic Unit expenses: 2.0% of the Sum Insured
  • Registration and Service

  Charges of Hospital/Nursing Home: Actual

• Medical Practitioner/ Anesthetist, Consultant fees.
• Expenses on Anesthesia, Blood, Oxygen, Operation Theatre, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs, Cost of Transplantation and similar expenses.
• Expenses on Vitamins and Tonics only if forming part of treatment as certified by the attending Medical Practitioner.
• The above stated relevant expenses incurred for Domiciliary Hospitalization at Reasonable and Customary Charges up to a maximum aggregate sub-limit of 20% of the Sum Insured.
• An additional Daily Allowance amount equivalent to Rs. 150/- per day, for the duration of Hospitalization towards defraying of miscellaneous expenses.
• Ambulance charges in connection with any admissible claim limited to Rupees 750/- or actual whichever is less for each claim.
• The below mentioned list of treatments has specified expenses limit per claim which is inclusive of all expenses as mentioned in (1), (2), (3), (4), (5), (6) and (7) or actual amount, whichever is less.

   

  Serial No	Treatment List	Expense Limit Per Claim
  A	Cataract	5% of the Sum Insured subject to maximum of Rs 15,000/-
  B	Piles, Fistula, Fissure, Tonsillitis, Sinusitis	8% of the Sum Insured subject to maximum of Rs 25,000/-
  C	Benign Prostatic Hypertrophy, Hernia	8% of the Sum Insured subject to maximum of Rs 30,000/-
  D	Knee/Hip Joint replacement, Cancer, renal failure	30% of the Sum Insured subject to maximum of Rs 1,00,000/-
  E	Appendicitis, Gall Bladder stones and Hysterectomy	10% of the Sum Insured subject to maximum of Rs 25,000/-

   

• AYUSH hospitalization expenses including Pre- Hospitalization and Post Hospitalization expenses

Incurred in Government recognized hospitals as mentioned.

Note: 35% copay if the Insured person takes treatment in a Zone A city (Please refer Definition no. 16– Geographical Zones under “Definition of words”).

Exclusions

• Any condition(s) defined as Pre - existing Disease in the Policy, until 48 months of continuous
• Any expense on Hospitalization for any Disease during first 30 days of commencement of this Insurance cover except due to accident
• Any expense incurred in the first year of operation of the insurance cover on treatment Specified Diseases.
• Any expense incurred during the first two continuous years of operation of the insurance cover on treatment of Specified Diseases.
• Injury or Diseases directly attributable to war, invasion, act of foreign enemy, war like operation
• Circumcision, vaccination, inoculation, cosmetic or aesthetic treatment, plastic surgery
• Cost of spectacles and contact lens or hearing aids
• Dental Treatment or dental surgery of any kind, unless due to Accident requiring Hospitalization
• Convalescence, general debility, run down condition or rest cure
• Congenital anomalies, sterility, venereal Disease, intentional self Injury and use of intoxicating drugs/alcohols
• Expenses on Diagnostics, X-Ray, or Laboratory examinations unless related to the active treatment of Disease or Injury
• Expenses on treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion, infertility, sub fertility
• Any expense on treatment of Insured Person as outpatient in a Hospital
• Any expense on procedure and treatment other than Allopathic and AYUSH
• External/Durable medical/non-medical equipment
• Stem cell implantation/ surgery.
• Treatment of obesity, hormone replacement therapy, sex change.

Cancellation

• By Insurer- On grounds of misrepresentation, fraud, non-disclosure of material facts or non-cooperation by any Insured Person, upon giving 30-day notice.
• By Insured- By sending 15-day notice