Swasthya Raksha Bima

What it covers?

Following hospitalization 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 ₹150/- per day, for the duration of Hospitalization towards defraying of miscellaneous expenses.
• Ambulance charges in connection with any admissible claim limited to ₹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 a maximum of ₹15,000/-
  B	Piles, Fistula, Fissure, Tonsillitis, Sinusitis	8% of the Sum Insured subject to a maximum of ₹25,000/-
  C	Benign Prostatic Hypertrophy, Hernia	8% of the Sum Insured subject to a maximum of ₹30,000/-
  D	Knee/Hip Joint replacement, Cancer, renal failure	30% of the Sum Insured subject to a maximum of ₹1,00,000/-
  E	Appendicitis, Gall Bladder stones, and Hysterectomy	10% of the Sum Insured subject to a maximum of ₹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”).