userThis policy is tailored for individuals with disabilities or HIV/AIDS, providing comprehensive coverage for their unique healthcare needs. Below is a summary of the plan essentials, eligibility criteria, and key features:
Plan Essentials
1. Entry Age:
Individuals: 18 to 65 years.
Dependent children: Newborn to 17 years.
2. Pre-Policy Medical Check-Up:
Not required.
Submission of previous medical records, including treatment details, is mandatory.
3. AYUSH Treatment: Covers inpatient care under Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy up to 100% of the sum insured.
4. Modern Treatment: Covers modern treatments (e.g., Robotic Surgeries, Deep Brain Stimulation) up to 50% of the sum insured.
5. Instalment Options: Premium can be paid quarterly (3% loading), half-yearly (2% loading), or annually.
Important Highlights
1. Unique Plan:
Designed for persons with disabilities (as per the Disability Act, 2016) and/or individuals with HIV/AIDS (as per the HIV/AIDS Prevention and Control Act, 2017).
2. Policy Type: Individual basis only.
3. Policy Term: 1 year.
4. Sum Insured Options: ₹4,00,000 or ₹5,00,000.
Eligibility
Disability Cover:
Covers persons with 40% or more certified disability, including:
Blindness, Muscular Dystrophy, Locomotor Disability, Parkinson’s Disease, Autism Spectrum Disorder, and others as listed under the Disability Act.
HIV Cover: Individuals diagnosed with HIV/AIDS with a CD4 count above 350 are eligible.
Hospitalisation Care (Including Disability and HIV/AIDS Cover)
1. In-Patient Hospitalisation: Covers expenses for hospital stays exceeding 24 hours.
2. Room Rent: Covered up to 1% of the sum insured per day.
3. ICU Charges: Covered up to 2% of the sum insured per day.
4. Pre-Hospitalisation: Covers medical expenses up to 30 days prior to admission.
5. Post-Hospitalisation: Covers expenses up to 60 days post-discharge, including consultations, diagnostics, and medicines.
6. Emergency Road Ambulance: Covered up to ₹2,000 per hospitalisation.
7. Day Care Procedures: Covers advanced treatments requiring less than 24 hours of hospitalisation.
8. Cataract Treatment: Expenses covered up to ₹40,000 per eye annually.
9. Co-Payment:
20% of the claim amount applies.
Waiver available for an additional premium.
Lumpsum Coverage for HIV/AIDS
If the insured’s CD4 count falls below 150, a lump sum amount (100% of the sum insured or the remaining balance) is paid after a 90-day waiting period.
Payable once in the insured’s lifetime.
Waiting Period
1. Pre-Existing Diseases:
General: Covered after 36 months of continuous coverage.
HIV/AIDS: Covered after 90 days of continuous coverage.
Disability: Covered after 24 months of continuous coverage.
2. Specific Diseases: Covered after 24 months of continuous coverage.
3. Initial Waiting Period: Excludes illness treatment within the first 30 days, except for accidents.
For detailed terms and conditions, please refer to the Policy Documents.
FAQs
Rahul Khanna
