What does it do?
Though this policy facilitates both cashless claim settlement for treatment in empanelled hospital and reimbursement of medical expenses incurred during treatment in a non-empanelled hospital, availing reimbursement facility should be avoided as there is a co- payment clause where 10 per cent of each claim has to be paid by the insured person. In this case, the insurance company will be liable to pay only 90 per cent of the admissible claim. To get rid off this clause, you need to shell out an additional premium.
It covers all relevant medical expenses where insured is admitted in a hospital for more than 24 hours. Apart from this, the policy covers 130 day care treatment which takes less than 24 hours to complete the treatment procedure due to technological advancement which would otherwise require admission to hospital. Emergency ambulance charges are also covered. It gives an advantage to policyholders covered for sum insured of Rs 5 lakh and above where, in case of critical illness, policyholder may ask for a second opinion from any doctor empanelled with insurance company. Health check-up at the end of four continuous claim-free years are also done.
It gives a cumulative bonus of 5 per cent for each claim-free year till a maximum of 50 per cent.
Besides these, there is a voluntary Deductible option where policyholder agrees to bear a certain initial amount of each admissible claim. Policyholders get a discount if this option is chosen.
Pros
It covers laser eye surgery after a waiting period of four years.
No sub-limits on room rent and boarding.
Second opinion in case of critical illness is a useful option.
Discount on premium is available if opted for a deductible.
It covers pre and post hospitalisation expenses.
This policy can be purchased online.
Premiums paid under this policy qualify for deduction under section 80D of Income Tax Act.
Cons
Co-payment clause of 10 per cent in case treatment is taken in a non-network hospital.
Co-payment clause where any insured person above 55 years of age has to bear 20 per cent of medical bills each time medical services are accessed.
In case, cumulative bonus has been passed and a claim arises during that year, cumulative bonus would be reduced by 10 per cent in the subsequent year.
