Claim Settlement Ratio 78.03%
Claim Settlement Facility 100%
COVID-19 Cover Yes
Network Hospitals 7000
Incurred Claim Ratio 110.51%
If during the policy period the sum insured is exhausted due to a single or multiple claims then the company would restore the entire sum insured up to 100% of the basic sum insured. The reinstatement would be done automatically and instantly on the exhaustion of the basic sum insured under the policy. The restoration of sum insured would be done only once during the policy period. The restored sum insured under the policy cannot be utilized for the illness or diseases for which the base sum insured is already utilized. For members above 60 years of age copay of 10% would be applicable on the admissible claim amount. The reinstated sum insured which is unutilized cannot be carried forward to the next policy period as the reinstated sum insured would be valid only for the policy period it was provided.
The policy would pay for the medical expenses incurred by the insured as an in-patient for a delivery which includes normal as well as cesarean and lawful termination of pregnancy during the policy period. The benefit payable under this section is limited to two deliveries or terminations during the lifetime of the insured person. The medical expenses sum insured is above the basic sum insured under the policy and is available as an add-on cover. The cover would be available subject to the base policy being with the add-on being continuously in force for more than 24 months. The policy also covers the new born baby expenses up to 90 days subject to the claim being admitted under the maternity section. The maximum amount of claim payable under this section would be up to 10% of the sum insured. After the 90 days period the child has to be added in the policy on payment of additional premium.
The policy provides up to Rs.2000 per day subject to a maximum of Rs.20,000 per policy period for every continuous and completed hospitalization of 24 hours period. The claim is payable under this section subject to the claim being admissible under the policy. The aggregate of daily cash allowance under this section during the policy period would not be more than the “per policy period limits” mentioned under the policy. There would be a deductible equivalent to the first 24 hours hospitalization benefit for each and every hospitalization under the policy.