Claim Settlement Ratio 78.03%
Claim Settlement Facility 100%
COVID-19 Cover Yes
Network Hospitals 7000
Incurred Claim Ratio 110.51%
Any person aged between 18 years and 65 years can take the policy. The policy can be taken on an individual or family floater basis. Beyond 65 years, only renewals without any break are allowed.
The midterm inclusion of family members is allowed on payment of pro rata premium. Mid term inclusions is possible only in case of occurrence of an event such as marriage or child birth.
The minimum and maximum sum insured under the plan is Rs.3 lakhs and Rs.25 lakhs.
The policy has a sub limit in respect of the cataract surgery where the expenses are limited to 10% of the sum insured subject to a maximum of Rs.5k per eye. The sub limit for mental illness cover is up to 25% of the basic sum insured subject to a maximum of Rs.3 lakhs per year.
The pre and post hospitalization expenses are covered up to 30 days prior to hospitalization and 60 days after the hospitalization. The maximum limit of coverage under this is a maximum of 10% of sum insured.
The policy covers the expenses for alternate treatments such as Ayurveda, Yoga, Unani, Siddha and Homeopathy up to the limits mentioned under the policy.
The policy covers the expenses incurred for an organ donor’s treatment for harvesting the organ donated up to the sum insured. In case of the insured being the donor a maximum of 10% of the sum insured would be made as lump sum payment.
The policy covers the emergency ambulance expenses up to 0.5% of the sum insured subject to a maximum of Rs.2500 per event and up to 1% of the sum insured subject to a maximum of Rs.5000 per policy period.
The United India health insurance plan covers the expenses incurred towards health checkup costs up to 1% of the average sum insured of preceding 3 years subject to a maximum of Rs.10000.
There would be a co-payment applicable for people with more than 60 years at the time of entry. A maximum of 10% of co-payment would be applicable on the treatments availed under the policy.
For the calculation of premium the cities in India are divided into zones and the premium is charged accordingly. The premium would be high in Zone 1 which includes the Metro cities and other big cities.