THE NEW INDIA ASSURANCE CO. LTD., Regd. & Head Office: 87, M.G. Road, Fort, Mumbai

Transcription

1 THE NEW INDIA ASSURANCE CO. LTD., Regd. & Head Office: 87, M.G. Road, Fort, Mumbai INFORMATION SHEET FOR EMPLOYEES & CUSTOMERS OF CANARA BANK (Fresh Enrollment) New India Flexi Floater Group Mediclaim Policy (New India Canara Mediclaim Policy) Who can take this policy? This insurance is available to Family consisting of self, spouse and three dependent children and is on FLOATER basis to Employees and Customers of Canara Bank between the age of 3 months to 79 years, provided the minimum age of the proposer is 18 years. Policy remains in force till continuous lifelong renewals. What does this policy cover? The policy covers hospitalisation expenses for the treatment of Illness/Injury provided Hospitalisation is more than 24 hours. Pre-hospitalisation expenses for 30 days and post Hospitalisation expenses for 60 days are also payable. Day-care treatment - The Medical expense towards specific technologically advanced daycare treatments / surgeries where 24 hour hospitalisation is not required DAY CARE PROCEDURES Room Rent, boarding and nursing expenses as provided by the Hospital not exceeding 1% of the Sum Insured per day. Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses not exceeding 2% of the Sum Insured per day. No Medical examination will be required before acceptance of proposal. Hospitalisation shall cover expenses incurred on the donor during the course of organ transplantation to the insured person. The company s liability towards expenses incurred on the donor and the insured recipient shall not exceed the sum insured, of the insured person receiving the organ 1

2 Health Check - up: The Insured Person along with insured family members, shall be entitled for reimbursement of the cost of Medical check-up at the end of a block of every three Renewal years, provided there are NO CLAIMS reported during the block for all members. Such payment shall be restricted to 1% of Sum Insured or Rs.5,000/- (per family) whichever is less. This benefit is available only once in three years. Preferred Provider Network rates: Rates and procedures available in PPN package shall be applicable in case an insured person goes for treatment under any of the above listed procedures. Even if the person does not take treatment in PPN hospital, claims shall be restricted for these procedures as per the PPN rates fixed. Ambulance Charges for shifting the insured from residence to hospital are covered up to 1% of Sum Insured or maximum Rs. 5,000/- whichever is less. Cataract claims are payable up to maximum of 40,000/- (per eye) Critical illness benefit: If during the Period of Insurance any Insured Person discovers that he or she is suffering from any Critical Illness (as listed below) which results in a claim admissible under this Policy, Rs.20,000/- flat would be paid as Critical Care Benefit along with the admissible claim amount. Critical Care Benefit is payable only once in the life time of Insured Person and is not applicable to any Insured Persons for whom it is a Pre- Existing Condition/Disease. Any payment under this Clause would be in addition to the Sum Insured and shall not deplete the Sum Insured. If critical care benefit has been paid under this policy to any insured person, then no other insured person of that policy shall be ever eligible for critical care benefit. List of Critical illnesses: 1. Cancer of Specified Severity 2. Myocardial Infarction (First Heart attack of specified severity) 3. Open chest CABG 4. Open Heart replacement or repair of Heart valves 5. Coma of specified severity 6. Kidney failure requiring regular dialysis 7. Stroke resulting in permanent symptoms 8. Major organ / bone marrow transplant 9. Permanent paralysis of limbs 10. Motor neurone disease with permanent symptoms 2

3 11. Multiple sclerosis with persisting symptoms 12. Angioplasty 13. Benign Brain Tumor 14. Blindness 15. Deafness 16. End Stage Lung Failure 17. End Stage Liver Failure 18. Loss of Speech 19. Loss of Limbs 20. Major Head Trauma 21. Primary (Idiopathic) Pulmonary Hypertension 22. Third Degree Burns Treatment of any Pre-existing Condition/Disease, until thirty six months of Continuous Coverage of such Insured Person have elapsed, from the date of inception of his/her first Policy (with any insurer) Pre-existing conditions like Hypertension, Diabetes, and their complications are covered after two years of continuous insurance. Few Main Exclusions: Diseases contracted within 30 days of insurance, Pre-existing disease not covered for 36 months. [not applicable on accidental cases] War, Act of foreign enemy, ionising radiation and nuclear weapon Circumcision, Cosmetic surgery, Plastic surgery unless required to treat injury or illness Vaccination and Inoculation Debility and General Run down Conditions. Dental treatment except arising out of accident Sexually transmitted diseases and HIV (AIDS) Naturopathy Treatment All external equipment such as contact lenses, cochlear implants etc. Domiciliary Treatment Treatment outside India Experimental or unproven treatment Cost of Organ (to donor) 3

4 Waiting period 24 months: Unless the Insured Person has Continuous Coverage in excess of twenty four months, expenses on treatment of the following Illnesses are not payable: All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps Benign ear, nose, throat disorders Benign prostate hypertrophy Cataract and age related eye ailments Diabetes Mellitus Gastric/ Duodenal Ulcer Gout and Rheumatism Hernia of all types Hydrocele Hypertension Non Infective Arthritis Piles, Fissures and Fistula in anus Pilonidal sinus, Sinusitis and related disorders Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident Skin Disorders Stone in Gall Bladder and Bile duct, excluding malignancy Stones in Urinary system Treatment for Menorrhagia/ Fibromyoma, Myoma and Prolapsed uterus Varicose Veins and Varicose Ulcers Note: Even after twenty four months of Continuous Coverage, the above illnesses will not be covered if they arise from a Pre-existing Condition, until 36 months of Continuous Coverage have elapsed since inception of the first Policy with the Company. Waiting period 36 months: Unless the Insured Person has Continuous Coverage in excess of thirty six months (with any insurer), the expenses related to treatment of Joint Replacement due to Degenerative Condition, and Age-related Osteoarthritis & Osteoporosis are not payable. 4

5 Sum Insured & Premium for a Family consisting of self, spouse and three dependent children PREMIUM CHART (PREMIUM RATES ARE INCLUSIVE OF 18%* SUM INSURED (INR) PREMIUM (INR) AGE GROUP 03 MONTHS TO 79 YEARS 1,00, [ ] 2,00, [ ] 3,00, [ ] 4,00, [ ] 5,00, [ ] 7,00, [ ] 10,00, [ ] *premium rates are subject to revision in Service Tax. How to avail cashless claim: Claims are administered through Third Party Administrators (TPA) whose contact particulars appear on the policy document. Insured can opt for cashless or reimbursement facility for their claims. Continuity Benefits If any policy holder who is currently insured with any Insurer with tie up of Canara Bank and on renewal wishes to renew the policy with us, then he/ she shall be given the benefit of continuity. To illustrate it further; if there is a waiting period of two years on certain diseases in our policy and if an insured migrates to our policy from any Canara Bank tie up policy that too after a continuous coverage of two years, then there shall be no waiting period in our policy. In effect, we have reckoned that this policy holder was deemed to be with us since last two years even though he is joining our policy today (at the time of second renewal) Similarly there is a waiting period of three years in our policy for Pre-existing diseases. If a policy holder of any Canara Bank tie up policy joins us after a continuous coverage in that policy for three years, then in our policy PED will be covered from DAY ONE. It is to be noted that, barring above mentioned deviations, policy holder will be governed by all the terms and conditions of our policy once he/ she opts for our policy. 5