Plan Types | Sum Assured under Individual and Floater Basis |
Basic | Rs.1 and Rs.2 lakhs |
Essential | Rs.3 lakhs, Rs.4 lakhs and Rs.5 lakhs |
Privilege | Rs.6 lakhs to Rs.10 lakhs |
Plan benefits | Variant - Basic | Variant – Essential | Variant – Privilege |
Pre and post hospitalization | Covered | Covered | Covered |
Inpatient hospitalization | Covered | Covered | Covered |
Day care procedures | 141 treatments covered | 141 treatments covered | 141 treatments covered |
Domiciliary treatment | Covered | Covered | Covered |
Organ donor expenses | Covered | Covered | Covered |
Ambulance cost | Lower of up to 1% of the Sum Insured or Rs.1000 | Lower of up to 1% of the Sum Insured or Rs.2000 | Lower of up to 1% of the Sum Insured or Rs.3000 |
Accidental dental treatments | Up to 100% of the inpatient Sum Assured | Up to 100% of the inpatient Sum Assured | Up to 100% of the inpatient Sum Assured |
AYUSH benefits | Covered | Covered | Covered |
Daily cash for accompanying an insured child below 12 years of age | Not covered | Up to Rs.300 per day to a maximum of Rs.9000 | Up to Rs.500 per day up to a maximum of Rs.15,000 |
Vaccination for post bite treatments | Lower of actuals or the Sum Assured chosen | Lower of actuals or the Sum Assured chosen | Lower of actuals or the Sum Assured chosen |
Outpatient benefits: A) Outpatient consultations B) Diagnostic tests C) Dental treatments D) Spectacles, lenses and hearing aids |
Lower of 1% of the Sum Insured or actuals up to a maximum of Rs.2500 | Lower of 1% of the Sum Insured or actuals up to a maximum of Rs.5000 | Lower of 1% of the Sum Insured or actuals up to a maximum of Rs.7500 |
Convalescence benefit | Rs.10,000 per insured member if hospitalization exceeds 10 days | Rs.10,000 per insured member if hospitalization exceeds 10 days | Rs.10,000 per insured member if hospitalization exceeds 10 days |
Maternity expenses | Not covered | Normal delivery – lower of actuals or Rs.15,000 Cesarean delivery – lower of actuals or Rs.25,000 which also includes pre and post-natal expenses up to Rs.2000 |
Normal delivery – lower of actuals or Rs.55,000 Cesarean delivery – lower of actuals or Rs.50,000 which also includes pre and post-natal expenses up to Rs.2000 |
New born baby cover | Not covered | Up to the Sum Insured from first day till policy renewal or till baby reaches 91 days of age | Up to the Sum Insured from first day till policy renewal or till baby reaches 91 days of age |
Restore benefit | Covered | Covered | Covered |
PLHA cover | Not covered | Not covered | Covered |
Health check-up | Once after 2 claim-free years for one member. In case of family floater plans for two members | Once after every claim-free year for one member or two members(family floater) | Once after every claim-free year for one member or two members(family floater) |
Value added benefits : A) Dial a doctor B) Health Educational Library for People C) Second opinion D) Specialist consultation with 2 follow-up sessions E) Wellness package F) 24*7 customer service G) Newsletter |
All benefits are covered except second opinion and specialist consultation | Covered | Covered |
Optional coverage options | |||
Personal accident | Available | Available | Available |
Critical Illness | Available | Available | Available |
Hospital daily cash | Rs.200 per day | Rs.500 per day | Rs.1000 per day |
Sub-limits applicability | Sub-limit A – 7.5% Sub-limit B – 5% |
Sub-limit A – 10% Sub-limit B – 7.5% Sub-limit C – 5% |
Sub-limit A – 10% Sub-limit B – 7.5% Sub-limit C – 5% |
Treatment only in tied network | 5% discount and 10% co-pay | 5% discount and 10% co-pay | 5% discount and 10% co-pay |
Minimum | Maximum | |
Entry age (Last Birthday) of the insured | Policyholder and other adults – 18 years Dependent Children – 91 days Children in case of floater plan – 1 day |
70 years Dependent children – 25 years |
Plan tenure | 1, 2 or 3 years | |
Premium payable | Depends on the age and Sum Assured chosen | |
Sum Assured | Rs.1 lakhs | Rs.10 lakhs |
Premium payment mode | Annually |
Coverage period | Within 1 month | Within 1-3 months | Within 3-6 months | Within 6-12 months | In the 2nd year | In the 3rd year |
1 year | 75% | 50% | 25% | 0% | NA | NA |
2 years | 75% | 65% | 50% | 25% | 0% | NA |
3 years | 75% | 70% | 60% | 45% | 11% | 0% |
Members covered | Basic | Essential | Privilege | |||
SA - 1 lakh | SA - 2 lakhs | SA - 4 lakhs | SA - 5 lakhs | SA - 8 lakhs | SA - 10 lakhs | |
Individual | 2,349 | 2,484 | 5,292 | 6,484 | 8,073 | 11,671 |
2 adults | 2,805 | 2,967 | 6,403 | 7,672 | 13,607 | 19,365 |
2 adults + 2 children | 4,773 | 5,047 | 7,987 | 10,214 | 13,158 | 19,078 |