Future Generali Future Aarogya Bima

Future Generali under this policy will pay the Reasonable and Customary Charges incurred for an organ donor’s treatment for the harvesting of the organ donated provided that :

• The organ donor is any person whose organ has been made available in accordance and in compliance with the Transplantation of Human Organs Act, 1994 and the organ donated is for the use of the Insured Person;
• We will not pay the donor’s screening expenses or pre and post hospitalisation expenses or for any other medical treatment for the donor consequent on the harvesting;
• We have accepted claim under Hospitalisation medical expenses for the Insured Person and the Insured Person has been Medically Advised to undergo an organ transplant;
• Costs directly or indirectly associated with the acquisition of the donor’s organ will not be covered.

If an Insured Person suffers an Illness or Injury during the Policy Period in respect of which a claim has been admitted under Hospitalisation medical expenses then at the Insured Person’s request We will arrange a maximum of two e-opinions (in a Policy Year) from a Medical Practitioner selected by the Insured Person from Our panel. The e-opinion will be based only on the information and documentation provided to the Medical Practitioner by or on behalf of the Insured Person.

If the Sum Insured and Cumulative Bonus (if any) is exhausted due to claims incurred and paid during the Policy Year or incurred during the Policy Year and accepted as payable, then it is agreed that a Restore Sum Insured (equal to 100% of the Sum Insured) will be automatically available for the particular Policy Year, provided that:

• The Restore Sum Insured will be enforceable only after the Sum Insured and the Cumulative Bonus have been completely exhausted in that Policy Year;
• The Restore Sum Insured can only be used for claims made by the Insured Person in respect of Benefits 1-4 (refer policy wordings).
• The Restore Sum Insured cannot be used for claims based on Maternity Expenses/Treatment;
• The Restore Sum Insured can be used for only future claims made by the Insured Person and not against any claim for an Illness (including its complications) for which a claim has been paid in the current Policy Year under Benefits 1-4(refer policy wordings).
• Only the Sum Insured (excluding Cumulative Bonus) will be considered as Restore Sum Insured;
• The Restore Sum Insured will only be applied once for the Insured Person during a Policy Year;
• If the Restore Sum Insured is not utilised in a Policy Year, it shall not be carried forward to any subsequent Policy Year.
• If the Policy is opted by You on a ‘Family Floater’ basis as specified in the Schedule, then the Restore Sum Insured will only be available in respect of claims made by those Insured Persons who were Insured Persons under the Policy before the Sum Insured and Cumulative Bonus was exhausted.

• 24 months waiting period for: Pre existing conditions, Internal Congenital Anomalies, Cataracts, Benign Prostatic Hypertrophy Hernia of all types, Deviated Nasal Septum, Hypertrophied Turbinate, Hydrocele, All types of sinuses Fistulae, haemorrhoids, fissure in ano, Dysfunctional uterine bleeding, Fibromyoma, Endometriosis, Hysterectomy, All internal or external tumors/cysts/nodules/polyps of any kind including breast lumps with exception of malignant tumor or growth. Surgery for prolapsed inter vertebral disc unless arising from Accident, Surgery of varicose veins and varicose ulcers, any types of gastric or duodenal ulcers, stones in the urinary and biliary systems, Surgery on ears and tonsils.
• 48 months waiting period for Organ transplant, Rheumatoid Arthritis, Gout, Joint replacement due to degenerative condition age related osteoarthritis, Osteoporosis , unless such joint replacement surgery is medically necessary due to injury
• First 30 days waiting period for medical expenses incurred for any illness diagnosed or diagnosable except those incurred as a result of Injury.