Benefits of Oriental jan arogya bima policy
- Benefits of up to Rs.5,000 per insured person.
- Hospital cover where expenses are reimbursed up to the sum insured when the insured is admitted for in-hospital treatment.
- Pre-hospitalization cover for 30 days before admission in a healthcare installation.
- Post-hospitalization cover for 60 days after treatment completed in hospital.
- Eligibility: Applicants should be above 5 years and less than 70 years old when applying for the policy.
- Children between 3 months and 5 years can also be covered subject to one or both parents being covered concurrently
- Renewal: Renewal of policy is allowed at the discretion of the insurance provider. Renewal can be done at the end of policy tenure.
Some Salient Features of Jan Arogya Bima Policy
A. AGE LIMIT :
This Insurance is available to persons between the age of 5 years and 70 years. Children between the age of 3 months and 5 years of age can be covered provided one or both parents are covered concurrently.
B. POLICY COVERAGES :
The policy covers reimbursement of Hospitalization / Domiciliary Hospitalization expenses for illness / diseases or injury sustained. In the event of any claim becoming admissible under this scheme, A. the Company will pay to the insured person the amount of such expenses as would fall under different heads mentioned below and as are reasonable and necessarily incurred thereof by or on -behalf of such Insured person but not exceeding the Sum Insured in any one period of Insurance,
A) Room, Boarding Expenses as provided by the hospital/nursing home.
B) Nursing Expenses.
C) Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.
D) Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & Cost of Organs and similar expenses.
C: SUM INSURED
In respect of all claims admitted during the period of insurance shall not exceed the Sum Insured of Rs. 5,000/- per person.
D : DAY CARE
Day Care Treatments include: Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Dental Surgery, Lithotripsy (Kidney stone removal), Tonsillectomy. DNC taken in the Hospital/ Nursing Home and the insured is discharged on the same day, the treatment will be considered to be taken under Hospitalization Benefit.
E : DOMICILIARY HOSPITALISATION BENEFIT :
Domiciliary hospitalization means medical treatment for a period exceeding three days for such an illness/disease/injury which in the normal course would require care and treatment at a hospital but is actually taken while confined at home under any of the following circumstances: - the condition of the patient is such that he/she is not in a condition to be removed to a hospital, or - the patient takes treatment at home on account of non availability of room in a hospital.
Subject however that domiciliary hospitalization benefits shall not cover (i)Expenses incurred for pre and post hospital treatment and (ii)Expenses incurred for treatment for any of the following diseases. 1. Asthma 2. Bronchitis 3. Chronic Nephritis and nephritic Syndrome. 4. Diarrhoea and all type of Dysenteries including Gastroenteritis 5. Diabetes Mellitus and insipidus 6. Epilepsy 7. Hypertension 8. Influenza, Cough and Cold 9. All Psychiatric or Psychosomatic Disorders 10. Pyrexia of unknown Origin for less than 10 days 11. Tonsillitis and Upper Respiratory Tracheal Infection including Laryngitis and Pharingitis 12. Arthritis, Gout and Rheumatism.
F : FREE LOOK PERIOD :
The Insured will be allowed a period of 15 days from the date of receipt of the policy to review the terms and conditions of the policy and return the same, if not acceptable. This will apply only in case of fresh policies.
Exclusions for jan arogya bima policy
The company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any insured person in connection with or in respect of;
4.1 Such diseases which have been in existence at the time of proposing this insurance. Pre-existing disease means any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice / treatment within 48 months prior to the first policy issued by the insurer. Complications arising from pre-existing disease will be considered part of the preexisting condition.
4.2 Any expenses on hospitalization incurred during first 30 days from the commencement period of insurance cover. Except in case of injury arising out of accident
4.3 During the first year of the operation of insurance cover, the expenses on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy Menouragia or Fibromyoma. Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, piles, Sinusitis and related disorders are not payable.
4.4 Injury or disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, Warlike operations (whether war be declared or not).
4.5 Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
4.6 Cost of spectacles and contact lenses, hearing aids.
4.7 Dental treatment or surgery of any kind unless requiring hospitalization.
4.8 Convalescence, general debility, 'Run-down' condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self-Injury and use of intoxicating drugs/ alcohol.
4.9 All expenses arising out of any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus type III (HTLB-III) or Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or variations Deficiency Syndrome or any Syndrome or condition of a similar kind commonly referred to as AIDS.
4.10 Charges Incurred at hospital or Nursing Home primarily for diagnostic, X-Ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury, for which confinement is required at a Hospital/Nursing Home.
4.11 Expenses on Vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending Physician.
4.12 Injury or disease directly or indirectly caused by is or contributed to by nuclear weapons/materials.
4.13 Treatment arising from traceable to pregnancy, childbirth including cesarean section.
4.14 Naturopathy treatment
