United India Family Medicare insurance

Family Medicare health insurance review

• Benefits under Family Medicare insurance plan

  Hospitalisation expenses	Room, Boarding and Nursing expenses not exceeding 1% of the Sum Insured or actuals whichever is less. ICU not exceeding 2% of the Sum Insured or actual whichever is less. Expenses incurred for Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees. Expenses incurred on Anesthetic, blood, oxygen, Operation theatre charges, surgical appliances, Medicines & drugs, dialysis, chemotheraphy, radiotheraphy, cost of artificial limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, orthopaedic implants, infra cardiac valve replacements, vascular stents, relevant laboratory/diagnostic tests, x-ray and similar expenses that are medically necessary and hospitalization expenses (excluding cost of organ) incurred for donor in respect of organ transplant to the insured. Other expenses covered Cataract 10% of sum insured subject to maximum of Rs.25,000. Hernia 15% of sum insured subject to maximum of Rs.30,000 Hysterectomy 20% of sum insured subject to maximum of Rs.50,000 Major 70% of sum insured subject to maximum of Rs.4 lakh
  Pre-hospitalisation	Pre-hospitalisation expenses incurred upto 30 days prior to date of admission
  Post-hospitalisation	Post-hospitalisation expenses incurred upto 60 days from the date of discharge.
  Day Care Treatment	Specified Day Care procedures which require less than 24 hours hospitalization.
  Ayush Treatment	Treatment taken in a Government Hospital or in any Institute recognized by the Government and/or accredited by Quality Council of India/National Accreditation Board on Health.
  Cashless facility	Cashless facilities at more than 7000 hospitals across India.
  No claim discount	3% after three continuous claim free years and subsequent claim free years subject to maximum of 15%
  Free Look period	15 days shall be applicable at the inception of the first policy.
  Medical Check up	Free Medical check-up once at the end of every three underwriting years provided no claims reported during the block and subject to policy renewed without any break.
  Tax	Premium paid for self, spouse, dependent children and dependent parents are exempt from Income Tax under Section 80-D of the IT act as per rules in force.

• Clamis under Family Medicare insurance plan

  • All claims shall be paid in Indian Rupees only.
  • Upon happening of any event, notice of Intimation about the hospitalization or claim should be sent to the address of Insurer/TPA stated in the Policy. In case of emergency hospitalization, notice of intimation to be sent within 24 hours from the time of hospitalization.
  • Claim form should be collected on intimation of claim. The completed claim form along with all required/relevant hospitalization documents should be submitted to servicing TPA within 15 days from the date of discharge from the hospital.
  • For Cashless treatment, the Insured or the representative has to submit the Pre-authorisation Cashless form to TPA through the hospital where the treatment is taken. No separate intimation is required if the pre-authorisation form is submitted immediately on admission.
  • In case of Reimbursement claims, the insured should submit documents in respect of the hospitalization expenses incurred within 15 days from the date of discharge from hospital.

• Exclusions under Family Medicare insurance plan

  1. All Pre-existing diseases upto 48 months of continuous coverage.
  2. Any disease contracted during the first 30 days of inception of policy.
  3. Waiting period of 2/4 years for certain specified illness/treatment.
  4. Vaccination and Inoculation of any kind unless it is post-animal bite
  5. General debility and Run down conditions
  6. Circumcision, Cosmetic surgery, Plastic surgery.
  7. HIV/AIDS
  8. Psychiatric and psychosomatic disorders
  9. Injury arising out of drug/alcohol abuse.
  10. Pregnancy, ailments related thereto and child birth
  11. War, act of foreign enemy, ionizing radiation and nuclear weapon.
  12. Naturopathy
  13. Experimental or unproven treatment
  14. All external equipments
  15. Dental treatments