What's good here?
Short waiting period for Pre Existing Diseases
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after just 1 year. It’s probably the best deal you can get to be honest.
Day Care treatments covered
If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover these costs too. Think dialysis, chemotherapy or minor surgeries.
Free Health Checkups every year
If you’re planning on getting a full body checkup every year just to make sure you’re in fine working condition, the insurer will cover the costs.
What's bad here?
You will have to pay a portion of the bill
The company mandates that you pay 30% of the bill on most occasions. However, in the case of pre-existing diseases, you’ll have to pay 50% of the bill. They call this mandatory co-payment.
Restrictions on the rooms you can pick and much more
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. But in the event, you breach this limit, get ready to pay a lot more. Read more here
Has disease wise sub-limits
Your insurance cover won’t be fully available in case you are treated for Heart diseases, Major surgeries and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
No coverage if you are forced to hospitalize at home
The insurer will not cover the costs if you are forced to hospitalize at home due to a medical condition. In insurance lingo, they call this a policy with no domiciliary cover.
Pre & Post hospitalization expenses covered up to a certain limit
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount upto ₹5,000 for about 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Doctor consultations covered
In the event, you are feeling sick and you want to visit your family physician for a general checkup, the insurer will cover the costs, up to a certain limit. In this case, it’s ₹1,000 annually with a cap on each visit — ₹200 per consultation.
What's lacking here?
No Restoration Benefit
Some policies will tell you - Even after you claim part of the cover on one occasion, you will have the full cover restored, if you are hospitalized another time during the same year. So if you have a family cover and multiple members of the family are hospitalized in the same year, this feature will come in handy. Unfortunately, this policy offers no such benefit.
No Bonus for being healthy and not claiming insurance
Some policies offer you extra cover if you go an entire year without claiming your insurance. This policy, however, offers no such benefit.
No Cover for Alternative Medicine
Think of getting Ayurvedic, Homeopathic or other alternative treatment to cure an illness. Tough Luck!!! Your insurer won’t cover this expense.
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