Health Insurance policy is always worked as a door opener for me. Mostly When I met Clients they are on duty or in hurry. Times is very important for everybody nowadays. Because of this they can’t give me time to explain any product they just said “Nisar I trust on you Lets Buy”. Yes I feel proud to hear this 😀 .But When it comes to Health Insurance Policy, I strictly want that My client should know Terms and Condition in Detailed about Product he bought. It will help client to take decision while hospitalization like which hospital Have cashless and Room Charges Etc. so, Today I decide to write detailed post On My Favorite Health Insurance policy United India Insurance Mediclaim. It is Floater Health Insurance Plan. I will also Update this Post time to time. So, If you bought this Policy already or planing to buy Bookmarked This Post to get reference in future. If you are getting any problem in claim You can contact me Or Read my article on Complete Process of Mediclaim Reimbursement Claim which will guide you for it.
Why I choose United India Insurance Mediclaim Policy (Family Medicare Policy)
First When I come to sell any Insurance policy I always prefer policy from government Insurance Companies. In govt. companies you will get Consistency. I know some time in claim process it take time but there many more benefits also.Now If we come to particular this Mediclaim Policy, In this Policy Customer get All which any Health Insurance should have. They don’t give any extra (like reimbursement of salary or in built maternity) That is why this product have reasonable Premium Rates. I am selling United India Inusrance’s Mediclaim Policy Since 12 Years and In Service and Product. You will see one thing is consistency which is needed in any insurance product. I know Some Private Insurance Product every Next Year they change their insurance premium OR Condition. I feel People Buy Mediclaim to renew for life long time so consistency is very important. Other thing In Family Medicare Policy Premium is very reasonable and Not Changing terms and condition quickly.Now Let see this policy information in detailed.
Details About Family Medicare Policy By United India Insurance
| Premium Rates | BUY NOW |
| UIN Alloted By IRDA | UIIHLIP22070V042122 |
| Issuing Company | United India Insurance Company Limited |
| Minimum Hospitalization | 24 Hours* * However All Day Care Treatments as defined in the Section IV.15 of the policy above are covered due to advancement in technology |
| Co-Payment | 10% of admissible Claim Payment If Entry Age Above 60 Years. Please Note in above I said entry age. it mean if you bought policy at 57 age and after 5 years at age 62 if there is claim No Co-Payment Will deduct |
| No Claim Discount | 5% on renewal Premium of every claim free year. Maximum 15% |
| Optional Add-on Covers | |
| Hospital Daily Cash Limit (Per Day)( | Yes |
| Restore SI Opted | If Age of older Member upto 40 Years – Rs. 25 Premium extra 41 to 50 – Rs. 50 51 to 60 – Rs. 150 Above 60 – Rs. 300 * Restore SI Available for Above 3 Lakh SI * 100% SI will be restore once in a year automatically and instantly. |
| Maternity & New Born Baby Cover Opted | Yes |
| Cashless Facility | Yes |
| Coverage Area | All Over India |
| PRE-HOSPITALISATION MEDICAL EXPENSES | 30 days before the Insured Person is hospitalized Subject to a maximum of 10% of Sum Insured |
| POST-HOSPITALISATION MEDICAL EXPENSES | 60 days after the Insured Person is discharged from the hospital Subject to a maximum of 10% of Sum Insured |
| Room Charges LIMIT | SumInsured Below 5 Lakhs — 1% of SumInsured* SumInsured 5 Lakhs & Above — 1% of Sum Insured* Single Occupancy Standard Air-Conditioned Room Charges whichever is higher ICU/ICCU room Below 5 Lakhs — 2% of Sum Insured* 5 lakhs & Above — Actuals *Above Amount given Per Day Limit Please Note PROPORTIONATE PAYMENT CLAUSE will applicable if room rent exceed above limit all associated medical expenses incurred at the Hospital shall be effected in the same proportion as the admissible rate per day bears to the actual rate per day of Room Rent. |
| Sub Limits | Cataract Surgery Limit : 10% of Sum insured Subject to maximum Rs. 50000 Per Eye Mental Illness Cover Limit: 25% of the Sum insured Subject to maximum Rs. 3 Lakhs in following mental Illness 1. Schizophrenia 2. Bipolar Effective Disorders 3. Depression 4. Obsessive Compulsive Disorders 5. Psychosis Ayurvedic/Homeopathic/Unani treatment: upto SI 3 Lakhs – Rs. 10000 > 3 Lakhs to 15 lakhs – Rs. 15000 Above 15 Lakhs – Rs. 25000 Above Limits is per policy Period.Hospital Should be Government Hospital OR Govt. approved Ambulance Cover: 0.5% of SI Maximum Rs. 2500 / Event 1% of SI Maximum Rs. 5000 / policy period Cost of Health Check-up: If there is 3 consecutive claim free years cost of health checkup will provide 1% of SI maximum of Rs. 10000. |
| Additional limits Related to Treatment Methods & Advancement in Technology | |
| Uterine Artery Embolization & High Intensity Focussed Ultrasound (HIFU): | Upto 20% of Sum Insured subject to a maximum of Rs. 2 Lacs per policy period for claims involving Uterine Artery Embolization & HIFU |
| Balloon Sinuplasty | Upto 10% of Sum Insured subject to a maximum of Rs. 1 Lac per policy period for claims involving Balloon Sinuplasty |
| Deep Brain Stimulation | Upto 70% of Sum Insured per policy period for claims involving Deep Brain Stimulation |
| Oral Chemotherapy | Upto 20% of Sum Insured subject to a maximum of Rs. 2 Lacs per policy period for claims involving Oral Chemotherapy |
| Immunotherapy- Monoclonal Antibody to be given as injection | Upto 20% of Sum Insured subject to a maximum of Rs. 2 Lacs per policy period |
| Intra vitreal Injections | Upto 10% of Sum Insured subject to a maximum of Rs. 1 Lac per policy period |
| Robotic Surgeries (including Robotic Assisted Surgeries) | • Upto 75% of Sum Insured per policy period for claims involving Robotic Surgeries for (i) the treatment of any disease involving Central Nervous System irrespective of aetiology; (ii) Malignancies • Upto 50% of Sum Insured per policy period for claims involving Robotic Surgeries for other diseases |
| Stereotactic Radio Surgeries | Upto 50% of Sum Insured per policy period for claims involving Stereotactic Radio Surgeries |
| Bronchial Thermoplasty | Upto 30% of Sum Insured subject to a maximum of Rs. 3 Lacs per policy period for claims involving Bronchial Thermoplasty |
| Vaporisation of the Prostate (Green laser treatment or holmium laser treatment) | Upto 30% of Sum Insured subject to a maximum of Rs. 2 Lacs per policy period |
| Intra Operative Neuro Monitoring (IONM) | Upto 15% of Sum Insured per policy period for claims involving Intra Operative Neuro Monitoring |
| Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered only | No additional sub-limit |
| Donor Expense Cover | Yes |
| WAITING PERIOD – EXCLUSIONS | |
| Pre-Existing Disease | 48 months |
| Two years waiting period (this diseases are waiting period of 2 years) | 1.All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps 2. Benign ENT disorders 3. Benign prostatic hypertrophy 4. Cataract 5. Acid Peptic diseases 6. Gout and Rheumatism 7. Hernia of all types 8. Hydrocele 9. Non infective Arthritis 10. Piles, Fissures and Fistula-in-ano; Pilonidal sinus 11. Prolapse intervertebral Disc and Spinal Diseases unless arising from Accident. 12. Benign Skin Disorders 13. Calculus diseases 14. Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapse of uterus. 15. Any treatment for varicose veins and ulcers including surgical intervention. 16. Polycystic ovarian disease 17. Internal Congenital Anomaly |
| Four years waiting period (this diseases are waiting period of 4 years) | 1. Joint Replacement due to Degenerative condition, unless necessitated due to an accident. 2. Age-related Osteoarthritis & Osteoporosis 3. Age-related Macular Degeneration (ARMD) 4. Named Mental Illnesses: Schizophrenia, Bipolar Affective Disorders, Depression, Obsessive Compulsive Disorders, Psychosis 5. All Neurodegenerative disorders |
| 30 Days Waiting Period | When you Bought New Policy (Not applicable for portable policy) First 30 Days will not cover anything excluded except claims arising due to an accident. |
| PERMANENT EXCLUSIONS | PERMANENT EXCLUSIONS: 1. All expenses caused by or arising from or attributable to foreign invasion, act of foreign enemies, hostilities, warlike operations (whether war be declared or not or while performing duties in the armed forces of any country), civil war, public defence, rebellion, revolution, insurrection, military or usurped power. 2. All Illness/expenses caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or hazardous form) or from any nuclear waste from the combustion of nuclear fuel nuclear, chemical or biological attack. 3. a) Stem cell implantation/Surgery/therapy, harvesting, storage or any kind of Treatment using stem cells except as provided for in Additional Limit Section above; b) growth hormone therapy. 4. Congenital External Diseases, Defects or anomalies. 5. Sterility and Infertility : Expenses related to sterility and infertility. 6. Maternity except ectopic pregnancy; 7. Unproven Treatments 8. Change-of-Gender treatments 9. Cosmetic or Plastic Surgery 10. Vaccination or inoculation of any kind unless it is post animal bite. 11. Routine eye-examinations, cost of spectacles, contact lenses. 12. Dental treatment or surgery of any kind unless necessitated by accident and requiring hospitalisation. 13. Rest Cure, rehabilitation and respite care : Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes: a . Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons. b . Any services for people who are terminally ill to address physical, social, emotional and spiritual needs. 14. Obesity/ Weight Control : Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions: A. Surgery to be conducted is upon the advice of the Doctor B. The surgery/procedure conducted should be supported by clinical protocols C . The member has to be 18 years of age or older and D. Body Mass Index (BMI); a . greater than or equal to 40 or b . greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss: i. Obesity-related cardiomyopathy ii. Coronary heart disease iii. Severe Sleep Apnoea iv. Uncontrolled Type2 Diabetes 15. Any treatment related to sleep disorder or sleep apnoea syndrome 16. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. 17. Intentional self-inflicted Injury, attempted suicide. 18. Breach of law : Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent. 19. Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalisation claim or day care procedure. 20. Treatments other than Allopathy and Ayurvedic, Homeopathic & Unani branches of medicine. 21. Any expenses incurred on Domiciliary Hospitalization. 22. Any expenses incurred on Outpatient treatment (OPD treatment) 23. Treatments received in health hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons. 24. H a z a r d o u s o r A d v e n t u r e s p o r t s : E x p e n s e s r e l a t e d t o a n y t r e a t m e n t n e c e s s i t a t e d d u e t o p a r t i c i p a t i o n a s a professional in hazardous or adventure sports, including but not limited to, para- jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving. 24. Unless used intra-operatively, any expenses incurred on prosthesis, corrective devices;; External and or durable Medical / Nonmedical equipment of any kind used for diagnosis and/or treatment and/or monitoring and/or maintenance and/or support including instruments used in treatment of sleep apnoea syndrome; Infusion pump, Oxygen concentrator, Ambulatory devices, sub cutaneous insulin pump and also any medical equipment, which are subsequently used at home. 25. Change of treatment from one system of medicine to another system unless recommended by the consultant/hospital under whom the treatment is taken. 26. Treatments including Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy, chondrocyte or osteocyte implantation, procedures using platelet rich plasma, Trans Cutaneous Electric Nerve Stimulation; Use of oral immunomodulatory/ supplemental drugs. 27. Artificial life maintenance including life support machine use, from the date of confirmation by the treating doctor that the patient is in a vegetative state. |