Health Insurance from Raheja QBE

Raheja QBE Health Insurance plan is one of the best health insurance plans in India. It is further sub-divided into 4 variants. These are Basic plan, Comprehensive Plan, Super Saver Plan and A la carte Plan. The overall features of and eligibility criteria of the plan are mentioned below:

• The plan covers medical expenses for 30 days & 60 days prior to hospitalization and 60 days and 90 days post hospitalization in the basic plan, super saver and a la carte plans. It covers 60 days pre hospitalization & 90 days post hospitalization in comprehensive plan and 90 only for related medical expenses.
• Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner’s charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
• Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
• Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the basic, comprehensive, super saver and a la carte plans
• Offers day-care treatments in case the insured is hospitalized for less than 24 hours
• Offers domiciliary hospitalization in case the treatment continues for minimum of three days
• Offers reduction in sum insured amount plus any amount accrued as no claim bonus by 90% of the claim amount in case the insured opts for a cashless facility in any of the network hospitals
• Offers re-instatement of base sum insured if you get exhausted due to claims paid during the policy period
• In case of the insured gets hospitalized during the policy tenure, Raheja QBE Health Insurance Company offers daily cash allowance for each completed day of hospitalization. However, this benefit would be paid for completed period of 24 hours hospitalization for consecutive 6 days of hospitalization per claim
• Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly.

Exclusions

Not anything and everything is covered under the Raheja QBE Health Insurance Plan. The exclusion list is mentioned below:

• Any claim raised for medical expenses within 30 days of the health insurance policy issuance, wouldn’t be covered, unless these medical expenses occur due to an injury.

• For any treatments which are medical or surgical, this company wouldn’t offer any coverage within a waiting period of 24 months from the policy inception date for the below mentioned diseases:

  • Fissure/fistula in anus, hemorrhoids, pilonidal sinus
  • Ulcer and erosion of stomach and duodenum
  • All forms of cirrhosis (cirrhosis due to alcohol will be permanent exclusion).
  • Perineal and/or Perianal Abscesses
  • Cholecystectomy and Surgery of hernia
  • Non infective arthritis , Osteoarthrosis /Gout / Rheumatism / Spondylosis / Spondylitis /
  • Varicose veins
  • Fibroids/Polycystic Ovarian Disease
  • Surgery of Hydrocele/Rectocele
  • Surgery of prostate
  • Intervertebral Disc Prolapse
  • Calculus diseases of Urogenital System and/or Benign Hyperplasia of prostate
  • Cataract
  • Internal tumors, cysts, nodules, polyps, skin tumors
  • Sinusitis/Rhinitis/Tonsillitis
  • Gastro Esophageal Reflux Disorder (GERD)
  • Surgery on tonsils / adenoids
  • Calculus diseases of gall bladder including Cholecystitis
  • Pancreatitis
  • Dilatation and curettage (D&C)

• Any pre-existing diseases would be covered only after a waiting period of 4 years and those specifically diseases which were declared during the policy inception as well as accepted at the time of proposal.

The following are the major exclusions which won’t be admissible under the Raheja QBE Health Insurance plan:

• Any expense, condition or treatment not admissible under the policy wordings
• Any treatment related to pregnancy including (including voluntary Termination), childbirth, maternity (Including caesarian section), miscarriage (unless due to an Accident), abortion or complications of any of these. However, this Exclusion will not apply to ectopic pregnancy
• Sexually transmitted diseases Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis, Human T-Cell Lymphotropic Virus Type III (HTLV–III or IITLB-III), Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV or Lymphadinopathy Associated Virus (LAV) or the mutants derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind.
• Any treatment related to fertility issues sterilization, contraceptive supplies or services including complications arising due to supplying services or assisted reproductive technology, birth control procedures
• Any treatment taken from a non-medical practitioner or from a medical practioner who does practice on his own for self-medication.
• Any treatment and expenses incurred due to routine eye and ear examinations, artificial teeth dentures, and all other similar external appliances and/or devices whether for diagnosis or treatment.
• Any treatment undergone due to any consequence of any unproven or experimental treatment is not covered
• Any treatment that is caused due to sleep disorders or a syndrome, rest cure, nature cure clinics, private duty nursing, rehabilitation measures, general debility convalescence, cure, health hydros, sanatorium treatment, long-term nursing care, respite care, custodial care or any treatment undertaken in a place which is not a Hospital.
• Any charges incurred due to prosthesis, corrective devices, external durable medical equipment of any kind, such as belts, braces, wheelchairs, diabetic footwear, glucometer/thermometer walkers, ambulatory devices, collars, caps, splints, stockings of any kind, crutches, cost of cochlear implants, instruments used in treatment of sleep apnea syndrome (C.P.A.P) or continuous ambulatory peritoneal dialysis (C.A.P.D.) and oxygen concentrator for asthmatic condition etc.
• Any treatment/surgery done for gender reassignments or for gender change which includes the complications arising due to such treatments
• Artificial life maintenance, including life support machine use, where recovery or restoration of the previous state of health is not possible
• Any treatment undergone due to surgery or a plastic surgery, aesthetic treatment, or any further consequences due to such treatments other than burns, cancer or injury
• Circumcision done unless necessary for treatment of an Illness or due to an Accident.
• Immunizations, preventive care, vaccination, vitamins and tonics, preventive care (except in case of post-bite treatment)
• Treatment of any Congenital External Anomaly or Illness
• Treatment of stress, mental illness or any psychological disorders.
• Any OPD Treatment.
• Any treatment undertaken abroad
• Non-allopathic treatment.
• Any expenses incurred due to X-ray or laboratory tests
• Any items or services due to barber or beauty services, cosmetics, hygiene articles, baby care products, stuff of personal comfort not limited to T.V., charges for access to telephone and telephone calls (wherever specifically charged separately), foodstuffs (except patient’s diet), guest service as well as similar incidental services.
• Any expenses due to service charge, RMO charge, night charge charged by the hospital under whatever head except to the extent covered
• Any Illness or Injury directly or indirectly causing or arising because of breach of any law by the insured who has a criminal intent
• War, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
• Illness or Injury caused due to consumption or abuse of tobacco, intoxicating drugs and alcohol or hallucinogens.
• Any act of self-inflicted injury, suicide or attempted suicide while sane or insane
• Any treatment for cirrhosis due to alcohol and complications arising from its
• Any treatment taken in a clinic, rest home, convalescent home for the addicted, detoxification center, sanatorium, home for the aged, mentally disturbed, remodeling clinic or similar institutions.
• Any charges incurred to procure any medical certificate, treatment or Illness related documents pertaining to any period of Hospitalization or Illness except to the extent covered under Section h – Non-Medical Expenses (if applicable) under the Policy.
• Alopecia, wigs and/or toupee and all hair or hair fall treatment and products.
• Any nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense
• Impairment of an Insured Person’s intellectual faculties by abuse of stimulants or depressants.
• Any medical or physical condition or treatment or service, which is specifically excluded under the Policy Schedule.

This is a very basic health insurance plan that has in-built health insurance benefits. This plan however doesn’t provide options for any add-on covers.

The features of this plan are mentioned below:

• The plan covers medical expenses for 30 days & 60 days prior to hospitalization and 60 days and 90 days post hospitalization in the basic plan
• Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner’s charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
• Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
• Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the basic, comprehensive, super saver and a la carte plans
• Offers day-care treatments in case the insured is hospitalized for less than 24 hours
• Offers domiciliary hospitalization in case the treatment continues for minimum of three days
• Offers reduction in sum insured amount plus any amount accrued as no claim bonus by 90% of the claim amount in case the insured opts for a cashless facility in any of the network hospitals
• Offers re-instatement of base sum insured if you get exhausted due to claims paid during the policy period
• In case of the insured gets hospitalized during the policy tenure, Raheja QBE Health Insurance Basic plan offers daily cash allowance for each completed day of hospitalization. However, this benefit would be paid for completed period of 24 hours hospitalization for consecutive 6 days of hospitalization per claim
• Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

Exclusions

Not anything and everything is covered under the Raheja QBE Health Insurance Plan. The exclusion list is mentioned below:

• Any claim raised for medical expenses within 30 days of the health insurance policy issuance, wouldn’t be covered, unless these medical expenses occur due to an injury.

• For any treatments which are medical or surgical, this company wouldn’t offer any coverage within a waiting period of 24 months from the policy inception date for the below mentioned diseases:

  • Fissure/fistula in anus, hemorrhoids, pilonidal sinus
  • Ulcer and erosion of stomach and duodenum
  • All forms of cirrhosis (cirrhosis due to alcohol will be permanent exclusion).
  • Perineal and/or Perianal Abscesses
  • Cholecystectomy and Surgery of hernia
  • Non infective arthritis , Osteoarthrosis /Gout / Rheumatism / Spondylosis / Spondylitis /
  • Varicose veins
  • Fibroids/Polycystic Ovarian Disease
  • Surgery of Hydrocele/Rectocele
  • Surgery of prostate
  • Intervertebral Disc Prolapse
  • Calculus diseases of Urogenital System and/or Benign Hyperplasia of prostate
  • Cataract
  • Internal tumors, cysts, nodules, polyps, skin tumors
  • Sinusitis/Rhinitis/Tonsillitis
  • Gastro Esophageal Reflux Disorder (GERD)
  • Surgery on tonsils / adenoids
  • Calculus diseases of gall bladder including Cholecystitis
  • Pancreatitis
  • Dilatation and curettage (D&C)

• Any pre-existing diseases would be covered only after a waiting period of 4 years and those specifically diseases which were declared during the policy inception as well as accepted at the time of proposal.

The following are the major exclusions which won’t be admissible under the Raheja QBE Health Insurance plan:

• Any expense, condition or treatment not admissible under the policy wordings
• Any treatment related to pregnancy including (including voluntary Termination), childbirth, maternity (Including caesarian section), miscarriage (unless due to an Accident), abortion or complications of any of these. However, this Exclusion will not apply to ectopic pregnancy
• Sexually transmitted diseases Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis, Human T-Cell Lymphotropic Virus Type III (HTLV–III or IITLB-III), Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV or Lymphadinopathy Associated Virus (LAV) or the mutants derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind.
• Any treatment related to fertility issues sterilization, contraceptive supplies or services including complications arising due to supplying services or assisted reproductive technology, birth control procedures
• Any treatment taken from a non-medical practitioner or from a medical practioner who does practice on his own for self-medication.
• Any treatment and expenses incurred due to routine eye and ear examinations, artificial teeth dentures, and all other similar external appliances and/or devices whether for diagnosis or treatment.
• Any treatment undergone due to any consequence of any unproven or experimental treatment is not covered
• Any treatment that is caused due to sleep disorders or a syndrome, rest cure, nature cure clinics, private duty nursing, rehabilitation measures, general debility convalescence, cure, health hydros, sanatorium treatment, long-term nursing care, respite care, custodial care or any treatment undertaken in a place which is not a Hospital.
• Any charges incurred due to prosthesis, corrective devices, external durable medical equipment of any kind, such as belts, braces, wheelchairs, diabetic footwear, glucometer/thermometer walkers, ambulatory devices, collars, caps, splints, stockings of any kind, crutches, cost of cochlear implants, instruments used in treatment of sleep apnea syndrome (C.P.A.P) or continuous ambulatory peritoneal dialysis (C.A.P.D.) and oxygen concentrator for asthmatic condition etc.
• Any treatment/surgery done for gender reassignments or for gender change which includes the complications arising due to such treatments
• Artificial life maintenance, including life support machine use, where recovery or restoration of the previous state of health is not possible
• Any treatment undergone due to surgery or a plastic surgery, aesthetic treatment, or any further consequences due to such treatments other than burns, cancer or injury
• Circumcision done unless necessary for treatment of an Illness or due to an Accident.
• Immunizations, preventive care, vaccination, vitamins and tonics, preventive care (except in case of post-bite treatment)
• Treatment of any Congenital External Anomaly or Illness
• Treatment of stress, mental illness or any psychological disorders.
• Any OPD Treatment.
• Any treatment undertaken abroad
• Non-allopathic treatment.
• Any expenses incurred due to X-ray or laboratory tests
• Any items or services due to barber or beauty services, cosmetics, hygiene articles, baby care products, stuff of personal comfort not limited to T.V., charges for access to telephone and telephone calls (wherever specifically charged separately), foodstuffs (except patient’s diet), guest service as well as similar incidental services.
• Any expenses due to service charge, RMO charge, night charge charged by the hospital under whatever head except to the extent covered
• Any Illness or Injury directly or indirectly causing or arising because of breach of any law by the insured who has a criminal intent
• War, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
• Illness or Injury caused due to consumption or abuse of tobacco, intoxicating drugs and alcohol or hallucinogens.
• Any act of self-inflicted injury, suicide or attempted suicide while sane or insane
• Any treatment for cirrhosis due to alcohol and complications arising from its
• Any treatment taken in a clinic, rest home, convalescent home for the addicted, detoxification center, sanatorium, home for the aged, mentally disturbed, remodeling clinic or similar institutions.
• Any charges incurred to procure any medical certificate, treatment or Illness related documents pertaining to any period of Hospitalization or Illness except to the extent covered under Section h – Non-Medical Expenses (if applicable) under the Policy.
• Alopecia, wigs and/or toupee and all hair or hair fall treatment and products.

This plan contains in-built health insurance benefits. The main feature is it offers add-on cover for Sub Limit Waiver.

Sub limit waiver: This plan waives off the sub-limits related to ICU charges, room rent, disease related sub-limits & medical practitioner’s fees, if the insured pays additional premium

The features of this plan include all the below inbuilt health insurance benefits:

• The plan covers medical expenses for 60 days pre hospitalization & 90 days post hospitalization in comprehensive plan and 90 only for related medical expenses.
• Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner’s charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
• Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
• Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the comprehensive plan
• Offers day-care treatments in case the insured is hospitalized for less than 24 hours
• Offers domiciliary hospitalization in case the treatment continues for minimum of three days
• Offers reduction in sum insured amount plus any amount accrued as no claim bonus by 90% of the claim amount in case the insured opts for a cashless facility in any of the network hospitals
• Offers re-instatement of base sum insured if you get exhausted due to claims paid during the policy period
• In case of the insured gets hospitalized during the policy tenure, Raheja QBE Comprehensive Health Insurance plan offers daily cash allowance for each completed day of hospitalization. However, this benefit would be paid for completed period of 24 hours hospitalization for consecutive 6 days of hospitalization per claim
• Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

Exclusions

Not anything and everything is covered under the Raheja QBE Health Insurance Plan. The exclusion list is mentioned below:

• Any claim raised for medical expenses within 30 days of the health insurance policy issuance, wouldn’t be covered, unless these medical expenses occur due to an injury.

• For any treatments which are medical or surgical, this company wouldn’t offer any coverage within a waiting period of 24 months from the policy inception date for the below mentioned diseases:

  • Fissure/fistula in anus, hemorrhoids, pilonidal sinus
  • Ulcer and erosion of stomach and duodenum
  • All forms of cirrhosis (cirrhosis due to alcohol will be permanent exclusion).
  • Perineal and/or Perianal Abscesses
  • Cholecystectomy and Surgery of hernia
  • Non infective arthritis , Osteoarthrosis /Gout / Rheumatism / Spondylosis / Spondylitis /
  • Varicose veins
  • Fibroids/Polycystic Ovarian Disease
  • Surgery of Hydrocele/Rectocele
  • Surgery of prostate
  • Intervertebral Disc Prolapse
  • Calculus diseases of Urogenital System and/or Benign Hyperplasia of prostate
  • Cataract
  • Internal tumors, cysts, nodules, polyps, skin tumors
  • Sinusitis/Rhinitis/Tonsillitis
  • Gastro Esophageal Reflux Disorder (GERD)
  • Surgery on tonsils / adenoids
  • Calculus diseases of gall bladder including Cholecystitis
  • Pancreatitis
  • Dilatation and curettage (D&C)

• Any pre-existing diseases would be covered only after a waiting period of 4 years and those specifically diseases which were declared during the policy inception as well as accepted at the time of proposal.

The following are the major exclusions which won’t be admissible under the Raheja QBE Health Insurance plan:

• Any expense, condition or treatment not admissible under the policy wordings
• Any treatment related to pregnancy including (including voluntary Termination), childbirth, maternity (Including caesarian section), miscarriage (unless due to an Accident), abortion or complications of any of these. However, this Exclusion will not apply to ectopic pregnancy
• Sexually transmitted diseases Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis, Human T-Cell Lymphotropic Virus Type III (HTLV–III or IITLB-III), Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV or Lymphadinopathy Associated Virus (LAV) or the mutants derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind.
• Any treatment related to fertility issues sterilization, contraceptive supplies or services including complications arising due to supplying services or assisted reproductive technology, birth control procedures
• Any treatment taken from a non-medical practitioner or from a medical practioner who does practice on his own for self-medication.
• Any treatment and expenses incurred due to routine eye and ear examinations, artificial teeth dentures, and all other similar external appliances and/or devices whether for diagnosis or treatment.
• Any treatment undergone due to any consequence of any unproven or experimental treatment is not covered
• Any treatment that is caused due to sleep disorders or a syndrome, rest cure, nature cure clinics, private duty nursing, rehabilitation measures, general debility convalescence, cure, health hydros, sanatorium treatment, long-term nursing care, respite care, custodial care or any treatment undertaken in a place which is not a Hospital.
• Any charges incurred due to prosthesis, corrective devices, external durable medical equipment of any kind, such as belts, braces, wheelchairs, diabetic footwear, glucometer/thermometer walkers, ambulatory devices, collars, caps, splints, stockings of any kind, crutches, cost of cochlear implants, instruments used in treatment of sleep apnea syndrome (C.P.A.P) or continuous ambulatory peritoneal dialysis (C.A.P.D.) and oxygen concentrator for asthmatic condition etc.
• Any treatment/surgery done for gender reassignments or for gender change which includes the complications arising due to such treatments
• Artificial life maintenance, including life support machine use, where recovery or restoration of the previous state of health is not possible
• Any treatment undergone due to surgery or a plastic surgery, aesthetic treatment, or any further consequences due to such treatments other than burns, cancer or injury
• Circumcision done unless necessary for treatment of an Illness or due to an Accident.
• Immunizations, preventive care, vaccination, vitamins and tonics, preventive care (except in case of post-bite treatment)
• Treatment of any Congenital External Anomaly or Illness
• Treatment of stress, mental illness or any psychological disorders.
• Any OPD Treatment.
• Any treatment undertaken abroad
• Non-allopathic treatment.
• Any expenses incurred due to X-ray or laboratory tests
• Any items or services due to barber or beauty services, cosmetics, hygiene articles, baby care products, stuff of personal comfort not limited to T.V., charges for access to telephone and telephone calls (wherever specifically charged separately), foodstuffs (except patient’s diet), guest service as well as similar incidental services.
• Any expenses due to service charge, RMO charge, night charge charged by the hospital under whatever head except to the extent covered
• Any Illness or Injury directly or indirectly causing or arising because of breach of any law by the insured who has a criminal intent
• War, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
• Illness or Injury caused due to consumption or abuse of tobacco, intoxicating drugs and alcohol or hallucinogens.
• Any act of self-inflicted injury, suicide or attempted suicide while sane or insane
• Any treatment for cirrhosis due to alcohol and complications arising from its
• Any treatment taken in a clinic, rest home, convalescent home for the addicted, detoxification center, sanatorium, home for the aged, mentally disturbed, remodeling clinic or similar institutions.
• Any charges incurred to procure any medical certificate, treatment or Illness related documents pertaining to any period of Hospitalization or Illness except to the extent covered under Section h – Non-Medical Expenses (if applicable) under the Policy.
• Alopecia, wigs and/or toupee and all hair or hair fall treatment and products.

This plan contains in-built health insurance benefits. It offers Add-on covers for Co-Pay.

Co-pay add-on cover: Offers a premium discount if you opt for a 20% co-pay

The features of this plan include all the below inbuilt health insurance benefits:

• The plan covers medical expenses for 30 days & 60 days prior to hospitalization and 60 days and 90 days post hospitalization in the super saver plans
• Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner’s charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
• Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
• Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the basic, comprehensive, super saver and a la carte plans
• Offers day-care treatments in case the insured is hospitalized for less than 24 hours
• Offers domiciliary hospitalization in case the treatment continues for minimum of three days
• Offers reduction in sum insured amount plus any amount accrued as no claim bonus by 90% of the claim amount in case the insured opts for a cashless facility in any of the network hospitals
• Offers re-instatement of base sum insured if you get exhausted due to claims paid during the policy period
• In case of the insured gets hospitalized during the policy tenure, Raheja QBE Health Super Saver Insurance plan offers daily cash allowance for each completed day of hospitalization. However, this benefit would be paid for completed period of 24 hours hospitalization for consecutive 6 days of hospitalization per claim
• Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

Exclusions

Not anything and everything is covered under the Raheja QBE Health Insurance Plan. The exclusion list is mentioned below:

• Any claim raised for medical expenses within 30 days of the health insurance policy issuance, wouldn’t be covered, unless these medical expenses occur due to an injury.

• For any treatments which are medical or surgical, this company wouldn’t offer any coverage within a waiting period of 24 months from the policy inception date for the below mentioned diseases:

  • Fissure/fistula in anus, hemorrhoids, pilonidal sinus
  • Ulcer and erosion of stomach and duodenum
  • All forms of cirrhosis (cirrhosis due to alcohol will be permanent exclusion).
  • Perineal and/or Perianal Abscesses
  • Cholecystectomy and Surgery of hernia
  • Non infective arthritis , Osteoarthrosis /Gout / Rheumatism / Spondylosis / Spondylitis /
  • Varicose veins
  • Fibroids/Polycystic Ovarian Disease
  • Surgery of Hydrocele/Rectocele
  • Surgery of prostate
  • Intervertebral Disc Prolapse
  • Calculus diseases of Urogenital System and/or Benign Hyperplasia of prostate
  • Cataract
  • Internal tumors, cysts, nodules, polyps, skin tumors
  • Sinusitis/Rhinitis/Tonsillitis
  • Gastro Esophageal Reflux Disorder (GERD)
  • Surgery on tonsils / adenoids
  • Calculus diseases of gall bladder including Cholecystitis
  • Pancreatitis
  • Dilatation and curettage (D&C)

• Any pre-existing diseases would be covered only after a waiting period of 4 years and those specifically diseases which were declared during the policy inception as well as accepted at the time of proposal.

The following are the major exclusions which won’t be admissible under the Raheja QBE Health Insurance plan:

• Any expense, condition or treatment not admissible under the policy wordings
• Any treatment related to pregnancy including (including voluntary Termination), childbirth, maternity (Including caesarian section), miscarriage (unless due to an Accident), abortion or complications of any of these. However, this Exclusion will not apply to ectopic pregnancy
• Sexually transmitted diseases Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis, Human T-Cell Lymphotropic Virus Type III (HTLV–III or IITLB-III), Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV or Lymphadinopathy Associated Virus (LAV) or the mutants derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind.
• Any treatment related to fertility issues sterilization, contraceptive supplies or services including complications arising due to supplying services or assisted reproductive technology, birth control procedures
• Any treatment taken from a non-medical practitioner or from a medical practioner who does practice on his own for self-medication.
• Any treatment and expenses incurred due to routine eye and ear examinations, artificial teeth dentures, and all other similar external appliances and/or devices whether for diagnosis or treatment.
• Any treatment undergone due to any consequence of any unproven or experimental treatment is not covered
• Any treatment that is caused due to sleep disorders or a syndrome, rest cure, nature cure clinics, private duty nursing, rehabilitation measures, general debility convalescence, cure, health hydros, sanatorium treatment, long-term nursing care, respite care, custodial care or any treatment undertaken in a place which is not a Hospital.
• Any charges incurred due to prosthesis, corrective devices, external durable medical equipment of any kind, such as belts, braces, wheelchairs, diabetic footwear, glucometer/thermometer walkers, ambulatory devices, collars, caps, splints, stockings of any kind, crutches, cost of cochlear implants, instruments used in treatment of sleep apnea syndrome (C.P.A.P) or continuous ambulatory peritoneal dialysis (C.A.P.D.) and oxygen concentrator for asthmatic condition etc.
• Any treatment/surgery done for gender reassignments or for gender change which includes the complications arising due to such treatments
• Artificial life maintenance, including life support machine use, where recovery or restoration of the previous state of health is not possible
• Any treatment undergone due to surgery or a plastic surgery, aesthetic treatment, or any further consequences due to such treatments other than burns, cancer or injury
• Circumcision done unless necessary for treatment of an Illness or due to an Accident.
• Immunizations, preventive care, vaccination, vitamins and tonics, preventive care (except in case of post-bite treatment)
• Treatment of any Congenital External Anomaly or Illness
• Treatment of stress, mental illness or any psychological disorders.
• Any OPD Treatment.
• Any treatment undertaken abroad
• Non-allopathic treatment.
• Any expenses incurred due to X-ray or laboratory tests
• Any items or services due to barber or beauty services, cosmetics, hygiene articles, baby care products, stuff of personal comfort not limited to T.V., charges for access to telephone and telephone calls (wherever specifically charged separately), foodstuffs (except patient’s diet), guest service as well as similar incidental services.
• Any expenses due to service charge, RMO charge, night charge charged by the hospital under whatever head except to the extent covered
• Any Illness or Injury directly or indirectly causing or arising because of breach of any law by the insured who has a criminal intent
• War, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
• Illness or Injury caused due to consumption or abuse of tobacco, intoxicating drugs and alcohol or hallucinogens.
• Any act of self-inflicted injury, suicide or attempted suicide while sane or insane
• Any treatment for cirrhosis due to alcohol and complications arising from its
• Any treatment taken in a clinic, rest home, convalescent home for the addicted, detoxification center, sanatorium, home for the aged, mentally disturbed, remodeling clinic or similar institutions.
• Any charges incurred to procure any medical certificate, treatment or Illness related documents pertaining to any period of Hospitalization or Illness except to the extent covered under Section h – Non-Medical Expenses (if applicable) under the Policy.
• Alopecia, wigs and/or toupee and all hair or hair fall treatment and products.

This plan offers in-built health insurance benefits. Here, you are offered a choice to choose your add-on as per your requirements. You may also change your plan if you wish to but only during renewals.

• The plan covers medical expenses for 30 days & 60 days prior to hospitalization and 60 days and 90 days post hospitalization in the a la carte plans.
• Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner’s charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
• Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
• Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the basic, comprehensive, super saver and a la carte plans
• Offers day-care treatments in case the insured is hospitalized for less than 24 hours
• Offers domiciliary hospitalization in case the treatment continues for minimum of three days
• Offers reduction in sum insured amount plus any amount accrued as no claim bonus by 90% of the claim amount in case the insured opts for a cashless facility in any of the network hospitals
• Offers re-instatement of base sum insured if you get exhausted due to claims paid during the policy period
• In case of the insured gets hospitalized during the policy tenure, Raheja QBE Health A la Carte Insurance plan offers daily cash allowance for each completed day of hospitalization. However, this benefit would be paid for completed period of 24 hours hospitalization for consecutive 6 days of hospitalization per claim
• Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

Exclusions

Not anything and everything is covered under the Raheja QBE Health Insurance Plan. The exclusion list is mentioned below:

• Any claim raised for medical expenses within 30 days of the health insurance policy issuance, wouldn’t be covered, unless these medical expenses occur due to an injury.

• For any treatments which are medical or surgical, this company wouldn’t offer any coverage within a waiting period of 24 months from the policy inception date for the below mentioned diseases:

  • Fissure/fistula in anus, hemorrhoids, pilonidal sinus
  • Ulcer and erosion of stomach and duodenum
  • All forms of cirrhosis (cirrhosis due to alcohol will be permanent exclusion).
  • Perineal and/or Perianal Abscesses
  • Cholecystectomy and Surgery of hernia
  • Non infective arthritis , Osteoarthrosis /Gout / Rheumatism / Spondylosis / Spondylitis /
  • Varicose veins
  • Fibroids/Polycystic Ovarian Disease
  • Surgery of Hydrocele/Rectocele
  • Surgery of prostate
  • Intervertebral Disc Prolapse
  • Calculus diseases of Urogenital System and/or Benign Hyperplasia of prostate
  • Cataract
  • Internal tumors, cysts, nodules, polyps, skin tumors
  • Sinusitis/Rhinitis/Tonsillitis
  • Gastro Esophageal Reflux Disorder (GERD)
  • Surgery on tonsils / adenoids
  • Calculus diseases of gall bladder including Cholecystitis
  • Pancreatitis
  • Dilatation and curettage (D&C)

• Any pre-existing diseases would be covered only after a waiting period of 4 years and those specifically diseases which were declared during the policy inception as well as accepted at the time of proposal.

The following are the major exclusions which won’t be admissible under the Raheja QBE Health Insurance plan:

• Any expense, condition or treatment not admissible under the policy wordings
• Any treatment related to pregnancy including (including voluntary Termination), childbirth, maternity (Including caesarian section), miscarriage (unless due to an Accident), abortion or complications of any of these. However, this Exclusion will not apply to ectopic pregnancy
• Sexually transmitted diseases Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis, Human T-Cell Lymphotropic Virus Type III (HTLV–III or IITLB-III), Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV or Lymphadinopathy Associated Virus (LAV) or the mutants derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind.
• Any treatment related to fertility issues sterilization, contraceptive supplies or services including complications arising due to supplying services or assisted reproductive technology, birth control procedures
• Any treatment taken from a non-medical practitioner or from a medical practioner who does practice on his own for self-medication.
• Any treatment and expenses incurred due to routine eye and ear examinations, artificial teeth dentures, and all other similar external appliances and/or devices whether for diagnosis or treatment.
• Any treatment undergone due to any consequence of any unproven or experimental treatment is not covered
• Any treatment that is caused due to sleep disorders or a syndrome, rest cure, nature cure clinics, private duty nursing, rehabilitation measures, general debility convalescence, cure, health hydros, sanatorium treatment, long-term nursing care, respite care, custodial care or any treatment undertaken in a place which is not a Hospital.
• Any charges incurred due to prosthesis, corrective devices, external durable medical equipment of any kind, such as belts, braces, wheelchairs, diabetic footwear, glucometer/thermometer walkers, ambulatory devices, collars, caps, splints, stockings of any kind, crutches, cost of cochlear implants, instruments used in treatment of sleep apnea syndrome (C.P.A.P) or continuous ambulatory peritoneal dialysis (C.A.P.D.) and oxygen concentrator for asthmatic condition etc.
• Any treatment/surgery done for gender reassignments or for gender change which includes the complications arising due to such treatments
• Artificial life maintenance, including life support machine use, where recovery or restoration of the previous state of health is not possible
• Any treatment undergone due to surgery or a plastic surgery, aesthetic treatment, or any further consequences due to such treatments other than burns, cancer or injury
• Circumcision done unless necessary for treatment of an Illness or due to an Accident.
• Immunizations, preventive care, vaccination, vitamins and tonics, preventive care (except in case of post-bite treatment)
• Treatment of any Congenital External Anomaly or Illness
• Treatment of stress, mental illness or any psychological disorders.
• Any OPD Treatment.
• Any treatment undertaken abroad
• Non-allopathic treatment.
• Any expenses incurred due to X-ray or laboratory tests
• Any items or services due to barber or beauty services, cosmetics, hygiene articles, baby care products, stuff of personal comfort not limited to T.V., charges for access to telephone and telephone calls (wherever specifically charged separately), foodstuffs (except patient’s diet), guest service as well as similar incidental services.
• Any expenses due to service charge, RMO charge, night charge charged by the hospital under whatever head except to the extent covered
• Any Illness or Injury directly or indirectly causing or arising because of breach of any law by the insured who has a criminal intent
• War, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
• Illness or Injury caused due to consumption or abuse of tobacco, intoxicating drugs and alcohol or hallucinogens.
• Any act of self-inflicted injury, suicide or attempted suicide while sane or insane
• Any treatment for cirrhosis due to alcohol and complications arising from its
• Any treatment taken in a clinic, rest home, convalescent home for the addicted, detoxification center, sanatorium, home for the aged, mentally disturbed, remodeling clinic or similar institutions.
• Any charges incurred to procure any medical certificate, treatment or Illness related documents pertaining to any period of Hospitalization or Illness except to the extent covered under Section h – Non-Medical Expenses (if applicable) under the Policy.
• Alopecia, wigs and/or toupee and all hair or hair fall treatment and products.

Raheja QBE has come up with a Cancer Insurance that would help you financially in case you get detected with the dreadful disease. You get adequate financial help to get cured in timely manner and lead a normal life.

The overall features of and eligibility criteria of the plan are mentioned below:

• If the insured is detected with Cancer and the same requires a detailed diagnostic investigation, the insured is paid the below:
  • A lump sum amount of 50% of the Sum Insured or Rs.2.5 lakh whichever is less
  • Any expenses incurred for diagnostic investigation or medical treatment of Cancer, in excess of 75% of the amount paid as a lump sum as stated above.
• Offers reimbursement of medical expenses only on submission of the original bills. This reimbursement of claims are made quarterly till the entire sum insured is exhausted.
• In case the insured is detected by Cancer and is suffering, even though there is a claim reported during the policy period, the insured would still get the benefits under the Cancer Health Insurance post expiry of the sum insured up to 5 years from the inception of the Policy
• Offers reimbursement for medical expenses for pre-policy medical examination would be limited to 50% of actual expenses.

Exclusions

Not anything and everything is covered under the Raheja Cancer Insurance Plan. The exclusion list is mentioned below:

• Any injury, disease or illness caused by nuclear weapons. If the same is caused due to contact of the insured person with radiation from non-diagnostic or therapeutic source.
• If the insured had any signs and symptoms of cancer or any related condition and if he has received the treatment for the same during the waiting period of 48 months prior to his/her first policy with Raheja QBE
• If any fraudulent or incorrect representation is done to make a claim under this policy
• Any claim where the diagnostic investigation does not reveal the positive existence or presence of Cancer.