Sehat Suraksha Bima

Product 1: Critical Illness

• 33 named critical illnesses are covered under the benefit (Kindly read PW for complete list of covered critical illnesses).
• Claim will be eligible if any of the 33 named critical illnesses are first diagnosed during the policy period after completion of the mandatory waiting period.
• A mandatory waiting period of 90 days is applicable from policy inception. Any Critical Illness where the symptoms have first manifested or first occurred prior to the Risk Inception Date or arisen within the first 90 days of commencement of the Period of Cover shall not be covered.
• Any Critical Illness arising on account of or in connection with any Pre-Existing Disease(s) shall not be covered (Kindly read policy wording for detailed list of exclusions).
• Only 1 claim will be accepted in a policy year under this cover. On acceptance of a claim under this benefit, the policy will cease and no further renewals will be allowed.

Product 2: Group Safeguard Insurance

A. Accidental Death, PTD & PPD

• Lump sum payout of sum insured to nominee or insured as the case may be for Death or permanent total disablement due to accidental injuries. For permanent partial disablement, disability grid will be followed for payout.
• Accident resulting in death or permanent total disablement should have occurred during the period of insurance.
• Death or permanent total disablement following injury sustained from such an accident should occur within 365 days from the date of accident.
• If injuries result in more than one Permanent Total Disablements, the maximum liability under this Benefit shall be limited to the Sum Insured.
• On the acceptance of a claim under this Benefit, all cover under this Benefit shall immediately and automatically cease and no further renewals will be allowed.

B. Death due to Animal, Insect & Reptile Attack Benefit

• We will pay the Sum Insured specified against this Benefit in the Policy Certificate in the manner specified in the Policy Certificate if the Insured Person suffers an Injury due to an Accident caused by bite, attack and/or sting of an animal, reptile or insect through direct violent skin contact that occurs during the Period of Cover and that Injury solely and directly results in the Insured Person’s death within 365 days from the date of the Accident.

C. Hospital Daily Cash Benefit

• A minimum of 24 hours of Hospitalization is necessary for the benefit to be triggered.
• Daily cash allowance will be paid as per plan chosen for each completed 24 hours of hospitalization up to the number of days hospitalized subject to a maximum of 30 days.
• We shall not be liable to pay for hospitalization beyond 30 days in a policy year.
• Initial 30 days waiting period is applicable except for accidental injuries.
• Pre-Existing Disease/s waiting period and specific illness waiting period of 24 months is applicable.

D. Emergency Medical Service Benefit

• Emergency Ambulance Service Benefit – If the Insured Person suffers an Illness or sustains an Injury during the Period of Cover which requires the Insured Person to be transported to Hospital in an emergency for Medically Necessary Treatment to be rendered, we will pay for the Ambulance Charges incurred on a Cashless Facility basis only.
• Tele Consultation Benefit – We will make available consultation with Medical Practitioners in case of need through our service provider helpline for assessing the case situation or routine health issues over the phone. OTC medicines may be prescribed/suggested on a case-to-case basis. The prescription/suggestion given by the Medical Practitioner will be based on the information provided by the Insured Person, and we have no responsibility or liability for any discrepancy in the information given.
• Health Assistance Benefit – We will provide health assistance through a dedicated helpline for assisting the Insured Person in identifying suitable Specialist/Hospital, fixing appointments and getting information on ailments & possible lines of treatment.

Product 3: Group Hospishield Plus

A. Specific Mosquito Borne Disease Benefit

• Specific Mosquito-Borne Disease means Malaria, Dengue, Chikungunya, Kala Azar, Japanese encephalitis, Zika Fever and Filariasis.
• The Hospitalization is for Medically Necessary Treatment of the Specific Mosquito Borne Disease and is commenced and continued on the written advice of the treating Medical Practitioner.
• The Insured Person’s stay in the Hospital should continue for a minimum period of 48 successive hours.
• We shall not be liable to make any payment under this Benefit, if the Insured is first Hospitalized prior to the commencement of the Period of Cover.
• We shall not be liable to make any payment under this Benefit, if the Insured Person is Hospitalized due to Specific Mosquito Borne Disease within a waiting period of 30 days from the commencement of the Period of Cover.

B. Communicable Disease

• The cumulative sum insured for this section is capped at ₹10,000. Once a claim under this section has been paid, no more claims shall be payable.

C. Specific Gastrointestinal Infectious Benefit

• Acute inflammatory diarrhea and Typhoid fever will be covered.
• The Hospitalization must be for Medically Necessary Treatment of Specific Gastrointestinal Infections and should commence and continue on the written advice of the treating Medical Practitioner.
• The Insured Person’s stay in Hospital should continue for a minimum period of 48 successive hours.
• A waiting period of 30 days is applicable.

D. Specific Viral Infections Benefit

• Specific Viral Infections means Viral Hepatitis (Hepatitis A, B, C and E), Measles, Mumps, Poliomyelitis, Avian Influenza and Swine Influenza.
• The Hospitalization must be for Medically Necessary Treatment of viral infections and should commence and continue on the written advice of the treating Medical Practitioner.
• The Insured Person’s stay in Hospital should continue for a minimum period of 48 successive hours.
• A waiting period of 30 days is applicable.

E. Specific Nervous System Infections Benefit

• Specific Nervous System Infections means Meningitis, Encephalitis, Creutzfeldt–Jakob disease, Guillain–Barre syndrome.
• The Hospitalization should be for Medically Necessary Treatment of specific nervous system infections and should commence and continue on the written advice of the treating Medical Practitioner.
• The Insured Person’s stay in Hospital should continue for a minimum period of 48 successive hours.
• A waiting period of 30 days is applicable.