AWARENESS SWASTHYA BIMA YOJANA
Policy Duration: 1 Year
Sum Insured:
Hospitalisation : Family floter of Rs. 10,000/- per family.
Personal Accident Rs. 10,000/- each for member & spouse
Premium: Rs. 300/- for a family of 4 members and Rs. 100/- for additional members.
Eligibility:
Who is eligible for this scheme?
- Member and his family.
- Family member comprise of Self, Spouse, Children, Son / Daughter in Law & Grand Children.
- 0-80 years of age on the date of enrollment.
Family Floater Advantage
The entire family is covered under one Sum Insured, hence any member of the family can claim up to the Sum Insured, any number of times during the policy period.
Policy Cover -
Standard Hospitalisation Cover on Floater Basis
 Hospitalisation Expenses for illness/diseases/injuries upon the advice of a Medical Practitioner.
Cover for inpatient treatment for more than 24 hours.
Cover for Day Care Procedures like Dialysis, Lithotripsy ( Kidney Stone removal – Kidney Related, Chemotherapy / Radio Therapy ( Cancer Related Treatment ), Eye Surgery, Tonsillectomy ( Removal of Tonsils), Coronary Angioplasty (heart related), fracture & other procedures which do not require 24 hours stay because of advancement in Medical technology, taken in the Hospital / Nursing Home.
Pre-Existing (Life Threatening) illness covered.
Maternity cover with Rs. 1500/- for normal delivery and Rs. 3000/- for Caesarean Section. Institutional delivery is compulsory. Cover applicable after 6 months of policy commencement period.
100% Cashless facility at networked hospitals only – The TPA (Third Party Administrator) will provide a list of Network Hospitals. At these hospitals the member of his family can get treatment ( as per the policy conditions ) on presenting the Health Card. The member does not need to pay any cash upfront. On discharge, they will sign the hospital bills which the TPA will settle later.
Reimbursement for the hospitals if the treatment is availed from non network hospitals & government hospitals. – In case of treatment availed in non network hospitals the members will have to settle the bills with their own funds and lodge the claim with the insurance company for reimbursement.
AWARENESS officials will assist the members in filing the reimbursement claims with the Insurance Company.
Charges Payable under the Hospitalisation Cover
Room / Boarding Expenses.
Surgeon, Anesthetist, Medical Practitioner, Consultant, Specialist fees.
Medical Consumables and Medicines.
Nursing Expenses.
Personal Accident – Accidental Death or Permanent Total Disablement
Death of the Insured person within a period of 12 months from the date of bodily injury, this bodily injury being the sole and direct cause of the death of the person insured.
Permanent Total Disablement. Physical separation or loss of usage of the hands and feet or permanent loss of vision.
Major Exclusions
Medical Expenses arising due to any of the following conditions are not covered under the policy.
AIDS / HIV
STD and Venereal Diseases
Vaccination
Experimental / Unproven Treatment
Cosmetic Surgery
Dental Treatment
Nuclear War
Suicide
Self Injury
Fertility: Sub Fertility or Assisted Conception operation or Sterlisation or procedure.
It does not cover disabilities, death from War Nuclear Risks
Occupational Hazards like Car Racing, Circus, Parachute Gliding, Military Activity, Piloting
Attempted Sucide / Self Injury
Influence of Liquor, drugs
In personal accident it does not cover medical expenses, loss of compensation.
It does not cover injury or death due to child birth or pregnancy.
First Year Exclusions
Cataract
Hysterectomy
Stones – Kidney, Gall bladder
Ulcers
Hernia
Arthritis
Sinusitis and Tonsillitis
Dilation and Curettage
Maternity in first six months
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