HEALTH GAIN
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HEALTH GAIN INSURANCE. Major Product Features. Flat premium of only Rs. 15,000/- including service tax Coverage for both inpatient and outpatient treatment Policy can be given for both individual and family floater basis.

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HEALTH GAIN INSURANCE

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Health gain insurance

HEALTH GAIN

INSURANCE


Health gain insurance

Major Product Features..

  • Flat premium of only Rs. 15,000/- including service tax

  • Coverage for both inpatient and outpatient treatment

  • Policy can be given for both individual and family floater basis.

  • Any unutilised amount under outpatient benefit can be carried forward to the next one year

Coverages..

  • Section – I

  • Hospitalization Expenses incurred as an inpatient for

  • Sickness/Illness/Diseases

  • Accidental injuries

  • Section – II

  • Hospitalization Expenses incurred at any Hospital / Nursing Home as an outpatient.


Health gain insurance

Family Size..

  • Proposer

  • Spouse

  • Dependent Children

Age Limits..

  • 5 Months – 65 Yrs

  • Life long Renewal

  • Dependent Children can be covered only with any one of their Parents


Health gain insurance

Pre - Insurance Medical Test

  • For persons with adverse medical history and

  • For all persons above 50 years, acceptance subject to Medical Examination at Company’s Cost.

Sum Insured..

  • Minimum Sum Insured - Rs. 1,00,000/-

  • Maximum Sum Insured - Rs. 5,00,000/-

  • The following Sum Insured options are available

    • Rs. 1,00,000/-

    • Rs. 2,00,000/-

    • Rs. 3,00,000/-

    • Rs. 4,00,000/-

    • Rs. 5,00,000/-


Health gain insurance

Allowable Expenses…

Section - I

  • Room rent & boarding charges as follows

    • Class A Cities – 2% of the Sum Insured subject to a maximum of Rs. 5,000/- per day (Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkatta, Mumbai including Thane, Pune, New Delhi and Secunderabad)

    • Class B Cities – 1% of the Sum Insured subject to a maximum of Rs. 3,000/- per day (Baroda, Coimbatore , Surat, Meerut and all State Capitals other than those falling under Class A)

    • Class C Cities – 1 % of the Sum Insured subject to a maximum of Rs. 1,000/- per day (Other Cities)

  • Nursing charges


Health gain insurance

Allowable Expenses…

Section - I

  • Anesthesia, Blood, Oxygen,Operation Theatre charges, medicines and drugs, diagnostic materials, cost of pace maker

  • Emergency Ambulance charges to go to Hospital for treatment @ Rs 750/- per hospitalisation upto maximum of Rs 1,500/- per policy period

  • Pre-hospitalization expenses incurred 30 days prior to the date of hospitalization

  • Post hospitalization expenses on a lump-sum basis @ 7% of the actual hospitalization expenses (excluding room rent and hospital registration charges), subject to a maximum of Rs 5,000/-


Health gain insurance

Sub limits…


Health gain insurance

Day Care Treatment..

Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time limit will not apply for

  • taken in the Hospital / Nursing Home and the Insured is discharged on the same day.

  • No limits for the above Day care procedures except Cataract surgery


Health gain insurance

Allowable Expenses…

Section - II

  • Medical expenses incurred at any Hospital / Nursing Home as an Out Patient.

  • Maternity expenses as Out Patient

  • Dental treatment as Out Patient

  • Unutilised benefit under this section can be carried forwarded to the next year on renewal

  • The maximum period of such carry over shall be limited to one immediately succeeding year only.


Limit of outpatient benefits for individual

Limit of Outpatient benefits for individual

IP – Inpatient NA – Not Available


Limit of outpatient benefits for family floater

Limit of Outpatient benefits for family floater

A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available (policy cannot be given)


Health gain insurance

Limit of Outpatient benefits for family floater

A- Adult C- Child IP- Inpatient OP- Outpatient NA- Not Available policy cannot be given


Health gain insurance

Renewal Discount..

  • Renewal Discount on Basic Premium is allowed on renewal for every Claim Free Year as per chart

  • It is not Cumulative

No Claim Discount for Individual basis


Health gain insurance

  • No Claim Discount for Family Floater basis


Health gain insurance

No Claim Discount for Family Floater basis


Health gain insurance

Other Benefits:

  • Benefits under Section 80-D of the IT Act

  • Cashless Service without intervention of TPA

  • Direct Tie up with hospitals on an All India Basis

Exclusions..

  • 48 months exclusion for Pre Existing Diseases (as per GIC council)

  • Any Disease contracted during first 30 days

  • First Year Exclusions

    • Benign prostate hypertrophy

    • Hernia, Hydrocele, Fistula in Anus, Piles

    • Sinusitis

    • Renal stone and Gall stone removal

    • Congenital internal disease/defect


Health gain insurance

Exclusions..

  • First Two Years Exclusions

    • Cataract

    • hysterectomy following menorrhia or fibromyoma

    • Knee Replacement Surgery

    • Joint Replacement Surgery

    • Prolapse of intervertibral

    • Vericose veins/ulcers

  • Naturopathy Treatment

  • Expenses incurred on Non Allopathic Treatment.


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