United Family Medicare Prospectus Policy-Wording

SALIENT FEATURES OF THE POLICY

This policy covers all the members of a family under a single sum insured.

Eligibility:      Family comprising of Self, Spouse and Dependent Children

Age:               Proposer between 18 and 80 years

Dependent children between the age of 3 months and 18 years provided either or both parents are covered concurrently. However, children above 18 years will ceases to be covered if they are employed / self – employed or married. For unmarried and unemployment girls, disabled children without income dependent upon Proposer, the age limit of 18 will not apply. Male child upto 26 years can be covered provided they pursue full-time higher studies and submit Bonafide Certificate from Institute.

Sum Insured: Beginning from Rs.1 Lac in multiples of Rs. 50,000/- upto Rs 5lac to Rs. 10 Lac in multiples of Rs.1 lac.

Existing Health Policyholder of the Company can also opt for Family Medicare Policy on expiry of their current policy if there has been no claim for the preceding two years in respect of insured persons. If parents are covered under existing health policy of the company they can opt for a separate Family Medicare Policy. Either parents or son / daughter can be the proposer for such a policy.

No Claim Discount / Cumulative Bonus, if any, under existing policy will not be carried forward.

COVERAGES

Policy covers Hospitalization Expenses.

Expenses prior to and after hospitalization are also covered. Further details of coverage are given below:

Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatments as detailed in the policy.

Note: Procedure / Treatments usually done in outpatient department are not payable under the policy even if covered as an in-patient in the hospital for more than 24 hours or carried out in Day Care Centers.

Hospitalization Expenses:

A. Room / Boarding / Nursing Expenses and other expenses as specified in policy upto 1% of sum insured per day. This also includes Nursing Care, RMO Charges, IV Fluids / Blood Transfusion / Injection administration charges and the like but does not included cost of materials.

B. IC Unit upto 2% of Sum Insured per day.

C. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees

D. Aneasthetist, Blood, Oxygen, Operation Theatre Charges, Surgical appliances, Medicines & Drugs, Diagnostic Materials and X-rays, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, relevant laboratory diagnostic tests, etc & similat expenses.

E. All Hospitalization Expenses (excluding cost of organ, if any) incurred for donor in respect of Organ transplant.

Expenses in the following specified illness will be restricted as details below:

Pre-Hospitalization (30 days) & ---- Actual expenses subject to maximum of 10%

Post Hospitalization (60 days) in of Sum Insured.

Respect of any illness

In respect of person above 60 years, 10% deduction will be applied on all admissible claims.

Any one illness will be deemed to means continuous period of illness and it includes relapse within 105 days from

The date of discharge from the Hospital / Nursing Home where treatment has been taken. Occurrence of the same illness after a lapse of 105 days as stated above will be considered as fresh illness for the purpose of this policy.

DEFINATION

HOSPITAL / NURSING Home should be registered as Hospital or Nursing Home. Should comply with minimum criteria of having 15 inpatient beds, operating theater, Qualified Doctor and Qualified Nurse.