Multiplier Health Insurance Plan

Inpatient care is provided mainly in a hospital where the individual is admitted and spends at least one night in the hospital depending on the condition.

• Room rent, boarding, and nursing expenses as provided by the hospital / nursing home.
• Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses.
• Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees, whether paid directly to the treating doctor / surgeon or to the hospital.
• Anesthesia, blood, oxygen, operation theater charges, surgical appliances, medicines and drugs, costs towards diagnostics, diagnostic imaging modalities, and similar other expenses.

Modern treatments covers the following:

• These will include, Uterine Artery Embolization and HIFU (High intensity focused ultrasound)

• Immunotherapy - Monoclonal Antibody to be given as an injection
• Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions to be covered.
• Vaporisation of the prostate (Green Laser Treatment or Holmium Laser Treatment)

It includes the medical expenses that the patient incurs before hospitalisation. It is for a fixed period of 60 days prior to the date of admissible hospitalisation covered under the policy.

The expenses here feature the medical expenses which the patient has to incur after being discharged from the hospital and it is for a fixed period of 90 days from the date of discharge from the hospital, following an admissible hospitalisation covered under the policy.

Daycare treatment includes treatments that do not last for more than 24 hours in a hospital or daycare centre due to advancements in technology. Any OPD treatment undertaken in a hospital / daycare centre will not be covered. Pre and Post-hospitalisation medical expenses are payable for up to 30 days under this benefit.

We will cover inpatient care medical expenses towards the donor for the harvesting of the organ donated provided that: (a) the organ donor is any person in accordance with the Transplantation of Human Organs Act, 1994, and other applicable laws. (b) the organ donated is for the use of the insured person who has been asked to undergo organ transplantation on medical advice; (c) we have admitted a claim towards inpatient care.

Organ donor expenses will be covered within the sum insured for the patient who has insured with us i.e. recipient of the organ (who is undergoing the transplant).

It is the condition where the patient cannot move to the hospital due to his prevailing health condition or non-availability of hospital beds and therefore is receiving the treatment at home.

We will cover medical expenses up to the sum insured for medical treatment taken at home if this continues for an uninterrupted period of 3 days and the condition for which treatment is taken would otherwise have necessitated hospitalisation as long as either:

• the attending medical practitioner confirms that the insured person could not be transferred to a hospital or
• the insured person satisfies us that a hospital bed was unavailable.

If a claim has been accepted under this benefit, the claims for Pre and Post-hospitalisation medical expenses are payable up to 60 days and 90 days respectively under this benefit.

The company shall indemnify medical expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy systems of medicines during each policy year up to the sum insured in any AYUSH Hospital.

We will cover reasonable and customary charges for ambulance expenses that are incurred towards transportation of an Insured Person by surface transport following an emergency to the nearest hospital with adequate facilities.

We will also cover charges for app-based cab service incurred towards the transportation of an insured person at the time of getting admitted to the hospital.

We will cover medical expenses of OPD Treatment for vaccinations including inoculation and immunizations in case of post-bite treatment. Our maximum liability will be limited up to the amount provided in the Product Benefits Table. This benefit is available only on a reimbursement basis.

We will reimburse you for your reasonable & necessary transportation from one hospital to another hospital in case of life-endangering emergency conditions for treatment of an illness or injury which is admissible and payable under the policy.

We will arrange for a health check-up as per your eligibility as defined in the Product Benefits Table provided that you or any insured person has requested for the same. We will cover health checkups arranged by us through our empanelled network provider.

We will provide various preventive healthcare & wellness-related activities like health-related articles on your registered email ids. We will also provide Disease Management Services wherein for certain specified health risks such as Heart, Kidney, Liver, Cancer, Hypertension, Diabetes, and other conditions as defined from time to time. You will be provided assistance to manage your disease condition better through preventive check-ups, advice on nutrition, diet, exercise regime, etc.

We will provide you with a second opinion from a medical practitioner if an insured person is diagnosed with a critical illness during the policy period. The expert opinion would be directly sent to the insured person.

We will increase your sum insured by 20% of the base sum insured per policy year up to a maximum of 100% of the base sum insured of the renewed policy if the policy is renewed with us and provided that there are no claims paid/outstanding in the expiring policy year by any insured person.

We will reload your sum insured, once in a policy year, up to 100% of the base sum insured, subject to the following:

• The base sum insured and no claim bonus (if any) is insufficient as a result of previous claims in that policy year.
• Flexi Reload benefit shall not apply to the first claim in the policy year.
• Flexi Reload once triggered can be used for the same illness to the same insured in a policy year.
• If the policy is issued on a floater basis, the Flexi Reload Sum Insured will also be available on a floater basis.
• If the Flexi Reload sum insured is not utilized in a policy year, it shall not be carried forward to any subsequent Policy year.

In life-threatening conditions, an additional amount equivalent to 4(four) times of sum insured and no claim bonus will be available to the insured persons for all claims admissible during the policy year, subject to the following conditions:

• This Benefit will be available only 4 (four) times in the lifetime of the policy/person across all insured members. This Benefit shall be available only after the exhaustion of the base sum insured and no claim bonus. Any unutilized amount of 4X Multiplier Benefit, in whole or in part, will not be carried forward to the subsequent policy year.
• However, in case of continuous hospitalisation from the current policy year to the next policy year, the multiplier sum insured will be applicable for the entire duration of hospitalisation.
• The 4X Multiplier Benefit once activated in a policy year, shall be available for any admissible claims arising out of life-threatening conditions in the same policy year.
• In the case of a family floater policy, the 4X Multiplier Benefit will be available on a floater basis for all insured persons covered under the policy and will operate in accordance with the above conditions. Life-threatening conditions should be certified by the qualified treating physician and should be clearly mentioned in the hospital admission summary or case summary or pre-authorisation form.

During the pre-existing diseases waiting period, for the 2nd and 3rd years, we will cover the expenses for treatment of pre-existing diseases declared by the insured person with a 50% co-payment and up to a maximum of sub-limit specified in the Product Benefit Table. Any claim under this section will reduce the sum insured.