Gramin Suswasthya Microinsurance Policy
The policy is a micro-insurance product provides cover to lower income class of the society covering Hospitalization expenses of the entire family and Personal Accident cover to the insured and his/her spouse. This policy is having two sections: Section I covers hospitalization expenses on family floater basis and Section II covers Personal Accident and Outdoor Patient(OPD)expenses to the insured and spouse due to accident only. Any adult residing in India can take the policy covering himself / herself between the age of 3 months to 60 years
Hospitalisation Expenses
- In the even of insured person and his/her spouse contracting any disease or suffering any illness or sustaining any bodily injury through accident requiring hospitalization, the company will pay through TPA to the Hospital/ Nursing Home or insured person the amount of such expenses as would fall under different heads as are reasonably and necessarily incurred thereof by or on behalf of such insured person
| Hospitalization Benefits | |
|---|---|
| Room, Boarding expenses as provided by the Hospital/Nursing Home | A |
| Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses | B |
| Anesthesia, Blood, Oxygen, OT charges, Surgical appliances, Medicines, drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs | C |
Section-II
Personal Accident
| Table of benefits | Compensation |
|---|---|
| Death | 100% of S.I |
| Total and irrecoverable loss of sight of both eyes or losses of use of two hands or feet or loss of sight of one eye and loss of use of one hand or foot | 100% of S.I |
| Total and irrecoverable loss of sight of one eye or loss of use of one hand or foot | 50% of S.I |
| Permanent total disablement due to accident | 100% of S.I |
Extensions/ Add Ons
Maternity Expenses Benefit
The policy can be extended to maternity expenses by charging additional premium.
First two living children of the insured/spouse will be covered under this benefit.
The maximum benefit allowable under this clause will be up to Rs.1, 000/- for Normal Delivery and 3500/- for caesarean delivery.
The detailed coverages are explained in Salient features.
The Gramin Suswasthya Bima policies can be bought on line using credit, debit cards as well as net banking .
The detailed coverages are explained in Salient features.
Major Exclusions
Section I
- Circumcision unless necessary for treatment or a disease not excluded
- Cost of spectacles, contact lenses and hearing aids.
- Dental treatment unless arising from disease or injury and which requires hospitalization for treatment.
- Convalescence general debility `Run Down’ condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self-injury and use of intoxicating drugs / alcohol.
- AIDS.
- Diagnostic, X-Ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence of presence of any ailment, sickness or injury for which confinement is required at a Hospital/Nursing Home.
- Vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.
- Pregnancy, childbirth, miscarriage, abortion or complications of any of these including caesarean section.
- Naturopathy treatment
Section-II
Personal Accident
- Injury or disablement directly or indirectly arising out of or contributed to by or traceable to any disability existing on the date of issue of this Policy.
- Intentional self-injury, suicide or attempted suicide, under the influence of intoxicating liquor or drugs, insanity,, any breach of the law with criminal intent.
- b. If such claim be in any manner be fraudulent or supported by any fraudulent means or device whether by the Insured Person or by any other person acting on his behalf.
Special Condition
Section I & II
- In the event of a claim notice with full particulars shall be sent to the TPA within 24 hours of hospitalization.
- All supporting documents relating to the claim must be filed with TPA within 7 days from the date of discharge from the hospital.
- The Insured person shall obtain and furnish the TPA with all original bills, receipts and other documents upon which a claim is based and shall also give the TPA such additional information and assistance as the TPA/Company may require in dealing with the Claim.
- Any Medical Practitioner authorized by the TPA/Company shall be allowed to examine the Insured person/records of the hospital in case of any alleged injury or disease requiring hospitalisation when and so often as the same may reasonably be required on behalf of the TPA/Company.
- In case of death of earning member of the family due to accident a post-mortem report must be submitted along with other documents of proof of death.
- Policy is subject to contribution cost.
- The benefits under this policy shall be in excess of the benefits available under the Cancer Insurance Policy.
Extensions/ Add Ons
Maternity Expenses Benefit
The policy can be extended to maternity expenses by charging additional premium.
First two living children of the insured/spouse will be covered under this benefit.
The maximum benefit allowable under this clause will be up to Rs.1, 000/- for Normal Delivery and 3500/- for caesarean delivery.
