Health Insurance 605 views May 22, 2021

Chola MS Baroda Swasthya Parivar Plan covers your medical expenses and ensures hassle-free medical treatments for you and your family. This policy is available for the customers of Bank of Baroda whose age is 18-65 years. Under this policy, you can cover your spouse and up to 4 dependent children. Chola MS Baroda Swasthya Parivar Plan is issued as a group policy to you and individual certificates may be issued to the beneficiaries. Read this page further to know more about the coverage and exclusion of the Chola MS Baroda Swasthya Parivar Plan.

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Chola MS Baroda Swasthya Parivar Plan Coverage

The insurer shall cover the following medical expenses under this plan –

In-patient Hospitalization Expenses – Under this, the insurer will cover all the medically necessary in-patient treatment expenses such as –

  1. Room, boarding and nursing charges up to 1% of the sum insured per day
  2. ICU charges up to 2% of the sum insured per day
  3. Surgeon, Anaesthetist, Medical Practitioner, Consultants & Specialist Fees
  4. Miscellaneous charges for services like laboratory, x-ray, and diagnostic test
  5. Cost of Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines, Drugs, Diagnostic Materials, Pacemaker, prosthetic and other devices implanted internally during a surgical procedure.
  6. Hospitalization expenses of the organ donor in case of harvesting the organ, except pre and post-hospitalization expenses for the donor.
  7. Cataract treatment up to 15% of sum insured per eye
  8. Lithotripsy (for removal of stone in Kidney/Urinary/Gallbladder) up to 30% of sum insured
  9. Appendectomy up to 30% of the sum insured
  10. Hernia Repair up to 40% of the sum insured
  11. Menorrhagia up to 40% of the sum insured
  12. Surgery for Piles, Fistula, Fissure, Anal, Abscess up to 20% of sum insured

Pre-hospitalization Expenses: You’ll get coverage for the medical expenses incurred 30 days before the date of hospitalization, provided such medical expenses are incurred for the same condition for which you are hospitalized.

Post-hospitalization Expenses: The insurer shall cover the medical expenses up to 60 days post the date of discharge from the hospital, provided the expenses are related to the same condition for which you have been hospitalized.

Day Care Procedures/Treatment Expenses: Under this policy, 141 Day Care Procedures/Treatment are covered up to the sum insured. In case you receive daycare treatment/procedure in a non-network hospital, the same must be pre-authorized by the insurer. Pre-authorization for daycare treatment/procedure must be sent 72 hours before the date of admission in case of planned admission, otherwise, within 24 hours of the admission. Payment under this benefit will reduce the policy sum insured.

Ambulance Expenses: The insurer shall reimburse the ambulance expenses that have incurred during your transfer to the nearest hospital. Ambulance expenses will be reimbursed to you on submission of original bills, and are covered up to INR 2,500 per hospitalization.

AYUSH Coverage Expenses: You will get coverage for the hospitalization expenses when you are admitted for more than 24 hours for non-allopathic treatments under Ayurveda, Unani, Siddha and Homeopathy systems. The treatment is admissible for the claim if you have received it in a central or state government AYUSH hospital, teaching hospital attached to AYUSH college recognized by Central Government/Central Council of Indian Medicine/Central Council for Homeopathy, AYUSH Hospital, standalone or co-located in-patient healthcare facility of any recognized system of medicine registered with the local authorities.

Note: Naturopathy treatment is not covered under the policy. And payment under this benefit will reduce the sum insured.

Waiting Period

Expenses related to the treatment of a Pre-Existing Disease (PED) and its direct complications shall be covered under this policy after the expiry of a 36-month waiting period, provided the policy is renewed without any break. The following specific disease/procedure has a 24-month waiting period in this policy:

  1. Cataract
  2. Benign Prostatic Hypertrophy
  3. Hysterectomy for Menorrhagia or Fibromyoma
  4. Hernia
  5. Hydrocele
  6. Fistula in anus
  7. Piles
  8. Congenital Internal Anomaly
  9. Sinusitis and related disorders

Nothing shall be payable in respect of the treatment of an illness within 30 days from the date of the policy commencement date except claims arising due to an accident.

Exclusions from Chola MS Baroda Swasthya Parivar Plan

Under Chola MS Baroda Swasthya Parivar Plan, you don’t get coverage for any losses caused directly due to the following:

  1. Admission primarily for diagnostics and evaluation purpose
  2. Admission primarily for enforced bed rest and not for receiving treatment
  3. Obesity treatment and weight control programs
  4. Change-of-Gender treatments
  5. Cosmetic or plastic surgery unless required for reconstruction due to an accident, burn or Cancer
  6. Hospitalization due to participation in hazardous or adventure sports such as para jumping, rock climbing, mountaineering, rafting, motor racing, horse racing, scuba diving, hand gliding, skydiving, deep-sea diving
  7. Treatment resulting from a breach of law
  8. Treatment for alcoholism, drug or substance abuse
  9. Treatments received in health hydros, nature cure clinics or similar establishments
  10. Unprescribed dietary supplements and substances
  11. Treatment for correction of eyesight due to refractive error < 7.5 dioptres
  12. Unproven treatments
  13. Sterility and infertility treatment such as contraception, sterilization, artificial insemination and advanced reproductive technologies like IVF, ZIFT, GIFT, ICSI, Gestational Surrogacy, Reversal of sterilization
  14. Medical treatment related to childbirth, miscarriage, complicated deliveries and cesarean sections except for ectopic pregnancy
  15. Vaccination or inoculation unless it is related to post-animal bite treatment
  16. Injury/illness due to war, invasion, an act of a foreign enemy, warlike operations
  17. Injury/illness due to ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste due to combustion.
  18. Sexually transmitted disease or illness
  19. Dental treatment or surgery unless necessitated due to an accident
  20. Intentional self-injury or attempted suicide
  21. Circumcisions unless a part of an illness or injury treatment
  22. Pre & Post-hospitalization expenses of the organ donor
  23. Any travel or transportation costs
  24. Admission on OPD basis without any hospitalization and outpatient treatment
  25. External congenital anomaly, illness, diseases, condition
  26. Naturopathy treatment/procedure
  27. Any treatment or investigation outside India
  28. Cyberknife surgery and Multifocal lens used for Cataract Surgery unless it is specifically covered under this policy
  29. Non-medical expenses incurred during hospitalization

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