Chola MS Flexi Plus Plan provides financial protection against medical expenses to those who have borrowed any type of loan from Banks/Financial Institutions. So, if you have a loan and are looking for health insurance that covers you and your family members, think of Chola MS Flexi Plus Plan. Read this page further to know more about the benefits, exclusions and terms and conditions of the Chola MS Flexi Plus Plan.
Chola MS Flexi Plus Plan Coverage
The insurer will indemnify necessary inpatient treatment expenses for the disease, illness, or injury contracted/sustained during the policy term, including –
- Room, Boarding and Nursing Charges
- ICU Charges
- Surgeon, Anaesthetist, Medical Practitioner, Consultants & Specialist Fees
- Hospital miscellaneous services such as laboratory, x-ray, and diagnostic tests
- Cost of Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, and Medicines & Drugs, Diagnostic Materials and Cost of Pacemaker, prosthetic and other devices implanted internally during a surgical procedure.
- Hospitalization expenses of the Organ donor during his/her stay as an in-patient
Note: If you are admitted to a hospital room where the rent is higher than the one specified in the policy, you need to bear the extra amount which is not covered.
Chola MS Flexi Plus Plan Optional Covers
You can enhance the coverage under Chola MS Flexi Plus Plan by adding any of the following –
- Pre-hospitalization Expenses
- Post-hospitalization Expenses
- Emergency Ambulance Expenses
- Day Care Procedures/Treatment Expenses
- AYUSH Coverage Expenses
- Domiciliary Hospitalization Expenses
- Sum Insured Restoration for Unrelated Claims
- Recharge Benefit for Related Claims
- Hospital Daily Cash Benefit
- Compassionate Travel
- Repatriation of Mortal Remains
- Maternity Benefit
- Outpatient Benefit
- No Proportionate Deduction
- Medical Second Opinion
- Pre-existing Waiver with Co-Payment
- Waiver of Initial Waiting Period
- Waiver of Specific Illness/Surgeries Waiting Period
- Waiver of Pre-existing Disease/Condition without Co-Payment
- Waiver of waiting period for Maternity cover
- Waiver of Pre Medical Health Checkup
You can’t claim for any illness contracted within 30 days from the date of policy commencement. However, this exclusion shall not apply if you are covered for more than twelve months under this policy. The 30-day waiting period applies to the enhanced sum insured in the event of granting a higher sum insured.
The listed conditions, surgeries or treatments shall be covered after the 12 months of continuous coverage –
- Congenital Internal Anomaly
- Varicose veins and Varicose Ulcers
- Rheumatism and arthritis of any kind
- Treatment of diseases on ears/tonsils/adenoids/paranasal sinuses/Deviated Nasal Septum
- Stones in the Urinary and Biliary systems
- Gastric or Duodenal Ulcer
- Any type of benign Cyst/ Nodules/Polyps/Tumours/Breast Lumps
- Intervertebral Disc Prolapse, and Degenerative Disc/Vertebral Disorders
- Benign Prostatic Hypertrophy
- Myomectomy, Hysterectomy unless caused due to malignancy
- Dilatation and curettage (D&C)
- Anal Fistula, Fissure and Piles
- All types of Hernia
- Chronic Renal Failure
- Joint replacement surgery unless it is the result of an accident
In case of sum insured enhancement, the waiting period shall apply afresh to the extent of sum insured increase. If any of the specified disease/procedure falls under the waiting period specified for pre-existing diseases, two waiting periods shall apply. The treatment of a Pre-Existing Disease (PED) shall be covered after 48 months of continuous coverage under this policy.
Exclusions from Chola MS Flexi Plus Plan
The company will not pay for any claim in case of the following:
- Expenses related to any admission which is primarily for diagnostics and evaluation purposes only
- Rest Cure, rehabilitation and respite care
- Obesity or weight control programs
- Change-of-Gender treatment
- Cosmetic or plastic surgery unless medically necessary treatment to remove a direct and immediate health risk
- Injury due to participation in hazardous or adventure sports
- Injury due to breach of law
- Treatment taken at excluded providers unless it is a life-threatening situation
- Treatment for alcoholism, drug or substance abuse
- Treatments received in health hydros, nature cure clinics, spas or similar type of establishments
- Unprescribed dietary supplements and substances
- Treatment of eyesight correction due to refractive error < 7.5 dioptres
- Unproven treatments
- Sterility and Infertility treatment
- Treatment rendered by a medical practitioner outside his/her discipline or the discipline for which he/she is licensed
- Treatments rendered by a medical practitioner who lives in the same residence or who is a member of the insured’s family
- Dental treatment or surgery
- Expenses of hearing aids, eyeglasses or contact lenses
- Circumcisions unless it is necessitated by illness or injury and a forming part of treatment
- Pre & Post-hospitalisation expenses of the organ donor and consequential loss to such organ donor
- Travel or transportation expenses.
- Intentional self-injury or attempted suicide whether sane or insane.
- Treatments that could have been done on an OPD basis without any hospitalization and Outpatient treatment.
- External congenital anomaly/illness/diseases/condition
- Treatment or investigation has taken outside India
- Vaccination or inoculation unless it is a part of post-animal bite treatment
- Injury/illness caused by war, invasion, an act of a foreign enemy, warlike operations, ionizing radiation, contamination of radioactive material/nuclear fuel/ nuclear waste/combustion of nuclear fuel, civil war, revolution, insurrection, mutiny, martial law.
- Non-medical expenses incurred during hospitalization.
After the completion of the moratorium period (continuous 8 years), no look back shall be applied to the policy. The moratorium applies to the sum insured and it shall apply again to the enhanced sum from the date of enhancement. After the expiry of the Moratorium Period, no health insurance claim shall be contestable except fraudulent ones and those that come under permanent exclusions as specified above.
Terms & Conditions of Chola MS Flexi Plus Plan
- The insured age should be a minimum of 18 years on the date of policy commencement
- The entry age for the primary insured, spouse and parents ranges from 18 years to 70 years
- Children between the age of 3 months to 26 years are covered under this policy
- You can purchase this plan on an individual and a family floater basis.
- On individual policy, you, your spouse, up to 3 and parents can be covered
- On the family floater plan, you, your spouse and up to 3 children can be covered
- This policy will be issued for a minimum term of one year or up to the loan period not exceeding 5 years.