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Health Insurance 402 views August 3, 2021
Chola Swasth Parivar Insurance Plan provides financial protection to you and your family against medical expenses during the policy tenure. The policy comes in two different variants – Pearl and Royale. Know more about the coverage of the Chola Swasth Parivar Insurance Plan on this page below.
Table of Contents
Chola Swasth Parivar Insurance Plan Base Cover
The insurer shall cover the following medical expenses as per your chosen plan.
Hospitalization Expenses
If you are diagnosed with an illness or suffer from an accidental bodily injury, the insurer will reimburse the following medically necessary expenses:
- Room, boarding and nursing charges
- Doctors fees
- Intensive Care Unit charges
- Surgical fees, operating theatre, anesthesia and oxygen charges
- Physical therapy
- Cost of drugs/medicines, laboratory, x-ray, diagnostic tests, dressing, ordinary splints and plaster casts
Pre-Hospitalization Expenses
If you are diagnosed with an illness and it results in hospitalization, the insurer will reimburse the pre-hospitalization expenses incurred up to 30 days.
Post-Hospitalization Expenses
In case you require further medical treatment related to the condition for which get hospitalized, the insurer will cover for up to 60 days from the date of discharge.
Day Care Expenses
Any day care procedure/treatment that requires less than 24 hours of hospitalization shall be covered up to the sum insured. In case the daycare procedure is performed in a non-network hospital, you need to obtain pre-authorization from the insurer.
Personal Accident (Available in Royale Variant Only)
If you sustain any bodily injury during the policy period and it results in death or disability, the insurer will pay a percentage of the sum insured as shown below:
| Event | Benefit Payable (% of the Sum Insured) |
|---|---|
| Accidental Death | The 100% of the sum insured, as stated in the policy schedule, shall be payable to the nominee, provided death occurs within twelve months from the date of injury. |
| Permanent Total Disablement | Loss of sight of both the eyes - 100% Loss of two entire hands or two entire feet - 100% Loss of one entire hand and one entire foot -100% Loss of sight of one eye and one entire foot or hand - 100% Complete loss of hearing of both ears and loss of speech - 100% Complete loss of hearing of both ears or loss of speech and loss of one limb or loss of sight of one eye -100% Loss of use of two hands - 100% Loss of use of two foot - 100% Loss of use of one hand and one foot - 100% Loss of sight of one eye and use of one hand - 100% Loss of sight of one eye and use of one foot - 100% Loss of sight of one eye - 50% Physical separation of one entire hand - 50% Physical separation of one entire foot - 50% Loss of use of one hand - 50% Loss of use of one foot - 50% |
| Permanent Partial Disablement | Loss of toes (all) - 20% Loss of great toe (both phalanges) - 5% Loss of great toe (one phalanges) - 2% Loss of other than the great toe, if more than one toe lost - 2% Loss of hearing of both ears - 60% Loss of hearing of one ear - 30% Loss of speech - 60% Loss of four fingers and thumb of one hand - 40% Loss of four fingers - 35% Loss of thumb (both phalanges) - 25% Loss of thumb (one phalanx) - 10% Loss of index finger (three or two phalanges or one phalanx) - 10% Loss of middle finger (three or two phalanges or one phalanx) - 6% Loss of ring finger (three or two phalanges or one phalanx) - 5% Loss of little finger (three or two phalanges or one phalanx) - 4% Loss of metacarpals (first or second, third, fourth or fifth) - 3% Loss of sense of smell - 10% Loss of sense of taste - 5% Loss of sight of one eye - 50% Loss of one hand - 50% Loss of one foot - 50% |
Conditions Applicable to Chola Swasth Parivar Insurance Plan
- If an accident results in impairment of several physical functions, the degree of disablement, as shown in the table above, shall be added together and payable to the insured. This shall not exceed 100% of the sum insured.
- In case of an accident to the aircraft wherein the insured is traveling as a fare-paying passenger and the body cannot be located within 365 days from the date of such accident, the insurer will pay 100% of the sum assured on death to the nominee.
- In the event of Permanent Total Disablement or Permanent Partial Disablement, the insured will be examined by the doctors appointed by the company.
- The claim amount payable per person under the policy is subject to the following sub-limit
Disease/Treatment Sub-Limit (In INR) Cataract - Surgery of eye for lens disorder 20,000 Treatment of fracture / dislocation / knee surgery 1 Lakh Coronary Angioplasty 1 Lakh Coronary Angiography 20,000 Gastrectomy - Removal of any part of the stomach 15,000 Urinary Surgery 25,000 ENT – Surgery of Ear, Nose & Throat 35,000 Appendectomy - Surgical removal of appendix 30,000 Surgery of Prostate Gland 25,000 Surgery Hydrocele 15,000 Hysterectomy - Surgical Removal of Uterus 40,000 Surgery of Hernia 40,000 D & C - Dilatation and Curettage of Uterus 5,000 per day care Lithotripsy - Laser treatment of kidney stone 10,000 per day care Tonsillectomy - Surgical removal of tonsils 20,000 Kidney Stone Removal 30,000 - Every admissible claim of hospitalization or daycare treatment/procedure is subject to a co-payment of 15%
- If you seek treatment in a non-network hospital, a co-payment of 10% shall apply. It won’t be applicable in the event of an accident
Free Look Period
You’ll get a free look period of fifteen days starting from the date of receipt of the policy to review the terms and conditions, and if the same is not acceptable, you can return the policy. On such cancellation, the insurer shall refund the paid premium after deducting the medical examination and stamp duty charges, provided you haven’t filed a claim. Where the risk has already commenced and you have returned the policy, a deduction towards a proportionate risk premium for the period on cover will be made. If only a part of the insurance coverage has commenced, such proportionate premium commensurates with the insurance coverage during the free look period.