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Health Insurance 2623 views December 12, 2020
Edelweiss General Insurance Company Limited has introduced Edelweiss Health Insurance on both individual and family floater basis. Under Edelweiss Health Insurance, you will have three wise options from which you can choose your cover – Silver, Gold and Platinum. No matter which option you choose, you will get the following services like Medical Referral, Medical Monitoring, Medical Repatriation, Emergency Medical Evacuation, Evacuation, Compassionate Visit, Mortal Remains, and Second Medical Opinion. The best part about the Edelweiss Health Insurance Plan is that it covers anyone above the age of 3 months, and under this one health insurance, up to 8 people can be covered, including you, your spouse, up to three children, etc. Let’s check here the variants of Edelweiss Health Insurance plan and their respective features and benefits.
Table of Contents
The Three Edelweiss Health Insurance Plans
The following are the Edelweiss Health Insurance plans from which you can choose:
| Health Care Expenses | SILVER (Availability) | GOLD (Availability) | PLATINUM (Availability) |
|---|---|---|---|
| Hospitalization Expenses (Up to the Sum Insured) | YES (up to INR 5 lakh) | YES (up to INR 50 lakh) | YES (up to INR 1 Crore) |
| Room Rent Limits | YES (1% of the Sum Insured) | NO | NO |
| ICU Charges | YES (2% of the Sum Insured) | NO | NO |
| Pre- & Post- Hospitalization Expenses | YES (for 30/60 days) | YES (for 60/90 days) | YES (for 90/180 days) |
| Daycare Treatment | YES | YES | YES |
| Ambulance Fee | YES (up to INR 1,500) | YES( up to INR 3,000) | YES (up to INR 10,000) |
| Organ Donor | NO | YES (up to INR 1 lakh) | YES (up to INR 2 lakh) |
| Domiciliary Hospitalization | YES | YES | YES |
| Ayush Treatment | YES | YES | YES |
| No Claim Bonus (NCB) | YES (up to 50%) | YES (up to 100%) | YES (up to 100%) |
| Free Health Check-Up | YES | YES | YES |
| Maternity Cover | NO | YES (up to INR 50,000) | YES (up to INR 2 Lakh) |
| Recovery Benefit | NO | YES (INR 1,000 per day) | YES (INR 1,500 per day) |
| Shared Accommodation | YES (INR 800 per day) | YES (INR 1,000 per day | YES (INR 1,200 per day |
| Critical Illness Coverage | NO | YES (Sum Insured Increases by up to 50%) | YES (Sum Insured Increases by up to 100%) |
| Sum Insured Restoration | NO | YES | YES |
Edelweiss Health Insurance Coverage
- Room Rent
- Nursing charges (except private nursing)
- Medical Practitioner fee
- Physiotherapy
- Investigation
- Diagnostics procedures (for the current admission only)
- Medicines (prescribed by the treating Doctor)
- Intravenous fluids
- Blood transfusion
- Injection
- Administration charges
- Consumables
- OT charges
- Prosthetics and other devices
- ICU charges
- Pre-hospitalization Medical Expenses
- Post-hospitalization Medical Expenses
- Day Care Treatment
- Ambulance fee
- Organ Donor expenses
- Domiciliary hospitalization
- AYUSH treatments
- Free Health Check-up (for a claim-free year if the persons aged above 18 years)
- Maternity expenses
- Critical illness (including Coronary Artery Bypass Graft (Open Chest CABG), Myocardial Infarction (First Heart Attack of specific severity), Cancer of Specified Severity, Stroke resulting in Permanent Symptoms, Permanent Paralysis of Limbs)
- Hospital Cash (if hospitalization is up to 7 days)
- Recovery Benefit (if hospitalization is up to 10 days)
- Shared accommodation benefit (if you have spent 24 hours in shared accommodation)
- 100% of the Sum Insured will be recovered with the Restoration benefit
Exclusions from Edelweiss Health Insurance
- Any condition due to Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice, Trichomoniasis, HTLV–III or IITLB-III, LAV, mutants derivative, Variations, or Deficiency Syndrome.
- Expenses for new-born
- Sterility and Infertility
- Treatment from a non-qualified Medical Practitioner
- Ear examinations
- Dentures
- Artificial teeth
- Investigation & Evaluation (primarily for diagnostics and evaluation that is not incidental to the current diagnosis and treatment)
- Rest Cure, rehabilitation and respite care
- External prosthesis
- Corrective devices
- External durable equipment like wheelchairs, walkers, crutches, ambulatory devices, and oxygen concentrators for asthmatic conditions.
- Treatments at health hydros, nature cure clinics, or spas
- Acupressure
- Acupuncture
- Magnetic therapy
- External Congenital Anomaly/Illness/defects
- Cosmetic or Plastic Surgery
- Cost of spectacles
- Contact lenses
- Hearing aids
- Eye & Ear examinations
- Refractive Error less than 7.5 dioptres
- Change of Gender
- Circumcision (unless necessary for the treatment)
- Vaccination
- Vitamins, Minerals, and Organic substances (if not prescribed by a medical practitioner)
- Donor treatment in case of a transplant surgery
- Unproven Treatments
- Illness or injury due to War, invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, etc.
- If you breach law with a criminal intent
- Alcoholism, drug or substance abuse
- Injury or illness from Nuclear, chemical or biological attack
- Hair fall treatment and products
- Stem cell transplantation
- Injury or illness due to participation in hazardous or adventure sports
- Obesity and Weight Control
- Expenses traceable to childbirth (if you haven’t added the optional cover)
Optional Benefits
For a customized health insurance plan, you can add the following covers such as:
- Critical Illness Coverage – This coverage will commence from the time when you’re diagnosed with a critical illness. If you have chosen the SILVER plan, the Sum Insured will increase by 50%. The optional benefits won’t apply for customers choosing the GOLD & PLATINUM Plan as it is already present in the base plan.
- Recharge – Using this optional benefit, you can top-up the Sum Insured by 100%. It will be available for GOLD & PLATINUM Plans.
- Voluntary Co-payment – if your age is 60 years and below, you can add this Edelweiss Health Insurance optional benefit to your plan. With this, you can choose to pay 10-20% of the claim amount that decreases your premium payments.
Edelweiss Health Insurance Eligibility
If you are impressed with this policy coverage and benefits, you should decide whether you are eligible to buy this plan or not.
- Entry Age: 3 months to 65 years (although in the PLATINUM plan, there is no maximum entry age limit)
- Policy Term: 1, 2 and 3 years
- Premium Payment: Single
- The number of people allowed for coverage in an individual plan: Eight including the policyholder
- The combination of Family Floater: A family with one adult, plus one child, one adult plus two-child, one adult plus three-child, two adults, two adults plus one child, two adults plus two-child, two adults and three-child.
Note- In the policy, your child shall be ported/renewed in an Individual Policy with a separate Sum Insured in continuity with no claim bonus on the expiring policy. Under that policy, your child will be treated as an adult upon attaining the age of 26 years. Every age calculation is done as per the “Age on the last birthday”. For a Family Floater policy, an additional child (a maximum of 3 children) can be added for a premium. In this health insurance, Child implies a child who is natural born or legally adopted (unmarried) and aged above 90 days but less than 26 years and dependent on his/her parent’s income. For an Individual Policy, if you cover your son or daughter, the maximum age allowed will be less than 26 yrs only.
Claim Process
Call Edelweiss General Insurance Company Limited on 1800 12000 or email at support@edelweissinsurance.com to send your claim details. The Claim Process for Edelweiss Health Insurance is easy, the company either transfers the money to you if you’ve already paid the hospital bills or directly pays to the hospital if you’ve chosen the cashless facility.