Health Insurance 1908 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.

Health Insurance

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The Three Edelweiss Health Insurance Plans

The following are the Edelweiss Health Insurance plans from which you can choose:

Health Care ExpensesSILVER
(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 LimitsYES (1% of the Sum Insured)NONO
ICU ChargesYES (2% of the Sum Insured)NONO
Pre- & Post- Hospitalization ExpensesYES (for 30/60 days)YES (for 60/90 days)YES (for 90/180 days)
Daycare TreatmentYESYESYES
Ambulance FeeYES (up to INR 1,500)YES( up to INR 3,000)YES (up to INR 10,000)
Organ DonorNOYES (up to INR 1 lakh)YES (up to INR 2 lakh)
Domiciliary HospitalizationYESYESYES
Ayush TreatmentYESYESYES
No Claim Bonus (NCB)YES (up to 50%)YES (up to 100%)YES (up to 100%)
Free Health Check-UpYESYESYES
Maternity CoverNOYES (up to INR 50,000)YES (up to INR 2 Lakh)
Recovery BenefitNOYES (INR 1,000 per day)YES (INR 1,500 per day)
Shared AccommodationYES (INR 800 per day)YES (INR 1,000 per dayYES (INR 1,200 per day
Critical Illness CoverageNOYES (Sum Insured Increases by up to 50%)YES (Sum Insured Increases by up to 100%)
Sum Insured RestorationNOYESYES

Edelweiss Health Insurance Coverage

  1. Room Rent
  2. Nursing charges (except private nursing)
  3. Medical Practitioner fee
  4. Physiotherapy
  5. Investigation
  6. Diagnostics procedures (for the current admission only)
  7. Medicines (prescribed by the treating Doctor)
  8. Intravenous fluids
  9. Blood transfusion
  10. Injection
  11. Administration charges
  12. Consumables
  13. OT charges
  14. Prosthetics and other devices
  15. ICU charges
  16. Pre-hospitalization Medical Expenses
  17. Post-hospitalization Medical Expenses
  18. Day Care Treatment
  19. Ambulance fee
  20. Organ Donor expenses
  21. Domiciliary hospitalization
  22. AYUSH treatments
  23. Free Health Check-up (for a claim-free year if the persons aged above 18 years)
  24. Maternity expenses
  25. 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)
  26. Hospital Cash (if hospitalization is up to 7 days)
  27. Recovery Benefit (if hospitalization is up to 10 days)
  28. Shared accommodation benefit (if you have spent 24 hours in shared accommodation)
  29. 100% of the Sum Insured will be recovered with the Restoration benefit

Exclusions from Edelweiss Health Insurance

  1. 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.
  2. Expenses for new-born
  3. Sterility and Infertility
  4. Treatment from a non-qualified Medical Practitioner
  5. Ear examinations
  6. Dentures
  7. Artificial teeth
  8. Investigation & Evaluation (primarily for diagnostics and evaluation that is not incidental to the current diagnosis and treatment)
  9. Rest Cure, rehabilitation and respite care
  10. External prosthesis
  11. Corrective devices
  12. External durable equipment like wheelchairs, walkers, crutches, ambulatory devices, and oxygen concentrators for asthmatic conditions.
  13. Treatments at health hydros, nature cure clinics, or spas
  14. Acupressure
  15. Acupuncture
  16. Magnetic therapy
  17. External Congenital Anomaly/Illness/defects
  18. Cosmetic or Plastic Surgery
  19. Cost of spectacles
  20. Contact lenses
  21. Hearing aids
  22. Eye & Ear examinations
  23. Refractive Error less than 7.5 dioptres
  24. Change of Gender
  25. Circumcision (unless necessary for the treatment)
  26. Vaccination
  27. Vitamins, Minerals, and Organic substances (if not prescribed by a medical practitioner)
  28. Donor treatment in case of a transplant surgery
  29. Unproven Treatments
  30. Illness or injury due to War, invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, etc.
  31. If you breach law with a criminal intent
  32. Alcoholism, drug or substance abuse
  33. Injury or illness from Nuclear, chemical or biological attack
  34. Hair fall treatment and products
  35. Stem cell transplantation
  36. Injury or illness due to participation in hazardous or adventure sports
  37. Obesity and Weight Control
  38. 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:

  1. 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.
  2. Recharge – Using this optional benefit, you can top-up the Sum Insured by 100%. It will be available for GOLD & PLATINUM Plans.
  3. 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.

  1. Entry Age: 3 months to 65 years (although in the PLATINUM plan, there is no maximum entry age limit)
  2.  Policy Term: 1, 2 and 3 years
  3. Premium Payment: Single
  4. The number of people allowed for coverage in an individual plan: Eight including the policyholder
  5. 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.

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