Health Insurance 201 views May 12, 2021

Future Aarogya Bima Plan provides coverage to your entire family from a newborn of day 1 to a person aged 70 years. You can purchase this plan on an individual or family floater basis. Key features of the Future Aarogya Bima Plan are –

  1. In-patient Cover
  2. Coverage for Other Medical Expenses 
  3. No Pre-Acceptance Medical Tests (Age <= 50 years)

Continue reading this page below and learn more about the benefits, terms and conditions of the Future Aarogya Bima Plan.

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Future Aarogya Bima Plan In-patient Cover

You will get coverage for the following medical expenses during your in-patient hospitalization –

  1. Room rent, boarding and nursing expenses up to 1% of the sum insured per day for non-ICU rooms
  2. Medicines & drugs, diagnostic materials and X-ray, Operation Theatre Charges, etc.
  3. Consultants and Specialists Fees

Future Aarogya Bima Plan Other Coverages

Other than the in-patient care coverage, the insurer will cover day care treatments, pre and post-hospitalization medical expenses. Pre and post-hospitalization expenses are covered up to 60 days before the date of admission and up to 90 days from the date of discharge from the hospital, respectively. The combined coverage for pre and post-hospitalization expenses is subject to 2% of the sum insured.

Eligibility Criteria for Future Aarogya Bima Plan

The plan comes with the following age criteria to meet –

  1. Minimum Entry Age of the Proposer – 18 years
  2. Maximum Entry Age of the Proposer – 70 years
  3. Minimum Entry Age of the Dependent Child – 1 day
  4. Maximum Entry Age of the Dependent Child – 25 years

Pre-Acceptance Medical Tests

No pre-insurance medical examination will be required if your age is up to 50 years. Whereas medical tests are mandatory if your age is 51 years and above. As per the policy terms and conditions, 50% of the pre-insurance medical test charges will be reimbursed in case of policy issuance.

Note – The medical report is valid for 30 days from the date the tests are conducted in the Future Generali empanelled diagnostic centre.

Exclusions from Future Aarogya Bima Plan

The insurer won’t cover the medical expenses if they arise due to the following –

  1. Any condition, ailment, injury signs/symptoms before the date of inception of the policy or any condition related to the diagnosis for which you have already received medical treatment
  2. Any illness diagnosed during the first 30 days from the date of commencement of the policy.
  3. Cataract, Hernia, Tumour, Gallstones, Renal stones, etc until the waiting period (24 months) expiry.
  4. Non-allopathic treatment
  5. Congenital External Illness/disease/defect/anomaly
  6. Sexually Transmitted Diseases, except treatment for AIDS and infection with HIV, will be covered after a waiting period of 48 months.
  7. Illness or injury arising out of alcohol or any narcotic substance abuse

Future Aarogya Bima Plan Basis of Claims Payment

The insurer will make payment as per the applicable conditions –

  1. 10% co-payment on every claim excluding pre and post-hospitalization claims
  2. You have the option to choose an additional co-payment of 20% or 30% which will provide you a discount on the premium payment
  3. If you opt for a room with higher rent, 15% co-payment will apply to room, boarding, nursing expenses, associated medical expenses (excluding pharmacy, consumables, implants, medical devices and diagnostics)
  4. Upon admission to a Non-ICU room and the room rent limit being higher than the one mentioned in the policy document, the co-payment shall be applicable on the total associated medical expenses excluding pharmacy, consumables, implants, medical devices and diagnostics
  5. If you are admitted to ICU during the hospitalization and later shifted to a Non-ICU room, no co-payment shall apply. However, if you are shifted to a Non-ICU room with a higher room rent limit, co-payment shall be applicable on the associated medical expenses.
  6. No co-payment is applicable in case of admission in an ICU room
  7. If you are admitted only to ICU during the entire hospitalization, the insurer will pay up to the actual expenses and no co-payment shall apply.
  8. Co-payments shall apply on associated medical expenses if the room rent is higher than the defined limit, except pharmacy, consumables, implants, medical devices and diagnostics
  9. Reasonable and customary charges are applicable only if Professional Fees, OT charges, etc are higher than the standard charges prevailing in your geographical area for identical or similar services, taking into account the nature of the illness/injury involved.
  10. Sub-limits apply to the following modern treatments – Uterine Artery Embolization and HIFU, Balloon Sinuplasty, Deep Brain stimulation, Oral chemotherapy, Immunotherapy- Monoclonal Antibody to be given as an injection, Intravitreal injections, Robotic surgeries, Stereotactic radio surgeries, Bronchial Thermoplasty, Vaporisation of the prostate (Green laser treatment or holmium laser treatment), Intra Operative Neuro Monitoring (IONM), Stem cell therapy for Hematopoietic stem cells for bone marrow transplant for hematological conditions.
  11. Co-payments don’t apply to modern treatments

Details of Future Aarogya Bima Plan

  1. If you choose an individual option, you can cover yourself, your spouse, up to 4 dependent children (Unmarried) and 2 dependent parents
  2. If you choose the family floater option, you can cover yourself, your spouse and up to 3 dependent children (Unmarried)
  3. You will be eligible for a discount of 5% and 10% for choosing a policy term of 2 years and 3 years, respectively.
  4. A family discount of 5% will be provided to you if you cover more than one member under an individual plan
  5. Sum insured options – INR 2,00,000, INR 3,00,000 5,00,000
  6. The minimum and maximum premium amount is INR 1,267 and INR 23,484, respectively, for an individual plan
  7. The minimum and maximum premium amount is INR 2,197 and INR 37,574, respectively, for a family floater plan
  8. You can pay premiums monthly, quarterly and half-yearly

Free Look Period

A free look period of fifteen days from the date of receipt of the policy document will be allowed to you during which you can review the terms and conditions of the policy and return the same if not acceptable. On such cancellation, you’ll be entitled to the following –

  1. Refund of the paid premium less medical examination expenses and stamp duty charges
  2. Where the risk has already commenced, a deduction towards the proportionate risk premium for the period of cover will be provided
  3. If only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage during such period will be refunded

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