Health Insurance October 15, 2020

As per the IRDAI regulations, there is a sub-limit on room rent and ICU charges in a health insurance policy. This could make it difficult for you sometimes to meet medical expenses. Therefore, if you buy a health insurance policy that does not have any limits on the room rent and ICU charges & expenses, it will help you immensely. With no capping, you can choose a room that is comfortable for you without worrying about hospital bills. Here in this post, you will know about the policies for which the insurer has not put a limit on room and ICU charges. Let’s read on!.

Health Insurance

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HDFC Ergo My Health Suraksha Plan

HDFC ERGO My Health Suraksha insurance is a new health insurance plan that gives you 360-degree protection against medical expenses. This insurance is for individuals, their families, as well as senior citizens. The cover amount ranges from INR 3- 5 lakh.

These are the list of benefits which the user will get in this policy:-

  1. Sum insured rebound is a backup that recharges your exhausted sum insured to treat you and other insured persons under this policy.
  2. If you like, you can pay the policy premium in monthly installments
  3. No capping for room rent and ICU charges
  4. No pre-medical check-up up to the age of 45 years
  5. Cashless home health care facility for the policyholder if a doctor or medical Practitioner under whosoever is treating you recommends a home treatment.
  6. Pre and Post-hospitalization expenses- The insurer will pay for all medical costs up to 60 days before admission to the hospital/nursing home and post-discharge expenses till 180 days that includes costs of diagnostics, investigation, etc.
  7. Daycare procedures where hospitalization is less than 24 hours
  8. Therapy treatments like Ayurveda, Unani, Siddha, Ayush and Homeopathy
  9. Covers medical and surgical expenses of the organ donor when the insured is harvesting an organ transplant for the surgery or treatment for an illness or injury
  10. When you stay in a hospital for more than 10 days at a stretch, the insurer will pay for other financial losses that might have occurred due to your absence at home. Doing this will help take care of other expenses during your hospitalization, subject to the amount as specified in the policy wording.
  11. Hospitalization due to physical illness or injury
  12. Accidental hospitalization
  13. Hospitalization for mental illnesses
  14. Free health check-up within 60 days at the time of renewing your policy
  15. Tax saving up to INR 75,000
  16. Lifetime renewability
  17. No entry age restrictions

Exclusions

The insurer will not pay for the following expenses:-

  1. Adventure sport injuries
  2. Self-inflicted injuries
  3. War-related injuries or illness
  4. Illness or injury due to participation in defence operations
  5. Venereal or sexually transmitted diseases
  6. Obesity or cosmetic surgery/treatment

Waiting Period

Under these, few illnesses and treatments are covered after 2 years of the policy issuance. And some of the declared or accepted pre-existing conditions at the time of policy application will be covered after the first 3 years of policy continuation.

Max Bupa Health Companion Individual Health Insurance Plan

Max Bupa Health Insurance Company Limited offers customers an individual health insurance plan with 3 different sum insured variants. You can choose a plan that meets your needs. The following is the list of Max Bupa Health Companion – Individual Health Insurance Plan variant.

Variant 1 –

  1. Cover available from INR 3 to 4 lakh
  2. Covers in-patient care expenses up to the sum insured
  3. Free health check-up once in 2 years
  4. Hospital cash benefits up to INR 1,000 per day
  5. Policy premium starts from INR 5,085 per year

Variant 2-

  1. Cover available from INR 5 to 12.5 lakh
  2. Covers in-patient care expenses up to the sum insured
  3. Free annual health check-up
  4. Hospital cash benefits up to INR 1,000 per day
  5. Policy premium starts from INR 5,085 per year

Variant 3 –

  1. Cover available from INR 15 lakh to 1 Crore
  2. Covers in-patient care expenses up to the sum insured
  3. Free annual health check-up
  4. Hospital cash benefits up to INR 4,000 per day
  5. Policy premium starts from INR 5,085 per year

Coverage Under Max Bupa Health Companion – Individual Health Insurance Plan

The insurer will pay the insured for the following expenses.

  1. Daycare treatments
  2. Pre and post-hospitalization
  3. No room rent capping except for suites for sum insured INR 5 lakh or above
  4. Health check-up based on your needs
  5. 20% addition on your sum insured for each claim-free year
  6. Ayurvedic, Unani, Siddha and Homeopathic treatments

Exclusions from Max Bupa Health Companion – Individual Health Insurance Plan

The insurer is not liable to pay for the following expenses –

  1. Ancillary hospital charges
  2. Hazardous activities
  3. Artificial life maintenance
  4. Behavioral, Neurodevelopmental and Neurodegenerative Disorders
  5. Circumcision
  6. AYUSH treatments, except for Ayurveda, Unani, Sidha and Homeopathy
  7. Conflict and disaster
  8. External congenital anomaly
  9. Convalescence and rehabilitation
  10. Cosmetic and reconstructive surgery
  11. Dental or oral treatment
  12. Eyesight and optical services
  13. Experimental or unproven treatment
  14. HIV, AIDS, and related complexities
  15. Unjustified hospitalization
  16. Inconsistent, irrelevant, or incidental diagnostic procedures
  17. Mental and psychiatric conditions
  18. Non-medical expenses
  19. Obesity and weight control programs
  20. Off- label drug/treatment
  21. Puberty and menopause-related disorders
  22. Reproductive medicine and other maternity expenses
  23. Robotic-assisted surgery
  24. Light amplification by stimulated emission of radiation (LASER)
  25. Light-based treatment
  26. Sexually transmitted infections and diseases
  27. Sleep disorders
  28. Substance-related and addictive disorders
  29. Unlawful activities
  30. Treatment received outside India
  31. Unrecognized physician or hospital

Reliance HealthGain Health Insurance Policy

HealthGain is a Health Insurance policy provided by Reliance General Insurance Ltd. It gives cover to an Individual as well as his/her families with benefits like cashless hospitalization, the sum insured reinstatement, pre and post hospitalization expenses, and much more.

The policy covers the following expenses –

  1. Pre and post-hospitalization
  2. In-Patient Treatment
  3. Daycare Treatment
  4. Road Ambulance
  5. Donor Expenses
  6. Domiciliary Hospitalization

Under this policy, a single room is defined as a room where only a single patient is accommodated that has an attached toilet. The room should also have a provision for accommodating an attendant to the patient. This is a basic type of room in a hospital. Any room, beyond this description, will be excluded from the health insurance policy as per the terms and conditions. The insurer does not put a limit on the health insurance for room and ICU charges.

The following are the expenses for which the insurer won’t pay –

  1. Intentional self-injury
  2. Injury under the influence of alcohol or drugs
  3. Criminal acts
  4. Treatment Outside India
  5. Robotic treatment
  6. Stem Cells transplant
  7. War, nuclear, chemical, or biological injuries
  8. HIV, AIDS or STDs
  9. Congenital diseases (from birth)
  10. Maternity or Fertility related conditions
  11. Cost of spectacles, contact lenses and hearing aids
  12. Dental treatment/surgery
  13. Mental illness treatment
  14. Cosmetic or aesthetic treatment
  15. Non-allopathic, diagnostics, self-medication and unproven treatments​​

The following is the list of illnesses or treatments covered under this policy post waiting period, which runs for 24 months.

  1. Non-infective Arthritis
  2. Osteoarthritis and Osteoporosis
  3. Gout
  4. Rheumatism
  5. All Vertebrae Disorders (including, but not limited to, Spondylitis, Spondylosis, Spondylolisthesis and Intervertebral Disc Prolapse)
  6. Joint Replacement Surgery
  7. Benign Ear, Nose and Throat (ENT) (including, but not limited to Adenoidectomy, Mastoidectomy, Tonsillectomy and Tympanoplasty)
  8. Nasal Septum Deviation Sinusitis (and its related disorders)
  9. Benign Prostatic Hypertrophy
  10. Cataract
  11. Surgery of Genito-Urinary System (unless it is necessitated by malignancy)
  12. All types of Hernia and Hydrocele
  13. Internal Tumours
  14. Skin Tumours
  15. Cysts
  16. Nodules
  17. Polyps
  18. Breast lumps (each of any kind)
  19. Kidney Stone
  20. Ureteral Stone
  21. Lithotripsy
  22. Gallbladder Stone

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