The benefit package under the scheme is as follows:
a) Coverage for meeting expenses of hospitalization for medical and/or surgical procedures, including maternity benefit and new born care, to the enrolled families for up to Rs 30,000/- per family per year. The benefit to the family will be on floater basis, i.e. the total reimbursement of Rs 30,000/- can be availed individually or collectively by members of the family per year.
b) Coverage of meeting expenses of hospitalization for surgical procedures to the enrolled families for up to 1,75,000/- (in addition to Rs. 30,000) per family per year on family floater basis under Critical Care Package for treatment of Cardiac and Cardiothoracic Surgeries ,Genito Urinary Surgery, Neurosurgery, Radiation Oncology, Trauma, Transplant Surgeries, Spinal Surgeries, Surgical Gastro Enterology, Hemophilia and Cancer.
c) For Cancer Patients, the limit has been increases to Rs. 2,25,000/- per year
d) Pre-existing conditions/diseases are to be covered from day one (subject to some exclusions).
d) The scheme also covers some defined day care treatments/ procedures, which are surgical in nature.
e) Provision for transport allowance of 100 per hospitalization subject to an annual ceiling of 1000 shall be a part of the Basic Package. Also there is provision for transport allowance of 1000 per hospitalization subject to an annual ceiling of 3000 as a part of the Critical Care package. Both these allowances will be provided by the hospital to the beneficiary at the time of discharge in cash.
f) Pre and post hospitalization costs up to 1 day prior to hospitalization and up to 5 days from the date of discharge from the hospital shall be part of the package rates under basic package. Under critical care, pre and post hospitalization costs up to 15 day prior to hospitalization and up to 60 days from the date of discharge from the hospital shall be part of the package rate.
g) Screening and follow up care will be covered as separate day care packages. This will be separate from pre and post hospitalization coverage.
h) Maternity and newborn children will be covered as indicated below:
- It shall include treatment taken in hospital/nursing home arising out of childbirth, including normal delivery/ caesarean section and/or miscarriage or abortion induced by accident or other medical emergency subject to certain exclusions.
- Newborn children shall be automatically covered from birth up to the expiry of the policy for that year, for all the expenses incurred in taking treatment at the hospital as in-patient. This benefit shall be a part of basic sum insured and new born children will be considered as a part of the insured family member till the expiry of the policy.
- The coverage shall be from day one of the inception of the policy. However, normal hospitalization period for both mother and children should not be less than 48 hours post-delivery.