Advanced Top Up Health Insurance Plan

Inpatient care is provided in a hospital where patients must be admitted for at least one or more nights depending on their condition.

• It will include all the expenses like room rent, boarding, and nursing expenses as provided by the hospital / nursing home.
• Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses.
• Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees whether paid directly to the treating doctor / surgeon or to the hospital.
• Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, costs towards diagnostics, diagnostic imaging modalities, and similar other expenses.

The modern treatment mainly includes Uterine Artery Embolization and HIFU (High intensity focused ultrasound) Balloon Sinuplasty, Deep Brain Stimulation, Oral Chemotherapy, Immunotherapy - Monoclonal Antibody to be given as an injection, Intravitreal injection, Robotic surgeries, Stereotactic radio surgeries, Bronchial Thermoplastic, Vaporisation of the prostrate (Green Laser Treatment or Holmium Laser Treatment), IONM - (Intra Operative Neuro Monitoring), Stem Cell Therapy: Hematopoietic Stem Cells for bone marrow transplant and haematological conditions to be covered.

It includes all the expenses which are incurred before the patient is hospitalised due to certain diseases.

The company shall cover all types of Pre-hospitalisation medical expenses that are mainly related to an eligible hospitalisation requiring inpatient care for a fixed period of 60 days before the date of hospitalisation covered as per the insurance policy.

Post hospitalisation expenses include all the medical expenses incurred by the patient once the patient has been discharged from the hospital.

The company shall pay for the post-hospitalisation medical expenses incurred related to an eligible hospitalisation requiring inpatient care, for a fixed period of 90 days. It is from the date of discharge from the hospital, following an admissible hospitalisation covered under the policy.

Day care treatments include treatment procedures that require hospitalisation for less than 24 hours.

We will cover the medical expenses of an insured person up to the sum Insured in case of any medically necessary day care treatment or surgery that requires less than 24 hours of hospitalisation. Any OPD treatment undertaken in a hospital / day care center will not be covered.

Pre and Post-hospitalisation medical expenses are payable up to 30 days under this policy.

We will cover inpatient care medical expenses towards the donor for the harvesting of the organ donated. organ donor expenses will be covered within the sum Insured for the patient who has been insured with us, i.e., the recipient of the organ (who is undergoing the transplant).

• the organ donor is any person in accordance with the Transplantation of Human Organs Act, 1994 and other applicable laws.
• the organ donated is for the use of the insured person who has been asked to undergo an organ transplantation on medical advice.
• we have admitted a claim towards inpatient care.

Domiciliary hospitalisation can be opted by the patient when they are not in a state to be moved to hospital. Due to this, the patient takes treatment at home.

We will cover medical expenses up to the sum Insured for medical treatment taken at home if this continues for an uninterrupted period of 3 days. The condition for which treatment is taken would otherwise have necessitated hospitalisation as long as either.

• the attending medical practitioner confirms that the insured person could not be transferred to a hospital or
• the insured person satisfies us that a hospital bed was unavailable.
• if a claim has been accepted under this benefit, the claims for pre and post-hospitalisation medical expenses are payable up to 30 days under this benefit.

The company shall indemnify medical expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) systems of medicine during each policy year up to the sum insured in any AYUSH Hospital.

We will cover reasonable and customary charges for ambulance expenses that are incurred towards transportation of an insured person by surface transport following an emergency to the nearest hospital with adequate facilities.

We will also cover charges for app-based cabs service incurred towards transportation of an insured person when getting admitted to the Hospital.

We will provide you with a second opinion from a medical practitioner if an insured person is diagnosed with a critical illness during the policy period. The expert opinion would be directly sent to the insured person.

We shall cover the treatment expenses for the insured person's treatment at their home in case of pandemic / endemic / any other exceptional circumstances.
Home Care Treatment is limited up to ₹50,000 per event per insured person and ₹1 Lakhs per policy year, per insured person.

In the event of a life-threatening condition, if the sum Insured becomes insufficient, we will give an additional amount for any claim admissible up to the limits specified in the policy. This additional amount is denoted as the life protect benefit.

• This benefit is available only in the event of a life-threatening condition.
• Certification by the treating medical practitioner of such a life-threatening emergency condition is necessary.
• Our maximum liability will be limited to 10% of the sum Insured per policy year.