Pregnancies can be an expensive affair but we've got you covered. Enjoy maternity cover upto two deliveries.
Enjoy new-born health cover including the expenses of vaccinations in the first year.
Cover your extended family, which can include up to 19 relations.
Exhausted your health cover? Not to worry. Simply reload your sum insured at no extra cost.
Enjoy cashless hospitalisation across our wide network of affiliated hospitals.
Unique combination of individual + floater sum insured in the same policy.
Never stress out about finding a suitable hospital. Our wide range of affiliated hospitals facilitates medical treatment all over India.
Experience a stress free claims process that allows you to focus on what matters most - recovering your health.
|Insured persons||Deduction amount|
|Self / spouse / children||Upto ₹25,000|
|Self / Spouse / Children / Parents (below 60)||Upto ₹50,000|
|Self / Spouse / Children / Parents (above 60)||Upto ₹75,000|
Key features of Family Plus are as mentioned below:
Coverage for 19 different relations in the same policy.
|Sum Insured (SI) INR(1)||Individual Base Sum Insured||2 lakhs | 3 lakhs | 5 lakhs | 10 lakhs | 15 lakhs|
|Floater Sum Insured||3 lakhs | 4 lakhs | 5 lakhs | 10 lakhs | 15 lakhs | 20 lakhs | 25 lakhs | 50 lakhs|
|BASELINE COVER(2)(3)||Inpatient Care||Covered up to Sum Insured|
|Pre And Post Hospitalisation Expenses||60/90 days, Covered upto Sum Insured|
|All Day Care Procedures||Covered up to Sum Insured|
|Organ Donor Expenses||Covered up to Sum Insured|
|OTHER BENEFITS||Ambulance Cover||Up to INR 4,000 per event of hospitalization for every insured member|
|No-Claim Bonus||20% of Base Sum Insured up to a max of 100%|
|Re-load of Sum Insured(4)||Up to Base Sum Insured, once during the policy year|
|Vaccination in case of Animal Bite(5)||Upto INR 5,000|
|Ayush Treatment(6)||Government Hospitals - Covered upto Sum Insured Other Hospitals - Covered upto Rs. 30,000|
|Domiciliary Hospitalisation(7)||Covered up to Sum Insured|
|Second Opinion for 11 specified CriticalIllness(8)||Available Once During The Policy Year|
|Emergency Domestic Evacuation (Bed To Bed on Advise of Treating Doctor)||Covered up to INR 100,000|
|HEALTH & WELLNESS||Health Check - up||Annual|
|Preventive Healthcare & Wellness(9)||Available|
|MATERNITY BENEFITS||Maternity Cover for up to 2 Deliveries(10)||INR 50,000|
|New Born Baby Cover||Base SI of mother|
|Vaccinations for New Born Baby in the first Year(11)||Up to INR 10,000|
|Nutritional Allowance for Mother post discharge(12)||Up to INR 10,000|
|CUSTOMER LEVEL OPTIONS||Hospital Cash (For 30 Days in case of Hospitalisation Beyond 2 Days)||INR 2,000 per day|
Note: Policy offers a combination of individual sum insured and floater sum insured in the same policy. Minimum 2 members need to be covered in the policy. The following relations of the proposer are allowed to be covered in the policy.
Spouse as long as he or she continues to be married to you, Son, Daughter-in-law, Daughter, Father, Mother, Father-in-law as long as your spouse continues to be married to you, Mother-in-law as long as your spouse continues to be married to you , Grandfather, Grandmother, Grandson, Granddaughter, Son-in-law, Brother, Sister, Sister-in-law, Brother-in-law, Nephew and Niece.
Customer has the option to choose from a wide range of Sum Insured's available as under:
|Type of Sum Insured||Sum Insured|
|Individual Sum Insured||Rs.2 lakhs, Rs.3 lakhs, Rs.5 lakhs, Rs.10 lakhs, Rs.15 lakhs|
|Floater Sum Insured||Rs.3 lakhs, Rs.4 lakhs, Rs.5 lakhs, Rs.10 lakhs, Rs.15 lakhs, Rs.20 lakhs, Rs.25 lakhs, Rs. 50 lakhs|
Organ Donor Expenses covers the expenses incurred on the hospitalization of the organ donor. All inpatient care expenses related to organ donor are covered, provided:
However, any other expenses related to acquisition of donor, related pre- and post-hospitalization expenses, and treatment of associated medical complications will not be covered Organ Donor Expenses are covered upto Sum Insured
If you ever exhaust your health cover due to claims in a given year and there is a further claim either by you for a different illness or your insured family member, we will reload the entire Individual sum insured of your policy at no extra cost. Reloaded sum insured will help you to settle those claims.
We will provide a Re-load equal to 100% of Individual Sum Insured of any one Insured Member. Re-load benefit will be applicable as under:
Initial Waiting Period is the cooling period applied at the start of new policy. This waiting period is not applicable for renewal policy or portability policy. Only Accidents are covered in the Initial Waiting period. Under Family Plus Policy, there is an Initial Waiting Period of 30 days. Pre Existing Disease waiting period is the waiting period applied for any of the existing disease customer is suffering from. It will be for a period of 3 years in the Family Plus policy. With each policy year, the pre existing disease waiting period reduces by 1 year. Any claim related to pre existing disease hospitalization will not be covered in the policy during waiting period.
Family Plus has an Innovative feature of Geographical pricing wherein customer in Non-Metros pay lesser premium as compared to premium paid by Metro customers. Under the Family Plus Product, the Premium charged on the Policy will depend on the Sum Insured, Policy Tenure, Age, Policy Type, Zone of Cover and Optional Covers opted. Additionally the health status of the individual will also be considered and premium might be loaded depending on the health condition. For the purpose of calculating premium, the country has been divided into 2 Zones. Zone 1: Delhi/NCR, Mumbai (inc. Thane and Vashi), Bengaluru, Chennai, Pune, Hyderabad, Kolkata and Gujarat. Zone 2: Rest of India. A discount of 15% for members in Zone 2 will be applicable. Grid as below:
Note: Proposer address will be an only valid proof for availing benefit under zonal discount.
There are many out of pocket expenses like Cab charges, Attendant Food expenses, etc which are not covered under the normal Hospitalization policies. Hospital Cash pays a lump sum amount to cater to these miscellaneous expenses. We will pay for up to 30 days (Rs.2000/day) of hospitalization in a policy year if the stay of hospitalization is more than 2 days It is an optional cover and customer can opt for the Hospital Cash benefit at the time of new purchase or renewal.
If you are suffering from 11 critical illnesses as mentioned below and feel uncertain about your diagnosis or wish to get a second opinion of an expert/doctor, we arrange one for free of cost for you:
To avail this benefit, customer need to contact our Assistance Service Provider viz; M/s. Europ Assistance India Pvt. Ltd on contact no. 022 67872035. Service Provider will seek details viz; Policy no. of the customer, past medical reports etc. and after submission of all relevant details, second opinion will be arranged by Europ Assist within a period of 7 days from a Indian qualified Doctor. This benefit can be availed once by an Insured Person during a Policy Year and once during the lifetime of an Insured Person for the same illness.
We will pay for transportation expenses from one Hospital bed to another Hospital bed in case of life threatening emergency condition for treatment of an Illness or Injury which is admissible and payable under the Policy. Our maximum liability will be limited to Rs. 1 Lakh and will be part of overall sum Insured; This benefit can be availed once by an Insured Person during a Policy Year. This benefit is on per Insured Person basis. For example: While on a road travel, Insured Person meets with an Accident and he is admitted to nearest government hospital and looking at the emergency condition, hospital has advised him to transfer to some hospital in Jaipur. Europ Assist our service provider will arrange for an air ambulance alongwith a trained team of doctors. Royal Sundaram will pay a maximum of Rs. 1 lakh and balance amount will be required to be paid by immediate kin of the patient directly to Europ Assist.
Family Plus offers 20% of Individual Sum Insured up to a max of 100%. Unlike NCB offered by other policies, there is no penalty in case of claim. Thus NCB earned by you remains as is even if you claim. For eg, if you have a policy with Individual SI of Rs.5lakhs and there has been no claim in the first year, then at the time of renewal you will get a NCB of 20% (Rs.1lakh). In second year, if you claimed then on second renewal your NCB of Rs.1lakh will remain intact and it will not be reduced. If there is a claim by any one member, then the NCB will not be given to any member in the renewal policy. NCB will not be applicable on Floater Sum Insured.
Family Plus is a medical underwritten product. This being a product offers guaranteed lifelong renewal needs to be medical underwritten at the time of first cover.
We will be having the 5 triggers basis which the case will be decided as STP or Non STP (which will flow into HUMS for further evaluation). The 5 triggers namely are -
The case will flow into HUMS if it triggers one of the above criteria and will be evaluated by a medical doctor. Suitable medical underwriting handles will be applied to mitigate the risk like
Post the case is referred to Medical Underwriting, Underwriters will ask the customers to undergo the medical tests. Medical tests will be arranged at the nearest center. In last three years, We have conducted tests at almost 35+ unique locations. Hence, we have large network of diagnostic centres for conducting medical tests.
Cost of medical tests will be borne by Royal Sundaram. Home visit can also be arranged for customers but the charges of Home visit will be paid by the customer. Approxi. Cost of home visit will be Rs. 250 and in case of more insured Person in the same house, max. cost of home visit will be Rs. 600.
Two steps of Medical underwriting:
We have a team of qualified doctors who calls up customers on their respective contact numbers to know about material information about their medical history, any medicines etc. customers is taking.
Typically, calls to the customers are made between 9.00 am. To 6.00 pm. From Monday to Friday.
Under Family Plus Product, there will be multiple rounds of tele underwriting since it may not be possible for the proposer to possess medical information of all Insured Person(s). example: Son-in-law may not be aware of medicines taken by his mother-in-law.
Post tele underwriting and performing medical tests, there could be counter offer sent to the customers with some loading or co-pay applied on specific 18 conditions listed hereunder.
Note: Co-pay is applied at Insured level and Loading is applied at policy level. Please note that Royal Sundaram is really scientific in Medical underwriting and any Loading or copay are applied in the form of ICD codes known worldwide. India being a country with big population of Chronic diseases patients and Family Plus is a product where we are able to offer cover to customers with chronic diseases by applying loading/copayment instead od straight away rejection of the proposal.
|Age/Sum Insured||Cumulative SI upto Rs.10lakhs||Cumulative SI above Rs.10lakhs|
|Upto 50 years||No Check-up||Set 1/Set 2|
|51 years and above||Set 1/Set 2||Set 1/Set 2|
The above grid is valid subject to no adverse declaration. If there is any adverse declaration then the case will move to medical uw in any case and subject to further medical tests. The battery of tests will be selected from the 2 groups - Set 1 or Set 2 depending on the doctors assessment post tele uw.
Cumulative sum insured is defined at individual level, which means that if customer opts for 2L individual and 5 L floater then the case will not move for uw as per above grid as at individual level the cumulative SI is < 10L (subject to no adverse declaration to health questions). Once the Cumulative SI crosses 10L the case will move to medical uw bucket. If there are 4 members in the family it doesn't mean that we add the total of all the individual sum insured and the floater to decide whether the case is STP or not. It has to be at individual level.
|Age/Sum Insured||Cumulative SI upto Rs.20lakhs||Cumulative SI above Rs.20lakhs|
|Upto 60 years||No Check-up||Set 1/Set 2|
|61 years and above||Set 1/Set 2||Set 1/Set 2|
Set 1: CBC, ESR, URA, MER, FBS/HbA1C, S Cholesterol, ECG, SGPT, S Creatinine Set 2: CBC, ESR, URA, MER, HbA1C, Lipid Profile, TMT or 2D Echo, LFT with GGT, RFT, HBsAg, S Creatinine
You can buy 2 years or 3 years policy in Family Plus. You get a discount of 7.5% for 2 year policy tenure and 12% for 3 year policy tenure.
Family Plus will support the external as well as internal portability. You can port your existing policy from National Insurance subject to our underwriting policy.
You can either buy a fresh policy of Family Plus or port the existing policy.
No. There is no such restriction. The porting benefit will be given in Family Plus, up to your existing policy SI + Cumulative Bonus if any.
Maternity Expenses: For this benefit, atleast one adult member need to be covered in the policy at the time of first inception under the same Family Floater Policy. We pay Medical Expenses for the delivery of a child, only after 24 months of continuous coverage of mother since the inception of the first Policy with Us. The waiting Period of 24 months will start only after two adults are covered under the policy.
In case, customer is porting from any other policy providing maternity benefit, the respective waiting period served in that policy will be considered as waiting period waiver in Family Plus policy as per portability guideline. Maternity benefits are paid a maximum of Rs. 50,000 per delivery only for two deliveries for each female member covered during the lifetime of the Policy including any of its renewals. However, expenses in respect of harvesting and storage of stem cells are not covered.
Miscarriage will not be payable as a part of Maternity Benefit Claim.
Miscarriage can occur as a result of:
If Miscarriage happens due to an internal injury/sickness/stress, it is not payable. However, it is payable when Miscarriage happens due to an accident.
New Born Baby: The new born baby will be covered as an insured person from birth. We will cover medical expenses towards the medical treatment of the Insured Person's new born baby while the Insured Person is Hospitalized as an Inpatient for delivery and we have accepted the maternity claim as payable. This benefit is equal to Individual Sum Insured of the mother. Post the expiry of the policy, new born need to be added as a separate member in the policy at the time of renewal.
Vaccination for New Born Baby: We will cover expenses for vaccination of the new born baby upto a limit of Rs. 10,000, if we have accepted the maternity claim as payable. If the Policy Period ends before the New Born Baby has completed one year, then, We will only cover such vaccinations until the baby completes one year, provided that We have accepted the baby as an Insured Person at the time of renewal of the Policy. This benefit is over and above the maternity benefit.
For example: Let us say child birth date is January 2, 2018 and the policy expiry date is April 13, 2018 and vaccination expenses paid till April 13, 2018 is Rs. 3500. Hence, for the rest of the charges to be paid, new born needs to be enrolled at the time of the renewal as a separate member in the policy.
|Time interval||Vaccination to be done (age) #||Frequency|
|Vaccination for first year|
|0-3 months||BCG (From birth to 2 weeks)||1|
|OPV (0,6,10 weeks) OR OPV + IPV1 (6,10 weeks)||3 OR 4|
|DPT (6 & 10 week)||2|
|Hepatitis-B (0 & 6 week)||2|
|Hib (6 & 10 week)||2|
|OPV (14 week) OR OPV + IPV2||BCG (From birth to 2 weeks)||1 OR 2|
|DPT (14 week)||1|
|Hepatitis-B (14 week)||1|
|Hib (14 week)||1|
|9 months||Measles (+9 months)||1|
|12 months||Chicken Pox(12 months)||1|
Nutrition allowance for mother post discharge
Pre Hospitalization covers the medical expenses incurred before hospitalization for Diagnostic Test, Medication, etc Post Hospitalization covers the medical expenses incurred on follow up visit with doctor, medication, further investigative test, etc Pre & Post Hospitalization expenses are covered upto Sum Insured
Vaccination in case of Animal Bite covers the expenses incurred by you upto a maximum of Rs. 5000 to take vaccination in OPD. For eg, in case of Dog Bite, Monkey bite, Honey bee bite, you need to take vaccination at regular interval which is an OPD procedure. Family Plus will cover the expenses incurred on vaccination upto Rs. 5,000. This will be paid on reimbursement mode post submission of bills. It does not cover the medicines, bandages or other expenses incurred while taking the vaccination.
We will cover the cost of health check-up arranged by us through our empaneled service providers as per your plan eligibility defined below: This benefit can be availed at each renewal.
|Annual Health Check-up||List of Medical Tests|
|Complete Blood Count, Urine Routine, ESR, Fasting Blood Sugar, Lipid Profile, Kidney Function Test, ECG, Complete physical examination by Physician|
Abbreviation of test is provided here: ESR - Erythrocyte Sedimentation Rate, ECG - Electrocardiogram, S Cholesterol - Serum Cholesterol, SGPT - Serum Glutamic Pyruvate Transaminase, TMT - Tread Mill Test This benefit is available to those insured person who have attained the age of 18 years or above on the Policy Period Start Date. This benefit is provided irrespective of any claim being made in the Policy Year. This benefit is over and above the Individual Sum Insured.
We will cover the expense incurred on an ambulance offered by a hospital or ambulance service provider for transferring you to the nearest hospital provided we accept the inpatient care claim for the given hospitalization. It is covered up to Rs.4000 per event of hospitalization for every Insured member. Expenses incurred on Hearse Van will be payable if inpatient claim is admissible.
Prosthetic Implants are artificial substitutes for body parts, and materials inserted into tissue for functional, cosmetic, or therapeutic purposes. Prostheses can be functional, as in the case of artificial arms and legs, or cosmetic, as in the case of an artificial eye. Implants, all surgically inserted or grafted into the body, tend to be used therapeutically. These are covered in Family Plus.
There are certain conditions for which customer can wait for treatment and does not need immediate medical treatment. Family Plus has 2 years waiting period for 17 conditions as mentioned below:
Family Plus is a carefully medical underwritten product and have an option to cover Chronic disease patients post carrying out medical underwriting of the Proposal. Either co-pay or loading may be applied on the proposal post evaluation of the proposal. Family Plus can be offered to almost all major illnesses viz; Diabetes, Heart conditions, Hypertension, Chronic renal failure, Epilepsy, Stroke, Glaucoma, Asthma etc.
We can cover all members, except your aunt in Family Plus. Aunt can be covered under a separate Lifeline Policy on Individual basis.
Ventillator treatment is covered if the person is not brain dead.
Any hospitalization due to these natural calamities like Vardah is covered
Yes. There is no capping on room rent category and customer can choose from any of the room available in hospital
Expenses which are not related to hospitalization are normally not covered. Please refer to policy document for details of exclusion.