| Key Features & Benefits of Diabetic Covrage Policy |
| Specialty Product |
Persons with Type I or Type II Diabetes Mellitus are covered |
| Age at Entry |
18 years to 65 years |
| Policy Type |
Individual or Floater 2A with spouse only (either of them diabetic ) |
| Renewal |
Life Long |
| Grace Period on Renewal |
30 days |
| Policy Term |
1 year |
| Sum Insured Options |
3 Lac; 4 Lac; 5 Lac; 10 Lac |
| Policy Options |
| Plan A - Issued after Medical Screening |
Lower Premium, Day 1 cover for Diabetes, No Sub Limits for cardio Vascular Disease, Higher OP Benefits |
| Plan B - Issued without Medical Screening |
30 days, 12 months and 24 months Waiting period for Diabetes coverage, Sublimt for Cardia vascular Disease,Lower OP Benefits, slightly Higher Premium |
| Plan Change |
Not allowed to change from Plan B to Plan A or vice versa |
| Sum Insured Enhancement |
SI can be enhanced on renewal - Subject to company's discretion - only when no claim lodged of paid - Waiting period will be applied on the enhanced Sum Insured |
| Section 1 - Diabetes related hospitalisation |
| Room Rent |
Single Standard A/C Room |
| ICU Charges |
Actual |
| Professional Fee |
Surgeon’s fees, Consultant’s fees and/or Anesthetist’s fees - Actual |
| Other Medical Expenses |
Actual |
| Ambulance Charges |
Rs. 2000 per policy period |
| Donor Expenses for Kidney Transplantation |
covered - Donor screening expenses and post-donation complications of the donor are not payable |
| Dialysis Expenses coverage |
At Rs. 1000 per sitting for 24 months from the month of dialysis recommendation |
| Cost of Artificial Limbs |
upto 10% of Sum Insured provided amputation surgery is admitted |
| Sublimit for Cardio Vascular related claims |
| Plan A |
No Sub limit for Plan A |
| Plan B |
Plan B - 3 Lac SI - Rs. 2 Lac ; 4 Lac SI - Rs. 2.5 Lac; 5 Lac SI - Rs. 3 Lac; 10 Lac SI - Rs. 4 Lac |
| Section 2 - Non-Diabetes Related Hospitalisation |
| Room Rent |
Single Standard A/C Room |
| ICU Charges |
Actual |
| Professional Fee |
Surgeon’s fees, Consultant’s fees and/or Anesthetist’s fees - Actual |
| Other Medical Expenses |
Actual |
| Ambulance Charges |
Rs. 2000 per policy period |
| Pre-hospitalisation Expenses Coverage (both diabetes related & Non-Diabetes related) |
30 days prior to hospitalisation - Actuals |
| Post-hospitalisation Expenses Coverage (both diabetes related & Non-Diabetes related) |
60 days prior to hospitalisation - (7% of nursing expenses, Surgeon/Consultant Fees, Diagnostic Charges, Cost of medicines and drugs with Max Rs. 5000) |
| Day Care Coverage |
All Day Care Procedures Covered |
| Sub-limit for Cataract Day Care Procedure |
SI can be enhanced on renewal - Subject to company's discretion - only when no claim lodged of paid - Waiting period will be applied on the enhanced Sum Insured |
| Sub-limit for Cataract Day Care Procedure |
| 3 Lac; 4 Lac; 5 Lac SI |
Rs. 20000 per event and Rs. 30000 per policy period |
| 10 Lac SI |
Rs. 30000 per event and Rs. 40000 per policy period |
| Copay - Hospitalisation on Package Cost basis |
No Copay |
| Copay - Age at entry more than 60 years |
No Copay |
| Section - 3 Outpatient Expenses coverage |
Benefits paid for the expenses at Network hospitals and Diagnostic Centres - Forms part of SI |
| 1. Cost of Fasting and Post Prandial and HbA1C tests |
once every six months – up to Rs.750/- per event up to Rs.1500/- per policy period |
| 2. medical consultation, other diagnostics, medicines and drugs |
| Plan A Individual |
3 lac - Rs. 1000; 4 Lac - Rs. 2500; 5 Lac - Rs. 3500; 10 Lac - Rs. 5500 |
| Plan B Individual |
3 lac - Rs. 500; 4 Lac - Rs. 2000; 5 Lac - Rs. 3000; 10 Lac - Rs. 5000 |
| Plan A Floater |
3 lac - Rs. 2000; 4 Lac - Rs. 3500; 5 Lac - Rs. 5500; 10 Lac - Rs. 7500 |
| Plan B Floater |
3 lac - Rs. 1500; 4 Lac - Rs. 3000; 5 Lac - Rs. 5000; 10 Lac - Rs. 7000 |
| Section 4 - Personal Accident Coverage |
| Accidental Death cover equal to medical Sum Insured |
For chosen Individual in the policy |
| Automatic Restortion - For Individual Policy only |
100% of Basic SI - on Exhaustion of Basic SI - can not be used for treatments for which claims already made - Restoration not available for Floater policies |
| Premium Reduction |
| 2A - Plan A |
20% |
| 2A - Plan A |
17% |
| 1A - Plan A |
17% |
| 1A - Plan B |
15% |
