General Insurance

ProHealth Group Insurance Policy

Eligibility Criteria

Minimum Entry Age No age bar
Maximum Entry Age No age bar



ProHealth Group Insurance Policy offers superior health solution with base hospitalization cover and easy to use optional benefits. ProHealth Group Insurance Policy base cover includes:

  • In-patient hospitalization expenses
  • Day care treatment
  • Pre & Post hospitalization
  • Ambulance cover
  • Domicliary hospitalization
  • Donor expenses cover

Product Features

Key Features

Sum Insured

Sum Insured is the amount of cover provided by the insurance company.
The plan provides a cover of Rs. 4.5, 5.5, 7.5, 10 lakhs.
In-patient hospitalisation

This covers hospitalisation expenses due to an illness or accident.
The plan covers hospital accommodation up to Single private room, charges for stay in Intensive Care Unit, related hospitalization expenses such as surgeon’s fees, nursing, anesthesia, blood, oxygen, operation theater charges, surgical appliances, medicines, drugs and consumables up to the sum insured.

It covers the medical expenses due to an illness before the insured is hospitalised.
The plan covers pre-hospitalisation expenses of up to 60 days.

It covers the medical expenses due to an illness after the insured is discharged from hospitalisation.
The plan covers post-hospitalisation expenses of up to 180 days.
Health check-up

A free medical check-up is provided by the insurance companies to its policyholders.
This plan provides free health check-up every year excluding 1st year.
Room Rent

Room rent specifies the sub-limit on room rent charges you can avail in case of hospitalisation.
In the event of hospitalisation, the policyholder is entitled to a single private room under this plan.

Other Features

Day Care Treatments

These are treatments that don’t require a 24-hr hospitalisation and conducted in a hospital or day-care center.
This plan covers the expenses of day care treatments up to Sum Insured.
Ambulance Cover

In case of an emergency, the ambulance charges are covered by the insurance company.
Ambulance expenses up to Rs. 3,000/- hospitalization is covered under this plan.
Ambulance Cover

In case of an emergency, the ambulance charges are covered by the insurance company.
Ambulance expenses up to Rs. 3,000/- hospitalization is covered under this plan.
The plan covers domiciliary hospitalization up to Sum Insured.
Restoration of Sum Insured

Under this feature, the policyholder’s entire sum insured is automatically restored back to him upon exhaustion of the limit of the coverage during the policy period.
If the policyholder’s basic sum insured inclusive of the no-claim bonus is exhausted, he will be automatically provided with 100% of sum insured.
No-claim Bonus
If the policyholder does not make any claim during the year, he is entitled to a bonus in addition to his sum insured.
With every claim-free year, the plan provides an additional 10% bonus on sum insured.
Organ Donor Cover
The medical expenses for an organ donor's treatment in the event of organ transplantation.
This policy covers the expenses for organ donor’s treatment up to Sum Insured.

Riders/ Optional/Add-on Covers


Reducing Maternity Waiting period

One can reduce maternity waiting period from 48 months to 24 months

Waiver of mandatory co-pay

Waiver of mandatory co-payment of 20% for insured persons aged 65 years and above

Critical Illness

Persons between 18 to 65 years can opt for Critical Illness cover as add-on benefit. The company will give a lump sum amount equal to Sum Insured in case of first diagnosis of the covered critical illnesses. In case of a family floater policy, once a claim has been paid for a critical illness under this benefit, the company will provide for 100% reinstatement of Sum Insured once during the lifetime of the policy for the other person covered.

Cumulative Bonus Booster

If opted, an additional Sum Insured of 25% will be added as cumulative bonus at the time of renewal in case there is no claim in the expiring policy. Maximum accumulation is up to 100%. This benefit is available in place of cumulative bonus.



  • Genetic Disorder
  • Sexually transmitted disease or illness
  • Artificial Life Maintenance
  • Mental disorders (including treatments for mental health)
  • Eye Cover
  • Dental Cover
  • Daily Cash
  • Alternative Practice
  • Recovery Benefit



Can I increase/decrease the sum insured or change the plan in my policy?

Alterations like increase or decrease in Sum Insured, change in plan will be allowed at the time of Renewal of Policy. However, any such change request will be subject to underwriting decision or requirement of medical tests on a case to case basis.


What do you mean by in-patient and out-patient treatment?

When an insured is hospitalized and stays in hospital for more than 24 hours solely for receiving treatment it is termed as in-patient treatment. Out-patient treatment is when insured visits a clinic/hospital or a consultation room for diagnosis and treatment based on the advice of medical practitioner. In out-patient hospitalization patient is not admitted under a day care or as an in-patient.


If I have a health insurance policy in one city, can I make a claim in another city?

Your health insurance policy is in force across India. You can check whether there is any network hospital near to your residence as well the city of your current location. Network hospitals are the hospitals that have tie-up with the Third Party Administrator for cashless settlement of claims. If there is no network hospital, you can opt for reimbursement mode of settlement.

Apart from this we also provide coverage in case of Emergency situations anywhere in the world.


What is a cumulative bonus booster?

It allows an increase in the Sum Insured by a fixed percentage of 25 % for a claim free policy period granted by the insurer. The maximum accumulation is upto 100%. This benefit is available with additional premium. Cumulative Bonus Booster if opted will be in place of Cumulative Bonus in the base policy.


Does the plan cover pre-existing diseases?

Pre-existing diseases/illness/injury/conditions will be covered post 24/36/48 months of continuous cover depending upon the plan opted.

Such waiting period shall reduce if the insured has been covered under a similar policy before opting for this policy, subject however to portability regulations.


How do you decide if a disease is a pre-existing one or not?

At the time of buying a health insurance you need to provide details of the illnesses you have suffered during your lifetime. The insurer refers such cases to their medical panel to differentiate between pre-existing and newly contracted illnesses.