General Insurance

ProHealth Insurance Premier Plan

Eligibility Criteria

Minimum Entry Age 91 days for children, 18 years for adults
Maximum Entry Age No age bar
 
 

Benefits

Expert Opinion on Critical Illness

The plan covers the cost of an expert opinion on listed critical illnesses such as cancer or stroke before you decide on the best treatment or procedure.

 

Worldwide Emergency Cover

You might need to avail emergency medical assistance when you are abroad. The plan covers your medical expenses abroad up to the full sum insured on reimbursement basis.

 
 

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. 100 lacs
In-patient hospitalisation

This covers hospitalization 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.
Pre-hospitalisation

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

It covers the medical expenses due to an illness after the insured is discharged from hospitalisation.
The plan covers post-hospitalization 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 get any type of room except Suite room.
 

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.
This plan covers actual expenses paid per hospitalization event.
Domicilliary Hospitalisation

If a patient is in a condition that he cannot be moved to the hospital or there is lack of accommodation in the hospital, he is been treated at home and this process is known as domicilliary hospitalisation.
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.
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.

 
 

Exclusions

  • 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
 

FAQs

 

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.

 

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.