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Mediclaim – Family / Individual

Family Floater Mediclaim Policy covers the family members with one sum insured. All the terms and conditions of Individual Mediclaim Policy will be applicable for Family Floater Mediclaim Policy.

 

Who can take the policy?

This insurance is available to persons between the age of 18 years to 60 years. The persons beyond 60 years can continue their insurance provided they are insured under Mediclaim policy with our Company without any break.

• FLOATER BENEFIT means the Sum Insured as specified for the proposer under the policy, is available for any or all the members of his /her family for one or more claims during the tenure of the policy.
• The Family Floater Mediclaim Policy can be issued to the persons up to 60 years of age covering the following family members:
• Self
• Spouse
• Dependent children? Maximum two
• Parents/Parents-in law/ brothers and sisters are not covered under Family Floater Mediclaim Policy even if they are residing with the proposer.
• Sum Insured: Minimum Sum Insured is Rs. 2 lacs and Maximum Sum Insured is Rs 5 lacs.
• Premium: Premium is as per Individual Mediclaim Policy (2007). The basic premium will be as per highest age of the family member. Apply 50% loading for covering spouse, and 25% loading for covering each and every additional dependent child.

 

Group Medical Insurance

The policy covers hospitalization expenses for the treatment of illness/injury provided hospitalization is more than 24 hours. Pre-hospitalization expenses for 30 days and post hospitalization expenses for 60 days are also payable. Day-care treatment - The Medical expense towards specific technologically advanced day-care treatments / surgeries where 24 hour hospitalization is not required. Ambulance Charges for shifting the insured from residence to hospital are covered up to the limits specified in the policy. Ayurvedic/Homeopathic and Unani system of medicine are covered to the extent of 25% of Sum Insured provided the treatment is taken in the Registered Hospital. Pre-existing diseases are covered only after 4 continuous and claim free renewals with our Company. Pre-existing conditions like Hypertension, Diabetes, and their complications are covered after two years of continuous insurance on payment of additional premium.

 

Exclusions

• Diseases contracted within 30 days of insurance.
• Dental treatment except arising out of accident.
• Debility and General Run Down Conditions.
• Sexually transmitted diseases and HIV (AIDS).
• Circumcision, Cosmetic surgery, Plastic surgery unless required to treat injury or illness.
• Vaccination and Inoculation.
• Pregnancy and child birth.
• War, Act of foreign enemy, ionizing radiation and nuclear weapon.
• Treatment outside India.
• Naturopathy.
• Domiciliary Treatment.
• Experimental or unproven treatment.
• All external equipments such as contact lenses, cochlear implants etc.

 

Premium

Premium is based on age of the proposer and geographical area of treatment.

 

Special Features of the Policy

• Loyalty Discount.
• Good Health Discount.
• Income Tax Benefit under Section 80D of IT Act.

 

How to Avail Claim?

If a misfortune befalls, leave the worry to us but please intimate such loss/damage immediately to Zoom Insurance Brokers (insurance@zoominsurancebrokers.com) so that a Competent Surveyor may be deputed to minimize the loss. Claims are administered through Third Party Administrators (TPA) whose contact particulars appear on the policy document. Insured can opt for cashless or reimbursement facility for their claims. For more details please contact our nearest Office.