Family Health Optima Insurance Plan

1. Affordable Premium – Family floater policy at an affordable premium

2. Get Extra Sum Insured – Get extra sum insured (auto recharge) at no extra cost

3. Health Checkup – Health Checkup benefit for every claim free year

4. Automatic Restoration – 3 times Automatic restoration of Sum insured by 100% each time upon complete exhaustion

5. Assisted Reproductive Treatment – Cover for Assisted Reproductive Treatment

6. New-born Baby – New-born baby cover from 16th day

7. Donor expenses cover – Donor expenses for organ transplantation

8. Day-care procedures – All day care procedures are covered

9. Grace Period – A grace period of 120 days from the date of expiry of the policy is available for renewal.

1. Policy Benefits:
   • Room, boarding and nursing expenses all inclusive as per the limits.
   • Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees, Oxygen, Operation Theatre Charges, ICU charges, Diagnostics, imaging modalities and Medicines and Drugs, Oxygen, Blood and Cost of pacemaker.
   • Ambulance charges for emergency transportation to hospital as per specified limits.
   • Air Ambulance charges upto 10% of the Sum Insured during the entire policy period.
   • Pre-Hospitalization expenses up to 60 days prior to admission in the hospital.
   • Post-hospitalisation expenses incurred up to 90 days after discharge from the hospital.
   • Domiciliary hospitalisation: Cover for medical treatment for a period exceeding three days.
   • Organ Donor Expenses: Cover upto 10% of the Sum Insured or Rupees One lakh, whichever is less.
   • Cataract: Expenses incurred on treatment of cataract is subject to the limits mentioned.
   • Cost of Health Checkup: Expenses incurred towards cost of health check-up up to the limits
   • New Born Baby cover: Cover starts from 16th day after birth and subject to a limit of 10% of the Sum Insured or Rupees Fifty Thousand, whichever is less


2. New Benefits:
   • Emergency Domestic Medical Evacuation: Company reimburse the expenses incurred towards transportation of the insured person from the treating hospital to another one upto the limits.
   • Compassionate Travel: The Company will reimburse the transportation expenses by air incurred upto Rs5000/- for one immediate family member (other than the travel companion) for travel towards the place where hospital is located.
   • Repatriation of Mortal Remains: The Company shall reimburse up to Rs.5,000/- towards the cost of repatriation of mortal remains of the insured person to the residence of the insured.
   • Treatment in Valuable Service Providers: In the event of a medical contingency requiring hospitalization, if the insured seeks advice from the Company, the Company may suggest an appropriate hospital from the network for treatment. If the insured accepts, an amount calculated at 1% of Basic Sum Insured subject to maximum of Rs.5,000/- per policy is payable as lumpsum.
   • Shared Accommodation: Upto the limits.
   • AYUSH treatment: Upto the limits.
   • Second Medical Opinion: The Insured Person can obtain a Medical Second Opinion from a Doctor in the Company’s network of Medical Practitioners
   • Assisted Reproductive Treatment: The Company will reimburse medical expenses incurred on Assisted Reproduction Treatment, where indicated, for sub-fertility
   • Waiting period of 36 months from the date of first inception of this policy is applicable.
   • Maximum liability of the Company for such treatment shall be limited to Rs.1 lakh for sum insured of Rs.5 lakh and Rs.2 lakhs for sum insured of Rs.10 lakhs and above for every block of 36 months.
   • Additional Sum Insured for RTA(Road Traffic Accident): If the insured person meets with a Road Traffic Accident resulting in in-patient hospitalization, then the Basic sum insured shall be increased by 25% subject to a maximum of Rs.5,00,000/- .This benefit is payable if the insured person was wearing a helmet and travelling in a two wheeler either as a rider or as a pillion rider


3. Automatic Restoration of Sum Insured : Available 3 times at 100% each time, during the policy period. Each restoration will operate only after the exhaustion of the earlier one.


4. Recharge Benefit: Available up to the limits.


5. Bonus: Following a claim free year bonus of 25% of the expiring basic sum insured in the second year and additional 10% for subsequent years (max.100%) would be allowed. Where there is a claim the Bonus would be reversed in the same order in which it was given.


6. Instalment Facility: Premium can be paid Quarterly and Half Yearly. Premium can also be paid Annually.

• Any person aged between 18 years and 65 years, residing in India, can take this insurance.
• Beyond 65 years only renewals
• Child from 16th day of age can be covered as part of the family.
• This policy is on floater basis. Family : Proposer, spouse, dependent children from 16 days up to 25 years (those who are economically dependent on their parents) , dependent parents and dependent parents in law.

Co-Payment: 10% of each and every claim for persons above 60 years at entry level and their subsequent renewals.

Tax Benefit: Amount paid by any mode other than by cash for this insurance is eligible for relief under Section 80D of the Income Tax Act.

Free look period:

At the time of inception of the policy, the Insured will be allowed a period of 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to return the policy if not acceptable. In such a case, the premium refund shall be as follows :

If the Insured has not made any claim during the free look period, the Insured shall be entitled to –

1. a refund of the premium paid less any expenses incurred by the Insurer on medical examination of the insured persons and the stamp duty charges
   or
2. where the risk has already commenced and the option of return of the policy is exercised by the policy holder, a deduction towards the proportionate risk premium for period on cover

   or

3. where only a part of the insurance coverage has commenced , such proportionate premium commensurate with the insurance coverage during such period. Free look period shall not be applicable at the time of renewal

_{^{Guaranteed Lifetime Renewals}}

Life-long renewals beyond 65 years are offered under this policy.

_^Co-Payment:

20% of each and every claim for insured persons whose age at the time of entry is 61 years and above.

_{^{Pre-Acceptance Medical Screening:}}

Persons above 50 years will be required to undergo pre-acceptance medical screening at the Company nominated centres. Cost of screening is currently borne by the company.

_{^{Pre-Existing Diseases/Illness:}}

Are covered after 48 months of continuous Insurance without break with Insurer.

NOTE: Renewal premium, terms and conditions are subject to change with prior approval from IRDAI.