Swasthya Kavach (Family Health Policy)

  1. Scope of Cover

    The Policy offers a protection cover for you and your family for any injury or disease related contingencies like hospitalization, medical expenses, surgical expenses, Organ transplantation etc. The Policy covers the members of the Family consisting of you, your spouse and dependent children up to the age of 23 years on a floater basis. Coverage is under a single Sum Insured and no separate Sum Insured is required for each member of the Family. Thus each member of Family draws claim from the single Limit of Indemnity.

    For the first time in India, additional optional cover of Critical illness is also provided to the Family under a single sum insured on floater basis. The Policy is brought to You by ITGI at an affordable premium.

    The Policy provides the coverage for one year and is available under two plans viz. Base Plan and Wider Plan . The coverage features are as follows:

    Common Coverage under Base Plan and Wider Plan

    Hospitalisation expenses including Doctor’s fees, Cost of Medicines, Pathological Tests,etc.

    Pre-existing disease after 4 continuous Policy years with us.

    Prosthetic Devices like Pacemaker, Artificial Limbs etc.

    Transplants including Donor’s treatment and organs transplantation cost

    Dental surgery and treatment following an accident

    Defined Day Care Surgeries

    Vitamin and tonics consistent with illness

    Common Coverage under Base Plan and Wider Plan (with varying limits of Coverage)

    Hospitalisation expenses for Room and ICU Charges

    Pre-Hospitalisation and Post Hospitalisation expenses including authorized home nursing

    Ambulance service expenses

    Daily Allowance for defraying miscellaneous expenses for the duration of Hospitalisation

    Additional Coverage under Wider Plan

    Cumulative Bonus of 5% on every claim free year subject to maximum of 50%.It shall be reduced by 10% on each claim year subject to Basic Sum Insured being maintained.

    Health check up for Family after every block of 4 claim free years.

    Additional floater Critical Illness Sum Insured covering whole family.(Optional)

    Hospitalisation for Critical Illness, an Optional Extension providing additional coverage for major diseases such as Coronary Artery Disease, Renal Failure, Paralytic Stroke, Cancer, Major Organ Transplantation and Injuries leading to loss of limb(s) on payment of additional premium over and above the Basic Cover premium. The coverage is again on floater basis and claim is settled on reimbursement basis.

    Difference between Base and Wider Plan on the basis of features and benefits.

    S.no. Benefits Base Plan Wider Plan
    Cost of Health Check up N/A The reimbursement shall not Exceed the amount equal to 1% of the average Floater Sum Insured during the block of four claim free years of Insurance with Us.
    Daily Allowance Rs 150 per day Rs 250 per day
    Post – Hospitalisation medical expenses upto 7% of Hospitalisation expenses incurred up to max.30 days after Hospitalisation maximum to Rs 7500 Relevant medical expenses incurred up to 60 days after Hospitalisation on Disease/illness/ Injury sustained, which will be part of Hospitalisation expenses claim
    Restriction on other hospital expenses in accordance with the room rent. Applicable Not Applicable
    Ambulance charges Rs. 750/-or actual whichever is less Rs. 1500/- or actual whichever is less.
    Sub limit per day for normal Room expenses: 1.0% of the Sum Insured 1.5% Basic Sum Insured
    Sub limit per day for Intensive 2.0% of the Sum Insured 2.5% of Basic Sum Insured
    Additional Exclusions for first two continuous years of Policy Chronic Renal failure or End Stage Renal Failure. Covered
    Heart Disease.
    Any type of Carcinoma / Sarcoma/ Blood Cancer.
    Add on features:    
    Cumulative Bonus N/A increased by 5% of the Basic Sum Insured at each renewal in respect of each claim free year of insurance, subject to maximum of 50% of the Basic Sum Insured
    Critical Illness N/A Optional cover
    Limit of Liability; Basic Sum Insured Under option I : Limit of Liability is the Sum Insured + Cumulative Bonus if earned for claim free year
    under option II : the total Sum Insured of the Basic Cover and Optional Extension + Cumulative Bonus (if any) on Basic Sum Insured
    Specified List of treatments have Expenses limit per treatment per claim or actual whichever is less for example Cataract, Piles, Fistula, Tonsillitis , Sinusitis, Hernia , Knee/ Hip Joint Replacement, etc. Applicable N/A

    *For detailed list, please refer the Policy terms and conditions
    Common Exclusions under Base Plan and Wider Plan

    Diseases which are Pre-existing at inception of the first Policy.

    Diseases contracted during the first 30 days of Policy

    During the first year of the Policy, the expenses on treatment of diseases such as Tonsillitis/ Adenoids, Gastric or Duodenal Ulcer, Any type of Cyst/ Nodules/ Polyps, Any type of Breast lumps.

    During the first two continuous years of the insurance with Us, the expenses on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Fistula in anus, Piles, Sinusitis, Choletithiasis and Cholecystectomy, Inter- vertebral Disc Prolapse (other than caused by an accident), Osteoarthritis, Varicose Veins / Varicose Ulcers etc.

    Cosmetic or aesthetic treatment, general debility, use of drugs, intentional self injury.

    AIDS related expenses, venereal disease, congenital disease

    Naturopathy, acupuncture, magnetic treatment.

    Additional Exclusions under the Base Plan

    During the first two continuous years of the Policy, the expenses on treatment of diseases such as Renal Failure, Heart Diseases, any type of Carcinoma/Sarcoma/Blood Cancer.

    Benefits under the Policy

    This Policy also provides unique value added Emergency Medical Assistance Services.
    The services are provided by Licensed Service Provider. ITGI is the first Insurer to bring to You these services and that too without any sub limits:

    Medical Consultation, Evaluation and Referral

    Emergency Medical Evacuation

    Medical Repatriation

    Transportation to Join Patient

    Care and/or Transportation of Minor Children

    Emergency Message Transmission

    Return of Mortal Remains

    Emergency Cash Coordination

    Key Condition: The Emergency Assistance Services are available when you meet with an accident while travelling 150 kms and more from your place of residence stated in the Policy .The services are to be availed through the Service Provider only and no reimbursement is provided for these.
    Additional Advantages

    Income Tax benefits under Section 80D. Click here to know more about Tax Benefit

    Hassle free claims procedure

    Cashless claim facility available at over 4000 network hospitals across India.

    Premium and Sum Insureds

    The cover is provided under two Plans viz.

    Base Plan and

    Wider Plan with two options viz. 1)Basic Cover and 2) Basic Cover + Critical illness The premium is dependent on the highest age of the member of the Family and on the number of insured person viz. Proposer and spouse, Proposer, spouse and dependent children.

    Age limit
    Proposer 18 years to 60 years
      Children 91 days to 23 years

    ITGI provides for the Policy with the premiums based on Age, the Plan and Family size as applicable from time to time. Dependent parents are not covered.

    Hospitalisation should be for a minimum period of 24 hours except for specific treatments such as eye surgery, lithotripsy, tonsillectomy and listed Day Care Surgeries.

    Under Wider Plan there is provision for Cumulative Bonus whereby Basic Sum Insured gets enhanced by 5% each year on renewal (maximum 50%) subject to no claims being lodged under the Policy.

    Section 80 D benefit under Income Tax Act is available on the total premium (basic cover+optional cover) paid by cheque for self and family (consisting of self, spouse, dependent children).

    There is a sub-limit under the Policy for room rent. ICU charges, Domiciliary Hospitalisation where expenses of treatment at home is reimbursed under specified conditions.

    Documents required for settlement of claims:

    Claim Form
    Discharge Summary, Bills and Receipt of Hospital/Nursing Home
    Attending Doctor’s Report and Bills as well as cash memos of medicines and pathological tests duly supported by proper prescription.

    This brochure provides only the salient features and for details kindly refer to the complete Policy wordings.