Universal Health Insurance Scheme (APL)
Salient features of the Policy
1.0 COVERAGE: The Policy covers reimbursement of Hospitalisation Expenses for Illness/ Injury sustained.
2.0 SCOPE OF COVER: HOSPITALISATION EXPENSES
In event of any claim being admissible, following Reasonable and Customary expenses are reimbursable under the policy:
SECTION I: Hospitalisation Expenses
| Hospitalisation Benefits | Limits |
|---|---|
| (i)Room, Boarding expenses as provided by the Hospital/Nursing Home (ii) If admitted in IC Unit | i) Upto to 0.5% of Sum Insured per day ii) Upto 1% of Sum Insured per day |
| Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses | Upto INR 15% of Sum Insured per Illness/ Injury |
| Anesthesia, Blood, Oxygen, OT charges, Surgical appliances, Medicines, drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs. | Up to 15% of Sum Insured per Illness/Injury |
N.B (a) Total expenses incurred for Any one Illness is limited to INR 15,000/-.
(b) Company’s liability in respect of all claims admitted during the period of Insurance shall not exceed the Sum Insured of INR 30,000/- per person or family as mentioned in the Schedule.
SECTION II: Coverage for Earning Head of the family as declared in the Schedule
If the Earning Head of the family shall sustain any bodily injury resulting solely and directly from accident caused by external, violent and visible means, and if such injury shall within six calendar months of its occurrence lead to death then the Company shall pay to the Insured a sum of INR 25,000/-.
SECTION III: Disability Compensation for earning Head of the Family
Disability compensation at the rate of INR 50/- per day up to maximum of period of 15 days in a policy year with a time excess of 3 days is payable if the Earning Head of the family is hospitalized due to accident/diseases/illness for which there is a valid claim admitted under Section I of the Policy.