The policy covers medical, surgical, and hospital expenses incurred as an in-patient by the Life Insured as a result of sustaining accidental bodily injury or sickness. Surgical and hospital expenses policy is generally arranged based on different annual / event limit for different categories of employees depending on their hierarchy in the company.
The basic benefits provided under this cover:
• Hospital accommodation, nursing care, drugs, dressings, etc.
• Room charges per day
• Surgeons and Anesthetist fee
• Operating theatre charges
• Consultant or specialist fee
• Emergency local travel expenses related to inpatient treatment
• If the patient has been hospitalized in a non-paying ward of a Government Hospital, which
• Offers free treatment, an allowance per day will be paid up to a limited period
Surgical policies are subject to exclusions and some of the exclusions are given below.
• Any physical, mental defect or infirmity, which existed prior to enrolment.
• Cosmetic surgery, cosmetic treatments, lasik treatment, eyeglasses, spectacle cover, dental cover, routine dental tests, routine eye tests, lens implants, and hearing aids except necessitated by injuries occurring wholly during the period of insurance.
• Congenital conditions
• Mechanical or chemical contraceptive methods of birth control or treatment pertaining to infertility / sub fertility & abortion.
• Non-medical services provided by a hospital ie television, telephone, fax services, radio, and other similar facilities, extra meals
• Treatments not recommended or undertaken by MBBS qualified doctor.
• Routine or other medical examinations or vaccinations or inoculations, which are not required for the treatment of an illness or injury including pregnancy.
• Treatments received in health hydrous, nature care clinics, acupuncture & homeopathy establishments.
• In respect of self-inflicted injury or disabilities or deliberate exposure to exceptional danger except in an effort to save human life.
• Attempted suicide, alcoholism, drug addiction, venereal disease, insanity, Acquired Immune Deficiency Syndrome (AIDS), or Aids Related Complex (ARC)
• Reusable medical equipment / apparatus / appliance whilst being hospitalized.
• Arising as a result of medical treatment obtained for which payment is not required or to the extent, which another insurer is liable to make payment.
• War, invasion, an act of foreign enemy, hostilities or warlike operations (whether war be declared or not)
• Participation in any professional sports, any bodily contact sports, or any other hazardous or potentially dangerous sports.
• Medical examinations / checkups without an ailment & unrelated to diagnosis.
• Outpatient benefit.
There are no standard policies for surgical and hospital expenses insurance. Policies could be arranged depending on the requirement of the company. However, the cost of medical insurance is generally high and when rider benefits are added to the basic medical cover, the cost will be further increased. There are policies available in the market without sub-limits such as room charges etc.
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