Health Total Plan

Comprehensive cover
Hospitalization Medical Expenses,Day Care Treatment expenses,Pre-hospitalization Medical Expenses,Post-hospitalization Medical Expenses,Restoration of the Sum Insured,Maternity Expenses,Organ Donor Expenses,Road Ambulance Charges,Domiciliary Hospitalisation Expenses,New Born Baby (applicable for Superior Plan and Premiere Plan),Alternative Treatment,Wellness Care,Cumulative Bonus,100% Reimbursement of cost of pre insurance medical examination upon acceptance of proposal,Cover up to 15 family members under Superior and Premiere plan,Patient Care,Accidental Hospitalization (Increase in sum insured),Accompanying Person,Emergency medical Evacuation (applicable for Superior Plan and Premiere Plan),Out Patient Medical Expenses (applicable for Superior Plan and Premiere Plan),Child Vaccination Benefits (applicable for Premiere Plan),E-Opinion in respect of an Illness or Injury,Medical Treatment Abroad (applicable for Premiere Plan)

Optional Covers
You get Long term discount if you pay premium for more than one year.,You get discounts in premium if you choose to opt voluntary deductible are chosen.

You can choose from 3 plan types ( Vital, Superior and Premier).

Plan - Sum insured (in Rs )
Vital - 3, 5, 10 lakhs
Superior - 15, 20, 25 lakhs
Premiere - 50 lakhs, 1 Crore.

The age eligibility of the insured for taking the policy is the Entry age. Age will mean completed age as on last birthday.

The minimum age required for entry is 1 day. There is no limit of Maximum age for entry. Children will be covered as dependents up to 25 years of age.

No, there is no exit age in this policy.

A nominee can be spouse, children or parents.

Vital Plan: Self, spouse, dependent children and dependent parents.Children will be covered as dependents up to 25 years of age.

Superior and Premiere Plan: Self, spouse, dependant or non-dependent children, dependent or non-dependent parents, Dependent Siblings, daughter in law, son in law, parents in law, grandparents and grandchildren.

Yes Senior citizens can apply for the cover as there is no limit on entry age.

Yes. Premium paid by any mode other than Cash / DD under the Policy shall be eligible for income tax benefit under Sec 80 D of the Income Tax Act and any amendments thereon.

When an insured is hospitalized and stays in hospital for more than 24 hours solely for receiving treatment it is termed as inpatient treatment.

Out-patient treatment is when insured visits a clinic/hospital or a consultation room for diagnosis and treatment based on the advice of medical practitioner. In out-patient hospitalizationpatient is not admitted under a day care or as an in-patient.

Day care Procedure means the course of medical treatment or a surgical procedure listed in the Policy wordings which requires less than 24 hours admission. This excludes all procedures or treatment taken in out- patient departments.

Hospitalization under Ayurveda, Unani, Siddha, or Homeopathy (AYUSH ) are covered provided that the treatment has been undergone in a government hospital or in any institute recognized by government and / or accrediated by Quality Council of India / National Accreditation Board on Health for that Alternative treatment.

Future Generali under this policy will pay the Reasonable and Customary Charges incurred for an organ donor’s treatment for the harvesting of the organ donated provided that:

The organ donor is any person whose organ has been made available in accordance and in compliance with the Transplantation of Human Organs Act, 1994 and the organ donated is for the use of the Insured Person;

We will not pay the donor’s screening expenses or pre and post hospitalisation expenses or for any other medical treatment for the donor consequent on the harvesting;

We have accepted claim under Hospitalisation medical expenses for the Insured Person and the Insured Person has been Medically Advised to undergo an organ transplant;

Costs directly or indirectly associated with the acquisition of the donor’s organ will not be covered.

If an Insured Person suffers an Illness or Injury during the Policy Period in respect of which a claim has been admitted under Hospitalisation medical expenses then at the Insured Person’s request We will arrange a maximum of two e-opinions (in a Policy Year) from a Medical Practitioner selected by the Insured Person from Our panel. The e-opinion will be based only on the information and documentation provided to the Medical Practitioner by or on behalf of the Insured Person.

If the Sum Insured and Cumulative Bonus (if any) is exhausted due to claims incurred and paid during the Policy Year or incurred during the Policy Year and accepted as payable, then it is agreed that a Restore Sum Insured (equal to 100% of the Sum Insured) will be automatically available for the particular Policy Year, provided that:

The Restore Sum Insured will be enforceable only after the Sum Insured and the Cumulative Bonus have been completely exhausted in that Policy Year;

The Restore Sum Insured can only be used for claims made by the Insured Person in respect of Benefits 1-4 (refer policy wordings).

The Restore Sum Insured cannot be used for claims based on Maternity Expenses/Treatment;

The Restore Sum Insured can be used for only future claims made by the Insured Person and not against any claim for an Illness (including its complications) for which a claim has been paid in the current Policy Year under Benefits 1-4(refer policy wordings).

Only the Sum Insured (excluding Cumulative Bonus) will be considered as Restore Sum Insured;

The Restore Sum Insured will only be applied once for the Insured Person during a Policy Year;

If the Restore Sum Insured is not utilised in a Policy Year, it shall not be carried forward to any subsequent Policy Year.

If the Policy is opted by You on a ‘Family Floater’ basis as specified in the Schedule, then the Restore Sum Insured will only be available in respect of claims made by those Insured Persons who were Insured Persons under the Policy before the Sum Insured and Cumulative Bonus was exhausted.

This is a health insurance policy which covers inpatient hospitalization expenses. In this cover, single sum insured floats/is shared by all family members.

The customer has to first pay the tests charges for his pre policy tests directly to the diagnostic centre. Upon acceptance of the proposal by Future Generali and issuance of policy for that member, customer can claim for 100% reimbursement by submitting the original payment receipt.

Yes 10 % Family discount will be given under Individual Health Total in case insured members are more than one under a policy. No family discount is applicable for floater policy.

Change in Sum Insured /Plan can be done at renewals only. No increase/decrease in Sum Insured/Plan is allowed during the currency of the policy. Increase in Sum Insured can be allowed up to two slabs higher, whereas increase in Plan can be allowed up to one plan higher.

For age group above 60 years, increase in Plan would not be allowed.For age group up to 50 years increase in sum insured up to Rs 10Lacs (within Vital Plan) can be allowed without medical examination (in case of no claim / no health declaration). For Superior/Premiere Plan (Sum Insured above 10 lakhs), medical examination is required irrespective of age.

For age group above 50 years increase in sum insured can be allowed with medical examination.Decrease in Sum Insured allowed up to one slab lower only, in case of no claim in any preceding Health Total policies.

The Dependent Sum insured criteria will apply for enhancement of sum insured for dependent.Sum insured enhancement would be allowed for age group lower than 50 years in case of portable policies.

In case of individual Sum Insured option, dependents sum insured can be upto two Sums Insured lower than Self /Proposer’s sum insured

In case of our renewal a grace period of 30 days is permissible and the Policy will be considered as continuous for the purpose of all waiting periods and health check-up benefits. However, We shall not provide coverage under the Policy to the Insured Persons for any Illness or Injury that occurs during the break period or for any claim which arises during the break period.

Cumulative Bonus means any increase in the sum insured granted by the insurer without an associated increase in premium.

If no claim has been made in respect of any Benefits with the exception of any claim under Benefit 13 (OPD Treatment) and the Policy is Renewed with Us without any break, We will apply a bonus to the next Policy Year by automatically increasing the Sum Insured for the next Policy Year by 50% of the Sum Insured for this Policy Year. The maximum bonus for any Policy Year will not exceed 100% of the Sum Insured of the first Policy Year.

If a Cumulative Bonus has been applied and a claim is made, then in the subsequent Policy Year We will automatically decrease the Cumulative Bonus by 50% of the Sum Insured in the following Policy Year. However this reduction will not reduce the Sum Insured below the base Sum Insured of the Policy.

Our obligation to make payment in respect of Surgery for cataracts (after the expiry of the two years waiting period), shall be restricted to 10% of the Sum Insured for each eye, and a maximum of Rs.1,00,000/- per eye.

24 months waiting period for:
Pre existing conditions, Internal Congenital Anomalies, Cataracts, Benign Prostatic Hypertrophy
Hernia of all types, Deviated Nasal Septum, Hypertrophied Turbinate, Hydrocele, All types of sinuses
Fistulae, haemorrhoids, fissure in ano, Dysfunctional uterine bleeding, Fibromyoma, Endometriosis, Hysterectomy,
All internal or external tumors/cysts/nodules/polyps of any kind including breast lumps with exception of malignant tumor or growth.
Surgery for prolapsed inter vertebral disc unless arising from Accident, Surgery of varicose veins and varicose ulcers, any types of gastric or duodenal ulcers, stones in the urinary and biliary systems, Surgery on ears and tonsils.

48 months waiting period for
Organ transplant, Rheumatoid Arthritis, Gout, Joint replacement due to degenerative condition age related osteoarthritis, Osteoporosis , unless such joint replacement surgery is medically necessary due to injury.

First 30 days waiting period for
For medical expenses incurred for any illness diagnosed or diagnosable except those incurred as a result of Injury.

The treatment of obesity (including morbid obesity) and other weight control programs, services and supplies. External Congenital Anomaly and related Illness/ defect.

Vitamins, tonics, nutritional supplements unless forming part of the treatment for Injury or Illness as certified by the attending Medical Practitioner. Genetic disorders and stem cell implantation/Surgery/storage. Treatment for any mental illness or psychiatric illness.

Expenses incurred towards treatment of Illness or Injury arising out of alcohol use/misuse or abuse of alcohol, narcotic substance or drugs (whether prescribed or not).

Any treatment received in convalescent home, rehabilitation centre, convalescent hospital, health hydro, nature care clinic or similar establishments.

Non-prescribed drugs and medical supplies, hormone replacement therapy, sex change or treatment which results from or is in any way related to sex change.

Any treatment required arising from Insured Person’s participation in any hazardous activity including but not limited to scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing unless specifically agreed by Us.

Any expenses in excess of the maximum amount payable under the outpatient medical expenses limit specified in the Schedule of Benefits.

Any expenses for OPD Treatment including dental expenses in case of Vital Plan.

Any expenses for prescribed medications in case of Superior Plan.

Any expenses for consultation, diagnostics, medications which are not duly supported with medical documents from the Medical Practitioner mentioning:

-Diagnosis;

-Referral for diagnostic test;

-Prescription for medications.

Costs incurred on all methods of treatment except Allopathic.

Network Provider means hospitals or health care providers enlisted by Future Generali to provide medical services to an insured on payment by a Cashless Facility.

(Please note: The Hospitals which have been empanelled by Us as Network Providers are as per the latest version of the schedule of Hospitals maintained by Us, which is available to You on request.)

Non-Network Provider means any hospital, day care centre or other provider that is not part of the network.

You may call on our 24 hours call center on 1800 103 8889 or Fax on 1800 103 9998.

Or mail us on fgh@futuregenerali.in

Call Centre will assist you with emergencies, your eligibility and status, documentation support and general information on the health policy. Call center will not impart any medical advice on the telephone.

The cashless facility can be availed in case of admission in network hospitals. If the policy holder presents the heath card or cashless card at the network hospital, the hospital authorities contact us and provide the details of the hospitalization. If the illness is covered as per the policy terms and conditions Authorization letter is issued to the hospital. The hospital sends all the bills and documents to us for settlement. The insured has to pay the non-admissible expenses to the hospital.

Claim-Reimbursement
If the admission is in Non-network hospital then you need to settle the hospitals bills & submit the hospitalization documents along with the claim form for reimbursement of hospitalization expenses.

In case of Emergency hospitalization You need to notify us at the earliest and not later than 48 hours from the time of hospitalization or prior to discharge whichever is earlier. In case of planned admission you need to notify atleat 48 hours in advance prior to admission in the hospital.

You can submit your claim documents at our nearest branch office or you may even send documents at the following address.

Claims Department
Future Generali Health (FGH)
Future Generali India Insurance Co. Ltd.
Office No. 3, 3rd Floor, “A” Building , G - O – Square
S. No. 249 & 250, Aundh Hinjewadi Link Road, Wakad, Pune - 411 057.
Toll Free Number: 1800 103 8889
Toll Free Fax: 1800 103 9998
Email: fgh@futuregenerali.in

In case of Individual policy it is as per the age band and the sum insured selected by the customer.

In case of family floater the premium for the primary insured remains at actuals from the individual table. For remaining dependent members discounts applicable on their respective premium is as table below.

Proposals with health declarations may also be advised Pre policy medical examinations irrespective of age.

Pre policy tests need to be done in the empanelled diagnostic centers only.

The test would be valid for a period of one month from the date the tests have been conducted.