Sum Insured
(in ₹) |
As per plan opted.
Min - ₹5LMax - ₹100L |
5 lakh, 10 lakh |
15 lakh, 20 lakh |
25 lakh, 50 lakh, 75 lakh, 1 crore |
| Eligibility |
| Proposer |
Adult – 18 years & Above |
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| Minimum entry age |
Child - 1 day |
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| Adult – 18 years |
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| Maximum entry age |
Child – 25 years |
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| Adult – 65 years |
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| Maximum renewal age |
Lifelong |
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| Individual SI / Family Floater SI options |
Both |
Both |
Both |
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| Family definition |
For Individual/Non-Floater Policy |
Self, Live-in partner / Spouse, Dependent Children (Max up to 4), Parents, Parents-in-law.
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Self, Live-in Partner/Spouse, Dependent Children (Max up to 4), Parents, Parents-in-law. |
Self, Live-in partner/Spouse, Dependent Children (Max up to 4), Parents, Parents- in- law. |
| For Floater Policy |
Self, Live-in Partner/Spouse, Dependent Children (Max up to 4), Parents /Parents in law. |
Self, Live-in Partner/spouse, Dependent Children (Max up to 4), Parents /Parents in law. |
Self, Live-in Partner/spouse, Dependent Children (Max up to 4), Parents /Parents in law. |
| Max No. of Insured covered under Single Policy |
For Individual/Non-Floater Policy |
10 |
10 |
10 |
| For Floater Policy |
8 |
8 |
8 |
| Policy Tenure |
1 / 2 / 3 Years |
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| Premium Payment Option |
Monthly, Quarterly, Half Yearly, Annually, Single |
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| Discount |
Family Discount - 10% In the case of more than 1 Insured covered under the same policy. (Applicable for Non-Floater Policy) |
60 days |
60 days |
60 days |
| Long Term Discount - 2 Years – 7.5% 3 Years – 10% |
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| Web sales / Tele sales discount/ Employee discount - 15% - If the Proposer opts to purchase the policy directly from the Company without any intermediary |
| Waiting Period |
Initial Waiting Period |
30 days |
30 days |
30 days |
| Specific Waiting Period |
24 Months and 36 Months |
24 Months and 36 Months |
24 Months and 36 Months |
| Pre-existing Waiting Period |
48 Months |
48 Months |
36 Months |
| Base Covers |
| Medical Expense Cover 30,000 40,000 50,000 |
| In-patient Hospitalization (For male Female) |
Covered up to Sum Insured |
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| Room Rent Limit (For male Female) |
Normal Room |
Single Private Room |
Single Private Room |
Single Private Room |
| ICU |
Actuals |
Actuals |
Actuals |
| Post-natal hospitalisation (Within maternity limits) |
45 days |
45 days |
45 days |
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| Day Care Treatment (For male Female) |
530 Listed Day Care procedures covered up to Sum Insured. |
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| Other Expenses (For male Female) |
(i) LASIK Surgery |
Up to ₹50K each policy year (Can be utilized towards one or both the eyes) |
Up to ₹75K each policy year (Can be utilized towards one or both the eyes) |
Up to ₹51L each policy year (Can be utilized towards one or both the eyes) |
| Coverage Details - Covers medical expenses incurred by the Insured Person for LASIK Surgery, including refractive keratotomy (RK) and photorefractive keratectomy (PRK) or any other advanced Surgical Procedures conducted to correct the refractive errors more than or equal to 7.5 diopters to change the refraction of one or both eyes. Note: Available only once in the lifetime of this Policy. · Covered up to sublimit and part of Policy Sum Insured. Waiting Period – 24 Months |
| (ii) Bariatric Surgery |
Up to 50% of SI, Max up to ₹5L each policy year |
Up to ₹5L each policy year |
Up to ₹5L each policy year |
Coverage Details - Covers medical expenses incurred by the insured person towards surgical procedure for obesity.
Note: Applicable for Insured Person 18 Years & Above Portability and Migration are not applicable. ·Covered up to sublimit and part of Policy Sum Insured. Waiting Period – 48 Months |
| (iii) Cataract Surgery |
Up to ₹1L each eye per policy year |
Up to ₹1L each eye per policy year |
Up to ₹1L each eye per policy year |
| Coverage Details - Covers medical expenses incurred for treatment of Cataract. Note: Covered up to sublimit and part of Policy Sum Insured. Waiting Period – 24 Months |
| Pre-Hospitalization Medical Expenses (For male Female) |
Cover on a reimbursement basis up to the Base Sum Insured for the number of days in accordance with the limits specified as per plan opted. |
Up to 30 Days |
Up to 60 Days |
Up to 60 Days |
| Post Hospitalization Medical Expenses (For male & Female) |
Up to 60 Days |
Up to 90 Days |
Up to 90 Days |
| Modern Treatment Method and Advancement in Technologies (For male & Female) |
Covers medical expenses incurred towards Modern Treatment Method and Advancement in Technologies under In-Patient Hospitalization or Day Care Treatment arising out of an Insured Person’s Hospitalization. |
Up to SI |
Up to SI |
Up to SI |
| Cosmetic/Plastic Surgery (For male & Female) |
Covers surgical procedure to restore the body’s normal appearance and function for the purpose of reconstruction following an accident, Burns & Cancer or as part of medically necessary treatment to remove immediate health risk to the Insured Person. |
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| Emergency Road Ambulance (For male Female) |
Reimburse expenses incurred towards Road Ambulance charges. |
Up to ₹2K per hospitalization Event |
Up to ₹3K per hospitalization Event |
Up to ₹4K per hospitalization Event |
| Emergency Air Ambulance (For male & Female) |
Reimburse expenses incurred towards Air Ambulance charges. |
X |
Up to ₹2L each policy year |
Up to ₹3L each policy year |
| Alternative Treatments (For male & Female) |
Covers In-patient Hospitalization expense incurred on treatment under Ayurveda, Yoga and Naturopathy, Siddha, Homoeopathy and Unani only. |
Up to Sum Insured |
Up to Sum Insured |
Up to Sum Insured |
| Organ Donor Expenses (For male & Female) |
Covers In-patient hospitalization medical expense incurred towards organ donor’s surgery for the harvesting of the organ donated. |
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| Home Health Care Expenses (For male & Female) |
Covers charges incurred by the insured person towards Home Health Care Services |
X |
Up to 20% of Sum Insured |
Up to 20% of Sum Insured
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| Restoration of Sum Insured (For male Female) |
Available once in a Policy Year (Up to 100% S.I.) Note: • The restoration of Sum Insured shall not apply to the first claim in the Policy Year and automatically trigger If a second claim is being reported accepted by Us, irrespective of the Sum Insured and Cumulative Bonus (if any) is completely or partially exhausted Available once in the lifetime for claims related to Chemotherapy and Dialysis under this Policy. |
X |
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| OPD Treatment (For Female) |
Covers medical expenses incurred towards medical consultations, diagnostic tests, and pharmacy expenses on an out-patient basis for female Insured, up to the limits specified. Note *Restoration of the OPD Sum Insured available up to 200% of SI, once in a Policy Year, in case the available OPD SI is insufficient for covering a claim incurred towards Mental/ Psychiatric illness. The cover under this benefit with part of the base Sum Insured. |
Up to ₹2.5K each policy year irrespective of Policy Type |
Up to ₹3.5K each policy year irrespective of Policy Type |
Up to ₹5K each policy year irrespective of Policy Type |
| Cumulative Bonus (For male & Female) |
The Cumulative Bonus shall be increased by % in respect of each claim free policy year provided the policy is renewed with Us without a break. Note: •Claiming under Optional Cover (Critical illness & Personal Accident Cover, OPD treatment and Wellness Benefits, Preventive care, Antenatal Care, OPD Claim under Puberty and Menopause disorder will not impact cumulative Bonus. If a claim is made in any particular year, the cumulative bonus accrued shall be reduced at the same rate at which it has accrued. |
10% of SI per annum, Max up to 50% of Base Sum Insured |
| Ante-Natal Care (For Female) |
Covers expenses for Ante-natal care after confirmation of pregnancy, incurred on an Out-patient Treatment. Note: • Applicable for female Insured Person 18 Years & Above. • The cover under this benefit will be part of the base Sum Insured. •Waiting period of 24 months is applicable. •Portability and Migration are not applicable. |
Up to ₹7.5K each policy year |
Up to ₹10K each policy year |
Up to ₹15K each policy year |
| Maternity Expenses (For Female) |
This benefit shall only be available for a female Insured Person who should be aged 18 years or above.
Coverage Details (i) Delivery of a child (Normal /Cesarean) – Applicable for Insured (Mother) & Surrogate Mother.
(ii)Pre Post Natal Hospitalization Up to 45 Days – Only Applicable for Insured (Mother) Note: In favor of Insured Mother - Coverage under this benefit shall include a maximum of 2 events. In Favor of Surrogate Mother - Coverage under this Benefit shall be available once in a Lifetime of this Policy. Pre Post Natal Hospitalization expense not covered for Surrogate Mother. Waiting period 24 months if Single Female Insured or Female Insured person along with spouse are covered. •The cover under this benefit shall be within the Sum Insured. • Portability and Migration are not applicable. |
Normal Delivery - Up to ₹ 50K Cesarean – Up to ₹ 75K |
Normal Delivery - Up to ₹ 75K Cesarean – Up to ₹ 1.25L |
Normal Delivery - Up to ₹1.25L Cesarean – Up to ₹ 2L |
| Miscarriage & Medical Termination of Pregnancy (For Female) |
Covers medical expenses incurred towards medically necessary and lawful termination of pregnancy. This benefit shall only be available for Female Insured Person who should be aged 18 years or above. Note: Cover under this benefit shall be available once in a Lifetime of this Policy. Waiting Period – 12 Months This benefit not available for Surrogate Mother. Cover under this benefit shall be within the Sum Insured. |
Up to ₹25K |
Up to ₹35K |
Up to ₹50K |
| Newborn Baby Expenses Cover (For newborn -male & Female) |
Covers In-patient Hospitalization expenses incurred towards the treatment of Newborn Baby while Insured Person (mother) or Surrogate Mother is hospitalized for delivery. It also includes coverage for the newborn baby (independent of Insured/Surrogate mother’s hospitalization) until the expiry date of the Policy Year in which the newborn baby is born. Note: Cover under this benefit becomes admissible only if we have accepted a claim under Maternity Expenses. •The cover under this benefit shall be within the Sum Insured. |
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| Newborn Defect (For newborn -male & Female) |
Lumpsum benefit (once in lifetime) payable in case the newborn is diagnosed with respect to below listed condition. 1. Down SyndromeCerebral Palsy 3.]pina Bifida Note: · Cover under this benefit becomes admissible only if we have accepted a claim under Maternity Expenses. The cover under this benefit shall be within the Sum Insured. |
₹50K |
₹75K |
₹1L |
| Newborn Vaccination (For newborn -male & Female) |
Covers vaccination expenses of the Newborn Baby until the Newborn completes one year of age. Note: • The cover under this benefit shall be within the Sum Insured. If the Policy ends before the Newborn Baby has completed one year, then we will cover such vaccinations until the Newborn Baby completes one year, provided we have accepted the Newborn Baby as an Insured Person at the time of Renewal of the Policy on receipt of requisite premium. |
₹5K |
₹7.5K |
₹10K |
| Stem Cell Storage (For newborn -male & Female) |
Covers one-time expenses incurred by the insured Person towards the harvesting and storage of stem cells of the Newborn Baby. Note: • The cover under this benefit shall be within the Sum Insured. Floater Policy - Part of Policy Sum Insured. Non-Floater Policy - Part of the Sum Insured opted by Female Insured. |
₹ 15K |
₹ 20K |
₹ 20K |
| Cancer Care Booster (For Female) |
Covers medical expenses incurred towards In-patient Hospitalization of the Female Insured Person who is Hospitalized for the treatment of “Cancer”, during the Policy Year. Note: • This benefit is payable provided the symptoms of Cancer first diagnosed or manifest itself during the Policy Period. • This Benefit can be utilized only after the Base Sum Insured and accumulated Cumulative Bonus (if any), is completely exhausted. • This benefit is payable only once in a lifetime for Policy. • Waiting Period – 12 Months. |
Additional 100% of SI for listed condition. · Breast · Cervix · Uterus · Fallopian Tube · Ovary · Vagina/Vulva Other Cancers Additional 50% of SI. |
Additional 200% of SI for listed condition. ·Breast · Cervix · Uterus · Fallopian Tube · Ovary · Vagina/Vulva Other Cancers - Additional 100% of SI. |
Additional 200% of SI for listed condition.· Breast · Cervix · Uterus · Fallopian Tube · Ovary · Vagina/Vulva Other Cancers - Additional 100% of SI. |
| Women Care |
| Infertility Expenses (For Male & Female) |
Cover medically necessary treatment for Infertility & cryopreservation during policy period. This benefit shall only be available for Insured aged above 18 years. Coverage Details: ·Surgical procedures related to correction of pathological abnormalities in reproductive organs. · Assisted Reproductive Technology procedures – IVF, ZIFT, GIFT, ICSI and pronuclear stage Transfer. Note: · Waiting Period – 36months · Cryo- preservation for up to 36 months from day of first retrieval of Oocyte, subject to policy being continuously renewed with Us. ·Covered up to Sublimit and part of Base Sum Insured. · Portability and Migration are Not applicable. |
X |
Infertility - Up to ₹2L Cryopreservation - Up to ₹15K (Lifetime limit for this benefit) |
Infertility - Up to ₹3L Cryopreservation - Up to ₹20K (Lifetime limit for this benefit) |
| Voluntary Sterilization (Tubal Ligation). (For Female) |
Covered expenses incurred for Voluntary Sterilization (Tubal Ligation). Note: • Available once in the Lifetime of the Policy. •Applicable for Female Insured who is Married Person and age between 23 to 48 years (both age inclusive). •The cover under this benefit will be part of the base Sum Insured. •Waiting Period – 36 Months •Expenses incurred for Reversal of Sterilization are not payable. • Portability and Migration - Not applicable. |
X |
Up to ₹50K |
Up to ₹50K |
| Senior Care (For Female) |
Covers expenses incurred towards the following Curative Care Treatments up to limit defined below for Female Insured 60 Years & above. Coverage details: • Intra articular joint injections •Intravitreal injections. • Bone strengthening Injection. Waiting Period – 24 months Note: The cover under this benefit will be part of the Base Sum Insured. |
Up to ₹15K in a Policy Year |
Up to ₹20K in a Policy Year |
Up to ₹20K in a Policy Year |
| Nursing Care Expenses (For Female) |
Covers expenses incurred towards the nursing care taken by the female Insured person at home from a Qualified Nurse, post discharge from Hospital. Note: · This benefit is payable provided we have accepted a claim for In-patient Hospitalization or Day Care Treatment against any adult female Insured covered in the Policy. The cover under this benefit shall be part of the Base Sum Insured. |
X |
₹500 per day, max up to 10 days for each claim, max up to 30 days per policy year. |
₹750 per day, max up to 10 days for each claim, max up to 30 days per policy year. |
| Temporary Domestic Help (For Female) |
Covers expenses incurred towards engaging services of temporary domestic help at insured person residential address for the duration while female Insured is hospitalized. Note: This benefit is payable provided we have accepted a claim for In-patient Hospitalization or Day Care Treatment against any adult female Insured covered in the Policy. The cover under this benefit will be part of the Base Sum Insured. |
Fixed Benefit of ₹500 per day, max up to 10 days per event, 30 days each policy year. |
Fixed Benefit of ₹750 per day, max up to 10 days per event, 30 days each policy year. |
Fixed Benefit of ₹1K per day, max up to 10 days per event, 30 days each policy year. |
| Puberty & Menopause Disorders (For Female) medical expenses |
Covers expenses incurred towards treatment for symptoms, illness, complications arising due to physiological conditions associated with Puberty & Menopause such as menopausal bleeding, flushing etc. up to the limits defined. Note – For Inpatient Hospitalization – The cover under this benefit shall be within the Sum Insured. · Waiting Period applicable for IPD & No Waiting period of OPD – 24 Months |
OPD Limit - Up to ₹7.5K each policy year IPD – Covered up to Sum Insured |
OPD Limit - Up to ₹10K each policy year IPD – Covered up to Sum Insured |
OPD Limit - Up to ₹15K each policy year IPD – Covered up to Sum Insured |
| Preventive Care (For Female) |
Available for Female Insured Person(s) covered in the Policy. Dexa Scan (Applicable for Insured 50 years & above.) - Covered up to ₹2.5K once in the block of 4 consecutive Policy year. HPV vaccination - Covered up to ₹2K, once in lifetime of the Policy. |
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| Value Added Services |
| Wellness Benefits (VAS) (For Female) |
Available for Female Insured Person(s) Aged 18 Years & above. |
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| Wellness Benefit - Per Policy Limit (irrespective of Policy Type) |
| Psychological Consultation - 4 teleconsultation per year (Online) |
| Gynecologist Consultations - 4 Online / In-Clinic Consultation (In-Clinic consultation available at Network only) |
| Home Diagnostic Services - 2 Sample Home Collections |
| Women Fitness Program-Gym - 12 Physical Sessions at network Gym. |
| Diet Nutrition Session - 4 Online Consultation session with a Dietitian and Nutritionist |
| Spa wellness centers - 2 sessions at Spa Wellness Centers |
| Face Yoga Sessions - 1 Online Session |
| Access to Online Annual Membership (Shilpa Shetty Fitness App) |
| Access to Health Contents Webinars - Access to articles, webinars & blogs on physical & mental wellness |
| Discount on Wellness Product/fashion products - Available |
| Health Check Up Hemogram, Thyroid function tests (T3, T4 & TSH), Glycosylated Hemoglobin (HbA1c), Lipid Profile, Fasting Blood Sugar Level, Anti Mullerian Hormone (AMH), Serum Calcium, Liver Function Test, Serum Phosphorus, Renal Profile, PAP smear, Mammography, Blood Pressure and Body Mass Index (BMI) - Once in a Policy Year |
| Note •The Insured Person shall be eligible to avail a health check-up every Policy Year (including First Policy Year). PAP smear and Mammography Test available once in the block of 2 Policy year and applicable for Insured who have completed 12 months from first policy inception. |
| Wellness Benefits (Wellness Reward Points) |
Same as offering in FG Health Absolute |
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| Otpional Covers |
| Voluntary Co-payment |
Co-pay applicable on each admissible claim Option to choose co-payment -10% or 20% or 30% |
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| Critical Care Benefit is available on Individual basis irrespective of policy type and payable over and above Base Sum Insured. This is an optional cover and available only if an additional premium has been received. |
| IV. (a) Critical Illness (For male & Female) |
Min Max Age at Entry Adult - 18 Years to 65 Years Child – Not Available Coverage Details - If an Insured Person is diagnosed to be suffering from a listed 21 Critical Illness while the Policy is in force, then We will pay the Lumpsum Benefit subject to the following conditions. •The symptoms of Critical Illness were first diagnosed or manifest themselves during the Policy Period and after completion of 90 days from the inception of the First Policy with Us. •The Insured Person survives for at least 7 days from the date of diagnosis of Critical Illness. Note: •Once a claim has been paid in respect of any of the Insured Persons, optional cover in respect of that person shall terminate and no further renewals with this optional cover will be available for that Insured Person. |
₹ 5L, 10L |
₹ 5L,10L, 15L, 20L |
₹ 5L,10L, 15L, 20L |
| IV. (b) E-Medical Second Opinion |
The insured can choose to secure a medical second opinion from Our Network of Medical Practitioners. |
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| Accident Care Benefit is available on Individual basis irrespective of Policy Type and payable over and above Base Sum Insured. This is an optional cover and available only if an additional premium has been received. |
| Personal Accident Cover- (AD, PTD, PPD)(For male & Female) |
Min & Max Age at EntryAdult - 18 Years to 65 Years Child – 3 Years to 25 Years Coverage Details: Note Our maximum liability is restricted to 100% of the Sum Insured irrespective of permanent loss of one or more body parts and / or death. |
₹ 5L, 10L |
₹ 5L,10L, 15L, 20L |
₹ 5L,10L, 15L, 20L |
| Other Details |
| PPMC |
As per the Underwriting Guidelines |
| Grace Period |
Single Payment – 30 Days Installment – 15 Days |
| Free Look Period |
15 Days |
