Accidental Hospitalisation & Family Transportation Allowance Cover

In-patient Hospitalisation

If during the policy year, the policyholder suffers an injury due to an accident caused by an event covered under the policy and directly results in hospitalization, the reasonable and customary charges will be paid. The payout is for hospitalization to avail medically necessary treatment of the policyholder, and the admission date is within the policy year.

1. Room charges up to the category specified in the policy schedule.
2. Charges for accommodation in ICU/CCU/HDU.
3. Operation theatre cost.
4. Medical practitioner’s fees.
5. Specialist’s fee. 
6. Surgeon’s fee.
7. Anaesthetist’s fee.
8. Radiologist’s fee.
9. Pathologist’s fee.
10. Assistant surgeon’s fee.
11. Qualified nurses’ fee.
12.  Medication.
13. Cost of diagnostic tests as an in-patient.
14. Surgical appliance or medical appliance.

If the policyholder is admitted in a room where the room rent incurred is higher than that which is specified in the policy schedule, then the policyholder shall bear a ratable proportion of the total associated medical expenses (including surcharge or taxes thereon). The expenses should be in proportion to the difference between the room rent of the entitled or eligible room rent to the room rent actually incurred, unless specified otherwise. 

Artificial life maintenance will be covered, including life support machine use, where such treatment will not result in recovery or restoration of the previous state of health under any circumstances unless in a vegetative state as certified by the treating medical practitioner.

Accidental Pre-hospitalization (5 days)

The pre-hospitalization Medical Expenses will be paid immediately before the policyholder's date of hospitalization or daycare (if opted) up to the limits as specified in the policy schedule. The claim must be admissible under ‘accidental hospitalization cover,’ and the pre-hospitalization medical expenses are related to the same injury. The date of admission to the hospital for this coverage shall be the date of the policyholder's first admission in relation to any injury.

Accidental Post-hospitalization (5 days)

The post-hospitalization medical expenses will be paid post-discharge of the policyholder immediately from the hospital or daycare (if opted) up to the limits as specified in the policy schedule. The payout is eligible provided that a claim is admissible under ‘accidental hospitalization cover’ and the post-hospitalization medical expenses are related to the same injury. 

The date of discharge from the hospital for this coverage shall be the date of the policyholder's last discharge from the hospital concerning any one injury.

Accident Family Transportation

If during the policy year, the policyholder suffers an injury due to an accident, covered under the policy and needs hospitalization in a hospital situated at a distance of at least 100 kilometer from their actual place of residence and the attending medical practitioner recommends the personal attendance of an immediate family member, the sum insured will be paid as specified in the policy schedule. This payout is towards the transportation of any one immediate family member to the place of hospitalization of the policyholder by one way airfare or one way first class railway ticket in a licensed common carrier.