Surgical Hospitalisation & Road Ambulance Benefit Cover

Surgical Hospitalisation

If during the policy year, the policyholder suffers an illness or injury due to an accident and needs to undergo a surgical procedure, covered under the policy, the sum insured will be paid as specified in the policy schedule, in case of in-patient hospitalisation, provided that the surgery is medically necessary and admission date of the hospitalisation is within the policy year.



Surgery 

1. Nervous system

Craniotomy

1. Endocrine

Total thyroidectomy
iii) Eye
Cataract
LASIK- Laser-Assisted In-Situ Keratomileusis

1. iv) ENT

Septoplasty
Tonsillectomy
Adenoidectomy
Excision of polyp
Myringoplasty or Tympanoplasty

1. v) Cardiovascular

Coronary Angiogram (CAG)
Angioplasty (PTCA)
Coronary Artery
Bypass Graft (CABG)
GI/mouth
Cholecystectomy
Appendicectomy
Hernia repair
Haemorrhoidectomy
Fissurectomy
Fistulectomy

1. vi) Urinary

Dialysis
Extracorporeal shockwave lithotripsy (ESWL)
Surgery for Renal
Calculi
vii) Female reproductive
Hysterectomy
Mastoidectomy
Bone, cartilage and joint
THR
TKR
ORIF
CRIF
vii)Cancer
Chemotherapy
Radiotherapy
Organ removal
Surgery

Surgery Road Ambulance

If during the policy year the policyholder suffers an injury due to an accident covered under the policy, the reasonable and customary charges incurred will be paid towards transportation of the policyholder by a registered healthcare or ambulance service provider to a hospital for treatment in case of an emergency. The necessity of the use of an ambulance must be certified by the treating medical practitioner. The benefit will be paid up to the limits specified in the policy schedule.

Waiting Period

The initial waiting period for this cover is 30 days, whereas the waiting period for a specific illness is 24 months.  Specified disease or procedure waiting period 

Since the inception date of the cover, a waiting period specified in the policy schedule shall apply to all treatments. The following treatments, medical or surgical, for all medical expenses along with their complications, are not covered: 

1. a) Cataract
2. b) Hysterectomy for Menorrhagia or Fibromyoma or prolapse of uterus unless necessitated by malignancy myomectomy for fibroids
3. c) Knee replacement surgery (other than caused by accident), non-infectious Arthritis, Gout, Rheumatism, Osteoarthritis and Osteoporosis, Joint Replacement Surgery (other than caused by accident), prolapse of intervertebral discs (other than caused by accident), all Vertebrae Disorders, including but not limited to Spondylitis, Spondylosis, Spondylolisthesis, Congenital Internal 
4. d) Varicose Veins and Varicose Ulcers
5. e) Stones in the urinary urogenital and biliary systems, including calculus diseases 
6. f) Benign Prostate Hypertrophy, all types of Hydrocele 
7. g) Fissure, Fistula in the anus, Piles, all types of Hernia, Pilonidal sinus, Hemorrhoids, and an abscess related to the anal region 
8. h) Chronic Suppurative Otitis Media (CSOM), Deviated Nasal Septum, Sinusitis, and related disorders, surgery on tonsils/Adenoids, Tympanoplasty, and any other benign ear, nose, and throat disorder or surgery
9. i) Gastric and duodenal ulcer, any Cysts/Nodules/Polyps/internal tumours/ 

skin tumours, and any Breast lumps (unless malignant), Polycystic Ovarian diseases 

1. j) Any Surgery of the Genito-urinary system unless necessitated by malignancy

If these diseases are pre-existing diseases at the time of proposal or subsequently found to be pre-existing, the waiting periods mentioned in the policy schedule shall apply.