Surgical Hospitalization & Road Ambulance 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.

Daycare will be covered under the benefit if opted and specified under the policy schedule.

The benefit is payable up to the limit as specified in the policy schedule.

Accidental Pre Hospitalisation (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 ‘surgical hospitalization cover,’ and the pre-hospitalization medical expenses are related to the same injury. The date of admission to the hospital for this benefit shall be the date of the policyholder's first admission in relation to any injury.

Accidental Post Hospitalisation (10 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 ‘surgical hospitalization cover’ and the post-hospitalization medical expenses are related to the same injury. 

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

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.

Room Rent Caping

For SI, 1Lakh and 2 Lakhs, the room rent limit is capped at Rs. 2000 per day for a normal room and Rs. 4000 per day for ICU. For SI, 5 Lacs, the room rent is limited to a single private room and there is no limit for ICU.