Oriental Health Of Privileged Elders (HOPE) Plan

Policy Benefits

• In-patient Hospitalization expenses like Room, NursingBoardingexpenses are covered for more than 24 hours stay in the hospital.
• Specified Diseases / illness/ injury are covered under the policy subject to the sublimits.
• Pre and Post Hospitalization expenses 30 days prior to the hospitalization and 60 days post discharge are covered.
• Expenses like Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees is covered.
• Covers specified illnesses like Knee Replacement, Cardio Vascular Diseases,chronic Renal Failure, Cancer, stroke, etc. (refer prospectus for more details)
• Domiciliary Hospitalization expenses for the specified diseases or illness are covered.
• Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like pacemaker, Relevant Laboratory / Diagnostic test, X-Ray etc. are covered subject to the policy limits.
• Covers Ayurvedic, Unani and Homeopathic treatment undertakenin Govt. Hospitals.

Value Added Benefits

• No Claim Discount at the rate of 5% (Five percent) of the renewal premium payable after every claim free policy year, subject to a maximum of 20% (Twenty percent).
• Tax Benefit under section 80 D of Income Tax Act,1961.
• TPA service available and Cashless Service through TPA only and limited to Rs. 1 lakh.
• Ambulance Service expenses are reimbursed under this plan.
• Option of Voluntary copayment and avail discount on premium subject to a maximum of 50%.
• Free health check up for every block of 4 claim free years.

Sub Limits

• Room, Boarding and Nursing Expenses as provided by the Hospital /Nursing Home not exceeding 1% of the Sum Insured per day.
• Domiciliary treatment expenses covred upto 20% of the basic sum insured.
• ICU expenses not exceeding 2% of the Sum Insured per day.
• Co-paymentof 20% of each admissible claim under this plan.
• Free health check up for the insured persons capped upto maximum 1%of average sum insured.
• Knee Replacement expenses capped upto 70% of the Sum insured.
• Cardio Vascular Diseases, Chronic Renal Failure, Cancer, Hepato-BilliaryDisorders treatment expenses are capped at 50% of the sum insured.
• Chronic Obstructive Lung Diseases and stroke treatment expenses capped upto 20% of the sum insured.
• Benign Prostrate and Orthopaedic Diseases expenses are capped upto 15 % of the sum insured.
• Ophthalmic Disease expensesare capped upto 10% of Sum Insured.

Waiting Period Clause

• Initial waiting period: 30 days for all illnesses (not applicable on renewal or for accidents)
• Specific waiting periods: 24 months for specified diseases.
• Pre-existing diseases: Covered after continuous coverage of 12 months.