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Diabetes

A POLICY FOR MEDICAL EMERGENCIES: Diabetes can assume frightening proportions if it remains uncontrolled. Living with Diabetes can sometimes feel lonely and bitter but it does not have to be that way anymore. Earlier, it was difficult for patients suffering from Diabetes to get a cover, however, with a new generation plan, the much-needed cover is now available to Diabetic patients. If you keep your sugar levels under control, insurance companies also give you many incentives in Diabetic plans. India is the second-largest country in the world with the Diabetic population. However, the awareness of the disease and its management is very poor in our country. Diabetes can assume frightening proportions if it remains uncontrolled. Diabetic patients in the older regime used to find it difficult to get a policy from any insurance company, not anymore. Health insurance companies have come out with special Diabetic plans where Type 1 and Type 2 patients, especially those taking Insulin can get Mediclaim Cover. Though the plan is slightly expensive than the normal plans, it is better to be covered rather than remain uncovered.

India is the second-largest country in the world with Diabetic population. However, the awareness of the disease and its management is very poor in our country. Diabetes can assume frightening proportions if it remains uncontrolled. Diabetic patients in the older regime used to find it difficult to get a policy from any insurance company, not any more. Health insurance companies have come out with special Diabetic plans where Type 1 and Type 2 patients, especially those taking Insulin can get Mediclaim Cover. Though the plan is slightly expensive than the normal plans, it is better to be covered rather than remain uncovered.

However, a medical check-up for such patients is compulsory and based on the reports the underwriter of the insurance company gives his approval. The features are also very innovative wherein if the patient keeps the sugar levels under control by maintaining self-discipline, he is entitled for a discount on the premium at the time of renewal. One is required to undergo a test at the cost of the insurance company on a quarterly basis and the same is sent to the underwriter to make the assessment for eligibility of discount at the time of renewal. You also get a discount on the purchase of medicine and many benefits are attached with this policy. It is highly recommended to buy a policy while you do not have any major ailment as when Diabetes goes out of control, you may find yourself in a difficult position to get a policy then. These plans also give a bonus which will enhance your coverage in case of a claim-free year. Moreover, Restore benefit is also available if the insured person exhausts his sum insured during a policy year and needs some more coverage during that particular period. In this case, the sum insured amount is restored in the policy and can be used for further claims in that period.

Features of POLICY

RESTORE BENEFIT:

A plan which restores your Sum Insured when you need it the most. Instant addition of 100% Basic Sum insured on complete or partial utilisation of your existing policy Sum Insured Cumulative Benefit if applicable during the policy year. This total amount (Basic Sum Insured, Cumulative Benefit and Restore Sum Insured) will be available to all Insured Persons for all claims under in-patient benefit during the current policy year.

CUMULATIVE BONUS:

A 10% cumulative bonus will be applied on the base sum insured for next policy year under the policy after every claim-free policy year, provided that the policy is renewed with the insurer without a break. The maximum cumulative bonus shall not exceed 100% of the Sum Insured in any policy year. If a cumulative bonus has been applied and a claim is made, then in the subsequent policy year, the insurer will automatically decrease the cumulative bonus by 10% of the sum insured. There will be no impact on the in-patient Sum Insured, only the accrued cumulative bonus will be decreased.

PRE AND POST HOSPITALISATION EXPENSES:

The old generation plans provide 30/60 days cover but in the new generation plans 60/180 days cover is provided.

AMBULANCE COVER:

Up to a certain limit subject to hospitalisation.  

ORGAN DONOR:

Covered up to Sum Insured. 

WITH CO-PAYMENT:

If opted and mentioned on the policy schedule that a co-payment is effective, and a claim has been admitted under benefits in-patient treatment, pre- and post-hospitalisation expenses, day care procedures, organ donor, shared accommodation benefit and ambulance cover then, the insurer shall bear 20% of the eligible claim amount payable under the policy and his liability, if any, shall only be in excess of that sum and would be subject to the Sum Insured. 

REWARD POINT:

 Based on the results of your medical tests and key health parameters such as BMI, BP, HbA1c and cholesterol, the insurer will offer you incentives for staying healthy.

  • Renewal premium discounts of up to 25% for management of health conditions.

  • Reimbursement up to 25% of renewal premium towards your medical expenses (like consultation charges, medicines and drugs, diagnostic expenses, dental expenses and other miscellaneous charges not covered under any medical insurance).

WELLNESS PROGRAM:

BTo avail wellness benefit you may choose to undergo a medical check-up twice in a policy period at a diagnostic centre which is approved by the insurer. Please note that the costs incurred for these tests is not borne by the insurer in the old generation plans but in some new generation plans, they will be borne by the insurer. Medical check-up reports have to be submitted to the insurer as per defined timelines. Any reports submitted after these timelines will not be accepted/considered. Half yearly check-up: HbA1c, blood pressure monitoring, BMI, diabetologist/cardiologist consultation Annual check-up: HbA1c, SMA 12, Total Cholesterol, HDL cholesterol, ECG, blood pressure monitoring, BMI, diabetologist consultation/general practitioner

To avail wellness benefit you may choose to undergo a medical check-up twice in a policy period at a diagnostic centre which is approved by the insurer. Please note that the costs incurred for these tests is not borne by the insurer in the old generation plans but in some new generation plans, they will be borne by the insurer. Medical check-up reports have to be submitted to the insurer as per defined timelines. Any reports submitted after these timelines will not be accepted/considered.

  • Half yearly check-up: HbA1c, blood pressure monitoring, BMI, diabetologist/cardiologist consultation.

  • Annual check-up: HbA1c, SMA 12, Total Cholesterol, HDL cholesterol, ECG, blood pressure monitoring, BMI, diabetologist consultation/general practitioner

  • SMA: FBS, Total Cholesterol, creatinine, high-density lipoprotein (HDL) , low-density lipoprotein (LDL), Triglycerides (TG), Total Protein, serum albumin, gammaglutamyltransferase (GGT), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), Billirubin. There are timelines for submitting the medical check-up reports. Based on medical check-up results, incentive points would be calculated. This shall be the basis for deciding appropriate level of reduction in renewal premiums.

ELIGIBILITY

  1. This policy covers persons in the age group 18 years to 65 years. The maximum entry age is restricted up to 65 years.

  2. There is no maximum cover ceasing age in this policy.

  3. This Policy offers cover to individuals with Type1 Diabetes, Type 2 Diabetes Mellitus, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), and /or Hypertension.

  4. The policy will be issued for a period 1 year.

  5. This policy can be issued to an individual only on individual Sum Insured basis.

  6. There will be no general waiting period of 30 days applicable in this product.


Exclusions of POLICY

 

Non-Medical Exclusions

  1. War or similar situations: Treatment directly or indirectly arising from or consequent upon war or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, radiation of any kind.

  2. Breach of law: Any insured person committing or attempting to commit a breach of law with criminal intent, or intentional self injury or attempted suicide while sane or insane.

  3. Dangerous acts (including sports): An insured person’s participation or involvement in naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing in a professional or semi professional nature.


Medical Exclusions

  1. Substance abuse and de-addiction programs: Abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol, including smoking cessation programmes and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies.

  2. Treatment of obesity and any weight control program.

  3. Prosthetic and other devices which are self-detachable/removable without surgery involving anaesthesia.

  4. Treatment for correction of eye due to refractive error (few examples of the treatments: fametolaser, lasik).

  5. Treatment availed outside India.

  6. Treatment at a healthcare facility which is NOT a Hospital.

  7. Cosmetic, aesthetic and re-shaping treatments and surgeries:

  • Plastic surgery or bariatric surgery or cosmetic surgery or treatments to change appearance unless necessary as a part of medically necessary treatment certified by the attending medical practitioner for reconstruction following an accident, cancer or burns.

  • Circumcisions (unless necessitated by illness or injury and forming part of treatment); aesthetic or change-of-life treatments of any description such as sex transformation operations.

        8. Types of treatment, defined Illnesses/ conditions/ supplies:

  • Non allopathic treatment.

  • Conditions for which hospitalisation is NOT required.

  • Charges related to peritoneal dialysis, including supplies.

  • Admission primarily for administration of monoclonal antibodies or IV immunoglobulin infusion.

  • Experimental, investigational or unproven treatment devices and pharmacological regimens.

  • Admission primarily for diagnostic purposes not related to illness for which hospitalisation has been done.

  • Convalescence, cure, rest cure, sanatorium treatment, rehabilitation measures, private duty nursing, respite care, long-term nursing care or custodial care.

  • Preventive care, vaccination including inoculation and immunisations (except in case of post-bite treatment); any physical, psychiatric or psychological examinations or testing.

  • Admission for Enteral feedings (infusion formulas via a tube into the upper gastrointestinal tract) and other nutritional and electrolyte supplements unless certified to be required by the attending medical practitioner as a direct consequence of an otherwise covered claim.

  • Provision or fitting of hearing aids, cochlear implant, spectacles or contact lenses including optometric therapy, any treatment and associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test strips, and similar products.

  • Artificial limbs, crutches or any other external appliance and/or device used for diagnosis or treatment (except when used intra-operatively).

  • Psychiatric, mental disorders (including mental health treatments), Parkinson and Alzheimer’s disease, general debility or exhaustion (“run-down condition”), sleep-apnoea.

  • Congenital external diseases, defects or anomalies.

  • Stem cell therapy or surgery, or growth hormone therapy.

  • Venereal disease, sexually transmitted disease or illness.

  • “AIDS” (Acquired Immune Deficiency Syndrome) and/or infection with HIV (Human Immunodeficiency Virus) including but not limited to conditions related to or arising out of HIV/AIDS such as ARC (AIDS Related Complex), Lymphomas in brain, Kaposi’s sarcoma, tuberculosis.

  • Pregnancy (including voluntary termination), miscarriage (except as a result of an Accident or Illness), maternity or birth (including caesarean section), except in the case of ectopic pregnancy in relation to a claim under 1a) for in-patient treatment only.

  • Sterility, treatment whether to effect or to treat infertility, any fertility, sub-fertility or assisted conception procedure, surrogate or vicarious pregnancy, birth control, contraceptive supplies or services including complications arising due to supplying services.

  • Expenses for organ donor screening other than that as provided under in organ donor benefit.

  • Treatment and supplies for analysis and adjustments of spinal subluxation, diagnosis and treatment by manipulation of the skeletal structure; muscle stimulation by any means except treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities.

  • Dental treatment and surgery of any kind, unless requiring hospitalisation.

  • Expense related to pancreatic islet transplantation.


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