Wellsurance Family Policy– Family Fixed Benefit Plan
Wellsurance Family Policy pays special attention to each member of your family, to prevent unexpected emergencies from affecting your financial health. From higher daily cash cover if a family member is admitted to the ICU to children’s education benefit, this family health insurance policy does more than just care for your family’s health.
It cares for their well being.
- We offer life-long renewal subject to application for renewal and the renewal premium in full has been received by the due dates and realisation of premium, unless the Insured Person or any one acting on behalf of an Insured Person has acted in an improper, dishonest or fraudulent manner or any misrepresentation or non cooperation under or in relation to this policy or the policy poses a moral hazard.
- Fixed lump sum benefit is paid for –
- Avail of unique Wellness benefits. Get the Wellsurance Advantage
- Free Look Period –You have a period of 15 days from the date of receipt of the Policy document to review the terms and conditions of this Policy. If You have any objections to any of the terms and conditions, You have the option of cancelling the Policy stating the reasons for cancellation and You will be refunded the premium paid by You after adjusting the amounts spent on stamp duty charges and proportionate risk premium. You can cancel Your Policy only if You have not made any claims under the Policy. All Your rights under this Policy will immediately stand extinguished on the free look cancellation of the Policy. Free look provision is not applicable and available at the time of renewal of the Policy
- Grace Period of 30 days for renewing the Policy is provided under this Policy. However, coverage would not be available for the period for which no premium has been received.
- Sum Insured Enhancement –The Insured may seek enhancement of Sum Insured and / or addition of insured in writing at the time of renewal, before the payment of premium. However, notwithstanding enhancement, for claims arising in respect of accident, injury or illness contracted or suffered during a preceding Policy period, liability of the Company shall be only to the extent of the Sum Insured under the Policy in force at the time when it was contracted or suffered. The Enhanced Sum Insured/Additional Insured will have a fresh proposal status where the waiting period, deductibles and exclusions shall apply afresh.
- Changes will be notified to the policyholders 3 months in advance in case of revision /modification in approved product.
- Likelihood of withdrawal of the product will be notified to the policy holders 3 months prior to the expiry of the policy and option would be given to migrate to similar Health Insurance policy
- Migration option for dependents at their exit age
- Tax Benefits - Get tax benefits for premium paid on policies as per section 80D of the Income Tax Act. Tax benefits are subject to income tax laws.
Hospitalisation: cover hospitalization, Intensive care unit (ICU) admission and convalescence benefit
Critical Illnesses: On diagnosis of any of the listed 11 covered critical illnesses. Coverage continues for remaining covered critical illnesses even after claiming benefit for diagnosed critical illness.
Children´s Education benefit in case of Accidental death/Permanent total disability of the policyholder.
|Wellsurance Family Policy Benefits (in )|
|1||Diagnosed critical Illness (waiting period 90 days, survival period 30 days)|
|i>||Cancer of specified severity||200000||300000||400000|
|ii>||First Heart Attack of specified severity||200000||300000||400000|
|iii>||Stroke resulting in permanent symptoms||200000||300000||400000|
|iv>||Kidney Failure requiring regular Dialysis||200000||300000||400000|
|v>||Coma of specified severity||200000||300000||400000|
|vi>||Open Chest CABG||200000||300000||400000|
|vii>||Major Organ/Bone MarrowTransplant||200000||300000||400000|
|viii>||Total Blindness(due to acute sickness or accident)||200000||300000||400000|
|ix>||Permanent Paralysis Of Limbs||200000||300000||400000|
|x>||Multiple Sclerosis with persisting symptoms||200000||300000||400000|
|xi>||Major Burns with persisting symptoms||200000||300000||400000|
|2||Hospital cash - upto 90 days (Per Day) deductible - 1 day||2000||3000||4000|
while admitting and while discharging from the Hospital
|4||ICU Benefit - Max 15 days (Per Day)||3000||4500||6000|
( payable after continuous Hospitalization for 5 days)
- For all sickness hospitalisation, waiting period of 90 days is applicable.
- No waiting period for Accident related hospitalisation.
- Hospital Cash : 1 day deductible for Sickness Hospital Cash benefit. Not applicable for hospitalisation due to any accident.
- Critical Illness benefit available for self & spouse only.
- Coverage for children under the policy for hospitalization benefits will be 50% of Sum Insured limits mentioned in the table.
- Critical Illness: The benefit for each critical illness will be paid once during the entire life time of the policyholder. On Renewal this benefit will be available for all Illnesses except for the one paid in the previous term(s).
- If an insured suffers a Critical Illness/Sickness/Disease or has to undergo a surgery for which benefits are payable under more than one such similar policy issued by us, the maximum amount payable under all policies combined will not exceed the amount payable under the policy which pays the largest benefit
- This policy covers hospitalization in India only.
- Free Health Helpline - Reach our expert physicians to avail help on health & wellness related information. Get instant phone access. Call our Toll Free no 1800 103 5252. Timings: 9:00am to 7:00pm (From Monday to Saturday).
- Health Portal – You will be given access to the Health Portal, exclusively developed for TATA-AIG General Insurance Co., which has a ‘Knowledge Centre” which will host ‘Health Articles’ on relevant topics like diabetes, Cholesterol, Weight management, Yoga, heart diseases, Fitness. The purpose of this service is to educate you on Health & Wellness topics so that you can start practicing Preventive Care.
The Health portal will also host the list of network hospitals for Cashless settlement, provided by the appointed Third Party Administrator (TPA).
- Health Query – You will be able to write queries on routine health problems like acidity, sinus, cough-colds, infections, diabetes etc on – “Post Your Health Query”
The Queries will be answered by a Physician, and will be e-mailed to your e-mail address.
- Discounted Services for Health & Wellness – You will be offered discounts at health related services like Gyms, Weight management Centers, beauty parlors, diagnostic centers by personally visiting / calling the respective centers in their respective cities and paying directly to the centre.
We will provide the list of discounted tie-ups, along with Centre address/ contact numbers available on the health portal which will be updated on regular intervals.
- e-News letter – You will receive regular updates on various health Topics, latest trends in Health & Wellness, via an ‘e-News Letter’ which will be mailed to your e-mail id (if available & provided). The purpose of this e-news letter is to educate you on Health & Wellness topics so that you can start practicing Preventive Care.
For all claims, contact E-Meditek (TPA) Services Ltd. (address below), our appointed service provider for your Health Policy. All admissible claims will be cashless, subject to admission in network hospitals authorized by E-Meditek (TPA) Services Ltd. If admitted to a non-network hospital, submit your bills to E-Meditek (TPA) Services Ltd. for reimbursements up to the specified limits.
E-Meditek (TPA) Services Ltd. has a network of 3000+ hospitals on all India basis.
Address: Plot 577, Udyog Vihar, Phase V, Gurgaon - 122016
Contact details: 24x7 Toll Free Claims Helpline 1800 103 5252 / 1800 22 9966 (Only for Senior Citizens)
Read more about cashless process
Click here to know more about our claims Service.
Who should buy Wellsurance Family Policy?
Entry from age 18 years up to 65 years(The age bands are for eldest member to be covered under this policy).
The eligible age for children is 6 months – 18 years (23 years in case studying for Higher Education)
What is not covered under Wellsurance Family Policy?
This entire Policy does not provide benefits for any loss resulting in whole or in part from, or expenses incurred, directly or indirectly in respect of:
- Any Pre-existing Condition, any complication arising from it. Except if the insured has taken a similar Wellsurance Policy from Us and is covered without a break, for a period of 4 consecutive years since inception of the first policy with Us.Please refer Section ‘Part B 1’ for detailed information.
- Intentionally self-inflicted Injury or illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS), Human Immune-deficiency Virus (HIV) infection; attempted suicide, or
- War, civil war, invasion, insurrection, revolution, act of foreign enemy, hostilities (whether War be declared or not), rebellion, mutiny, use of military power or usurpation of government or military power; or
- Serving in any branch of the Military or Armed Forces of any country, whether in peace or War, and in such an event We, upon written notification by You, shall return the pro rata premium for any such period of service; or
- Ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from burning nuclear fuel; or
- The radioactive, toxic, explosive or other dangerous properties of any explosive nuclear equipment or any part of that equipment; or
- Congenital anomalies or any complications or conditions arising there from; or
- Professional Sports, Hazardous Activities ; or
- Cosmetic or plastic surgery or any elective surgery or cosmetic procedure, circumcision, (except as a result of an Injury caused by a Covered Accident while Our Policy is in force ) that improve physical appearance, surgical and non-surgical treatment of obesity (including morbid obesity) and weight control programs, or treatment of an optional nature; Routine health checks or convalescence, Custodial Care, general debility, lethargy, rest cure; expenses on vitamins, tonics and any other health supplement; vaccination, inoculation of any kind.
- Any investigation(s) or treatments not directly related to a Covered Illness or Covered Injury or the conditions or diagnosis necessitating hospital admission; or Any surgery done on the organ(s), if they are not infected or affected;
- services, supplies, or treatment, including any period of Hospital confinement, which were not recommended, approved, and certified as Medically Necessary by a Physician; or
- organ transplants that are considered experimental in nature; expenses incurred for hospitalization or surgery for donation of organs ; or
- pregnancy and all related conditions, including services and supplies related to the diagnosis or treatment of infertility or other problems related to inability to conceive a child; birth control, including surgical procedures and devices; this however does not include ectopic pregnancy proved by diagnostic means and is certified to be life threatening by the Physician; or
- Medical expenses incurred as the result of alcohol and/or drug abuse, addiction or overdose.
- Any surgery for donation of organs.
- treatment of Spondylosis/ Spondilitis
- Cost of Spectacles and contact lenses, hearing aids, walkers, crutches, wheel chairs and such other aids
- Any Ayurvedic, Homeopath or naturopathy treatments.
A waiting period of 90 days for all sickness hospitalization. There is no waiting period for accident related hospitalization. 1 day deductible for sickness related hospital cash benefit is applicable. In children education benefit in case of more than 1 child; the benefit will be paid equally to the eligible children.
The benefit for each critical illness is payable only once in the whole life for Self & Spouse. Waiting period of 90 days & survival period of 30 days is applicable for critical illness Benefit. This policy covers hospitalization in India only.
Please refer to policy wording for detailed benefits and exclusions.
Is Wellsurance Family Policy a family floater or a family coverage plan?
Wellsurance Family Policy is a family coverage plan. The Sum Insured mentioned against in each section are applicable to the Principle Insured and Spouse individually.
Does this plan cover Hospitalization Benefits?
Fixed lump sum benefit is paid for hospital cash, Intensive care unit (ICU), convalescence & Ambulance Charges.
Is my pre-existing condition covered under the policy?
Any Pre-existing Condition, any complication arising from it is not covered in the policy, except if the insured has taken a similar Wellsurance Policy from Us and is covered without a break, for a period of 4 consecutive years since inception of the first policy with Us. Please refer Section ‘Part B 1’ for detailed information.
Is there a waiting period before one can get critical illness benefit?
A waiting period of 90 days from the policy inception date and a 30 day survival period from the date of diagnosis is applicable.
Are the children covered for the critical illnesses under the plan?
Children are not covered for the critical illnesses covered under the plan.