What does our Family Health Insurance Plan cover?

From treating a sudden injury to being diagnosed with an ailment, medical expenses are always unforeseen. Such circumstances give rise to not only emotional stress, but also financial stress. These expenses are especially high when you have kids and elderly members in the family. That’s where the family health cover adds most value, as it greatly lightens the monetary pressure that comes with medical requirements. Under our family healthcare plans, we offer medical coverage to the policyholder and their family, up to the sum for which the policy insures them.

At Chola MS, we cover you for the following:

Inpatient Hospitalisation Expenses: We pay for hospitalisation expenses that require over 24 hours of hospitalisation. These expenses include room and boarding charges, the doctor’s fee, intensive care unit charges, nursing expenses operating expenses, physical therapy expenses, cost of drugs and medicines consumed in the premises, cost of dressing, costs of prosthetic devices, radiotherapy, chemotherapy, organ transplantation, and other miscellaneous hospital expenses.

Pre-Hospitalisation Expenses: The policyholder receives indemnity for the expenses incurred before hospitalisation. These include blood tests, X-rays, sonography, urine tests, MRIs, etc. Note: These expenses are borne by your insurance provider only for the medical condition that the insured has been hospitalised for.

Post-Hospitalisation Expenses: We provide coverage for the expenses that arise after the discharge such as medicines, blood tests to keep a check on the policyholder’s health, etc.

AYUSH Expenses Coverage (Ayurvedic, Unani, Sidha, and Homeopathy): We also cover the charges that require more than 24 hours of hospitalisation under non-allopathic treatments, except naturopathy. The policyholder must undergo the treatment in a government hospital or in any institute recognised by the government, or accredited by the Quality Council of India, or the National Accreditation Board of Hospitals and Healthcare.

Day Care Procedures: The insured remains covered for treatments that require less than 24 hours of hospitalisation.

Ambulance Charges: We provide compensation for emergency ambulance charges.

Additional Benefits of choosing Chola MS Family Healthcare Plans

Other than the basic cover, we also offer a few additional benefits to our policyholders.

These include:

1. Per-day allowance during hospitalisation

2. Home nursing care charges for a milted period, but the Treatment Medical Practitioner needs to recommend such care to the policyholder.

3. If the insured requires external aids and appliances after a treatment, the expenses will be paid off by us. Only the following aids and appliances are covered under our family health insurance plan:

- Abdominal belts

- Belts for Prolapsed Inter-Vertebral Disc

- Artificial limbs

- Crutches

- Wheelchair

- Trusses

What does Chola MS Family Health Insurance not cover?

1. Right after the commencement of the policy, the insured needs to wait for 30 days to make any claim, except for injuries caused due to an accident. This exclusion is not applicable for subsequent renewals of the policy with the company.

2. The treatment of the following health issues aren’t covered during the first year of the policy:

- Cataract

- Benign Prostatic Hypertrophy

- Hysterectomy or for Menorrhagia or Fibromyoma

- Hernia

- Hydrocele

- Fistula in anus, Piles

- Congenital Internal Anomaly

- Sinusitis and related disorders

3. Coverage for pre-existing diseases won’t be offered until you have been insured for 48 months continuously, with an Indian insurer.

4. The insured won’t be covered if they are involved in a war or in an act of war, invasion, acts of foreign enemies, and hostilities, whether war be declared or not.

5. We are not responsible to indemnify the cost in case the policyholder commits or attempts any breach of law, or attempts suicide.

6. The use of misuse of tobacco, alcohol, any banned substances, narcotic drugs (prescribed or not).

7. Any travel charges except ambulance.

8. The medical expenses incurred due to ionising radiation or contamination by radioactivity from nuclear waste or nuclear fuel.

9. Experimental or unproven treatment.

10. We are not liable to cover the policyholder if they participate in any hazardous activity such as scuba diving, motorcycling, parachuting, rock or mountain climbing, etc. Also, members of the armed forces, paramilitary, security forces, fire or ambulance services, lifeboat services, police service, etc. are not covered under this policy.

11. Treatment for reducing weight, debility, convalescence, run-down conditions, rest cure, and treatment for sleep apnoea.

12.Treatments to affect or treat infertility and any fertility and sub-fertility procedures. Surrogacy, birth control, contraceptives, or any complications caused by supplying these services. Also, treatments to cure impotency or improve potency are not covered under family health insurance.

13. Circumcisions, unless necessary due to an illness or injury.

14. Any sex transformation operation or any procedures to improve physical appearance.

15. Cosmetic procedures and any complications caused due to cosmetic procedure, unless it is done after a traumatic injury, burn, or cancer.

16. Vaccination or inoculation, unless required as a post-animal-bite treatment.

17. Treatment for psychiatric or mental sickness.

18. Covering the cost of medical equipment, unless it is needed after a treatment or an injury.

19. Treatment for external congenital diseases, defects, or anomalies and genetic disorders.

20. The expenses included in buying hearing aids or eyeglasses or lens.

21. Expenses incurred primarily during the diagnosis stage, such as X-ray, MRI, blood test, etc. that are not incidental to the diagnosis or treatment for which the policyholder was hospitalised.

22. Costs that include all personal comfort services such as TV, barber, guest service, etc., unless they are already included in the room charges.

23. The treatment extended by an unauthorised doctor, or a doctor who lacks specialisation in the required field of treatment, or any medical help provided by a doctor who is also a family member.

24. Any medication that’s not supported by a prescription.

25. Any non-medical expenses incurred during the treatment.

26. Naturopathy.

Note: The above is a partial listing of the policy exclusions. Please refer to the policy clauses for the full listing