Navi Group Health Insurance

Navi Health Insurance is a wholly owned subsidiary of Navi Technologies – a Sachin Bansal-owned digital finance lending institution. Navi Health Insurance began its functioning in November 2017 and adopted a digital mode of selling its insurance products through the Navi Health Insurance App. It has over 1.1 million customers and provides various health insurance schemes along with motor, commercial, property, and gadget insurance solutions.

Navi Health Insurance operates on the values of integrity, collaboration, innovation, respect, and customer-centricity. Navi Health Insurance provides so many advantages including in-patient hospitalization, pre, and post-hospitalization, cashless hospitalization, COVID-19 cover, hospitalization at home cover, no room rent capping, optional critical illness cover, daycare treatment, optional maternity cover, etc.

Coverage

In-patient Hospitalization

Navi Group Health Insurance will cover the Medical Expenses incurred for:

1. Room Rent & Nursing charges;
   
   
2. Operation Theatre charges;
   
   
3. Fees of Surgeon / Specialists / Medical Practitioner/ Anaesthetist;
   
   
4. Intensive Care Unit (ICU) charges;
   
   
5. Drugs, Medicines, and Consumables;
   
   
6. Oxygen, Blood, Surgical appliances;
   
   
7. Physiotherapy, Investigation & Diagnostic procedures;
   
   
8. The cost of prosthetics and other devices or equipment recommended by the attending Medical Practitioner and if implanted internally during a Surgical Procedure.

Modern Treatment Methods

The following procedures will be covered (wherever medically indicated) either as an inpatient or as part of daycare treatment in a hospital up to the Sum Insured, specified in the policy schedule, during the policy period:

1. High-intensity focused ultrasound (HIFU) or Uterine Artery Embolization
   
   
2. Deep Brain stimulation
   
   
3. Intravitreal injections
   
   
4. Robotic surgeries
   
   
5. Stereotactic radio surgeries
   
   
6. Oral chemotherapy
   
   
7. Balloon Sinuplasty
   
   
8. Holmium laser treatment or Green laser treatment (Vaporization of the prostate)
   
   
9. IONM – (Intra Operative Neuro Monitoring)
   
   
10. Immunotherapy – Monoclonal Antibody to be delivered as an injection
    
    
11. Bronchial Thermoplasty
    
    
12. Therapy of Stem cells: Hematopoietic stem cells for bone marrow transplant for hematological cases to be covered.

Mental Illness

Navi Group Health Insurance will cover Mental Illness as per the provisions of the Mental Healthcare Act of 2017. However, in case of following mental illnesses the Inpatient Hospitalization benefit will be restricted to Policy Sum Insured or 3 lacs, whichever is lower;

1. Schizophrenia

2. Bipolar Affective Disorders

3. Depression

4. Obsessive Compulsive Disorders

5. Psychosis

HIV & AIDS

Navi Group Health Insurance will cover up to the Sum Insured in circumstances of Inpatient hospitalization (including Day Care Treatment) for treatment of any condition caused by or associated with HIV or acquired immuno-deficiency syndrome (AIDS).

Pre-hospitalization

Navi Group Health Insurance will cover Pre-Hospitalisation Medical Expenses incurred during thirty (30) days preceding the Hospitalisation of the Insured Person including Day Care Treatment.

Note – The date of hospitalization for the purpose of this coverage shall be the date of the insured individual’s first admission to the hospital in respect of any one illness.

Post-hospitalization

Navi Group Health Insurance will cover Post-Hospitalisation Medical Expenses incurred during sixty (60) days immediately after the Insured Person is discharged from the Hospital including Day Care Treatment.

Note – In case of any one illness where the insured person undergoes more than one hospitalization within 45 days, the cover for post-hospitalization expenses cumulatively shall not exceed 60 days.

Day Care Treatment

Navi Group Health Insurance will cover day care treatment (including pre-hospitalization and post-hospitalization medical expenditures). A list of such treatments is available in Annexure II of this document.

Domiciliary Hospitalisation

Navi Group Health Insurance will cover the Domiciliary Hospitalisation if medical treatment is continuously required for at least three (3) days, in which case the cost of medical treatment for the entire period shall be payable. Navi Group Health Insurance will also cover the pre and post Hospitalization medical expenses.

Organ Donor

Navi Group Health Insurance will cover the Surgical Expenses incurred towards the donor in case of a major organ transplant for Harvesting of the organ provided that:

i. The organ donor is any person whose organ has been made available in accordance and in compliance with the Transplantation of Human Organs Act 1994 and amendments thereof and other applicable laws & rules.

ii. The donated organ is for the use of the insured individual.

iii. The Insured Individual (recipient) has been medically instructed to undergo an organ transplant.

iv. Navi Group Health Insurance has accepted a claim under In-patient Hospitalization.

Navi Group Health Insurance will not pay for

i. Any expense other than those specified above.

ii. Cost towards donor screening.

iii. Pre/post hospitalization Medical Expenditures of the organ donor.

iv. Costs directly or indirectly related to organ acquisition.

v. Any other medical cure for the donor as a result of harvesting.

vi. Expenses related to organ transportation or preservation.

vii. Transplantation of any tissue/organ where the transplant is investigational or experimental.

viii. Hospitalization or any related Medical Expenses if an Insured Person is Hospitalized for donating organs.

Vaccination (Post-bite treatment)

Navi Group Health Insurance will cover the Medical Expenditures incurred for vaccination including inoculation and immunizations for post-bite treatment. However, Medical Expenses incurred on outpatient treatment will be limited to the sub-limit of up to Rs.5000.

Family Transportation Benefit

Navi Group Health Insurance will cover the transportation expenses incurred by anyone Immediate Family Member of the Insured Person up to the limits stated in the Policy Schedule/ Certificate of Insurance if –

The insured person is admitted to a Hospital that is not in the city as reflected in the address in the Policy and no adult member of his immediate family is present in the hospital at his bedside for the duration of his stay in the hospital.

Note: Coverage shall be applicable only if Navi Group Health Insurance has accepted a claim under In-patient Hospitalization.

Emergency Ambulance / Funeral expenditures/ Repatriation of Mortal Remains (RMR)

I. Navi Group Health Insurance will cover the expenses up to the limits stated in the Policy Schedule/ Certificate of Insurance, incurred towards transportation of an Insured Person by a registered healthcare or Ambulance service provider for treatment of a disease / Illness / Injury in case of an Emergency.

Expenses shall include:

1. Transportation Costs towards transferring the Insured Person from the place of incident to the Hospital or from one Hospital to another Hospital or to a diagnostic center for advanced diagnostic treatment where such a facility is not available at the existing Hospital and advised by the treating Medical Practitioner.
   
   
2. When the insured individual needs to be shifted to a better hospital facility due to lack of super specialty treatment in the current hospital.
   
   
3. When the insured individual needs to move home after being discharged from the hospital. The medical condition of the Insured Person is such that it requires Ambulance services and is certified by a treating Medical Practitioner.

II. Navi Group Health Insurance will also cover the following expenses if the Insured Person dies in the Hospital during the course of Hospitalization.

1. Transportation of Mortal remains from hospital to home and/or crematorium for the cremation;
   
   
2. Cremation Expenses;
   
   
3. Coffin Charges.

Exclusions

Standard exclusions apply to all policies

1. Breach of Law – Expenses for treatment caused by or in consequence of any Insured Person breaking or attempting to break the law with criminal intent.
   
   
2. Chemical & Nuclear Exposure – Navi Group Health Insurance will not pay for the treatment costs directly or indirectly caused by or contributed to or arising from nuclear weapons/materials, radioactive material, nuclear waste, nuclear fuel, chemical weapons/material, or biological weapons/material.
   
   
3. War – Navi Group Health Insurance will not pay for the treatment related to any condition resulting from, or as a consequence of War, invasion, the act of a foreign enemy, public defense, rebellion, insurrection, military or usurped acts, civil war, or revolution.