United India Healthcare Coverage for Senior Citizens

United India Insurance’s Senior Citizen Health Insurance is the best medical insurance purchase an elderly person can make. The policy is specifically designed to cover medical expenses incurred while in the hospital as a result of an accident, injury, or illness, which can be of great assistance in avoiding financial difficulties in the event of a medical emergency.

Inclusions of United India Healthcare Coverage for Senior Citizens

The following are the main inclusions of United India Health Insurance for older citizens:

  1. Hospital/Nursing Home room, board, and nursing expenditures not to exceed 1% of the total covered per day or the actual amount, whichever is smaller. This covers nurse care, RMO fees, IV fluids/blood transfusion/injection administration fees, and other related costs.

  2. Intensive Care Unit (ICU) expenditures are limited to 2% of the insured amount per day or the actual amount, whichever is smaller.

  3. Fees for Surgeons, Anaesthetists, Medical Practitioners, Consultants, and Specialists

  4. Anaesthesia, blood, oxygen, operating room charges, surgical appliances, medicines and drugs, dialysis, chemotherapy, radiotherapy, cost of artificial limbs, cost of prosthetic devices implanted during surgical procedure such as pacemaker, orthopaedic implants, infrared cardiac valve replacements, vascular stents, relevant laboratory/diagnostic tests, X-ray, and other medical expenses related to the treatment

  5. Hospitalization expenses (excluding organ cost) incurred by the donor in connection with an organ transplant to the insured.

  6. DOMESTIC HOSPITALISATION: It includes pre and post-hospitalization expenses for the following diseases:

  7. Allergies

  8. Bronchitis

  9. Nephritic Syndrome and Chronic Nephritis

  10. Diarrhoea and other dysenteries, including gastroenteritis

  11. Diabetes Mellitus with Insipidus

  12. Epilepsy

  13. High blood pressure

  14. Flu, cough, and cold

  15. Any and All Psychiatric or Psychosomatic Disorders

  16. Pyrexia of Unknown Cause lasting fewer than 10 days

  17. Tonsillitis and upper respiratory tract infection, including laryngitis and pneumonia

  18. Rheumatism, Arthritis, and Gout

  19. Hospitalization charges for Ayurvedic Treatment are allowed only if the treatment was received in a Government Hospital or any Institute recognized by the Government and/or certified by the Quality Council of India/National Accreditation Board on Health.

Exclusions of United India Healthcare Coverage for Senior Citizens

  1. Any pre-existing condition(s) as stated in the policy, unless such covered individual has had 48 months of continuous coverage after the start of his/her first Policy, as mentioned.

  2. in the policy’s timetable

  3. Direct or indirect injury or sickness caused by, originating from, or traceable to war, invasion, foreign hostile act, or war-like actions (whether war be declared or not)

  4. Any type of dental therapy or surgery, unless caused by an accident that necessitates hospitalisation.

  5. Naturopathy therapy, acupressure, acupuncture, magnetic therapies, experimental and untested treatments/therapies

  6. Genetic diseases and stem cell implantation/surgery

  7. Treatment for all mental and psychosomatic diseases, infertility, and sterility.

  8. Venereal illness, purposeful self-injury, and use of intoxicating drugs/alcohol

Notice of Claim

When an incident occurs that may give rise to a claim under this Policy, a notification with full particulars must be given to the TPA indicated in the schedule promptly and, in the case of emergency Hospitalisation, within 24 hours of the time of Hospitalisation / Domiciliary Hospitalisation.

All supporting paperwork for the claim must be submitted to TPA within 15 days after release from the hospital. In the case of post-hospitalization therapy (limited to 60 days), all claim documentation must be filed within 7 days of the treatment’s conclusion.

Note: Waiver of this Condition may be considered in exceptional situations of hardship when it is demonstrated to the satisfaction of the Company that given the circumstances in which the insured was put, it was not practicable for him or any other person to provide such notice or file claim within the required time-limit.

Free Look Time

The policy includes a free look period that begins at the policy’s introduction as well as the policy;

1. The insured shall be given at least 15 days from the date of receipt of the policy to study the terms and conditions and return it if they are not acceptable.

2. If the insured makes no claims throughout the free look period, the policyholder is entitled to –

a. A return of the premium paid less any medical expenses incurred by the insurer inspection of insured individuals and stamp duty costs or

b. Where the risk has already begun and the policyholder’s opinion of return is exercised, a reduction towards the proportional risk premium for the time under cover or

c. Where just a fraction of the risk has begun, a proportionate risk premium corresponding with the risk covered during such period is charged.

Renewal Clause 

1. The Company will renew this Policy provided the Insured pays the required Premium to the Company prior to the expiration of the Period of Insurance specified in the Schedule.

2. If the following conditions are met, the company may refuse to renew:

a. any fraud, misrepresentation, or suppression by the Insured or on his behalf is discovered either in obtaining insurance or subsequently in relation thereto, or

b. the Company has discontinued issue of the Policy, in which case the Insured shall have the option for renewal under any similar Policy being issued by the Company; provided, however, that benefits payable shall be subject to the terms contained in such other policy.

3. If the Insured fails to return the Premium for renewal before the Period of Insurance expires, but within 30 days thereafter, the acceptability of any claim during the future Policy period must be examined in the same manner as under a Policy renewed without break. The Company, on the other hand, will not be liable for any claim deriving from an illness or hospitalisation that begins in the interim period following the expiration of the previous Policy and before to the date of beginning of the subsequent Policy.

4. Sum Insured Enhancement – The Insured may request an increase in the Sum Insured in writing at or before the payment of the renewal premium, which may be granted at the Company’s discretion. However, regardless of augmentation, the Company’s responsibility for claims originating from an illness, sickness, or injury contracted or incurred during a prior Policy term shall be limited to the Sum Insured under the Policy in effect at the time it was contracted or suffered.

Any such request for enhancement must be accompanied by a declaration that the insured or any other covered person for whom such enhancement is sought is unaware of any symptoms or other indicators that may give rise to a claim under the policy. The Company may ask such insured person/s to undergo a medical examination in order for the Company to make a judgement on granting the request for an increase in the Sum Insured. On acceptance of the request for an increase in the sum covered, the insured person will be reimbursed 50% of the cost of the medical examination.

Cancellation Policy

The Company may terminate the Policy at any time for misrepresentation, fraud, non-disclosure of material fact, or non-cooperation by the insured by delivering fifteen days’ notice in writing by Registered A/D to the insured at his last known address, in which case the Company shall repay to the insured a share of the final premium equivalent to the unexpired period of insurance if no claim has been paid under the policy.

Portability

If an insured individual wishes to port to another insurer, he or she must apply with policy and claim data at least 45 days before the policy’s expiration date.

Portability is permitted in the following situations:

a. All individual health insurance plans issued by non-life insurance firms, including family floater policies; and

b. All family floater policies.

Individual members, including family members, insured by a non-life insurance company’s Group Health insurance policy have the right to migrate from such a group policy to an individual health insurance plan or a family floater plan with the same insurer. After one year, the covered individual is entitled to move to another non-life insurance provider.

FAQs

Q1. Are there any waiting periods for senior citizens who have United India Health Insurance?

Ans: Yes. The following waiting periods are included in the United India Senior Citizen Mediclaim policy:

Initial Waiting Period: 30 days for Pre-existing Diseases; Specific Diseases: 24 Months for Joint Replacement; Initial Waiting Period: 48 Months for Joint Replacement.

Q2. Under the United India Health Insurance, is a health check-up required prior to acceptance for senior citizens?

Ans: Before purchasing a United India Senior Citizen Mediclaim policy, senior citizens may be required to have their health checked before acceptance.

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