Acko General Insurance Limited Arogya Sanjeevani Policy |
This Policy is a contract of insurance issued by Acko General Insurance Ltd. (hereinafter called the 'Company') to the proposer mentioned in the schedule (hereinafter called the 'Insured') to cover the person(s) named in the schedule (hereinafter called the 'Insured Persons'). The policy is based on the statements and declaration provided in the proposal form by the proposer and is subject to receipt of the requisite premium.
If during the policy period one or more Insured Person (s) is required to be hospitalized for treatment of an Illness or Injury at a Hospital/ Day Care Centre, following Medical Advice of a duly qualified Medical Practitioner, the Company shall indemnify Medically necessary, expenses towards the Coverage mentioned in the policy schedule.
Provided further that, any amount payable under the policy shall be subject to the terms of coverage (including any co-pay, sub limits), exclusions, conditions and definitions contained herein. Maximum liability of the Company under all such Claims during each Policy Year shall be the Sum Insured (Individual or Floater) opted and Cumulative Bonus (if any) specified in the Schedule.
The terms defined below and at other junctures in the Policy have the meanings ascribed to them wherever they appear in this Policy and, where, the context so requires, references to the singular include references to the plural; references to the male includes the female and references to any statutory enactment includes subsequent changes to the same.
3.1 Accident means a sudden, unforeseen and involuntary event caused by external, visible and violent means.
3.2 Age means age of the Insured person on last birthday as on date of commencement of the Policy.
3.3 Any One Illness means continuous period of illness and it includes relapse within forty-five days from the date of last consultation with the hospital where treatment has been taken.
3.4 AYUSH Treatment refers to hospitalisation treatments given under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems.
3.5 An AYUSH Hospital is a healthcare facility wherein medical/surgical/para-surgical treatment procedures and interventions are carried out by AYUSH Medical Practitioner(s) comprising of any of the following:
3.6 AYUSH Day Care Centre means and includes Community Health Centre (CHC), Primary Health Centre (PHC), Dispensary, Clinic, Polyclinic or any such health centre which is registered with the local authorities, wherever applicable and having facilities for carrying out treatment procedures and medical or surgical/para-surgical interventions or both under the supervision of registered AYUSH Medical Practitioner (s) on day care basis without in -patient services and must comply with all the following criterion:
3.7 Break in Policy means the period of gap that occurs at the end of the existing policy term, when the premium due for renewal on a given policy is not paid on or before the premium renewal date or within 30 days thereof
3.8 Cashless Facility means a facility extended by the insurer to the insured where the payments, of the costs of treatment undergone by the insured person in accordance with the Policy terms and conditions, are directly mad e to the network provider by the insurer to the extent preauthorization is approved.
3.9 Condition Precedent means a Policy term or condition upon which the Company’s liability under the Policy is conditional upon.
3.10 Congenital Anomaly refers to a condition(s) which is present since birth, and which is abnormal with reference to form, structure or position.
3.11 Co-payment means a cost sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claims amount. A co- payment does not reduce the Sum Insured.
3.12 Cumulative Bonus means any increase or addition in the Sum Insured granted by the insurer without an associated increase in premium.
3.13 Day Care Centre means any institution established for day care treatment of disease/ injuries or a medical setup within a hospital and which has been registered with the local authorities,wherever applicable, and is under the supervision of a registered and qualified medical practitioner AND must comply with all minimum criteria as under:
3.14 Day Care Treatment means medical treatment, and/or surgical procedure which is:
3.15 Dental Treatment means a treatment carried out by a dental practitioner including examinations, fillings (where appropriate), crowns, extractions and surgery.
3.16 Disclosure to information norm: The policy shall be void and all premium paid thereon shall be forfeited to the Companying the event of misrepresentation, mis-description or nondisclosure of any material fact.
3.17 Emergency Care: Emergency care means management for an illness or injury which results in symptoms which occur suddenly and unexpectedly, and requires immediate care by a medical practitioner to prevent death or serious long term impairment of the insured person's health
3.18 Family means, the Family that consists of the proposer and any one or more of the family members as mentioned below:
3.19 Grace Period means specified period of time immediately following the premium due date during which a payment can be made to renew or continue the Policy in force without loss of continuity benefits such as waiting period and coverage of pre-existing diseases. Coverage is not available for the period for which no premium is received.
3.20 Hospital means any institution established for in-patient care and day care treatment of disease/ injuries and which has been registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under Schedule of Section 56(1) of the said Act, OR complies with all minimum criteria as under:
3.21 Hospitalisation means admission in a hospital for a minimum period of twenty-four (24) consecutive 'In- patient care' hours except for specified procedures/ treatments, where such admission could be for a period of less than twenty-four (24) consecutive hours.
3.22 Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological function which manifests itself during the policy period and requires medical treatment.
3.23 Injury means accidental physical bodily harm excluding illness or disease solely and directly caused by external, violent and visible and evident means which is verified and certified by a medical practitioner.
3.24 In-Patient Care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.
3.25 Insured Person means person(s) named in the schedule of the Policy.
3.26 Intensive Care Unit means an identified section, ward or wing of a hospital which is under the constant supervision of a dedicated medical practitioner(s), and which is specially equipped for the continuous monitoring and treatment of patients who are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the ordinary and other wards.
3.27 ICU (Intensive Care Unit) Charges means the amount charged by a Hospital towards ICU expenses on a per day basis which shall include the expenses for ICU bed, general medical support services provided to any ICU patient including monitoring devices, critical care nursing and intensivist charges.
3.28 Medical Advice means any consultation or advice from a Medical Practitioner including the issue of any prescription or follow up prescription.
3.29 Medical Expenses means those expenses that an insured person has necessarily and actually incurred for medical treatment on account of illness or accident on the advice of a medical practitioner, as long as these are no more than would have been payable if the insured person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.
3.30 Medical Practitioner means a person who holds a valid registration from the Medical Council of any state or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of the licence.
3.31 Medically Necessary Treatment means any treatment, tests, medication, or stay in hospital or part of a stay in hospital which
3.32 Migration means, the right accorded to health insurance policyholders (including all members under family cover and members of group Health insurance policy), to transfer the credit gained for pre-existing conditions and time bound exclusions, with the same insurer.
3.33 Network Provider means hospitals enlisted by insurer, TPA or jointly by an insurer and TPA to provide medical services to an insured by a cashless facility.
3.34 Non- Network Provider means any hospital that is not part of the network.
3.35 Notification of Claim means the process of intimating a claim to the Insurer or TPA through any of the recognized modes of communication.
3.36 Out-Patient (OPD) Treatment means treatment in which the insured visits a clinic/ hospital or associated facility like a consultation room for diagnosis and treatment based on the advice of a medical practitioner. The insured is not admitted as a day care or in-patient.
3.37 Pre-Existing Disease (PED): Pre-existing disease means any condition, ailment, injury or disease
3.38 Pre-hospitalisation Medical Expenses means medical expenses incurred during the period of 30days preceding the hospitalisation of the Insured Person, provided that:
3.39 Post-hospitalisation Medical Expenses means medical expenses incurred during the period of 60days immediately after the insured person is discharged from the hospital provided that:
3.40 Policy means these Policy wordings, the Policy Schedule and any applicable endorsements or extensions attaching to or forming part thereof. The Policy contains details of the extent of cover available to the Insured person, what is excluded from the cover and the terms & conditions on which the Policy is issued to The Insured person.
3.41 Policy period means period of one policy year as mentioned in the schedule for which the Policy is issued.
3.42 Policy Schedule means the Policy Schedule attached to and forming part of Policy.
3.43 Policy year means a period of twelve months beginning from the date of commencement of the policy period and ending on the last day of such twelve-month period. For the purpose of subsequent years, policy year shall mean a period of twelve months commencing from the end of the previous policy year and lapsing on the last day of such twelve-month period, till the policy period, as mentioned in the schedule.
3.44 Portability means the right accorded to an individual health insurance policyholder (including all members under family cover), to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to another insure.
3.45 Qualified Nurse means a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any state India.
3.46 Renewal: Renewal means the terms on which the contract of insurance can be renewed on mutual consent with a provision of grace period for treating the renewal continuous for the purpose of gaining credit for pre-existing diseases, time-bound exclusions and for all waiting periods.
3.47 Room Rent means the amount charged by a hospital towards Room and Boarding expenses and shall include the associated medical expenses.
3.48 Sub-limit means a cost sharing requirement under a health insurance policy in which an insurer would not be liable to pay any amount in excess of the pre-defined limit.
3.49 Sum Insured means the pre-defined limit specified in the Policy Schedule. Sum Insured and Cumulative Bonus represents the maximum , total and cumulative liability ty for any and all claims made under the Policy, in respect of that Insured Person (on Individual basis) or all Insured Persons (on Floater basis) during the Policy Year.
3.50 Surgery or Surgical Procedure means manual and / or operative procedure (s) required for treatment of an illness or injury, correction of deformities and defects, diagnosis and cure of diseases, relief of suffering and prolongation of life, performed in a hospital or day care centre by a medical practitioner.
3.51 Third Party Administrator (TPA) means a Company registered with the Authority, and engaged by an insurer, for a fee or by whatever name called and as may be mentioned in the health services agreement, for providing health services.
3.52 Waiting Period means a period from the inception of this Policy during which specified diseases/treatments are not covered. On completion of the period, diseases/treatments shall be covered provided the Policy has been continuously renew ed without any break .
The covers listed below are in-built Policy benefits and shall be available to all Insured Persons in accordance with the procedures set out in this Policy.
The Company shall indemnify medical expenses incurred for Hospitalization of the Insured Person during the Policy year, up to the Sum Insured and Cumulative Bonus specified in the policy schedule, for,
The Company shall indemnify medical expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to the limit of sum insured as specified in the policy schedule in any AYUSH Hospital.
The Company shall indemnify medical expenses incurred for treatment of Cataract, subject to a limit of 25% of Sum Insured orRs.40,000/-, whichever is lower, per each eye in one policy year.
The company shall indemnify pre-hospitalization medical expenses incurred, related to an admissible hospitalization requiring inpatient care, for a fixed period of 30 days prior to the date of admissible hospitalization covered under the policy.
The company shall indemnify post hospitalization medical expenses incurred, related to an admissible hospitalization requiring inpatient care, for a fixed period of 60 days from the date of discharge from the hospital, following an admissible hospitalization covered under the policy.
4.7 The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment in a hospital up to 50% of Sum Insured, specified in the policy schedule, during the policy period:
4.8 The expenses that are not covered in this policy are placed under List-I of Annexure-A. The list of expenses that are to be subsumed into room charges, or procedure charges or costs of treatment are placed under List-II, List-III and List-IV of Annexure-A respectively.
Cumulative Bonus will be increased by 5% in respect of each claim free policy year (where no claims are reported), provided the policy is renewed with the company without a break subject to maximum of 50% of the sum insured under the current policy year. If a claim is made in any particular year, the cumulative bonus accrued shall be reduced at the same rate at which it has accrued. However, sum insured will be maintained and will not be reduced in the policy year
The Company shall not be liable to make any payment under the policy in connection with or in respect of following expenses till the expiry of waiting period mentioned below:
6.1 Pre-Existing Disease (Code- Excl01)
6.2 First Thirty Days Waiting Period (Code- Excl03)
6.3 Specific Waiting Period (Code- Excl02)
ii. 24 Months waiting period
iii. 48 Months waiting period
The Company shall not be liable to make any payment under the policy, in respect of any expenses incurred in connection with or in respect of:
Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.
Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.
Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.
Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in its website / notified to the policyholders are not admissible. However, in case of life threatening situations following an accident, expenses up to the stage of stabilization are payable but not the complete claim.
7.9 Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof: (Code-Excl12)
7.10 Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons. (Code-Excl13)
7.11 Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure (Code-Excl14)
7.12 Refractive Error:(Code- Exc115) Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.
Expenses related to sterility and infertility. This includes:
7.15 Maternity Expenses (Code - Exel18):
7.16 War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest , restraints and detainment of all kinds.
7.17 Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss , claim or expense. For the purpose of this exclusion:
7.18 Any expenses incurred on Domiciliary Hospitalization and OPD treatment
7.19 Treatment taken outside the geographical limits of India
7.20 In respect of the existing diseases, disclosed by the insured and mentioned in the policy schedule(based on insured's consent), policyholder is not entitled to get the coverage for specified ICD codes.
After completion of eight continuous years under this policy no look back would be applied. This period of eight years is called as moratorium period. The moratorium would be applicable for the sums insured of the first policy and subsequently completion of eight continuous years would be applicable from date of enhancement of the sums insured only on the enhanced limits. After the expiry of Moratorium Period no claim under this policy shall be contestable except for proven fraud and permanent exclusions specified in the policy contract. The policies would however be subject to all limits, sub limits, co-payments as per the policy.
9.1 Procedure for cashless claims:
At the time of discharge, the insured person has to verify and sign the discharge papers, pay for non-medical and inadmissible expenses.
9.2 Procedure for reimbursement claims:
For reimbursement of claims the insured person may submit the necessary documents to TPA (if applicable)/Company within the prescribed time limit as specified hereunder.
Sr No | Type of Claim | Prescribed Time limit |
---|---|---|
1. | Reimbursement of hospitalization, day care and pre hospitalization expenses | Within thirty days of date of discharge from hospital |
2. | Reimbursement of post hospitalization expenses | Within fifteen days from completion of post hospitalization treatment |
9.3 Notification of Claim
Notice with full particulars shall be sent to the Company/TPA (if applicable) as under:
9.4 Documents to be submitted:
The reimbursement claim is to be supported with the following documents and submitted within the prescribed time limit.
Note:
Each and every claim under the Policy shall be subject to a Co-payment of 5% applicable to claim amount admissible and payable as per the terms and conditions of the Policy. The amount payable shall be after deduction of the co-payment.
9.6 Claim Settlement (provision for Penal Interest)
Servicing of claims, i.e., claim admissions and assessments, under this Policy by way of pre- authorization of cashless treatment or processing of claims other than cashless claims or both, as per the underlying terms and conditions of the policy.
The services offered by a TPA shall not include
All claims under the policy shall be payable in Indian currency only.
The Policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of misrepresentation, mis-description or non-disclosure of any material fact.
The due observance and fulfilment of the terms and conditions of the policy, by the insured person, shall be a condition precedent to any liability of the Company to make any payment for claim(s) arising under the policy.
The Insured shall notify the Company in writing of any material change in the risk in relation to the declaration made in the proposal form or medical examination report at each Renewal and the Company may, adjust the scope of cover and/ or premium, if necessary, accordingly.
The Insured Person shall keep an accurate record containing all relevant medical records and shall allow the Company or its representatives to inspect such records. The Policyholder or Insured Person shall furnish such information as the Company may require for settlement of any claim under the Policy, within reasonable time limit and within the time limit specified in the Policy.
Any payment to the Insured Person or his/ her nominees or his/ her legal representative or to the Hospital/Nursing Home or Assignee, as the case may be, for any benefit under the Policy shall in all cases be a full, valid and an effectual discharge towards payment of claim by the Company to the extent of that amount for the particular claim.
All medical treatment for the purpose of this insurance will have to be taken in India only.
If any claim made by the insured person, is in any respect fraudulent, or if any false statement, or declaration is made or used in support thereof, or if any fraudulent means or devices are used by the insured person or anyone acting on his/her behalf to obtain any benefit under this policy, all benefits under this policy shall be forfeited.
Any amount already paid against claims which are found fraudulent later under this policy shall be repaid by all person(s) named in the policy schedule, who shall be jointly and severally liable for such repayment.
For the purpose of this clause, the expression "fraud" means any of the following acts committed by the Insured Person or by his agent, with intent to deceive the insurer or to induce the insurer to issue a insurance Policy:-
The company shall not repudiate the policy on the ground of fraud, if the insured person / beneficiary can prove that the misstatement was true to the best of his knowledge and there was no deliberate intention to suppress the fact or that such mis-statement of or suppression of material fact are within the knowledge of the insurer. Onus of disproving is upon the policyholder, if alive, or beneficiaries.
Timing of Cancellation | Refund (%) |
---|---|
Up to 30 days | 75.00% |
31 to 90 days | 50.00% |
3 to 6 months | 25.00% |
6 to 12 months | 0.00% |
The coverage for the insured, Person(s) shall automatically terminate:
All disputes or differences under or in relation to the interpretation of the terms, conditions, validity, construct, limitations and/or exclusions contained in the Policy shall be determined by the Indian court and according to Indian law.
The Insured Person will have the option to migrate the Policy to other health insurance products/plans offered by the company as per extant Guidelines related to Migration. If such person is presently covered and has been continuously covered without any lapses under any health insurance product/plan offered by the company, as per Guidelines on migration, the proposed Insured Person will get all the accrued continuity benefits in waiting periods as per below:
For Detailed Guidelines on Migration, kindly refer to www.acko.com
The Insured Person will have the option to port the Policy to other insurers as per extant Guidelines related to portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance plan with an Indian General/Health insurer as per Guidelines on portability, the proposed Insured Person will get all the accrued continuity benefits in waiting periods as under:
For Detailed Guidelines on Portability, kindly refer to www.acko.com
The policy shall ordinarily be renewable except on grounds of fraud, moral hazard, misrepresentation by the insured person. The Company is not bound to give notice that it is due for renewal.
If the insured person has opted for Payment of Premium on an instalment basis i.e. Half Yearly, Quarterly or Monthly, as mentioned in Your Policy Schedule/Certificate of Insurance, the following Conditions shall apply (notwithstanding any terms contrary elsewhere in the Policy).
The Company, with prior approval of IRDAI, may revise or modify the terms of the policy including the premium rates. The insured person shall be notified three months before the changes are affected.
The Free Look Period shall be applicable at the inception of the Policy and not on renewals or at the time of porting the policy.
The insured shall be allowed a period of fifteen days from date of receipt of the Policy to review the terms and conditions of the Policy, and to return the same if not acceptable.
If the insured has not made any claim during the Free Look Period, the insured shall be entitled to
The policyholder may be changed during the Policy Period only in case of his/her demise or him /her moving out of India.
Sum insured can be changed (increased/ decreased) only at the time of renewal or at any time, subject to underwriting by the Company. For any increase in SI, the waiting period shall start afresh only for the enhanced portion of the sum insured.
The terms and conditions contained herein and in the Policy Schedule shall be deemed to form part of the Policy and shall be read together as one document.
The policyholder is required at the inception of the policy to make a nomination for the purpose of payment of claims under the policy in the event of death of the policyholder. Any change of nomination shall be communicated to the company in writing and such change shall be effective only when an endorsement on the policy is made. For Claim settlement under reimbursement , the Company will pay the policyholder. In the event of death of the policyholder, the Company will pay the nominee {as named in the Policy Schedule/Policy Certificate/Endorsement (if any)} and in case there is no subsisting nominee, to the legal heirs or legal representatives of the Policyholder whose discharge shall be treated as full and final discharge of its liability under the Policy.
Where the grievance is not resolved, the insured may, subject to vested jurisdiction, approach the Insurance Ombudsman for the redressal of grievance. The details of the Insurance Ombudsman are available below:
Insurance Ombudsman -The insured person may also approach the office of Insurance Ombudsman of the respective area/region for redressal of grievance. The contact details of the Insurance Ombudsman offices have been provided as Annexure-B. The updated list of the Ombudsman offices are available in the website http://ecoi.co.in/ombudsman.html.
No shall apply on renewals based on individual claims experience. Insurance is subject matter of solicitation.
Name | Arogya Sanjeevani Policy- Acko General Insurance Limited |
Product Type | Individual/ Floater |
Category of Cover | Indemnity |
Sum insured (₹) Lakhs | 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5 On Individual basis SI shall apply to each individual family Member On Floater basis SI shall apply to the entire family |
Policy Period | 1 year |
Eligibility | Policy can be availed by persons between the age of 18 years and 65 years, as Proposer. Proposer with higher age can obtain policy for family, without covering self. Policy can be availed for Self and the following family members legally wedded spouse. Parents and Parents- in -law. Dependent Children (i.e. natural or legally adopted) between the age 3 months to 25 years. If the child above 18 years of age is financially independent, he or she shall be ineligible for coverage in the subsequent renewals |
Grace Period | For Yearly payment of mode, a fixed period of 30 days is to be allowed as Grace Period and for all other modes of payment a fixed period of 15 days be allowed as grace period. |
Hospitalization Expenses | Expenses of Hospitalization for a minimum period of 24 consecutive hours only shall be admissible |
Time limit of 24 hrs. shall not apply when the treatment is undergone in a Day Care Centre | |
Pre - Hospitalization | For 30 days prior to the date of hospitalization |
Post Hospitalization | For 60 days from the date of discharge from the hospital |
Sublimit for room / doctor’s fee |
|
Cataract Treatment | Up to 25% of Sum insured or Rs.40,000/-, whichever is lower, per eye, under one policy year. |
AYUSH | Expenses incurred for Inpatient Care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines shall be covered up to sum insured, during each Policy year as specified in the policy schedule. |
Pre-Existing Disease | Only PEDs declared in the Proposal Form and accepted for coverage by the company shall be covered after a waiting period of 4 years |
Cumulative bonus | Increase in the sum insured by 5% in respect of each claim free year subject to a maximum of 50% of SI. In the event of claim the cumulative bonus shall be reduced at the same rate. |
Co Pay | 5% co pay on all claims |
List I - Items for which coverage is not available in the policy
Sr No | Item |
---|---|
1 | BABY FOOD |
2 | BABY UTILITIES CHARGES |
3 | BEAUTY SERVICES |
4 | BELTS/BRACES |
5 | BUDS |
6 | COLD PACK/HOT PACK |
7 | CARRY BAGS |
8 | EMAIL/ INTERNET CHARGES |
9 | FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED BY HOSPITAL) |
10 | LEGGINGS |
11 | LAUNDRY CHARGES |
12 | MINERAL WATER |
13 | SANITARY PAD |
14 | TELEPHONE CHARGES |
15 | GUEST SERVICES |
16 | CREPE BANDAGE |
17 | DIAPER OF ANY TYPE |
18 | EYELET COLLAR |
19 | SLINGS |
20 | BLOOD GROUPING AND CROSS MATCHING OF DONORS SAMPLES |
21 | SERVICE CHARGES WHERE NURSING CHARGE ALSO CHARGED |
22 | TELEVISION CHARGES |
23 | SURCHARGES |
24 | ATTENDANT CHARGES |
25 | EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS PART OF BED CHARGE) |
26 | BIRTH CERTIFICATE |
27 | CERTIFICATE CHARGES |
28 | COURIER CHARGES |
29 | CONVEYANCE CHARGES |
30 | MEDICAL CERTIFICATE |
31 | MEDICAL RECORDS |
32 | PHOTOCOPIES CHARGES |
33 | MORTUARY CHARGES |
34 | WALKING AIDS CHARGES |
35 | OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL) |
36 | SPACER |
37 | SPIROMETRE |
38 | NEBULIZER KIT |
39 | STEAM INHALER |
40 | ARMSLING |
41 | THERMOMETER |
42 | CERVICAL COLLAR |
43 | SPLINT |
44 | DIABETIC FOOTWEAR |
45 | KNEE BRACES (LONG/ SHORT/ HINGED) |
46 | KNEE IMMOBILIZER/SHOULDER IMMOBILIZER |
47 | LUMBO SACRAL BELT |
48 | NIMBUS BED OR WATER OR AIR BED CHARGES |
49 | AMBULANCE COLLAR |
50 | AMBULANCE EQUIPMENT |
51 | ABDOMINAL BINDER |
52 | PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES |
53 | SUGAR FREE Tablets |
54 | CREAMS POWDERS LOTIONS (Toiletries are not payable, only prescribed medical pharmaceuticals payable) |
55 | ECG ELECTRODES |
56 | GLOVES |
57 | NEBULISATION KIT |
58 | ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETCL |
59 | KIDNEY TRAY |
60 | MASK |
61 | OUNCE GLASS |
62 | OXYGEN MASK |
63 | PELVIC TRACTION BELT |
64 | PAN CAN |
65 | TROLLY COVER |
66 | UROMETER, URINE JUG |
67 | AMBULANCE |
68 | VASOFIX SAFETY |
List II - Items that are to be subsumed into Room Charges
Sr No | Item |
---|---|
1 | BABY CHARGES (UNLESS SPECIFIED/INDICATED) |
2 | HAND WASH |
3 | SHOE COVER |
4 | CAPS |
5 | CRADLE CHARGES |
6 | COMB |
7 | EAU-DE-COLOGNE/ ROOM FRESHNERS |
8 | FOOT COVER |
9 | GOWN |
10 | SLIPPERS |
11 | TISSUE PAPER |
12 | TOOTHPASTE |
13 | TOOTHBRUSH |
14 | BED PAN |
15 | FACE MASK |
16 | FLEX! MASK |
17 | HAND HOLDER |
18 | SPUTUM CUP |
19 | DISINFECTANT LOTIONS |
20 | LUXURY TAX |
21 | HVAC |
22 | HOUSE KEEPING CHARGES |
23 | AIR CONDITIONER CHARGES |
24 | IM IV INJECTION CHARGES |
25 | CLEAN SHEET |
26 | BLANKET/WARMER BLANKET |
27 | ADMISSION KIT |
28 | DIABETIC CHART CHARGES |
29 | DOCUMENTATION CHARGES/ ADMINISTRATIVE EXPENSES |
30 | DISCHARGE PROCEDURE CHARGES |
31 | DAILY CHART CHARGES |
32 | ENTRANCE PASS/ VISITORS PASS CHARGES |
33 | EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE |
34 | FILE OPENING CHARGES |
35 | INCIDENTAL EXPENSES/ MISC. CHARGES (NOT EXPLAINED) |
36 | PATIENT IDENTIFICATION BAND/ NAME TAG |
37 | PULSEOXYMETER CHARGES |
List III - Items that are to be subsumed into Procedure Charges
Sr No | Item |
---|---|
1 | HAIR REMOVAL CREAM |
2 | DISPOSABLES RAZORS CHARGES (for site preparations) |
3 | EYE PAD |
4 | EYE SHEILD |
5 | CAMERA COVER |
6 | DVD, CD CHARGES |
7 | GAUSE SOFT |
8 | GAUZE |
9 | WARD AND THEATRE BOOKING CHARGES |
10 | ARTHROSCOPY AND ENDOSCOPY INSTRUMENTS |
11 | MICROSCOPE COVER |
12 | SURGICAL BLADES, HARMONICSCALPEL, SHAVER |
13 | SURGICAL DRILL |
14 | EYE KIT |
15 | EYE DRAPE |
16 | X-RAY FILM |
17 | BOYLES APPARATUS CHARGES |
18 | COTTON |
19 | COTTON BANDAGE |
20 | SURGICAL TAPE |
21 | APRON |
22 | TORNIQUET |
23 | ORTHOBUNDLE, GYNAEC BUNDLE |
List IV - Items that are to be subsumed into costs of treatment
Sr No | Item |
---|---|
1 | ADMISSION/REGISTRATION CHARGES |
2 | HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC PURPOSE |
3 | URINE CONTAINER |
4 | BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING CHARGES |
5 | BIPAP MACHINE |
6 | CPAP/ CAPO EQUIPMENTS |
7 | INFUSION PUMP- COST |
8 | HYDROGEN PEROXIDE\SPIRIT\ DISINFECTANTS ETC |
9 | NUTRITION PLANNING CHARGES - DIETICIAN CHARGES- DIET CHARGES |
10 | HIV KIT |
11 | ANTISEPTIC MOUTHWASH |
12 | LOZENGES |
13 | MOUTH PAINT |
14 | VACCINATION CHARGES |
15 | ALCOHOL SWABES |
16 | SCRUB SOLUTIONISTERILLIUM |
17 | Glucometer& Strips |
18 | URINE BAG |
Ombudsman Offices | |
---|---|
Jurisdiction | Office Address |
Gujarat, Dadra & Nagar Haveli, Daman and Diu |
AHMEDABAD Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, Ahmedabad – 380 001. Tel.: 079 - 25501201/02/05/06 Email: [email protected] |
Karnataka | BENGALURU Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078. Tel.: 080 - 26652048 / 26652049 Email: [email protected] |
Madhya Pradesh Chattisgarh |
BHOPAL Office of the Insurance Ombudsman, Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar, Opp. Airtel Office, Near New Market, Bhopal – 462 003. Tel.: 0755 - 2769201 / 2769202 Fax: 0755 - 2769203 Email: [email protected] |
Orissa | BHUBANESHWAR Office of the Insurance Ombudsman, 62, Forest park, Bhubneshwar – 751 009. Tel.: 0674 - 2596461 /2596455 Fax: 0674 - 2596429 Email: [email protected] |
Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir, Chandigarh |
CHANDIGARH Office of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building, Sector 17 – D, Chandigarh – 160 017. Tel.: 0172 - 2706196 / 2706468 Fax: 0172 - 2708274 Email: [email protected] |
Tamil Nadu, Pondicherry Town and Karaikal (which are part of Pondicherry) |
CHENNAI Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018. Tel.: 044 - 24333668 / 24335284 Fax: 044 - 24333664 Email: [email protected] |
Delhi | DELHI Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002. Tel.: 011 - 23239633 / 23237532 Fax: 011 - 23230858 Email: [email protected] |
Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura |
GUWAHATI Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Nr. Panbazar over bridge, S.S. Road, Guwahati – 781001(ASSAM). Tel.: 0361 - 2132204 / 2132205 Fax: 0361 - 2732937 Email: [email protected] |
Andhra Pradesh, Telangana, Yanam and part of Territory of Pondicherry |
HYDERABAD Office of the Insurance Ombudsman, 6-2-46, 1st floor, "Moin Court", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 - 65504123 / 23312122 Fax: 040 - 23376599 Email: [email protected] |
Rajasthan | JAIPUR Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005. Tel.: 0141 - 2740363 Email: [email protected] |
Kerala, Lakshadweep, Mahe-a part of Pondicherry. |
ERNAKULAM Office of the Insurance Ombudsman, 2nd Floor, Pulinat Bldg., Opp. Cochin Shipyard, M. G. Road, Ernakulam - 682 015. Tel.: 0484 - 2358759 / 2359338 Fax: 0484 - 2359336 Email: [email protected] |
West Bengal, Sikkim, Andaman & Nicobar Islands. |
KOLKATA Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 4th Floor, 4, C.R. Avenue, KOLKATA - 700 072. Tel.: 033 - 22124339 / 22124340 Fax : 033 - 22124341 Email: [email protected] |
Districts of Uttar Pradesh: Laitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. |
LUCKNOW Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001. Tel.: 0522 - 2231330 / 2231331 Fax: 0522 - 2231310 Email: [email protected] |
Goa, Mumbai Metropolitan Region excluding Navi Mumbai & Thane. |
MUMBAI Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054. Tel.: 022 - 26106552 / 26106960 Fax: 022 - 26106052 Email: [email protected] |
State of Uttaranchal and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautambodhanagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. |
NOIDA Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301. Tel.: 0120-2514250 / 2514252 / 2514253 Email: [email protected] |
Bihar, Jharkhand. |
PATNA Office of the Insurance Ombudsman, 1st Floor,Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur, Patna 800 006. Tel.: 0612-2680952 Email: [email protected] |
Maharashtra, Area of Navi Mumbai and Thane excluding Mumbai Metropolitan Region. |
Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030. Tel.: 020-41312555 Email: [email protected] |
The updated details of Insurance Ombudsman are available in the website. http://ecoi.co.in/ombudsman.html