Royal Sundaram Family Health Insurance

Product Description:

Royal Sundaram’s Family Health Insurance is designed to offer complete protection and Family Health Insurance coverage to the insured and his/her family members (Spouse, upto 3 dependent children between 91 days & 21 years and dependent Parents upto 50 years of age). The hospitalization cover (max upto Sum Insured) is available to all the covered members on a floater basis. Apart from providing inpatient hospitalization benefits (for a period more than 24hrs), the policy also covers all related expenses for 30 days prior to and 60 days post hospitalization period. The renewals are accepted only up to the age of 70 years.

Know more about your Insurance

Key features: Availability, Benefits and Exclusions

Minimum Age at Entry : 3 months
Maximum Age at Entry : 50 years
Maximum Age at Renewal : 70 years
Minimum Sum Assured : Rs 1 lacs
Maximum Sum Assured : Rs 5 lacs
     
 
No claim Bonus – Annual : 5%
No claim Bonus – cumulative : upto 50%
Maternity Benefits : N/A
Pre-Existing Disease cover : after 4 years
Waiting Period : 30 Days


Product pricing (Incl. S/Tax)   (Rs)
2 Adults    
Age of the eldest member SA 1 lacs SA 1.5 lacs SA 2 lacs SA 2.5 lacs SA 3 lacs SA 4 lacs SA 5 lacs
Upto 35 yrs 2255 NA 3592 N/A 5387 6875 7735
36 – 45 yrs 3127 NA 5177 N/A 7764 9837 11064
46 – 50 yrs 4012 NA 7115 N/A 10908 13817 15545

Claim procedure
  1. Intimation & Assistance - In case of planned hospitalization, select and approach the service desk of the chosen network hospital, preferably at least 3 days in advance. Use your Royal Sundaram Health card for identification purpose. You can also share your policy no and passport no with the healthcare provider or use your PAN card or voter ID card for the same.

  2. Pre-authorization: Get the pre-authorization form (available at the hospital help desk and/or TPA website), filled and signed from the treating doctor and submit the same with the hospital along with other necessary documents. The network hospital checks the identity of the Insured for validation and submits the pre-authorization form (through fax) to the TPA. After cross verifying the identity of the Insured and the policy coverage, the TPA will provide confirmation to the provider by e-mail/fax with in 24 hrs. If cashless treatment is not approved by the TPA, please get admitted, undergo treatment and settle all bills directly with the hospital. Later, file for a re-imbursement of your expenses with the Insurer/TPA by intimating them (toll free at 1800 345 8899 or mobile no 9444448899) not later than 7 days of discharge. You can follow your intimation up with all claim documents (ORIGINALS) anytime within 30 days of discharge.

  3. Cashless settlement: Get admitted for treatment at the network hospital and sign all forms, invoices and documents on discharge. Royal Sundaram will directly make the payment to the hospital for pre-approved treatment and as per policy terms & conditions. Any non-medical expense and/or expenses towards conditions not authorized under hospitalization need to be paid directly by the beneficiary of treatment. Also, remember signing the Royal Sundaram claims form and hand it over to the hospital along with all the relevant supporting documents.

*Please note in case of emergency, authorization should be taken not later than 24 hrs of admission.

Some key statistics for Max Bupa

ITEM   NUMBER
Claims Pending Ratio : To be Announced soon
Complaints Resolved Ratio : To be Announced soon
Provider Network (cashless) : To be Announced soon


General Health Insurance Tips

Understand the cost of healthcare in your city/area before deciding the total cover (Sum Assured)

If your family includes a young bride, it is important to ensure the coverage of maternity benefits

Ask about the coverage of pre-existing diseases

Look at the waiting period

Satisfy yourself about the specific disease’s coverage under the Critical Illness cover

Inquire about the availability of cashless facility at the Network hospitals

Always compare before buying

Disclaimer: This is only an illustrative document to serve as a quick guide for aide in decision making.

Information Source: Royal Sundaram website www.royalsundaram.in as on 11th Oct’2011
IRDAI annual report’2010