Complete Healthcare Individual Eligibility

• Entry Age: 3 months to 55 years 
• Speedy Policy Process: Instant Policy can be bought online or through agents with minimum documentation without pre-medical checkup upto age of 55 years for healthy individuals.
• Sum Insured: Rs 1 Lakh - Rs 10 Lakh
• Basic Plan covers sum insured from Rs 1 Lac to Rs 2 Lac.
• Essential Plan covers sum insured from Rs 3 Lac to Rs 5 Lac.
• Privilege Plan covers sum insured from Rs 6 Lac to Rs 10 Lac.

Complete Healthcare Individual Benefits

• Minimum Entry age: 18 years.
• Enrollment under the Policy: Day 1 to 70 years of age only.
• Pre –Acceptance Medical Checkup*: If the proposer is above 60 years.
• Cashless facility: Cashless facilities at over 4000+ quality hospitals across India.Cashless facilities at over 4000+ quality hospitals across India.
• Speedy Claims Processing: Prompt settlement of both Cashless and Reimbursement claim.
• Portability Benefits: We can cover portability of benefits to similar cover under indemnity plan subject to intimation of complete details by application at least 45 days prior to the expiry of existing policy.

Complete Healthcare Individual Features

• Inpatient hospitalisation (over 24 hrs.) includes boarding, services of medical professionals, cost of required equipment and consumables used for treatment
• 141 day care procedures
• Domiciliary hospitalisation (over 3 days)
• Pre/Post-hospitalisation expenses: Up to 30/60 days
• Organ donor’s hospitalisation expenses
• Ambulance charges
• Dental treatment required as a result of an accident
• AYUSH (Ayurveda, Unani, Sidha, Homeopathy) treatment
• Daily cash allowance to accompany a hospitalised child (over 3 days)
• Vaccinations for treatment of bites
• Specified outpatient expenses (after 3 policy yrs.): Diagnostic tests, non-cosmetic dental treatment, pair of spectacles or contact lenses, consultation
• Convalescence benefits (one-time): Rs.10,000 for hospitalisation over 10 days
• Maternity /newborn expenses: Includes pre/post-natal costs
• HIV/AIDS treatment: for life-threatening conditions

Complete Healthcare Individual Claim Process

• Cashless Claim

  1. Put a request for services of a claims associate to provide You personal assistance at the time of cashless admission and discharge at the Hospital. (Service available on request on> selected cities only)
  2. Carry health card, Photo ID, and past medical records (if any) of the patient to the hospital.
  3. Put in a request for cashless approval by filling the pre-authorization form.
  4. Pay all uncovered expenses at the time of discharge.
  5. Counter sign and retain copies of all the Hospitalisation related documents, bills and papers for Your record. It may help You in the post-hospitalisation treatment or resolution of any disputes arising in the future.

• Reimbursement Claim

  1. Ensure You obtain the claim documents as given in the claim process.
  2. Collect all vital documents like Medical papers, Prescriptions, Discharge Summary, Investigation reports, Bills and recipts in original from the Hospital.
  3. Forward all the documents and reports in original for claim reimbursement within 30 days from the date of discharge along with claim form duly filled form at the address given on website.
  4. Retain copy of all the Hospital related documents for Your records.

Complete Healthcare Individual Exclusions

• Waiting Periods: We are not liable for any treatment which begins during waiting periods except if you suffer an accident.
• Specific Waiting Periods: The illnesses and treatments listed below will be covered subject to a waiting period of 1 year as long as in the second policy year has been insured under this policy continuously and without any break:

  1. Illnesses: Arthritis if non-infective; calculus diseases of gall bladder and urogenital system; cataract; fissure/fistula in anus, hemorrhoids, pilonidal sinus, gastric and duodenal ulcers; gout and rheumatism; internal tumors, cysts, nodules, polyps including breast lumps (each of any kind unless malignant); osteoarthritis and osteoporosis if age related; polycystic ovarian diseases; sinusitis and related disorders and skin tumors unless malignant.
  2. Treatments: Benign ear, nose and throat (ENT) disorders and surgeries (including but not limited to adenoidectomy, mastoidectomy, tonsillectomy and tympanoplasty); dilatation and curettage (D&C); hysterectomy for menorrhagia or fibromyoma or prolapse of uterus unless necessitated by malignancy; joint replacement; myomectomy for fibroids; surgery of gallbladder and bile duct unless necessitated by malignancy; surgery of genito urinary system unless necessitated by malignancy; surgery of benign prostatic hypertrophy; surgery of hernia; surgery of hydrocele; surgery for prolapsed inter vertebral disk; surgery of varicose veins and varicose ulcers; surgery on tonsils and sinuses; surgery for nasal septum deviation. However, a waiting period of 1 year will not apply if you were insured continuously and without interruption for at least 1 year under Our or any other Indian insurer‘s individual health insurance policy for the reimbursement of medical costs for inpatient treatment in a hospital.
  3. Maternity and Childcare Benefit: Maternity and Childcare Benefit Waiting Period of 3 years. The expenses covered under benefit n) Maternity and Childcare benefit shall be excluded for a period of 3 years unless You were insured continuously and without interruption for at least 3 years under any other Indian insurer‘s or our individual health insurance Policy for reimbursement of medical costs for delivery of child in a Hospital .
  4. Out-patient Treatment: Out-patient Treatment Waiting Period of 3 years expenses covered under benefit l) Out – Patient treatment shall be excluded for a period of 3 years unless You were insured continuously and without interruption for at least 3 years under any other Indian insurer‘s or Our individual health insurance Policy for reimbursement of medical costs incurred by You as an Out-patient in a Hospital or Out-patient Treatment centre.