Key Features of Digit Health Plus Policy
Here’s what this medical insurance policy has to offer:
- Complimentary Health Check-up Facility: Compensation provided is limited to a maximum of 5000 rupees or up to 0.25% of the SI.
- Restoration of the Sum Insured: The sum insured amount is refilled upon exhaustion. In case of a family floater policy, the sum insured amount is restored. For example, if the sum insured amount is 3 lakh rupees, and there are 3 members, and the sum insured is exhausted on claiming then each member will get a refill of 3 lakhs as their sum insured. It is permissible only for unrelated diseases for every individual.
- Cumulative Bonus: If you have not filed any claims for illness related hospitalization, accidental hospitalization and critical illness hospitalization then you will get cumulative Bonus while renewing your policy. The sum insured amount will increase without paying any extra premium.
What is Covered Under Digit Health Plus Policy?
This plan covers most of the hospitalization expenses including:
- Room rent charges, doctor fees, cost of medicines and medical tests
- Second medical opinion expenses
- Pre-hospitalization and Post-hospitalization expenses
- Day care procedures
- Dental treatment required after an accident
- Road ambulance expenses
And there are Other Special Benefits as Well:
- Bariatric Surgery, it is applicable to heart diseases and respiratory problems etc. resulting due to obesity
- Psychiatric Illness Cover is provided in cases related to depression, anxiety, dementia, schizophrenia and bipolar disorder to name a few.
- You can also opt for onetime lump sum payment of post-hospitalization expenses for an amount equal to 1.5% of the claim amount.
- Accidental cover is also provided
- Organ transplantation charges, including donor’s pre and post hospitalization expenses are covered and the limit is 5% of the amount claimed.
- In-patient treatment expenses including Ayurveda, Homeopathy, Unani, or Siddha treatment.
- Air ambulance cover is provided in case of life threatening medical conditions requiring immediate transportation to the proximate hospital.
- It takes care of the maternity expenses including the new-born baby cover (subjected to terms and conditions). It also covers pregnancy related complications and medically necessary termination.
- It also covers second delivery, and the coverage is increased to 200% of the original coverage amount.
- Other non-hospitalization expenses such as doctor’s consultation fees, dental treatment, health checkups, diagnostic tests, pharmacy bills etc. can also be covered.
- Domiciliary hospitalization cover is provided
- Critical illness hospitalization coverage including the cost of medication, ICU, diagnostics, physician fees etc.
*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.
Here is a List of Critical Illnesses that are Covered:
The insurer will cover the expenses incurred on the following critical illnesses:
- Cancer of Specified Severity (malignant tumor). The term cancer includes lymphoma, leukemia and sarcoma ( subjected to terms and conditions)
- Open Chest CABG
- Apallic Syndrome
- Myocardial Infarction (1st heart attack of specific severity)
- Open heart surgery
- Surgery to Aorta
- Lung failure (end stage)
- Liver failure ( end stage)
- Kidney Failure ( regular dialysis)
- Bone Marrow/Major Organ Transplant
- Benign Brain Tumor
- Major Head Trauma
- Paralysis of Limbs ( permanent)
- Coma of Specified Severity
- Stroke(permanent symptoms)
- Motor Neuron Disease (permanent symptoms)
- Aplastic Anaemia
- Multiple Sclerosis ( persisting symptoms)
- Loss of independent existence
What is not Covered Under Digit Health Plus Policy?
If you have opted for outpatient benefits, then the insurer will not cover expenses incurred during the hospitalization:
- The minimum tenure for hospitalization needs to be 24 hours
- A non-medical expense such as equipment’s purchased for non-treatment purposes, food consumed by visitors etc.
- It does not cover home care nursing
- Overseas treatments are also not covered
- Artificial Life Maintenance
- Any accident/illness resulting due to the consumption/overdose of drugs or alcohol
- Minimum hospitalization tenure should be 24 hours
- Alternative treatment expenses incurred on hospitalization, outpatient medical expenses and daycare procedures
- Any type of rejuvenation and preventive treatments
- Maternity cover includes only two deliveries and is available after completion of a waiting period of 24 months. It does not cover prenatal and postnatal expenses are not covered unless it requires hospitalization. Expenses incurred on stem cell harvesting and storage is not covered.
- Suicidal attempts and self-injuries re excluded
- Hazardous activities
- Professional Sports
- Sexually transmitted diseases
Cashless Claim Procedure for Digit Health Plus Policy
The insurer has a tie-up with MediAssist to help you with the cashless claim process:
- Cashless hospitalization is available in more than 6400 network hospitals. The list is available online that you can check using your MediAssist account
- You can easily get the pre-authorization form at the Insurance/TPA helpdesk
- You need to submit the form at the helpdesk after filling it and signing it. They will then share this form with MediAssist
- MediAssist will then assess your documents with the treatment required/recommended
- Once the approval is given, you can carry on with the treatment
- You can also inform the insurer at 1800-103-4448 to settle/initiate cashless claims
Reimbursement Procedure for Digit Health Plus Policy
Reimbursement is provided for treatments taken in a non-network hospital. By submitting all the relevant documents you can get compensation for the hospitalization expenses. You can also you’re your claim online but the following information is required from your end:
Once you have notified the insurer over a call, you will get a link on your registered email id or phone number where you can submit all the original documents such as reports, bills, and etc. along with your bank details where the money will be transferred.
All the documents need to be self-attested with your signature and date. Also, you would need to submit the original documents (in some cases). You will need to upload the documents within 30 days of getting discharged from the hospital.
Once the documents are verified your claim will be processed and you will get compensation within 30 days.
Filing a claim can sometimes be a daunting process, but you can make it simple by providing all the details beforehand. The documents required may vary from one claim to another. To file a claim for Digit Health plus Policy you may need to submit the following documents, as per the case may be:
- Duly filled and signed Digit health insurance claim form
- Discharge summary
- Digit health plus policy papers
- Medical records (Indoor Case Papers, OT notes, PAC Notes etc.)
- Original copy of the main hospital bill
- Original copy of the pharmacy bills
- Original copy of the break-up of the hospital bill
- Medical prescriptions
- Investigation reports /scans
- Consultation papers
- KYC (Photo ID card, If applicable)
- FIR/ MLC report
- Original sticker/ invoice
- Post Mortem Report ( if applicable)
- Disability certificate
- Attending doctor’s certificate
- Ante-natal record
- Bank details with a cancelled cheque (If applicable)
- Birth certificate ( if applicable)
- Death certificate (If applicable)