United India Family Medicare Health Plan

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United India Family Medicare Health Plan Overview

A single sum assured is offered to comprehensively cover family members. As long as either of the parents is covered, any dependent child between 3 months and 18 years is liable to be covered. The sum assured offered is between 1 to 10 lakh. The entry age is 18-80 years and a medical screening required for anyone above 45 years of age. There are more than 7000 network hospital options available for cashless treatment and claim reimbursement treatment for the insured members.

Benefits of United India Family Medicare Policy

  • Premiums paid are tax exempt with regards to Section 80 D of the Income tax act.
  • A maximum of 3% (first 3 years) - 15% claim discount after subsequent claim free years.
  • Cashless and reimbursement facilities in over 7000 hospitals across India
  • At the end of 3 claim-free years, one is liable to get a free medical checkup subject to continuous policy renewal. The limit set on this is 1% of the sum assured during the 3 year period.
  • Free look period of up to 15 days is given prior to the first policy inception.

Coverage under the United India Family Medicare Plan

Additional covers are optional such as ambulance cover and daily cash allowance covers that can be paid twice during the policy period at additional premiums.

  • Ayurvedic Treatment in a Government Hospital
  • Cataract Surgery up to 10% of SI or a maximum of Rs. 25,000
  • Hernia up to 15% of SI or up to a maximum of Rs. 30,000
  • Hysterectomy 20% of SI or up to a maximum of Rs. 50,000
  • Hospitalization Expenses ( minimum 24 hours) that are covered under the plan are listed below:
  • Room expenses, boarding charges, and nursing expenses
  • ICU cover up to 2% of SI per day
  • Medical Practitioner, Surgeon, Specialists Fees, Anaesthetist, Consultants, Anaesthetist, , Operation Theatre Charges, Blood, Oxygen, Radiotherapy, Surgical Appliances, Dialysis, Medicines & Drugs, Chemotherapy, cost of Artificial Limbs, and other similar expenses.
  • Home hospitalization up to 1% of SI per day. It includes RMO charges, Nursing Care, Administration Charges, IV Fluids, Injection and similar expenses.
  • Organ donor expenses ( except the cost of the organ)

Exclusions of United India Family Medicare Plan

  • Any illness that was diagnosed during the initial 30 days of policy inception
  • The waiting period for pre-existing illness is 2 years
  • Certain specified illnesses to be treated after a waiting period of 2 to 4 years
  • Treatment for HIV and AIDS
  • Inoculation and vaccination unless it is after an animal bite
  • Naturopathy treatment
  • General debility is not covered
  • Cost of circumcision, plastic and cosmetic surgery is also not covered
  • Psychosomatic and psychiatric disorders
  • Health ailment resulting due to alcohol abuse and drug overdose
  • Dental care expenses
  • Pregnancy, and child birth related ailments
  • Health issues arising due to nuclear weapons
  • Experimental and unproven hospitalization
  • Any external medical equipment

Claim Procedure for United India Family Medicare Policy

In case of hospitalization, you need to notify about the hospitalization or send a claim request to the Insurer’s or TPA’s address as mentioned in the policy documents:

  • For all the emergency hospitalizations the insurance company needs to be notified within 24 hours of the hospitalization
  • Collect the claim form after the claim intimation. Send the completed claim form and fill all the required details along with the hospital documents to the Third-party Administrator within 15 days of getting discharged from the hospital.
  • For all the cashless hospitalizations, the policyholder needs to submit a pre-authorization cashless form to the Third-party administrator through the hospital
  • No other intimation is required after the submission of the pre-authorization form
  • For all the reimbursement claims you need to submit documents related to the hospitalization expenses that took place within 15 days of getting discharged from the hospital.