Good Health Mediclaim Insurance

Policy Overview

• Target Audience: Axis Bank Credit Card members.
• Age Eligibility: Adults aged 18 to 65 years. Children aged 3 months to 18 years are eligible if at least one parent is covered.
• Medical Check-up Requirements: Applicants between 61 and 65 years require medical reports; 50% of reasonable diagnostic/consultation fees are reimbursed if accepted.

Core Coverage & Limits

• Room Rent: Up to 1% of Sum Insured (SI) + Cumulative Bonus (CB) per day.
• ICU/ICCU Charges: Up to 2% of SI + CB per day.
• No Proportionate Deduction Penalty: Proportionate deduction on associated medical expenses is waived, though insured members must pay room rent differences if opting for a room category above their limit.
• Pre & Post-Hospitalization: Covers pre-hospitalization expenses up to 30 days and post-hospitalization expenses up to 60 days.
• AYUSH Treatments: Covered up to 100% of SI for Ayurveda, Yoga, Unani, Siddha, and Homeopathy.
• Cataract Limit: Up to 20% of SI, capped at ₹40,000 per eye.
• Emergency Ambulance: Up to 1% of SI, capped at ₹5,000.
• Organ Donor Expenses: Inpatient hospitalization expenses for donors are covered up to the remaining SI.
• Cumulative Bonus: Increases SI by 5% per claim-free year, with a maximum accumulation of 50%.

Specific Treatments & Sub-Limits

• Modern Treatments & Advanced Procedures: Standard sub-limits apply based on the procedure, e.g. Robotic Surgeries up to 50% of SI capped at ₹5 Lakh; Oral Chemotherapy up to 10% capped at ₹1 Lakh.
• Mental Illness: Sub-limit of 25% of SI after a 36-month waiting period.
• Genetic Diseases: Sub-limit of 25% of SI after a 36-month waiting period.
• Puberty & Menopause Disorders: Inpatient procedures covered up to 25% of SI after 24 months.
• Artificial Life Maintenance: Up to 10% of SI for up to 15 days per policy period for patients certified to be in a vegetative state.

Optional Covers (Add-ons)

1. Hospital Cash Benefit: Pays daily cash at 0.2% of SI per day, up to a maximum of 15 days per policy period, for incidental expenses.
2. Maternity Benefit: Up to 10% of average SI of the preceding 3 years. Available for SI of ₹5 Lakhs and above, subject to a 36-month waiting period and limited to the first two children.
3. Modern Treatment Enhancements: Allows coverage for specified modern treatments up to 100% of SI with a 10% deductible on admissible amounts above base sub-limits.
4. Non-Medical Items (Consumables): Covers consumable items listed in Annexure II (List 1) up to ₹15,000 per policy period. Available for SI of ₹7 Lakhs and above.

Waiting Periods & Key Exclusions

• Initial Waiting Period: 30 days for all illnesses, except accidental injury.
• Specific Condition Waiting Period: 90 days for Diabetes, Hypertension, and Cardiac Conditions.
• 24-Month Waiting Period: Benign tumors, Hernia, Hydrocele, Piles, Gallstones/Kidney stones, Renal failure, etc.
• 36-Month Waiting Period: Pre-Existing Diseases (36 months for ages >45 years; 24 months for ages <=45 years), Joint Replacements, Cataracts, and External Congenital Diseases.
• Major Exclusions: Domiciliary hospitalization, cosmetic surgeries, hazardous sports, drug/alcohol abuse treatment, and outpatient (OPD) procedures.

UIN: NIAHLGP24181V022324