TABLE OF BENEFITS. Maximum coverage per insured, per policy year No limit In-patient benefits and limitations Coverage Hospital services 100% Hospital room and board (standard private/semi private) • In Bupa hospital network • In other hospitals, per day 100% US$1,000 Intensive care unit • In Bupa hospital network • In other hospitals, per day 100% US$3,000 Medical and nursing fees 100% Mental Health while in-patient (must be pre-approved) 100% Drugs prescribed while in-patient 100% Diagnostic procedures (pathology, lab tests, X-rays, MRI/CT/PET scan, ultrasound, and endoscopies) 100% Accommodation charges for companion of a hospitalized child, per day US$300 Out-patient benefits and limitations Coverage Ambulatory surgery 100% Physicians and specialists visits 100% Prescription drugs: • Following hospitalization or out-patient surgery (for a maximum of 6 months) • Per policy year thereafter • Out-patient or non-hospitalization (with 20% co-insurance) 100% US$2,000 US$1,000 Diagnostic procedures (pathology, lab tests, X-rays, MRI/CT/PET scan, ultrasound, and endoscopies) 100% Physical therapy and rehabilitation services (must be pre-approved) 100% Home health care (must be pre-approved) 100% Adult Routine health checkup (all inclusive) • No deductible applies US$600 Pediatric Health check-up, max. per policy year • No deductible applies US$600 Vaccines (medically necessary) • No deductible applies • Subject to 20% of coinsurance US$1,600 Urgent Care Facilities or Walk-in Clinics in the U.S.A. Expenses derived from treatment in emergency care centers and convenience clinics in the United States of America that are necessary to treat an injury, illness or medical condition covered under the policy. • US$50 copay • No deductible applies 100% 4 | TERMS AND CONDITIONS Maternity benefits and limitations Coverage Pregnancy, maternity, and birth, per pregnancy (includes normal delivery, cesarean delivery, all pre- and post-natal treat- ment, required vitamins during pregnancy and well baby care) • 10-month waiting period • No deductible applies • Plans 1, 2 and 3 only US$7,500 Complications of pregnancy, maternity, and birth (per lifetime, per policy) • 10-month waiting period • Plans 1, 2 and 3 only • No deductible applies US$1,000,000 Provisional coverage for newborn children (for a maximum of 90 days after delivery) • Covered pregnancies only • No deductible applies US$30,000 Evacuation benefits and limitations Coverage Medical emergency evacuation: • Air ambulance • Ground ambul...
TABLE OF BENEFITS. Description of Disablement Percentage of sum covered (%) Loss of Limbs (two limbs) 100% Loss of both hands, or of all fingers and both thumbs 100% Injuries resulting in being permanently bedridden 100% Total insanity 100% Any other injury causing Permanent Total Disablement 100% Loss of arm at shoulder 100% Loss of arm between shoulder and elbow 100% Loss of arm at elbow 100% Loss of arm between elbow and wrist 100% Loss of hand at wrist 100% Loss of leg - at hip 100% - between knee and hip 100% - below knee 100% Eye: Loss of - whole eye 100% - Sight 100% - Sight, except perception of light 55% - lens 55% Loss of four (4) fingers and thumb of one (1) hand 55% Loss of four (4) fingers 45% Loss of thumb - both phalanges 35% - one (1) phalanx 20% Loss of index finger - three (3) phalanges 20% - two (2) phalanges 15% - one (1) phalanx 10% Loss of middle finger - three (3) phalanges 10% - two (2) phalanges 7% - one (1) phalanx 5% Loss of ring finger - three (3) phalanges 8% - two (2) phalanges 7% - one (1) phalanx 5% Loss of little finger - three (3) phalanges 7% - two (2) phalanges 6% - one (1) phalanx 5% Loss of metacarpals - first and second (additional) 6% - third, fourth and fifth (additional) 5% Loss of toes - all phalanges 25% - great, both phalanges 10% - great, one (1) phalanx 5% - other than great, if more than one toe lost each 4% Loss of Hearing - both ears 80% - one (1) ear 30% Loss of Speech 60% Shortening of arm - more than 1” up to 2” 5% - more than 2“ up to 4” 8% - more than 4” 15% Shortening of leg - more than 1” up to 2” 8% - more than 2” up to 4” 15% - more than 4” 30% The degree of shortening of limbs must be certified by a Physician. Where the Bodily Injury is not specified, We reserve the right to adopt a percentage of sum covered based on the disablement, which, in Our opinion, is consistent with the provisions of the above Table of Benefits. “Loss” of limb or member or part thereof shall mean loss by actual physical severance or total and permanent Loss of Use. Loss of Use of body member shall be treated as loss of body member. The aggregate of all percentages payable in respect of any one (1) Accident shall not exceed 100%. In the event a total of 100% is paid, all coverage hereunder shall immediately cease to be in force. All other losses less than 100% if having been paid shall reduce the coverage under Benefit B by that amount from the date of Accident until the expiry of the Certificate Schedule. BENEFIT C – Double Indemnity We wil...
TABLE OF BENEFITS. Description of Disablement Percentage of Sum Covered (%) Accidental Death 100% Loss of Limbs (two limbs) 100% Loss of both hands, or of all fingers and both thumbs 100% Total paralysis 100% Total insanity 100% Injuries resulting in being permanently bedridden 100% Any other injury causing Permanent Total Disablement 100% Loss of arm at shoulder 100% Loss of arm between shoulder and elbow 100% Loss of arm at elbow 100% Loss of arm between elbow and wrist 100% Loss of hand at wrist 100% Loss of leg at hip 100% between knee and hip 100% below knee 100% Eye: Loss of whole eye 100% Sight 100% Sight, except perception of light 50% lens 50% Loss of four fingers and thumb of one hand 50% Loss of four fingers 40% Loss of thumb both phalanges 25% one phalanx 10% Loss of index finger three phalanges 10% two phalanges 8% one phalanx 4% Loss of middle finger three phalanges 6% two phalanges 4% one phalanx 2% Loss of ring finger three phalanges 5% two phalanges 4% one phalanx 2% Loss of little finger three phalanges 4% two phalanges 3% one phalanx 2% Loss of metacarpals first or second (additional) 3% third, fourth or fifth (additional) 2% Loss of toes All phalanges 15% two great, both phalanges 5% great one phalanges 2% other than great, if more than one toe lost, each 1% Loss of Hearing both ears 75% one ear 15% Loss of Speech 50% The degree of shortening of limbs must be certified by a Physician. Where the Bodily Injury is not specified, We reserve the right to adopt a percentage of sum covered based on the disablement, which, in Our opinion, is consistent with the provisions of the above Table of Benefits. “Loss” of limb or member or part thereof shall mean loss by actual physical severance or total and permanent Loss of Use. Loss of Use of body member shall be treated as loss of body member. The aggregate of all percentages payable in respect of any one (1) Accident shall not exceed 100%. In the event a total of 100% is paid, all coverage hereunder shall immediately cease to be in force. All other losses less than 100% if having been paid shall reduce the coverage under Benefit A or B by that amount from the date of Accident until the expiry of the Certificate of Takaful.
TABLE OF BENEFITS. Type of incident Cover • Natural or Accidental Death • Accidental Total and permanent disablement • Total and permanent loss of sight in both eyes as a result of an accident • Total loss by physical severance of total and permanent loss of the following parts, as a result of an accident: a) Two limbs b) Both hands c) Arm above the elbow d) Leg above the knee 100% of the credit outstanding up to an aggregate maximum of LKR 2,000,000 per credit cardholder Policy Exclusions
TABLE OF BENEFITS. The table in this agreement that sets out the benefits covered by each plan. Temporary trip A trip for business and/or recreational purposes, which has a defined return date and is for a period that is no longer than the maximum duration specified for your USA cover option. If your treatment extends beyond the end of your trip's specified return date, your cover will cease at the end of the term defined in your USA cover option wording. For example, if you have selected the USA-45 option and you are on a 30-day trip to the United States of America, which becomes extended to 60 days, your cover in the United States of America will cease 45 days after your date of entry to the United States of America. Terminal medical condition A condition that has become incurable and all the treatments given are to prolong life. Treatment Surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure a disease, illness or injury. Unused premium The amount of premium that is attributable to the period from the date after the date of cancellation, up to the date before the next premium due date. In the event of a refund of unused premium being eligible, the unused premium amount refunded (using an annually paid plan as an example) will be the annual premium paid divided by 12 and multiplied by the number of whole calendar months remaining in the period of cover. If the plan is cancelled part way through a month, an additional amount, equal to one twelfth of the annual premium paid, multiplied by the proportion of days without cover in the calendar month of cancellation will also be paid. For example, if the annual premium for an insured person is US$3,000, the period of cover is 1st January to 31st December 2020, and the insured person leaves the plan on 27th September 2020, the unused premium will be US$775, as: - • (US$3,000 / 12) x 3 = US$750 for the three whole months without cover (October, November and December); added to -
TABLE OF BENEFITS. Unless otherwise stated and subject to any sub-limit as stated in any Section, the maximum liability in respect of each of the Insured Persons is shown under the Table of Benefits below:
TABLE OF BENEFITS. Description of Disablement Percentage of Sum Covered (%) Accidental Death 100% Loss of Limbs (one (1) or both limbs) - loss by physical separation at or above the wrist or ankle joint 100% Total paralysis 100% Injuries resulting in being permanently bedridden 100% Any other Bodily Injury causing Permanent Total Disablement 100% Eye: Loss of one (1) or both eyes including Loss of Sight 100%
TABLE OF BENEFITS. Missed Departure (Pays for actual expenses incurred due to missing the departure and up to the limit stated) Refer to 4.3.11 $1,000 Assistance Department Covered Section 4 - Additional Optional Coverage: Hazardous Sports Benefits Terrorism Extension Amount noted for the applicable above cover under Section 1 and Section 2 and 4.4.1 HAZARDOUS SPORTS BENEFITS as above Per Tooth Deductible maximum of $1,000 $200 $100 Emergency Medical Evacuation Included in Emergency Medical Expenses Repatriation of Remains $10,000 Section 3 - Travel Inconvenience Benefits Baggage Loss (Common Carrier) Refer to 4.3.1 Per Bag Per Item $2,500 $1250 $125 Baggage Delay (Pays for actual expenses incurred due to the delay and up to the limit stated) - Refer to 4.3.2) Excess $50 per hour up to $1,000 4 Hours Travel Delay (Pays for actual expenses in- curred due to the delay and up to the limit stated) - Refer to 4.3.3 Excess $50 per hour up to $1,000 4 Hours Personal Liability $1,000,000 Hijacking $250 per hours up to $10,000 Emergency Family Travel $2,500 Legal Fees $5,000 Bail Bond $10,000 Loss of Passport $500 Trip Cancellation or Curtailment (Non Refundable Travel and Accomodation Bookings) Refer to 4.3.10 $5,000 Section 4 - Additional Optional Coverage: Hazardous Sports Benefits Terrorism Extension Amount noted for the applicable cover under Section 1 and Section 2 as above or $100,000 whichever is less Family includes Participant, Spouse and unlimited number of Children. Children are charged only 50% of the premium charged for adults. Children are covered for 10% of the Participant’s Sum Protected and up to a maximum of $10,000 under Accidental Death.
TABLE OF BENEFITS. Name Group Corona Kavach Policy, Niva Bupa Health Insurance Co. Ltd. Product Type Individual/Floater Category of Benefit Indemnity/Benefit Sum Insured Rs. 50,000/- (Fifty Thousand) to 5,00,000 (Five Lakh) (in the multiples of fifty thousand) On Individual basis- SI shall apply to each individual family member On Floater basis- SI shall apply to the entire family. Policy Period Three and half months (3 ½ months), Six and half months (6 ½ months), Nine and half months (9 ½ months) including waiting periods Eligibility Policy can be availed by persons between the age of 18 Years up to 65 Years, as Proposer. Proposer with higher age can obtain policy for family, without covering self. Policy can be availed for Self and the following family members 1. Legally wedded spouse 2. Parents & Parents-in-law 3. Dependent Children (i.e natural or legally adopted) between the day 1 of age to 25 years. If the child above 18 years of age is financially independent, he or she shall be ineligible. Hospitalization Expenses Medical Expenses of Hospitalization for Covid for a minimum period of 24 consecutive hours shall be admissible. Pre-Hospitalization For 15 days prior to the date of hospitalization/home care treatment Post Hospitalization 30 days from the date of discharge from the hospital/completion of home care treatment Sub-limits Hospital Daily Cash: 0.5% of Sum Insured per day subject to maximum of 15 days in a policy period for every insured member. Home Care Treatment: Maximum up to 14 days per incident AYUSH Medical Expenses incurred for inpatient care treatment for Covid under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines shall be covered up to sum insured during the Policy period as specified in the policy schedule. Home Care Treatment Expenses The Company shall indemnify costs of treatment incurred by the Insured person for availing treatment at home for Covid on positive diagnosis of Covid in a Government authorized diagnostic Centre maximum up to 14 days per incident, which in the normal course would require care and treatment at a hospital but is actually taken while confined at home subject to policy terms and conditions ANNEXURE A List I- Items for which coverage is not available in the policy Sl. No. Item 1 BABY FOOD 2 BABY UTILITIES CHARGES 3 BEAUTY SERVICES 4 BELTS/ BRACES 5 BUDS 6 COLD PACK/HOT PACK 7 CARRY BAGS 8 EMAIL / INTERNET CHARGES 9 FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED BY HOSPITAL) 10 LEGGINGS 11 L...
TABLE OF BENEFITS. INSURANCE GUARANTEES CEILING Subject to the eligibility conditions and exclusions detailed in this Information Notice 1 / CANCELLATION • Death following Covid-19 infection • Serious illness or disease following Covid-19 infection • Infection with Covid-19 • Refusal of boarding by the means of transport reserved following temperature measurement • Case of Contact with Covid-19 2/ LATE ARRIVAL • Serious illness or disease following Covid-19 infection • Infection with Covid-19 • Refusal of boarding by the means of transport reserved following temperature measurement • Case of Contact with Covid-19 3 / INTERRUPTION OF STAY • Interruption of stay following illness or death due to a Covid-19 infection during the stay. 4/ HOTEL EXPENSES FOLLOWING QUARANTINE FOR DISEASE • extension of stay following quarantine Maximum compensation of 20 000 € / file Without deductible Maximum 3 days of refundable rental Deductible of one day Maximum compensation of 20 000 € / file Deductible of one day Hotel fee 80 € per file / Max 7 nights l Gritchen Affinity 00, xxx Xxxxxxx Durand CS70139 - 18021 Bourges Cedex xxx.xxxxxxxx.xx
