Family Health Optima Insurance Plan Eligibility

  • Min Child age: 16 days
  • Max adult age: 65yrs
  • Max child age: 25yrs
  • Members covered: Individual and family plan. You can avail this policy for maximum combination of 2A3C
  • Policy Period: Policy available for 1yr
  • Policy Available for: Sum Insured Rs.2L-15L

Family Health Optima Insurance Plan Benefits

  • Single policy, wider coverage for whole family at an affordable premium.
  • Get extra sum insured (auto recharge) at no extra cost, up to 30%  of sum insured.
  • Health Checkup costs up to Rs.5,000/- for every block of 3 years of policy coverage.
  • Automatic restoration of entire Sum insured by 100%.
  • New-born baby cover from 16th day.
  • Donor expenses for organ transplantation.
  • Domiciliary Hospitalization Expenses for treatment exceeding 3 days.
  • Cover for over 400 day care procedures.

Family Health Optima Insurance Plan Features

  • Recharge Benefit.
  • More than 400 Day Care procedures.
  • Expenses incurred towards cost of Health Check up.
  • Coverage for New born Baby.
  • Coverage for Domiciliary hospitalization treatments.
  • Donor expenses for organ transplantation.
  • Automatic Restoration of Sum Insured.
  • Bonus in respect of a claim-free year of insurance.

Family Health Optima Insurance Plan Claim Process

When the member of the covered family is aware of the hospitalisation in advance.In case of planned hospitalisation:
  • Please contact the toll-free help line: 1800 425 2255
  • Fax the Pre-Authorization form duly filled from the hospital at the below numbers
  • Toll-free: 1800 425 5522
  • Non Toll-free: 044 28302200
  • Please carry your ID card and policy schedule.
Emergency:When the Insured meets with an accident or suffers from bout of illness that requires immediate admission to the hospital.
  • After the patient is rushed to the hospital and avails treatment.
  • Family to contact the toll free help line - 1800 425 2255 and Fax the Pre-Authorization form duly filled from the hospital at the below numbers within 24 hours of admission.
  • Toll-free:1800 425 5522
  • Non Toll-free: 044 28302200
When the Insured gives prior intimation about the treatment and the insured pays the expenses himself with the hospital and then claims for a reimbursement of those expenses.

Family Health Optima Insurance Plan Exclusions

  • All treatments of illness / disease / sickness by the insured person within the first 30 days from the date of commencement of the policy
  • Exclusion of certain diseases from the first two policy years namely - cataract, Replacement surgery for knee and/or joint, Hysterectomy for Menorrhagia or Fibromyoma, varicose veins and Prolapse of intervertebral disc, varicose ulcers. Some of them are covered in case caused due to accident.
  • Exclusion of few diseases from the first policy year like Piles, Hernia, congenital internal disease/defects, Hydrocele, Fistula in anus, Sinusitis and related disorders, removal of gallstones and renal stone, Benign Prostate Hypertrophy
  • If certain expenses are incurred but are only diagnostic in nature and there is no positive existence of any illness or disease
  • Non-allopathic treatment expenses
  • Treatment of any congenital disease, defects or anomalies that are external
  • Naturopathy treatment
  • Expenses that are cosmetic in nature.