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Health Total

Paradise is where you live your life in perfect peace and harmony. However, in today’s world, your days are often mired with stress, pollution and other lifestyle hazards, the worst victim of which is your health. You may have a number of health requirements, right from regular health issues to serious ailments, leading to hospitalisation and expensive medical treatments. Although none of these are welcome, it is always good to take a health policy and be prepared for such unforeseen events.Read More

And won’t it be convenient to take just one policy against all such requirements? With Health Total, we give you a comprehensive cover, a near-perfect answer to all your medical needs.Read Less

FEATURES

PLAN OPTIONS/VARIANTS

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    Health Total Vital

    • Hospitalization Medical Expenses – A minimum period of 24 Inpatient Care consecutive hours.
    • Day Care Treatment expenses- Specified procedures/treatments, where such admission could be for a period of less than 24 consecutive hours.
    • Pre-hospitalisation Medical Expenses –Related medical expenses 60 days prior to hospitalisation.
    • Post-hospitalisation Medical Expenses - Related medical expenses post hospitalisation within 90 days from date of discharge from the hospital
    • Maternity Expenses - maximum liability per pregnancy (delivery/termination) will be subject to the specified sub-limit as mentioned in the Schedule of Benefits
    • Organ Donor Expenses - Charges incurred for an organ donor’s treatment for the harvesting of the organ donated.
    • Patient Care - Charges for a Qualified Nurse for the Insured Person for a period of up to 10 days immediately following the Insured Person’s discharge from Hospital
    • Accidental Hospitalisation - 25% increase in balance SI
    • Accompanying Person expenses- Payment for the Accompanying Person for the hospitalized Insured Person (Dependent Child who is less than 12 years of age)
    • Road Ambulance Charges Covered
    • Domiciliary Hospitalisation Expenses - maximum up to 10% of SI
    • Alternative Treatment Covered
    • Wellness care - Wellness including medical tests at designated centres
    • Death succeeding a hospitalization claim - a 10% discount in premiums on the immediate Renewal of the Policy for existing family members at the time of insured’s death
    • Cumulative Bonus - 50% for every claim-free year to max 100%
    • Restoration of the Sum Insured - a Restore Sum Insured (equal to 100% of the Sum Insured) will be automatically available for the particular Policy Year on exhaustion of Sum Insured and Cumulative Bonus (if any).

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    Health Total Superior

    • Health Total Superior = Health Total Vital + the below features
    • Pre-natal hospitalisation (within maternity limits)
    • Post-natal hospitalisation (within maternity limits)
    • Newborn Baby - Automatic cover upto Sum Insured till expiry date of policy
    • Emergency medical evacuation - reimbursement up to a maximum of 5% of SI
    • OPD Treatment - consultations and diagnostics

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    Health Total Premiere

    • Health Total Premiere = Health Total Vital + the below features
    • Pre-natal hospitalisation (within maternity limits)
    • Post-natal hospitalisation (within maternity limits)
    • Newborn Baby - Automatic cover upto Sum Insured till expiry date of policy
    • Child vaccination benefits
    • Emergency medical evacuation - reimbursement up to a maximum of 5% of SI
    • OPD Treatment – consultations, diagnostics and prescribed medicines
    • Medical treatment abroad

Eligibility

Eligibility

  • Entry Age – Minimum – 1 Day
  • Entry Age – Maximum – None
  • Cover type – Individual and Family Floater
  • Co-payment - Compulsory Co-payment applicable on every admissible claim

    Entry Age Co-payment applicable
    60 years to 64 years 20%
    65 years to 69 years 25%
    70 years to 74 years 30%
    75 years and above 40%

Documentation

For transaction on net banking – no documentation

For transaction on Mobile App– no documentation

For paper based transactions

  • Insurance company form
  • KYC Documents :ID Proof & address proof(PAN & Aadhar)

Exclusions

  • Pre-existing disease: Compulsory waiting period - 2 Years, max liability 3rd year onwards 50%, 4th Year onwards 100%.
  • 30-day waiting period - fresh proposals excluding accidental hospitalisation
  • 2-year waiting period for listed conditions
  • 4-year waiting period - joint replacement and organ transplant
  • 4-year Waiting Period - Mental illness and psychiatric illness
  • 4-year Waiting Period - HIV/ AIDS
  • 4-year Waiting Period - Behavioural and Neuro developmental disorders
  • Cost of an annual health check-up
  • Injury or illness directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, war like operations
  • Cosmetic treatments, plastic surgery other than as may be necessitated due to an accident or as a part of any illness, refractive error corrective procedures, experimental, investigational or unproven/experimental treatment, devices and pharmacological regimens of any description
  • Expenses incurred towards treatment of illness or injury arising out of alcohol use/ misuse or abuse of alcohol, narcotic substance or drugs
  • Charges incurred in connection with cost of spectacles and contact lenses, hearing aids, durable medical equipment, namely that equipment used externally for the human body which can withstand repeated use; is not designed to be disposable; is used to serve a medical purpose, such cost of all appliances/devices whether for diagnosis or treatment after discharge from the hospital.

Claims

Cashless Claim - Cashless treatment is only available at a Network hospital. In order to avail cashless treatment, the following procedure must be followed by You:

  • Choose the network hospital.
  • You can find the complete list of network hospitals on our website.
  • Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor.
  • We will scrutinize the document and convey the decision to the hospital. We will sanction the cashless request or call for additional documents if required.
  • On approval of a cashless claim, the hospital bills will be settled directly.

Reimbursement Claim - If treatment is taken in a Hospital which is not on our Network or if You do not wish to avail cashless facility the following procedure must be followed by You for reporting a claim:

  • Intimate Us through the toll free number - 1800 103 8889 immediately on admission not later than 15 days from the date of discharge from a Hospital.
  • Avail treatment and settle all the bills with the hospital and then file a claim for reimbursement.
  • Claim documents may be submitted at below address:
  • Claims Department,
    Future Generali Health (FGH), Future Generali India Insurance Co. Ltd. Office No. 3, 3rd Floor, “A” Building , G - O – Square, S. No. 249 & 250, Aundh Hinjewadi Link Road, Wakad, Pune - 411 057.
    Toll Free Number: 1800 103 8889
    Toll Free Fax : 1800 103 9998
    Email: fgh@futuregenerali.in

Claim Documents

  • The indicative list of claim documents required is mentioned below
  • The claim form specified by Us duly completed and signed by the claimant or a family member
  • First consultation letter
  • First prescription from the Medical Practitioner
  • Original vouchers
  • Original Hospital bills giving a detailed break up of all expense heads mentioned in the bill
  • Money receipt duly signed with a revenue stamp
  • Birth/death certificate (as applicable)
  • The original Hospital discharge card
  • All original laboratory and diagnostic test Reports such as X-Ray, E.C.G, USG, MRI Scan, Haemogram, etc
  • If medicines have been purchased in cash and if this has not been reflected in the Hospital bill, please enclose a prescription from the Medical Practitioner and the supporting medicine bill from the chemist
  • If diagnostic or radiology tests have been paid for in cash and it has not been reflected in the Hospital bill, please enclose a prescription from the Medical Practitioner advising the tests, the actual test reports and the bill from the diagnostic centre for the tests.

Health Total

Disclaimer

1Tax deductions under Section 80D is as per applicable provision of the Act (including any amendments thereto) and are subject to changes in the tax laws. 2Factors determining the renewal premium are (i) age slab of the senior most insured member at the time of renewal (ii) any change in the renewing policy. 10Following is an indicative list of the policy exclusions. Please refer to the policy clause for the complete list.Read More

“For detailed information on risk factors, term & conditions etc., please refer to the product brochure and policy wordings, consult your advisor/agent or visit Future Generali’s website before concluding a sale” Health Total. FGIHLIP21163V022021.Read Less

FREQUENTLY ASKED QUESTIONS

What do you mean by entry age?

The age eligibility of the insured for taking the policy is the Entry age. Age will mean completed age as on last birthday.

What are the entry age limits under Health Total?

The minimum age required for entry is 1 day. There is no limit of Maximum age for entry. Children will be covered as dependents up to 25 years of age.

Is there an exit age under Health Total?

No, there is no exit age in this policy.

What is the family definition?

Vital Plan: Self, spouse, dependent children and dependent parents.Children will be covered as dependents up to 25 years of age.

Superior and Premiere Plan: Self, spouse, dependant or non-dependent children, dependent or non-dependent parents, Dependent Siblings, daughter in law, son in law, parents in law, grandparents and grandchildren.

What do you mean by in-patient and out-patient Treatment?

When an insured is hospitalized and stays in hospital for more than 24 hours solely for receiving treatment it is termed as inpatient treatment.

Out-patient treatment is when insured visits a clinic/hospital or a consultation room for diagnosis and treatment based on the advice of medical practitioner. In out-patient hospitalizationpatient is not admitted under a day care or as an in-patient.

What is Day Care Procedure?

Day care Procedure means the course of medical treatment or a surgical procedure listed in the Policy wordings which requires less than 24 hours admission. This excludes all procedures or treatment taken in out- patient departments.

Are all the systems of medicine covered under this insurance plan?

Hospitalization under Ayurveda, Unani, Siddha, or Homeopathy (AYUSH ) are covered provided that the treatment has been undergone in a government hospital or in any institute recognized by government and / or accrediated by Quality Council of India / National Accreditation Board on Health for that Alternative treatment.

What are Network /Non-network provider?

Network Provider means hospitals or health care providers enlisted by Future Generali to provide medical services to an insured on payment by a Cashless Facility.

(Please note: The Hospitals which have been empanelled by Us as Network Providers are as per the latest version of the schedule of Hospitals maintained by Us, which is available to You on request.)

Non-Network Provider means any hospital, day care centre or other provider that is not part of the network.

What do terms Cashless Facility and Claim Reimbursement mean? Cashless Facility?

The cashless facility can be availed in case of admission in network hospitals. If the policy holder presents the heath card or cashless card at the network hospital, the hospital authorities contact us and provide the details of the hospitalization. If the illness is covered as per the policy terms and conditions Authorization letter is issued to the hospital. The hospital sends all the bills and documents to us for settlement. The insured has to pay the non-admissible expenses to the hospital.

Claim-Reimbursement
If the admission is in Non-network hospital then you need to settle the hospitals bills & submit the hospitalization documents along with the claim form for reimbursement of hospitalization expenses.

More FAQs