Let’s Know The Plan Better!
The Chola Flexi Health Insurance Plan is a comprehensive health insurance plan offered by Cholamandalam MS General Insurance Company Limited. With its extensive coverage and extensive range of benefits, this plan is designed to cater to all healthcare needs of you and your loved ones. Chola Flexi Health Insurance is not just any ordinary indemnity health insurance, it is a testament to the idea that life should be all about flexibility. It offers a captivating ensemble of choices to ensure that you have the freedom to shape your health coverage according to your unique requirements.
Are You Eligible?
Minimum Entry Age
- Adults: 18 years
- Dependent Children: 3 months
Maximum Entry Age
- Adults: 65 years
- Dependent Children: 26 years
An Overview Of The Plan’s Benefits & Limits
Chola MS FLexi Health Plan includes coverage for inpatient hospitalisation expenses, such as the costs incurred while admitted in a hospital for over 24 hours. This includes charges for room boarding and nursing, fees for medical practitioners, the cost of prescribed medications, ICU charges, and other related expenses.
Furthermore, the following expenses are also covered in the Chola MS Flexi Health Plan:
- Pre & Post Hospitalisation Expenses
If your doctor deems it necessary to conduct multiple diagnostic tests before or after your hospital admission, you can rest easy knowing your insurer has got you covered. Chola MS Flexi Health Plan will bear the expenses for these tests up to the sum insured, within a reasonable timeframe of 30 days prior to your hospitalisation and 60 days following your discharge. It is important to note that it will only cover these costs if they are directly associated with the medical condition that led to your hospitalisation, and if your claim is approved under inpatient hospitalisation coverage.
- Daycare Treatment Coverage
A daycare treatment is a medical procedure or surgery that used to require a long stay in the hospital. However, thanks to advances in medical technology, it can now be done and completed within just 24 hours. With the Chola MS Flexi Health Plan, 539 daycare procedures are covered up to the sum insured - without any limit.
- Domiciliary Treatment Coverage
Domiciliary treatments are medical treatments that are given at home in case you are too sick or injured to be safely taken to a hospital or because there are no available hospital beds nearby. With the Chola MS Flexi Health Plan, you can have peace of mind knowing that it covers the costs of domiciliary treatments up to the sum insured.
- Organ Donor Coverage
The Chola MS Flexi Health Plan provides coverage for organ donor expenses. This means that it will cover the hospitalisation costs associated with organ transplantation (where you are the recipient) up to the sum insured you select under your policy.
- Modern Treatment Coverage
In the fast-changing world of healthcare, medical technology has made big advancements. This has led to new and innovative treatments like robotic surgeries, deep brain stimulation, etc. which were once thought impossible. Chola MS Flexi Health Plan keeps up with these modern treatments and provides coverage up to the sum insured.
- Room Rent Limit
The room rent limit refers to the highest amount that your insurance company will cover for the room you stay in during your hospitalisation. By selecting a room within this limit, you can avoid any out-of-pocket expenses. However, if you opt for a room that exceeds your eligibility, a proportional deduction will be applied. In such cases, you will be responsible for paying a proportionate portion of the total bill, rather than just the difference in room rent.
With the Chola MS Flexi Health Plan, you can enjoy the freedom to select your preferred room type - be it a shared room, single room, deluxe room, suite, or any other available option.
- No Claim Bonus
With the Chola MS Flexi Health Plan, you have the opportunity to receive a bonus for maintaining good health and not making any claims throughout the duration of a policy year. It boosts your sum insured by 10% for every claim-free year, up to a maximum of 50% of the sum insured. However, if you do make a claim in the future, the accumulated bonus will be reduced at the same rate it accumulated.
The restoration benefit restores your sum insured if it runs out during the policy year. It gets activated when you fully or partially use your base sum insured and cumulative bonus (if applicable). This benefit can be used for subsequent claims during the policy year and can be utilised for unrelated illnesses. The restoration will happen once every policy year for your lifetime, as long as you renew your policy.
Noteworthy Features You Should Be Aware Of
- No Sub-limit On Treatment
This policy doesn't impose any sub-limit on specific diseases or treatments like cataracts, joint replacement, etc. This means, that if your insurer doesn't specifically exclude coverage for a particular illness, you can claim the full amount up to the sum insured, regardless of the disease you have.
- New Born Benefit
This built-in cover includes all inpatient medical expenses for the newborn baby from day 1, as long as the mother has continuous coverage for a year without any gaps. It provides coverage up to 10% of the sum insured or Rs 50,000/-, whichever is less. This coverage ensures that the baby can receive medical care for unexpected health issues during the early stages of life. Please note that certain terms and conditions apply to this coverage.
- Road Traffic Accident Cover
The road traffic accident cover provides extra financial protection if you are hospitalised due to an accident. It increases your sum insured by 25%, up to a maximum of Rs 3 lakhs, to help with accident-related expenses, once during the policy period. This increased sum insured is an extended part of your coverage that focuses on helping you with the immediate financial consequences of an accident.
Note: Terms and conditions are applicable.
Understanding Waiting Periods
Once you have purchased a health insurance policy, you’ll need to wait a certain period of time before availing coverage for specific illnesses or conditions. This time frame is called a waiting period. Once this waiting period is over, you will be able to make claims for these conditions.
Here are the various types of waiting periods -
- Initial Waiting Period: There is a waiting period of 30 days before you can make a claim for any medical condition, except for accidents. This means, that within the first 30 days of purchasing your policy, you will not be eligible to claim for hospitalisation unless it is due to an accident.
- Waiting Period For Pre-Existing Diseases: A pre-existing disease refers to any medical condition or illness that you have experienced within the 48 months prior to purchasing your health insurance policy. It is important to note that under the Chola MS Flexi Health Plan, there is a waiting period of 36 months for pre-existing conditions. During this time, any expenses related to pre-existing conditions will not be covered by the policy.
- Waiting Period For Specific Diseases: Insurance companies will impose a waiting period for a specific list of medical conditions or illnesses, apart from pre-existing conditions. This waiting period is applicable regardless of whether you have had these diseases before or not. The duration of this waiting period is decided by the insurer and is not influenced by your current health. In Chola MS Flexi Health Plan, there is a waiting period of 24 months for specific diseases.
What The Plan Does Not Cover!
Exclusions refer to specific situations that are not covered by your health insurance policy. Some of the types of exclusions include -
- Standard Permanent Exclusions:
Please note that the Insurance Regulatory and Development Authority of India (IRDAI) has defined a set of "standard permanent exclusions" that all insurance companies are required to adhere to. These exclusions encompass various conditions and circumstances that are not covered by health insurance policies. Some examples of these exclusions are:
- Rest cure, rehabilitation, and respite care: Admission to a facility for bed rest, without any active treatment.
- Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurer.
- Expenses related to birth control, sterility, infertility: Treatments like contraception methods, sterilisation procedures, artificial insemination techniques, as well as advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc. are excluded.
- Refractive error: Expenses related to correcting refractive errors of up to 7.5 diopters to improve your eyesight.
- Obesity/weight control: Treatments or surgeries for weight control or obesity.
- Breach of law: Expenses related to the treatment if you have committed or attempted to commit a breach of law with criminal intent.
- Treatments in establishments arranged for domestic purposes: Treatment received at health spas, nursing homes, or similar establishments that were arranged completely or partially for domestic reasons.
- Unproven treatments: Surgeries, medical procedures, or treatments that have not been proven to be effective.
- Investigation and evaluation: Hospital admissions for observation or monitoring purposes.
- Profession in hazardous or adventure sports: Expenses incurred as a result of engaging in adventurous activities like mountaineering, kayaking, parachuting, rafting, etc. as a professional.
- Narcotics: Treatments related to addictive conditions such as alcohol addiction, drug usage, etc.
- Maternity expenses: Pre/post-natal costs, expenses related to childbirth hospitalisation, etc. are excluded.
- Change of gender treatment: Treatment that aims to change your body's characteristics to match those of the opposite sex.
- Plastic/cosmetic surgery: Any kind of surgery/treatment to modify body characteristics or appearance.
- Dietary supplements, substances purchased without prescription: Vitamins, minerals, or other supplements that are not prescribed by a medical practitioner.
- Additional Permanent Exclusions
In addition to the standard permanent exclusions mentioned earlier, insurance companies may also apply specific exclusions in your policy for certain situations or medical conditions. If you have a particular disease or medical condition that insurers deem risky to insure, they may choose to permanently exclude them from coverage. It is worth noting that insurers in India are obligated to follow a specified list of illnesses provided by the Insurance Regulatory and Development Authority of India (IRDAI). They cannot exclude illnesses outside of this list.
- Non-Standard Exclusions (Specific Exclusions)
The Chola MS Flexi Health Plan has specific exclusions that go beyond the standard permanent exclusions set by the IRDAI. It is important for you to be aware that these exclusions may differ among insurance companies and are dependent on the specific terms and conditions of your policy.
Here are some of the specific exclusions under the Chola MS Flexi Health Plan -
- Deliberate self-harm or attempted suicide, notwithstanding the person’s mental state.
- Circumcisions, unless medically necessary due to illness or injury and part of treatment.
- Vaccinations or inoculations, unless they are required as part of post-animal bite treatment.
- Sexually transmitted diseases or illnesses.
- Any external congenital illnesses, defects, or abnormalities.
- Costs related to hearing aids, eyeglasses, or contact lenses.
- Yoga and Naturopathy
- Claims related to impotence treatment or potency improvement.
- Claims arising from war, invasion, acts of foreign enemies, civil war, revolution, etc.
- Injuries or conditions caused by ionising radiation or contamination by radioactivity from nuclear fuel or waste combustion.
A Quick Recap Of The Benefits & Limits
30 days up to the sum insured
60 days up to the sum insured
Daycare Treatment Coverage
539 daycare treatments are covered up to the sum insured
Domiciliary Treatment Coverage
Up to the sum insured
Organ Donor Coverage
Hospitalization expenses during organ transplantation up to the sum insured
Room Rent Limit
No Claim Bonus
10% increase in sum insured every claim-free year, subject to a maximum of 50% of the sum insured.
It will reduce at the same rate if a claim is made.
100% of the sum insured on full/partial use of the sum insured.
Covered after a 36-month waiting period
Covered after a 24-month waiting period
Some OG reading Material for your Reference
- Are AYUSH treatments covered under Chola MS Flexi Health?
Certainly! The policy includes coverage for non-allopathic treatments such as Ayurveda, Unani, Siddha, and Homeopathy up to the sum insured.
- What is the maximum coverage that one can choose under the Chola MS Flexi Health Plan?
Chola MS Flexi Health Plan provides you with health coverage of up to Rs 25 lakhs.
- Are there any limitations on room rent with Chola MS Flexi Health?
No, there is no restriction on the room category for hospitalisation under the Chola MS Flexi Health Plan.
- Does the Chola MS Flexi Health Plan offer a monthly premium payment option?
Absolutely! The Chola MS Flexi Health Plan provides you with the flexibility to conveniently pay your premiums on a monthly basis.
- What is the maximum entry age limit in the Chola MS Flexi Health plan?
The maximum age of entry for adults is 65 years and for children is 26 years.