United India Health Insurance

United India Family Medicare

United India Family Medicare

Let's Explore The Plan In Detail!

United India Family Medicare Plan is a health insurance policy offered by United India Insurance Company Limited. The United India Family Medicare Plan offers peace of mind by ensuring access to necessary medical care for you and your loved ones, alleviating concerns about the financial burden of unexpected medical expenses. The plan comes with several features and benefits designed to cater to your unique needs.

Are You Eligible?

  • For Adults:
    • Minimum Age Of Entry: 18 years.
    • Maximum Age Of Entry: 65 years.
  • For Dependent Children:
    • Children between the age of 91 days and 18 years can be covered, provided either one or both parents are covered. Children above 18 years can continue to be covered along with their parents till the age of 26.
       

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An Overview of The Plan's Benefits And Limits

In addition to providing coverage for inpatient hospitalisation expenses, such as costs incurred during a hospital stay exceeding 24 hours, encompassing room boarding, nursing charges, medical practitioner's fees, prescribed medicines, drugs, ICU charges, and related expenses, here's a glimpse of other expenses covered under the United India Family Medicare Plan -

  • Pre & Post-Hospitalisation Expenses
    No need to worry if your doctor orders a series of diagnostic tests before or after hospitalisation – your insurer has you covered. The policy provides coverage for up to 10% of the sum insured for 30 days before hospitalisation and 60 days after discharge. It's important to note that these expenses will be covered only if they are related to the medical condition that results in hospitalisation and your claim is approved as part of inpatient hospitalisation coverage.
     
  • Daycare Treatment Coverage
    Daycare treatments are medical procedures or surgeries that required an extended hospital stay in the past but can now be done in less than 24 hours due to groundbreaking advancements in the medical field. All daycare treatments are covered by the United India Family Medicare Plan. Notably, there is no limit imposed on any daycare treatment, ensuring that all related expenses will be covered up to the sum insured.
     
  • Organ Donor Coverage
    The United India Family Medicare Plan includes coverage for organ donor expenses when you are the recipient. It encompasses inpatient expenses of the donor related to organ transplantation up to the chosen sum insured under the policy.
     
  • Modern Treatment Coverage
    The healthcare landscape is advancing swiftly with technological innovations, bringing forth modern treatments that were previously deemed impossible. The United India Family Medicare Plan is crafted to align with these progressions, providing coverage for expenses related to modern treatments. It's important to note that there are sub-limits applicable to various modern treatments.
     
  • Restoration Benefit
    The Restoration Benefit is a distinctive feature that reinstates your sum insured once it's exhausted within a policy year. This benefit is activated upon the complete or partial utilisation of the base sum insured and remains available for subsequent claims under the inpatient benefit throughout the policy year. You can utilise the restore benefit once every policy year for a lifetime, ensuring you keep renewing your policy. Importantly, this benefit is applicable exclusively for unrelated illnesses and is accessible for sum insured options starting from Rs 3 Lakhs and above - if you choose an add-on.
     
  • Room Rent Limit
    It is the maximum amount your health insurance company will cover for the room you choose to stay in during your hospitalisation. If you opt for a room within your plan's room rent limit, you won't face any additional expenses. Selecting a room with a higher rent results in a proportionate deduction, requiring you to cover a portion of the entire bill, not solely the difference in room rent. The capping on room rent under the United India Family Medicare Plan is determined by the sum insured option you select, as shown below -
     

Sum Insured Option

Room Rent Limit

Below 5 Lakhs

Up to 1% of the sum insured per day

Rs 5 Lakhs and above

1% of the sum insured or single occupancy standard AC room, whichever is higher

 

Some Cool Features Of The Product

  • Maternity Expenses And New Born Baby Cover
    The United India Family Medicare Plan provides financial support for childbirth, allowing expectant mothers and their families to embrace this special journey without being burdened by associated costs. This coverage encompasses pregnancy-related expenses, covering up to 10% of the chosen sum insured. Both normal and caesarean sections are included, subject to specific limits outlined in the policy. Additionally, coverage extends to newborns from day 1 to 90 days of birth, up to 10% of the sum insured. It's essential to note that this optional benefit is subject to the waiting period and applicable only for the sum insured exceeding 3 Lakhs. And there are other conditions associated with coverage as well.
     
  • Mental Illness Cover
    While prioritising physical health is crucial, recognising the significance of mental health is equally vital for a well-rounded and satisfying life. The United India Family Medicare Plan extends coverage for inpatient expenses associated with specified mental disorders or conditions following a waiting period. This coverage encompasses up to 25% of the sum insured, subject to a maximum of Rs. 3,00,000 per policy year.
     
  • Organ Donor Benefit – Where You Are The Donor
    Choosing the selfless journey of organ donation may involve unexpected financial commitments, including expenses for medical evaluations and post-operative care. The United India Family Medicare Plan is designed to ease the financial strain associated with these selfless acts by providing a lump sum payout equal to 10% of the sum insured after a stipulated waiting period - if you donate an organ. Certain terms and conditions apply to this coverage.
     

Understanding Waiting Periods

Certain illnesses and diseases will not be covered for a certain period of time after you purchase a health insurance policy. This timeframe is known as the waiting period. You can file a claim for these conditions after the waiting period is over. Below are some of the types of waiting periods -

  • Initial Waiting Period: In the initial 30 days following the policy issuance, a waiting period applies to all medical conditions, excluding accidents. This means that you are not eligible to claim hospitalisation expenses related to any medical condition during this period, except in the event of an accident.
     
  • Waiting Period For Pre-existing Diseases: A pre-existing disease is any health condition or illness that you have experienced in the last 48 months before applying for a health insurance policy. The United India Family Medicare Plan incorporates a waiting period of 48 months specifically for pre-existing diseases. Throughout this duration, the policy will not provide coverage for any expenses incurred due to your pre-existing diseases.
     
  • Waiting Period For Specific Diseases: Insurers maintain a specific list of medical conditions or illnesses for which they apply a waiting period, apart from your pre-existing conditions, regardless of whether you have had those diseases in the past or not. This waiting period is decided by the insurer and is not based on your current status of health. United India Family Medicare Plan applies a waiting period of 24 months and 48 months, depending on the specific disease.
     

Exclusions

These are situations that will not be covered under your health insurance policy. They include -

  1. Standard Permanent Exclusions
    The IRDAI has laid down some 'standard permanent exclusions' that all insurance companies must adhere to. Some of them include –
  • Plastic/cosmetic surgery: Any treatment/surgery that is aimed towards altering your body's characteristics or appearance.
  • Rest cure, rehabilitation, and respite care: Admission to a healthcare facility for bed rest with no requirement for any active treatment.
  • Obesity/weight control: Treatments/surgeries for weight control or obesity.
  • Profession in hazardous or adventure sports: Expenses incurred from engaging in adventurous activities like rafting, scuba diving, mountaineering, horse racing, etc., as a professional.
  • Excluded providers: Treatments from a medical practitioner or hospital excluded by the insurance company.
  • Unproven treatments: Surgeries, medical procedures, or treatments that have not been proven to be effective.
  • Investigation and evaluation: Hospital admission for observation or monitoring purposes.
  • Change of gender treatment: Treatment that aims to change your body's characteristics to match those of the opposite sex.
  • Narcotics: Treatments related to addictive conditions such as alcohol addiction, drug usage, etc.
  • Maternity expenses: Pre/post-natal expenses, costs related to childbirth hospitalisation, and more.
  • Breach of law: Expenses related to the treatment if you have committed or attempted to commit a breach of law with criminal intent.
  • Expenses associated with birth control, sterility, and infertility: Contraception methods, sterilisation procedures, artificial insemination techniques, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
  • Dietary supplements, substances purchased without prescription: Vitamins, minerals, or other supplements that a medical practitioner hasn't prescribed.
  • Treatments in establishments arranged for domestic purposes: Treatments administered at health spas, nursing homes, or similar establishments arranged fully or partially for domestic reasons.
  • Refractive error: Costs related to correcting the refractive errors of up to 7.5 diopters for improving eyesight.
  1. Additional Permanent Exclusions: Along with the abovementioned standard permanent exclusions, insurers may impose additional exclusions under your health insurance plan. If you have a certain illness or severe health condition and the insurer finds your profile risky to cover, they may choose to exclude these conditions from the coverage permanently. However, in India, insurers are required to abide by a specific list of permanent exclusions laid down by the IRDAI. They cannot exclude anything beyond this list.
     
  2. Non-Standard Exclusions (Specific Exclusions): The United India Family Medicare Plan also levies specific exclusions beyond the standard permanent exclusions fixed by the IRDAI. These exclusions can vary across insurance providers and are based on the plan's T&Cs. Here is a list of some top specific exclusions under the United India Family Medicare Plan -
  • Expenses related to domiciliary hospitalisation.
  • Treatment for sleep disorder or sleep apnoea syndrome.
  • Changing treatment from one system of medicine to another system unless recommended by the treating consultant/hospital.
  • Circumcision, unless deemed necessary for treating an illness or injury or is a result of an accident.
  • Congenital external diseases or defects or anomalies.
  • Expenses of hearing aids, including optometric therapy.
  • Treatments other than allopathy, ayurveda, homoeopathy and Unani branches of medicine.
  • Expenses related to dental treatment or surgery of any type unless required in case of a disease or accident and requiring hospitalisation.
  • Expenses for treating intentional self-inflicted injury or attempted suicide.
  • Expenses related to routine eye examination, spectacles, contact lenses, etc.
  • Expenses related to vaccination or inoculation of any type unless it is for a post-animal bite.

 

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A Quick Recap of The Benefits & Limits

Product Benefits

Coverage Limits

Pre-Hospitalisation Expenses

Covered for 30 days up to 10% of the sum insured

Post-Hospitalisation Expenses

Covered for 60 days up to 10% of the sum insured

Daycare Treatment Coverage

All daycare treatments covered up to the sum insured

Organ Donor Expenses

Inpatient expenses of the donor covered up to the sum insured

Modern Treatment Coverage

Sub-limits apply for various modern treatments

Room Rent Limit

For SI below 5 Lakhs: Up to 1% of Sum Insured per day No restrictions

For SI 5 Lakhs and above: 1% of Sum Insured or Single Occupancy Standard AC Room, whichever is higher

Restore Benefit

Available for subsequent claims, once in a policy year for unrelated illnesses on complete or partial utilisation of the base sum insured. Applicable for sum insured options from Rs 3 lakhs and above.

Pre-Existing Diseases

Covered after a 48-month waiting period.

Specific Diseases

Covered after a 24-month and 48-month waiting period, depending on the type of specific disease.


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FAQs

  1. Are domiciliary treatments covered under the United India Family Medicare Plan?
    No, it doesn't provide coverage for domiciliary treatments, i.e. treatments taken at home.
     
  2. Are AYUSH treatments covered under the United India Family Medicare Plan?
    Yes, AYUSH or alternative or non-allopathic treatments like Ayurveda, Unani, and Homeopathy are covered under the plan up to the specified limit.
     
  3. Does the United India Family Medicare Plan cover consumables?
    No, the costs associated with consumables like gloves, masks, syringes, etc. aren't covered under the United India Family Medicare Plan.
     
  4. Does the United India Family Medicare Plan cover maternity-related expenses?
    Yes, the expenses associated with pregnancy are covered up to the limits specified in the policy if you opt for an add-on and choose a sum insured above 3 Lakhs.
     
  5. Does the United India Family Medicare Plan have room rent restrictions?
    Yes, the restrictions on the type of room you choose for your hospitalisation vary based on the sum insured you choose -

Sum Insured Option

Room Rent Limit

Below 5 Lakhs

Up to 1% of the sum insured per day

Rs 5 Lakhs and above

1% of the sum insured or single occupancy standard AC room, whichever is higher