Zuno Health Insurance

Let’s Know The Plan Better!

Zuno Health Insurance, offered by Zuno General Insurance Company Limited, is a health insurance policy that aims to safeguard you and your family against ever-rising medical costs. With this policy, you can rest easy knowing that you'll have access to necessary medical care without financial worries. The plan offers a range of features and benefits to keep you covered during uncertain times. You can choose from the three variants available: Silver, Gold, and Platinum.

Are You Eligible?

Minimum Entry Age

• Adults: 18 years
• Dependent Children: 3 months

Maximum Entry Age

This depends on the variant you choose -

• Silver and Gold: 65 years
• Platinum: No age restriction

An Overview Of The Plan’s Benefits & Limits

With the Zuno Health Insurance Plan, you're covered for your inpatient hospitalisation expenses. This includes costs incurred when you are hospitalised for more than 24 hours, such as room and board charges, nursing fees, medical practitioner's fees, prescribed medications, ICU charges, and other related expenses.

Here are some of the other expenses covered under the plan -

• Pre- and Post-Hospitalisation Expenses
  If you need to undergo tests, consultations, or any other medical procedures before or after your hospital admission, Zuno Health Insurance has got you covered. Your expenses will be taken care of, depending on the variant you choose.
  • Silver Variant - Covers pre-hospitalisation expenses for 30 days and post-hospitalisation expenses for 60 days up to the sum insured.
  • Gold Variant - Covers pre-hospitalisation expenses for 60 days and post-hospitalisation expenses for 90 days up to the sum insured.
  • Platinum Variant - Covers pre-hospitalisation expenses for 90 days and post-hospitalisation expenses for 180 days up to the sum insured.

The insurer will only cover these expenses if they are directly related to your medical condition that leads to your hospitalisation, and your claim for these expenses is approved as part of the inpatient hospitalisation coverage.

• Daycare Treatment Coverage
  Daycare treatments are medical procedures or treatments that used to require hospitalisation for a prolonged period of time but now can be completed within 24 hours due to technological advancements in the field of healthcare. With Zuno Health Insurance (all three variants), you can enjoy extensive coverage for all daycare procedures up to the sum insured.
   
• Domiciliary Treatment Coverage
  Domiciliary treatments are medical treatments or procedures that necessitate immediate attention in a hospital but are carried out at home if you are too sick or injured to be transported safely to a hospital or there are no hospital beds available nearby. With the Zuno Health Insurance Plan, expenses related to domiciliary treatments are covered up to the sum insured under all three variants (Silver, Gold, and Platinum).
   
• Organ Donor Coverage
  The Zuno Health Insurance Plan offers coverage for organ donor expenses, except in the case of the Silver variant. In the event of an organ transplant surgery, this plan will cover the inpatient expenses of the organ donor incurred during organ transplantation where you are the organ recipient. The expenses will be covered up to the following limits mentioned in the policy document -

1. Gold Variant -  Covered up to a maximum of Rs 1,00,000
2. Platinum Variant - Covered up to a maximum of Rs 2,00,000.

• Modern Treatment Coverage
  The field of medicine is undergoing an amazing transformation in the last few decades, all thanks to incredible technological advancements. As a result, treatments that were once beyond imagination are now becoming a reality. The Zuno Health Insurance Plan is designed to keep up with these advancements and provides coverage for these modern treatments up to the sum insured under all 3 variants.
   
• No Claim Bonus
  Zuno Health Insurance provides you with a reward called a No Claim Bonus if you maintain good health and do not make any claims throughout the policy year. This bonus is offered every year you don’t make a claim, up to a certain limit. Here are the specific limits that apply as per the variants:
   
  1. Silver - 10% of the sum insured every year subject to a maximum of up to 50% of the sum insured.
  2. Gold - 50% of the sum insured every year subject to a maximum of up to 100% of the sum insured.
  3. Platinum - 50% of the sum insured every year subject to a maximum of up to 100% of the sum insured.

If you ever make a claim in the future, note that the accumulated bonus will decrease at the same rate it was earned under all the variants.

• Restore Benefit
  The Restoration Benefit ensures that your sum insured is replenished when it is exhausted within a policy year. Once you have fully or partially utilised your base sum insured and applicable cumulative bonus, the restore benefit will get activated. This benefit can be utilised for subsequent claims throughout the policy year. It's important to note that the restore benefit can only be used once per policy year for a lifetime as long as you continue to renew your policy.  In the Silver variant, this benefit is available as an add-on, and it can be used for only unrelated illnesses. And, in the Gold and Platinum variants, this benefit is applicable for both unrelated and related illnesses by paying an extra premium.
   
• Room Rent Limit
  The room rent limit is the highest amount that your insurance company will cover for the room you choose while staying in the hospital. By selecting a room within this limit, you can avoid out-of-pocket expenses. However, if you decide to go for a room that exceeds your eligibility limit, a deduction will be applied proportionately. In such situations, you will be responsible for paying a proportionate share of the total bill rather than just the room rent difference.
  The different variants under the Zuno Health Insurance Plan have certain limitations on the type of room you can choose. The highest room category available for Silver (above Rs 2 lakhs sum insured), Gold, and Platinum plans is the single private AC room. If you select the Silver variant with a sum insured up to Rs 2 lakhs, there is a room rent limit of up to 1% of the sum insured per day.
   

Noteworthy Features You Should Be Aware Of!

• Critical Illness Coverage
  Under the Zuno Health Insurance Plan, you'll receive a sum of money if you are diagnosed with critical illnesses such as coronary artery bypass graft (open chest CABG), myocardial infarction (first heart attack of specific severity), cancer of specified severity, etc. listed in the policy document. This benefit is available after 90 days of policy commencement. Silver Variant offers this benefit as an add-on.
  Here are the maximum limits applicable under the three variants -

1. Silver variant - Covers up to 50% of the sum insured
2. Gold variant - Covers up to 50% of the sum insured
3. Platinum variant - Covers up to 100% of the sum insured    

• Maternity Benefit
  Zuno Health Insurance Plan is here to support you during the beautiful journey of childbirth. With this plan, expectant mothers and their families can enjoy the joyous occasion without worrying about the financial burden.
  Here are the maximum limits applicable under the maternity benefit -

1. Gold variant - Covers the costs of childbirth, up to Rs 50,000.
2. Platinum variant - Covers the childbirth costs up to Rs 2,00,000.

Please note that the silver variant doesn’t offer this benefit and the coverage under this benefit is subject to certain terms and conditions.

• Health 241
  If you're looking for a smart way to enhance your health insurance policy, Zuno Health Insurance has got you covered with their "Health 241" add-on. It's an exceptional policy extension that offers a fantastic bonus - free coverage for your second policy year. Well, if you maintain good health and don't make any claims during your first policy year, you won't have to worry about any costs in the second year. It's a valuable perk that rewards your commitment to staying healthy and helps you focus on preventative care.

Understanding Waiting Periods

Once you've purchased a health insurance policy, you need to wait a certain period of time before you can claim for certain illnesses and diseases. This timeframe is known as the waiting period. However, once this waiting period is over, you'll be able to file claims for these conditions.

Let's take a look at some of the different types of waiting periods:

• Initial Waiting Period
  After purchasing your policy, please note that there is a 30-day waiting period before you can make a claim for any medical condition, except in the case of accidents. During this period, you cannot make a claim for hospitalisation unless it is related to an accident.
   
• Waiting Period For Pre-Existing Diseases
  A pre-existing disease refers to any medical condition or illness that you have experienced in the 48 months prior to purchasing a health insurance plan. During this period, the policy will not provide coverage for any expenses you may incur related to your pre-existing conditions. Under the Zuno Health Insurance Plan, the waiting periods applicable for pre-existing conditions are as follows-
  • Silver - 48-month waiting period
  • Gold - 36-month waiting period
  • Platinum - 24-month waiting period
     
• Waiting Period For Specific Diseases
  Insurers enforce waiting periods for certain medical conditions or illnesses, regardless of whether you have previously experienced them or not. It's important to note that these waiting periods are determined by the insurer and are not influenced by your current health status. In Zuno Health Insurance, there is a waiting period of 24 months for certain diseases under all 3 variants.

What The Plan Does Not Cover?

Exclusions are situations or conditions that your health insurance policy does not cover. Let's look at some exclusions that you should be aware of:

1. Standard Permanent Exclusions
   IRDAI has put forth a set of 'standard permanent exclusions' that all insurance companies must adhere to -

• Obesity/weight control: Treatments or surgeries for weight control or obesity.
• Profession in hazardous or adventure sports: Expenses from engaging in adventurous activities like mountaineering, surfing, paragliding, etc., as a professional.
• Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurer.
• Investigation and evaluation: Hospital admissions for observation or monitoring purposes.
• Rest cure, rehabilitation, and respite care: Admission to a bed rest facility without active treatment.
• Plastic/cosmetic surgery: Treatment or surgery that aims to alter your body characteristics or appearance.
• Narcotics: Treatments related to addictive conditions such as alcohol addiction, drug usage, etc.
• Breach of law: Expenses related to treating someone who has committed or attempted to commit a breach of law with criminal intent.
• Change of gender treatment: Treatment that aims to change your body's characteristics to match those of the opposite sex.
• Dietary supplements, substances purchased without prescription: Vitamins, minerals, or other supplements that a medical practitioner hasn’t prescribed.
• Unproven treatments: Surgeries, medical procedures, or treatments that have not been proven to be effective.
• Treatments in establishments arranged for domestic purposes:  Treatment received at health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
• Maternity expenses: Pre/post-natal costs, expenses related to childbirth hospitalisation, and more.
• Refractive error: Expenses related to correcting refractive errors of up to 7.5 diopters to improve your eyesight.
• Expenses related to birth control, sterility, and infertility: Treatments like contraception methods, sterilisation procedures, artificial insemination techniques, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.

2. Additional Permanent Exclusions
   In addition to the permanent exclusions mentioned earlier, insurance providers may also apply additional exclusions in your policy for certain circumstances or medical conditions. If you happen to have certain diseases or severe medical conditions that are considered high-risk to cover, the insurance provider may opt to exclude them from your policy permanently. In India, insurers can impose permanent exclusions on certain illnesses as determined by the Insurance Regulatory and Development Authority of India (IRDAI). However, they are prohibited from excluding any illnesses that are not on this list.
    
3. Non-Standard Exclusions (Specific Exclusions)
   Zuno Health Insurance Plan (all three variants) has specific exclusions that go beyond the standard permanent exclusions set by the IRDAI. It's important to remember that these exclusions can differ among insurance companies and are determined by the policy's terms and conditions. Here are some of the specific exclusions listed under the Zuno Health Insurance Plan -

• Medical expenses for newborns or children below 91 days old
• Expenses related to external prostheses, corrective devices, durable medical equipment, wheelchairs, walkers, crutches, ambulatory devices, and oxygen concentrators for asthmatic conditions.
• Treatments related to acupressure, acupuncture, and magnetic therapy.
• Treatment of any external congenital anomaly, illness, defects, or anomalies unless they are related to external birth defects.
• Expenses related to spectacles, contact lenses, hearing aids, routine eye and ear examinations.
• Circumcision, unless it is necessary for the treatment of an illness or is required due to an accident.
• Vaccinations, including inoculations and immunizations, except in case of post-bite treatment.
• Injuries or illnesses resulting from war, war-like occurrences, invasions, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
• Expenses related to treating alopecia or hair fall, including alopecia wigs and/or toupees, various hair treatments and products to address your needs.
• Stem cell storage services (except allogeneic bone marrow transplantation)
• Participation in naval, military, air force, or aviation operations as a professional or semi-professional.
   

A Quick Recap Of The Benefits and Limits

The OG Reading Material for Your Reference

• Policy Wording: https://cms.hizuno.com/uploads/Zuno_Health_Product_Policy_Wording_DMV_1_8b71ac426f.pdf?updated_at=2023-02-06T10:58:57.104Z

FAQs:

1. What is the maximum coverage you can opt for under the Zuno Health Insurance Plan?
   The maximum coverage amount you can select depends on the plan variant you choose:

• Silver: Up to Rs 5 lakhs
• Gold: Up to Rs 20 lakhs
• Platinum: Up to Rs 1 Crore

2. Are there room rent restrictions under the Zuno Health Insurance plan?
   Depending on the variant you select, there are certain restrictions on the type of room you can choose for your hospital stay. For the Silver variant (up to Rs 2 lakhs sum insured), you can avail a room at 1% of the sum insured per day. For Silver (above Rs 2 lakhs sum insured), Gold, and Platinum variants, the highest room category available is a Single Private AC Room.
    
3. Are AYUSH treatments covered under Zuno Health Insurance?
   Zuno Health Insurance includes coverage for AYUSH treatments such as Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy under all 3 variants. You can enjoy the benefits of these alternative or non-allopathic treatments up to the sum insured.
    
4. Does the Zuno Health Insurance Plan provide coverage for consumables?
   Zuno Health Insurance Plan does not provide coverage for consumables such as gloves, masks, syringes, and similar items.
    
5. Does the Zuno Health Insurance Plan provide coverage for maternity benefits?
   Zuno Health Insurance Plan covers maternity-related expenses up to the limits stated in your policy except in the case of the Silver variant.