List of Network Hospitals Eligible for Cashless/Direct Payment Facility: Click Here

Lifestyle Benefit Network (up to 45% Discount on selected services): Click Here

WHAT IS COVERED

• This policy covers you for the diagnosis and treatment of medical conditions that arise after the start of your policy. It may also provide coverage for medical conditions that you had prior to taking out your policy, but only if you declare about them when you apply for cover and the insurance company agrees to cover them.
• It will cover the items detailed in your table of benefits subject to any limits detailed
• Insurance company will pay for treatment received during the period of cover for which the premium has been received
• Insurance company will only pay reasonable and customary charges

WHAT IS NOT COVERED (EXCLUSIONS)

• Medical Expenses incurred for any disease/illness within 30 days of the commencement of the Policy Period and claims arising out of any medical conditions where signs or symptoms or diagnosis of an ailment/sickness occurring during the first 30 days of cover and leading to any hospitalization after the 30 day waiting period is over. Accidents would be covered from Day 1.
• treatment received before the inception of the policy or after its expiry, or for any period for which you have not paid premium
  
• Acts of terrorism, war, and illegal acts
• Alcohol or drug abuse
• Alternative therapies
• Chemical exposure
• Circumcision
• Congenital conditions
• Cosmetic treatment
• Costs covered elsewhere
• Dental treatment
• Developmental issues
• Domestic and long term care
• Eating disorders
• External prosthesis
• Experimental treatment and drugs
• Failure to seek medical advice
• Flying
• Hearing tests or aids
• Hazardous sports
• HIV, AIDS, and sexually transmitted disease
• Infertility and gender reassignment
• Mental or psychiatric illness - except where specifically included
• Non-medical charges
• Not medically necessary or reasonable and customary
• Obesity
• Optical care
• Organ donation
• Personal medical exclusions - any treatment of any medical condition shown on your Policy Schedule as excluded
• Police or military service
• Pre-existing Conditions
• Pregnancy, maternity, childbirth, and foetal surgery
• Routine medical examinations
• Removal of foreign bodies
• Self-inflicted injuries or suicide
• Sleep disorders

Medical expenses incurred for conditions having a waiting period of 24 months of continuous coverage:

• Deviated Nasal Septum/ Nasal & Paranasal Sinus Disorders (except Malignancy), Treatment for Chronic Suppurative Otitis Media (CSOM) and Serous Otitis Media (Grommet Insertion)
• Medical or Surgical management of diseases of Tonsils / Adenoids (except Malignancy)
• Surgery of Thyroid Gland excluding for the reason of Malignancy
• All types of Hernias and Cataract excluding traumatic cataracts
• Hydrocoele / Varicocoele / Spermatocoele
• Piles / Fissure / Fistula-in-Ano / Rectal Prolapse / Pilonidal Sinus
• Benign Prostatic Hypertrophy
• Treatment of all gynecological conditions (Such as but not limited to Uterine Fibroid, Dysfunctional Uterine Bleeding, Hysterectomy, Uterine Prolapse, Endometriosis, Adenomyosis Uteri, Ovarian Cyst, etc.) except those arising from malignancy
• Diabetes, Peripheral Vascular Disease due to Diabetes, Diabetic Foot / Hypertension, and related complications
• Skin and all internal cysts / tumors / nodules / polyps / ganglions / lipomas of any kind unless malignant
• Calculus Diseases of any etiology
• Retinopathy / Retinal Detachment
• All types of CRF and acute on chronic Renal Failures but not ARF, including Renal Failure due to Diabetes
• Osteoporosis / Pathological Fracture / Degenerative Joint Diseases / Prolapsed Intervertebral Disc
• Treatment for degenerative joint conditions including joint replacement surgeries. However, joint surgeries necessitated due to accidents would not be a part of this exclusion
• Treatment for benign breast disorders fibroadenoma, fibrocystic diseases, etc.
• Treatment for Carpal tunnel syndrome and Peripheral Vascular disease including varicose veins

*Please read the policy wording document for detailed terms and conditions of this insurance policy.

• Policy will be issued within 1-2 working days of ordering.
• Cancellation is available until your policy is issued by the Insurance Company. Once the policy is issued, it cannot be cancelled or refunded.

Claim submission guideline: Download

1. Cashless/Direct Payment Process

Cashless/Direct Payment will be applicable only at the network hospitals of the insurance company.

If you receive treatment from a network hospital, the insurance company will pay pre-authorized eligible treatment charges directly to the hospital. You do not need to worry about the bill payment. You will only need to pay any costs or fees not covered under your insurance policy.

To enjoy a cashless/direct payment facility, you must notify the insurance company before admitting to the hospital. If the hospitalization is due to an emergency medical condition, you should inform the insurance company within 48 hours of admission.

Send an email to ihealth@pragatilife.com by providing the following information to raise a Guarantee of Payment: 

1. Name of Policy Holder
2. Policy Number
3. Policy date
4. Plan name (i.e., 501 - Plan 1 or 2)
5. Address
6. Phone number
7. Email address
8. Patient Name (should be same as the policyholder)
9. Hospital Name
10. Date of admission
11. Bed/Cabin/Ward Number
12. Provisional Diagnosis
13. Approximate date of discharge

2. Reimbursement Process

When your treatment cost is not pre-authorized, or there is any out-patient or pre and post-hospitalization cost, in that case, you need to pay for the charge by yourself and then claim the expense for reimbursement. You should submit reimbursement claims within 7 days of discharge from the hospital. 

Fill up the claim form and submit it to the insurance company/Bimafy for reimbursement.

Claim form: Download