About Familyplus

About Family Plus

Family Plus is a unique health insurance plan which provides the most comprehensive health coverage at an affordable price. Family Plus is a Family Floater Plan which is designed especially for large families and it covers up to 19 relationships. Family Plus is a health insurance cover which is simple to buy and easy to understand. The product offers a unique benefit where each insured member of the family will have an individual sum insured apart from a floater sum insured and reload benefit which any of the family member can consume in case of a major illness. This ensures you are adequately covered at all times. It comes with rich no claim bonus which also helps make your insurance inflation proof by adding 20% additional sum insured for each claim free year.

Family Plus will have an individual base sum insured and a common floater sum insured in the same policy.

The customer has to choose one individual sum insured and one floater sum insured from the below available options. The base sum insured has to be the same for all members.

Individual Base Sum Insured - Rs.2 lacs, Rs.3 lacs, Rs.5 lacs, Rs.10 lacs & Rs.15 lacs.

Floater Sum Insured - Rs.3 lacs, Rs.4 lacs, Rs.5 lacs, Rs.10 lacs, Rs.15 lacs, Rs.20 lacs, Rs.25 lacs & Rs.50 lacs.

Familyplus Key Benefits

Key Benefits

Royal Sundaram offers affordable health insurance plans with a wide range of benefits to take care of you and your family.
No RoomRent Capping

19 Different Relations

Coverage for 19 Different Relations in Same Policy

 

 

 

Lifeline Coverages

Maternity Benefit with Nutritional Allowance Benefit

Maternity Benefit with Nutrional Allowance Benefit

Easy to Keep Records

Individual + Floater Sum Insured

A unique combination of Individual + Floater Sum Insured in the same policy.

Reload SumInsured

Reload Benefit

Reload Benefit doubles your Base Sum Insured at No Extra Cost

Protection From Inflation

No Claim Bonus

Double the Base Sum Insured in 5 Claim-Free years with our accelerated No-Claim Bonus

Double Your SumInsured

Age Eligibility

There is No Restriction on Maximum Entry Age

 

 

 

Who Can be Covered (FamilyPlus)

Who Can Be Covered ?

 

 

Any person who is more than 18 years of age can be the proposer of the plan.

Children above the age of 91 days can be covered.

Adults can be covered from 18 years onwards.

There is no restriction on maximum entry age.

Minimum of 2 members need to be covered in a policy. There is no restriction on the maximum number.

The below given relations can be offered cover in the policy.

Spouse as long as he or she continues to be married to you, Son, Daughter-in-law, Daughter, Father, Mother, Father-in-law as long as your spouse continues to be married to you, Mother-in-law as long as your spouse continues to be married to you, Grand father, Grand mother, Grand son, Grand daughter, Son-in-law, Brother, Sister, Sister-in-law, Brother-in-law, Nephew and Niece.

Familyplus Coverages

Coverages

This distinct insurance plan will take care of the medical treatment for critical illnesses, severe medical conditions, or any other serious health condition.

Here is a list of features that are covered and exclusions that are not covered.

Here are the key benefits offered by Family Plus.

  • Inpatient hospitalization expenses up to Sum Insured.
  • Pre and post-hospitalization expenses repayment up to the amount of sum insured for 60 and 90 days, respectively.
  • All day-care procedures up to the sum insured amount.
  • Coverage for the treatment of organ donor up to the amount of sum insured.
  • Ambulance cover of up to Rs. 4,000, for per event of hospitalization for every insured member.
  • No-claim bonus (NCB) starts from 20% of the base sum insured and extends up to 100%. No reduction in NCB, even when a claim is filed during a particular year.
  • 100% Re-load of the base sum insured in case the total sum insured and NCB is completely exhausted.
  • Vaccination in case of animal bite - Expenses up to Rs.5,000 covered.
  • AYUSH Treatment - Inpatient hospitalization cover of the amount up to the sum insured in government hospitals and up to Rs. 30,000 in other hospitals.
  • Domiciliary hospitalization expenses covered up to the sum insured amount.
  • Second opinion for diagnosis and treatment of 11 specified critical illnesses.
  • Emergency domestic evacuation cover of up to Rs. 1 lac.
  • Health & Wellness - We will provide various preventive healthcare & wellness related services that will help you to assess your health status and aid in improving your overall wellbeing. These services include health related articles on your registered email Id, doctor on email chat and annual health check-ups for every member more than 18 years old, irrespective of claim.
  • Maternity Benefit cover for up to 2 deliveries if 2 adults are covered under the same family floater policy including New Born Baby Cover and Vaccination for New Born in first year
  • Nutritional Allowance for mother post discharge after delivery
Royal Sundaram will not settle claims for treatment of certain medical conditions under the Family Plus health insurance plan. Following are the indicative list of exclusions under the policy:
  • Pre-existing medical conditions described in the policy and declared by the insured at the time of purchase will avail cover only after 36 months of continuous policy coverage. No claims will be settled if there is any gap in renewal of policy.
  • Diseases that are contracted by the insured person within first 30 days after the commencement of policy will not be considered for claims.
  • Diseases such as Cataract, Benign Prostatic Hypertrophy, Knee/Hip Replacement, Chronic Renal Failure/ End Stage Renal Failure etc., will not be covered during first two years of insurance.
  • Permanent exclusions include medical cover availed due to Addictive Conditions and Disorders, Adventure or Hazardous Sports, Ageing and Puberty, Alternative Treatment (except AYUSH), Artificial Life Maintenance, Charges for Medical Papers, Circumcision, Conflict and Disaster, Congenital Conditions, Convalescence and Rehabilitation, Cosmetic Surgery, Dental/Oral Treatment, Drugs and Dressing for OPD Treatment or Take-home use, Eyesight Treatment, Health Hydros, Nature Cure, Wellness Clinics, HIV and AIDS, Hereditary Conditions, Hospitalization for Observation or Investigative purpose only, Items of personal comfort and convenience, Psychiatric and Psychosomatic Conditions, Obesity, OPD Treatment, Preventive Care, Reproductive Medicine, Self-inflicted Injuries, Sexual problems and gender issues, Sexually Transmitted Diseases, Sleep Disorders, Speech Disorders, Stem Cell Implantation, Treatment for Alopecia, Treatment for Developmental Problems, Treatment received outside India, Unproven/Experimental Treatment, Treatment from Unrecognized Hospital or Physician, Unrelated Diagnostic, or Injury due to Unlawful Activity.
Family Plus Claim Procedure

Family Plus - Claims Procedure

 

Please review your Family Plus policy and familiarize yourself with policy benefits, terms and conditions and exclusions which will help you during claims.

All claims for 2 benefits - Second Opinion for 11 Critical Illness / Emergency Domestic Evacuation  will be serviced through Europ Assistance India Pvt. Ltd.

All claims for benefits other than 2 benefits will be serviced through Paramount Health Services & Insurance TPA Pvt Ltd.

Claim Intimation

Policy Particulars

1.You should intimate Royal Sundaram atleast 72 hours prior to hospitalization in case of planned hospitalization or within 48 hours in case of any emergency hospitalization

Claim Process Letter

2.Provide the following details during intimation:

  • Name of the patient (insured person)
  • Diagnosis
  • Hospital Details – Name, Address, Contact No
  • Treating Doctor Details – Name & Contact No
  • Date of Hospitalization
  • Expected Discharge

Contact Details of Service Provider:

 

The following 2 benefits are serviced through the below mentioned service provider.

  • Second opinion for critical illness.
  • Emergency domestic evacuation

Europ Assistance India Pvt Ltd

Star Hub Building No. 2, 7th Floor, Near ITC Maratha Hotel,

Sahar, Andheri East, Mumbai – 400 059

24 hour dedicated landline number is + 91-22-67872035

Email: royalsundaram@europ-assistance.in

 

Cashless claims will be serviced by the below mentioned TPA:

 

Paramount Health Services & Insurance TPA Pvt Ltd

Plot No A – 442, Road No28, MIDC Industrial Area,

Wagle Estate, Ram Nagar, Thane West – 400 604.

Contact details: +91-22-66620858

Toll Free Help Line Number – 1800 22 6655

Procedure to avail Pre-Authorization for Cashless facility

Policy Particulars

1.For any planned hospitalization, kindly intimate to TPA and seek cashless authorization atleast 72 hours prior to the start of the hospitalization.

Re Imbursement

2.2. For any emergency hospitalization, inform TPA within 48 hours of the hospitalization.

Survey

3.3. TPA will check your coverage as per the eligibility and send a cashless authorization letter to the hospital within 3 hours post receipt of complete documents. In case there is any deficiency in the documents sent, the same will be communicated to the hospital within 3 hours of receipt of documents.

Voucher

4.4. Please pay the non medical and expenses which are not covered to the hospital prior to the discharge.

Claim Process Letter

5.In case the ailment/treatment is not covered under the policy, a rejection letter would be sent to the hospital Within 2 hours

Note:

You are entitled for cashless only in our Network Hospitals, list of which can be referred on our website. Rejection of cashless in no way indicated rejection of the claim.

 

Contact Details of Service Provider:

 

The following 2 benefits are serviced through the below mentioned service provider.

  • Second opinion for critical illness.
  • Emergency domestic evacuation

Europ Assistance India Pvt Ltd

Star Hub Building No. 2, 7th Floor, Near ITC Maratha Hotel,

Sahar, Andheri East, Mumbai – 400 059

24 hour dedicated landline number is + 91-22-67872035

Email: royalsundaram@europ-assistance.in

 

Cashless claims will be serviced by the below mentioned TPA:

 

Paramount Health Services & Insurance TPA Pvt Ltd

Plot No A – 442, Road No28, MIDC Industrial Area,

Wagle Estate, Ram Nagar, Thane West – 400 604.

Contact details: +91-22-66620858

Toll Free Help Line Number – 1800 22 6655

Procedure for Reimbursement Claims

Policy Particulars

1.Please send the duly filled and signed claim form and all the information/documents mentioned* therein to Royal Sundaram within 30 days from the date of discharge. * Please refer to claim form for complete documentation.

Re Imbursement

2.If there is any discrepancy in the documents/information submitted by you, Royal Sundaram will send the deficiency letter within 7 days of receipt of claim documents.

Survey

3.On receipt of the complete set of claim documents, Royal Sundaram will make the payment for the admissible amount (as per Policy Terms & Conditions), along with a settlement letter within 30 days.

Voucher

4.The payment will be made in the name of the proposer.

Claim Process Letter

5.Claim documents can be sent on:

Health Claims Department
Royal Sundaram General Insurance Co Ltd
Vishranthi Melaram Towers,
No.2/319, Rajiv Gandhi Salai (OMR)
Karapakkam, Chennai – 600097

Contact Details of Service Provider:

 

The following 2 benefits are serviced through the below mentioned service provider.

  • Second opinion for critical illness.
  • Emergency domestic evacuation

Europ Assistance India Pvt Ltd

Star Hub Building No. 2, 7th Floor, Near ITC Maratha Hotel,

Sahar, Andheri East, Mumbai – 400 059

24 hour dedicated landline number is + 91-22-67872035

Email: royalsundaram@europ-assistance.in

 

Cashless claims will be serviced by the below mentioned TPA:

 

Paramount Health Services & Insurance TPA Pvt Ltd

Plot No A – 442, Road No28, MIDC Industrial Area,

Wagle Estate, Ram Nagar, Thane West – 400 604.

Contact details: +91-22-66620858

Toll Free Help Line Number – 1800 22 6655

Procedure to avail Pre-Authorization for Cashless facility (for Worldwide Emergency Hospitalization)

Policy Particulars

1.You need to notify the Service Provider within 24 hours of hospitalization.

Survey

2.Our Service Provider will evaluate the request and the eligibility of the Insured Person under the Policy and call for more information or details, if required.

Claim Process Letter

3.Our Service Provider will communicate directly to the Hospital whether the request for pre-authorization has been approved or denied.

Cashless Facility

4.If the pre-authorization request is approved, Our Service Provider will directly settle the claim with the Hospital. Any additional costs or expenses incurred by or on behalf of the Insured Person beyond the limits pre-authorized by the Service Provider shall be borne by the Insured Person.

Contact Details of Service Provider:

 

The following 2 benefits are serviced through the below mentioned service provider.

  • Second opinion for critical illness.
  • Emergency domestic evacuation

Europ Assistance India Pvt Ltd

Star Hub Building No. 2, 7th Floor, Near ITC Maratha Hotel,

Sahar, Andheri East, Mumbai – 400 059

24 hour dedicated landline number is + 91-22-67872035

Email: royalsundaram@europ-assistance.in

 

Cashless claims will be serviced by the below mentioned TPA:

 

Paramount Health Services & Insurance TPA Pvt Ltd

Plot No A – 442, Road No28, MIDC Industrial Area,

Wagle Estate, Ram Nagar, Thane West – 400 604.

Contact details: +91-22-66620858

Toll Free Help Line Number – 1800 22 6655

Procedure for International Treatment for 11 specified Critical Illness

Policy Particulars

1.In the event of the diagnosis of a Specified Critical Illness, the Insured Person should call Our Service Provider immediately and in any event before the commencement of the travel for treatment overseas, on the helpline number specified in the Schedule of Insurance Certificate requesting for a pre-authorization for the treatment.

Survey

2.• Our Service Provider will evaluate the request and the eligibility of the Insured Person the Policy and call for more information or details, if required.

Claim Process Letter

3.Our Service Provider will communicate directly to the Hospital and the Insured Person whether the request for pre-authorization has been approved or denied.

If the pre-authorization request is approved, Our Service Provider will directly settle the claim with the Hospital. Any additional costs or expenses incurred by or on behalf of the Insured Person beyond the limits pre-authorized by the Service Provider or at any Non-Network Hospital shall be borne by the Insured Person.

Contact Details of Service Provider:

 

The following 2 benefits are serviced through the below mentioned service provider.

  • Second opinion for critical illness.
  • Emergency domestic evacuation

Europ Assistance India Pvt Ltd

Star Hub Building No. 2, 7th Floor, Near ITC Maratha Hotel,

Sahar, Andheri East, Mumbai – 400 059

24 hour dedicated landline number is + 91-22-67872035

Email: royalsundaram@europ-assistance.in

 

Cashless claims will be serviced by the below mentioned TPA:

 

Paramount Health Services & Insurance TPA Pvt Ltd

Plot No A – 442, Road No28, MIDC Industrial Area,

Wagle Estate, Ram Nagar, Thane West – 400 604.

Contact details: +91-22-66620858

Toll Free Help Line Number – 1800 22 6655

 

Familyplus Plan Comparision

Coverage Details

These coverages are designed to enhance the level of protection offered in the basic cover.

Familyplus Faq

FAQs

Questions about Familyplus Insurance? Get your answers here.

Maternity Expenses: For this benefit, atleast one adult member need to be covered in the policy at the time of first inception under the same Family Floater Policy. We pay Medical Expenses for the delivery of a child, only after 24 months of continuous coverage of mother since the inception of the first Policy with Us. The waiting Period of 24 months will start only after two adults are covered under the policy.

In case, customer is porting from any other policy providing maternity benefit, the respective waiting period served in that policy will be considered as waiting period waiver in Family Plus policy as per portability guideline. Maternity benefits are paid a maximum of Rs. 50,000 per delivery only for two deliveries for each female member covered during the lifetime of the Policy including any of its renewals. However, expenses in respect of harvesting and storage of stem cells are not covered.      

Miscarriage will not be payable as a part of Maternity Benefit Claim.

Miscarriage can occur as a result of:  

  • Accident
  • Internal Injury/Sickness/stress

  If Miscarriage happens due to an internal injury/sickness/stress, it is not payable. However, it is payable when Miscarriage happens due to an accident.

New Born Baby: The new born baby will be covered as an insured person from birth. We will cover medical expenses towards the medical treatment of the Insured Person’s new born baby while the Insured Person is Hospitalized as an Inpatient for delivery and we have accepted the maternity claim as payable.  This benefit is equal to Individual Sum Insured of the mother. Post the expiry of the policy, new born need to be added as a separate member in the policy at the time of renewal.

Vaccination for New Born Baby: We will cover expenses for vaccination of the new born baby upto a limit of Rs. 10,000, if we have accepted the maternity claim as payable.  If the Policy Period ends before the New Born Baby has completed one year, then, We will only cover such vaccinations until the baby completes one year, provided that We have accepted the baby as an Insured Person at the time of renewal of the Policy. This benefit is over and above the maternity benefit.

For example: Let us say child birth date is January 2, 2018 and the policy expiry date is April 13, 2018 and vaccination expenses paid till April 13, 2018 is Rs. 3500. Hence, for the rest of the charges to be paid, new born needs to be enrolled at the time of the renewal as a separate member in the policy.

 

Time interval

Vaccination to be done (age) #

Frequency

Vaccination for first year

0-3 months BCG (From birth to 2 weeks) 1
OPV (0‚6‚10 weeks) OR OPV + IPV1 (6,10 weeks) 3 OR 4
DPT (6 & 10 week) 2
Hepatitis-B (0 & 6 week) 2
Hib (6 & 10 week) 2
3-6 months OPV (14 week) OR OPV + IPV2 1 OR 2
DPT (14 week) 1
Hepatitis-B (14 week) 1
Hib (14 week) 1
9 months Measles (+9 months) 1
12 months Chicken Pox(12 months) 1

 

 

Nutrition allowance for mother post discharge a. We will provide Nutrition allowance for mother post-delivery of the child.

b. This benefit is available in the form a fixed benefit and maximum liability under this is Rs. 10,000 and it is payable after a period of 2 months from the date of discharge of mother after delivery of the child.

c. This benefit is payable only if we accept the claim made under the Maternity Benefit. At the time of settlement of Maternity Claim, we shall issue a post-dated cheque of Rs. 10,000 towards Nutritional allowance.

Pre Hospitalization covers the medical expenses incurred before hospitalization for Diagnostic Test, Medication, etc Post Hospitalization covers the medical expenses incurred on follow up visit with doctor, medication, further investigative test, etc Pre & Post Hospitalization expenses are covered upto Sum Insured
Vaccination in case of Animal Bite covers the expenses incurred by you upto a maximum of Rs. 5000 to take vaccination in OPD. For eg, in case of Dog Bite, Monkey bite, Honey bee bite, you need to take vaccination at regular interval which is an OPD procedure. Family Plus will cover the expenses incurred on vaccination upto Rs. 5,000. This will be paid on reimbursement mode post submission of bills. It does not cover the medicines, bandages or other expenses incurred while taking the vaccination.

We will cover the cost of health check-up arranged by us through our empaneled service providers as per your plan eligibility defined below: This benefit can be availed at each renewal.

 

Annual Health Check-up List of Medical Tests
Complete Blood Count, Urine Routine, ESR, Fasting Blood Sugar, Lipid Profile, Kidney Function Test,  ECG, Complete physical examination by Physician

 

 

Abbreviation of test is provided here: ESR – Erythrocyte Sedimentation Rate, ECG – Electrocardiogram, S Cholesterol – Serum Cholesterol, SGPT – Serum Glutamic Pyruvate Transaminase, TMT – Tread Mill Test This benefit is available to those insured person who have attained the age of 18 years or above on the Policy Period Start Date. This benefit is provided irrespective of any claim being made in the Policy Year. This benefit is over and above the Individual Sum Insured.
We will cover the expense incurred on an ambulance offered by a hospital or ambulance service provider for transferring you to the nearest hospital provided we accept the inpatient care claim for the given hospitalization. It is covered up to Rs.4000 per event of hospitalization for every Insured member. Expenses incurred on Hearse Van will be payable if inpatient claim is admissible.
Prosthetic Implants are artificial substitutes for body parts, and materials inserted into tissue for functional, cosmetic, or therapeutic purposes. Prostheses can be functional, as in the case of artificial arms and legs, or cosmetic, as in the case of an artificial eye. Implants, all surgically inserted or grafted into the body, tend to be used therapeutically. These are covered in Family Plus.
There are certain conditions for which customer can wait for treatment and does not need immediate medical treatment. Family Plus has 2 years waiting period for 17 conditions as mentioned below:
1.      Cataract

2.      Stones in biliary and urinary systems

3.      Hernia / Hydrocele

4.      Hysterectomy for any benign disorder

5.      Lumps / cysts / nodules / polyps / internal tumours

6.      Gastric and Duodenal Ulcers

7.      Surgery on tonsils / adenoids

8.      Osteoarthrosis / Arthritis / Gout / Rheumatism / Spondylosis / Spondylitis / Intervertebral Disc Prolapse

9.      Fissure / Fistula / Haemorrhoid

10.  Sinusitis / Deviated Nasal Septum / Tympanoplasty / Chronic Suppurative Otitis Media

11.  Benign Prostatic Hypertrophy

12.  Knee/Hip Joint replacement

13.  Dilatation and Curettage

14.  Varicose veins

15.  Dysfunctional Uterine Bleeding / Fibroids / Prolapse Uterus / Endometriosis

16.  Diabetes and related complications

17.  Chronic Renal Failure or end stage Renal Failure
Family Plus is a carefully medical underwritten product and have an option to cover Chronic disease patients post carrying out medical underwriting of the Proposal. Either co-pay or loading may be applied on the proposal post evaluation of the proposal. Family Plus can be offered to almost all major illnesses viz; Diabetes, Heart conditions, Hypertension, Chronic renal failure, Epilepsy, Stroke, Glaucoma, Asthma etc.
We can cover all members, except your aunt in Family Plus. Aunt can be covered under a separate Lifeline Policy on Individual basis.
Ventillator treatment is covered if the person is not brain dead.
Any hospitalization due to these natural calamities like Vardah is covered
 

 

 
Familyplus Brouchers

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Family Plus

Policy Terms and Conditions

We request you to carefully read and understand the Terms and Conditions, before you buy the Policy. All claims are processed strictly according to it. Please speak or chat with our Customer Support Team, if you need any clarifications
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