Key design and service features of Family Plus are as mentioned below:

• 1. Coverage for 19 different relations in the same policy.
  • Legally married 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
  • Grandfather
  • Grandmother
  • Grandson
  • Granddaughter
  • Son-in-law
  • Brother
  • Sister
  • Sister-in-law
  • Brother-in-law
  • Nephew
  • Niece
• 2. A unique combination of Individual + Floater SI in the same policy.
• 3. No upper age limit for enrolment in policy.
• 4. Access best class healthcare facilities with no capping in terms of Room Rent, disease specific sublimits, etc
• 5. Cashless hospitalization across 3500+ network hospitals across India
• 6. Easy documentation and hassle free claim settlement
• 7. Zonal Pricing depending upon the location of your stay. Pay less if you do not stay in Metro Cities and Gujarat State

Customer has the option to choose from a wide range of Sum Insured's available as under:

Sum Insured is on Annual basis. Mandatory to choose one base SI and one floater SI.

No. The customer has to choose a combination of individual + floater SI. The individual SI chosen has to be the same for all covered members. For eg) if there are 5 members covered in a policy, then each of them will be eligible for the below SI.

Base SI of RS 5 lakhs + Floater SI of RS 10 lakhs = RS15 lakhs.

While the base SI of RS 5 lakhs is exclusively available for each member (not to be shared), the floater SI is available on a sharing basis.

Maternity Expenses: For this benefit, two adult members need to be covered in the policy at the time of first inception under the same Family Plus 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. 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:

• i. Accident
• ii. 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.

Vaccination for New Born Baby: We will cover Reasonable & Customary Charges for vaccination of the new born baby, 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.

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.

Organ Donor Expenses covers the expenses incurred on the hospitalization of the organ donor. All inpatient care expenses related to organ donor are covered, provided:

• He fulfils the Transplantation of Human Organs Act,1994 and other applicable laws.
• The organ donated is used by the insured person.
• A claim is filed for inpatient care by the insured.

However, any other expenses related to acquisition of donor, related pre- and post-hospitalization expenses, and treatment of associated medical complications will not be covered

Organ Donor Expenses are covered upto Sum Insured

If you ever exhaust your health cover due to claims in a given year and there is a further claim either by you for a different illness or your insured family member, we will reload the entire base sum insured of your policy at no extra cost. Reloaded sum insured will help you to settle those claims

We will provide a Re-load equal to 100% of Base Sum Insured of any one Insured Member. Re-load benefit will be applicable as under:

• a) the Base Sum Insured, No Claim Bonus (if any) and Floater Sum Insured is insufficient as a result of previous claims in that Policy Year; AND
• b) The Re-load Sum Insured shall be activated in following conditions:
  • i. Re-load can get activated for same Insured Member in the same Policy year for different illness/injury other than the illness/injury for which claim has already been paid in the current Policy year and/or;
  • ii. Re-load can get activated for different Insured Member in the same Policy year
  • iii) Re-load benefit once activated for any one of the Insured Member and can be used jointly or severally.
  • iv) Re-load once activated for any one of the Insured Member will not get activated again for another Insured Member in the same Policy Year.
• c) If the Re-load Sum Insured is not utilised in a Policy Year, it shall not be carried forward to any subsequent Policy Year.

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 to take vaccination in OPD. For eg, in case of Dog Bite, you need to take Rabbies vaccination at regular interval which is an OPD procedure. Family Plus will cover the expenses incurred on vaccination upto the SI limit.

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 eligibility defined below:

This benefit can be availed at each renewal.

18 to 40 years
Complete Blood Count, Urine Routine, Blood Group, ESR, Fasting Blood Sugar, ECG, S Cholesterol, SGPT, Creatinine, Complete physical examination by Physician

41 years onward
Complete Blood Count, Urine Routine, Blood Group, ESR, HbA1C, 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 Base 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 for any one admittance.

Expenses incurred on Hearse Van is not covered.

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

Initial Waiting Period is the cooling period applied at the start of new policy. This waiting period is not applicable for renewal policy or portability policy. Only Accidents are covered in the Initial Waiting period

Pre Existing Disease waiting period is the waiting period applied for any of the existing disease customer is suffering from. It will be for a period of 3 years in the Family Plus policy. With each policy year, the pre existing disease waiting period reduces by 1 year. Any claim related to pre existing disease hospitalization will not be covered in the policy during waiting period.

The Premium charged on the Policy will depend on the Sum Insured, Policy Tenure, Age, Policy Type, Zone of Cover and Optional Covers opted. Additionally the health status of the individual will also be considered and premium might be loaded depending on the health condition.

For the purpose of calculating premium, the country has been divided into 2 Zones.

Zone 1: Delhi/NCR, Mumbai (inc. Thane and Vashi), Bengaluru, Chennai, Pune, Hyderabad, Kolkata and Gujarat.

Zone 2: Rest of India.

A discount of 15% for members in Zone 2 will be applicable. Grid as below:

There are many out of pocket expenses like Cab charges, Attendant Food expenses, etc which are not covered under the normal Hospitalization policies. Hospital Cash pays a lump sum amount to cater to these miscellaneous expenses. We will pay for up to 30 days of hospitalization in a policy year if the stay of hospitalization is more than 2 days

It is an optional cover and customer can opt for the Hospital Cash benefit at the time of new purchase or renewal.

If you are suffering from 11 critical illnesses as mentioned below and feel uncertain about your diagnosis or wish to get a second opinion of an expert/doctor, we arrange one for free of cost for you:

• 1. Cancer of Specified Severity
• 2. First Heart Attack of Specified Severity
• 3. Open Chest CABG
• 4. Open Heart Replacement or Repair of Heart Valves
• 5. Coma of Specified Severity
• 6. Kidney Failure requiring Regular Dialysis
• 7. Stroke resulting in Permanent Symptoms
• 8. Major Organ/Bone Marrow Transplant
• 9. Permanent paralysis of Limbs
• 10. Motor Neurone Disease with Permanent Symptoms
• 11. Multiple Sclerosis with Persisting Symptoms

To avail this benefit, you need to contact us and we will arrange for the second opinion. You can choose from our empanelled doctors/hospitals. Please note that this benefit is not on reimbursement basis

If you are stuck in an emergency due to accident or illness in India, we will assist to transport you safely from one hospital to another hospital to provide a suitable medical treatment.

For eg, in case of a natural calamity like Kashmir Flood, you are rescued by Army and admitted in a hospital in one of the relief camp. Royal Sundaram will arrange for Domestic Evacuation from this hospital to another hospital having better medical facilities for treatment.

Family Plus offers 20% of Base Sum Insured up to a max of 100%.

Unlike NCB offered by other policies, there is no penalty in case of claim. Thus NCB earned by you remains as is even if you claim.

For eg, if you have a policy with Base SI of RS.5lacs and there has been no claim in the first year, then at the time of renewal you will get a NCB of 20% (RS.1lac). In second year, if you claimed then on second renewal your NCB of RS.1lac will remain intact and it will not be reduced.

If there is a claim by any one member, then the NCB will not be given to any member in the renewal policy.

Every insured person will have to answer the medical questions as mentioned in proposal form. Basis the response to those medical questions, underwriters will decide on the medical test to be undertaken.

Apart from that, every insured person will be subject to medical test as per below grid.

Medical Underwriting Grid for Non Bancassurance Channels:(other than Nationalized, Private and Foreign Banks):

Medical Underwriting Grid for Bancassurance Channels(Nationalized, Private and Foreign Banks):

# - Subject to no adverse health condition

Set 1
CBC, ESR, URA, MER, FBS/ HbA1C, S Cholesterol, ECG, SGPT, S Creatinine

Set 2
CBC, ESR, URA, MER, HbA1C, Lipid Profile, TMT or 2D Echo, LFT with GGT, RFT, HbsAg , S Creatinine

A customer with diabetes or hypertension can be offered Family Plus subject to underwriting criteria. Underwriter will evaluate the medical history and accept the case either on standard rates or with loading/co-payment.

Medical expenses incurred on the treatment of New Born Baby is covered if claim for maternity benefit is payable. New Born Baby is covered till the renewal of the policy.

First year vaccinations for New Born Baby is covered if claim for maternity benefit is payable.

We can cover all members, except your aunt in Family Plus.

Family Plus not only take care of your medical expenses but also provide benefits which help you in proactively manage your good health. You can obtain opinion from a doctor using our Health & Wellness Program. You can email your query on fever and you will get a response within 24 working hours. Please note that this does not substitute the medical treatment you would have otherwise taken

Doctor on Chat facility is through email which can be accessed through Internet either on computer or mobile phone

You can buy 2 years or 3 years policy in Family Plus. You get a discount of 7.5% for 2 year policy tenure and 12% for 3 year policy tenure.

Family Plus will support the external as well as internal portability. You can port your existing policy from National Insurance subject to underwriting

You can either buy a fresh policy of Family Plus or port the existing policy

No. There is no such restriction. The porting benefit will be given in Family Plus, up to your existing policy SI + CB if any.

Ventilator treatment is covered if the person is not brain dead

Any hospitalization due to these natural calamities like Vardah is covered

Yes. There is no capping on room rent category and customer can choose from any of the room available in hospital

Expenses which are not related to hospitalization are normally not covered. Please refer to policy document for details of exclusion.