Royal Sundaram Lifeline Health Insurance Plan

Key design and service features of Lifeline are as mentioned below:

1. Wide range of Sum Insured – from ₹2 Lakhs to ₹1.5 Cr
2. No upper age limit for enrolment in policy
3. Provides coverage for International treatment (excluding US and Canada in the Base cover) for 11 specified illnesses up to Sum Insured along with return airfare up to ₹3 Lakhs
4. No worries in case of any Emergency Hospitalisation while you are abroad during business/leisure trip. (excluding US and Canada in the Base cover)
5. Access best class healthcare facilities with no capping in terms of room rent, disease specific sub limits, etc.
6. Reload of Sum Insured – In case customer has utilized the entire sum insured, then sum insured will be automatically reloaded at no extra cost which can be used for different illness
7. Maternity Benefit including cover for new born baby and vaccination for new born baby
8. OPD Treatment covering the expenses incurred on doctor’s consultation, medicines, diagnostic tests, etc.
9. Accelerated No Claim Bonus which helps in doubling your Sum Insured in 5 claim free year period (Supreme & Elite Variants). In Classic Variant, your sum insured will increase by 50%
10. Coverage not limited only to Allopathic treatment. You can also take treatment under Ayurveda, Homeopathy in case of hospitalisation
11. Health check-up for insured members – irrespective of claims history
12. Health & Wellness benefits to proactively manage your health. Avail exciting offers across various services at Royal Sundaram’s preferred network along with communication on latest health topics
13. Covers all day care procedures so that customer need not to worry if something is covered or not
14. Domestic Evacuation in case of emergency
15. Second Opinion for 11 specified Critical Illness
16. Cashless hospitalisation across 3500+ network hospitals across India
17. Easy documentation and hassle free claim settlement
18. One sum insured covering all family members
19. Zonal Pricing depending upon the location of your stay. Pay less if you do not stay in Metro Cities and Gujarat State
20. Hospital Cash Benefit to take care of miscellaneous expenses incurred during hospitalisation
21. Top-up Plan to enhance your coverage. Choose the deductible on annual aggregate basis rather than per claim basis

Lifeline offers 3 different plans – Classic, Supreme and Elite. Sum Insured offered under these plans is as mentioned below:

Plans Sum Insured

While Classic Plan offers similar benefits like other health insurance plans available in market, Supreme and Elite offer much more comprehensive coverages like Second Opinion for Critical Illness, International Treatment for 11 Critical Illness, Worldwide Emergency Hospitalisation, etc. to provide a very comprehensive coverage to customer

Maternity Benefit is covered in Lifeline’s Elite Plan. It covers the expenses related to Maternity and also covers the new born baby till the next renewal. It also covers the vaccination for the new born baby in the first year. Maternity benefit is payable only when Husband and Wife both are covered under the policy after a continuous coverage of 3 years. Maternity Benefit can be claimed maximum up to 2 times.

OPD Treatment is covered in Lifeline’s Elite Plan. OPD Treatment covers the consultation, diagnostic fees, medicines, etc. It also covers the expenses incurred on Dental OPD Treatment, Cost of Spectacles, Contact Lenses and Hearing Aids once in 2 years with a sublimit of 30% of OPD Treatment

If the customer is diagnosed with any of the 11 specified critical illnesses, customer can avail the treatment in any hospital of his choice across the world. The policy will cover the expenses incurred on the hospitalisation for the treatment of the critical illness covered. It will also cover the return airfare up to ₹ 3 lacs of the insured person. This benefit is available on cashless basis only. Customer need to obtain a pre-authorization from us by submitting the pre-authorization request along with diagnosis confirmed in India, before the treatment. The diagnosis of the 11 specified CIs should be as per definitions of these 11 specified 11 CIs given under Policy wording. All claims will be subject to co-payment of 20%.

a.Our maximum liability for this claim will be limited as mentioned below:

1. Year 1 – 50% of Sum Insured
2. Year 2 onwards – 100% of Sum Insured

Worldwide Emergency hospitalisation covers hospitalisation expenses abroad (out of India) subject to:

• The treatment is Medically Necessary and has been certified as an Emergency by a Medical Practitioner, where such cannot be postponed until the Insured Person has returned to the India
• Indicative conditions – what could be covered as inpatient – heart attack, stroke, major accident, paralysis, high grade fever, severe stomach ache, bleeding from nose etc.
• 2 yrs Pre-existing diseases waiting period and 2 yrs initial waiting period for 17specified diseases, and 30 day initial waiting period (except accidents) will be applicable in this benefit
• Expenses payable shall be limited to Inpatient Hospitalisation only – in case of small injuries, fractures, burns, minor bleeding (cut on a finger not covered but if its bleeding from nose it may be covered), etc. it is covered as OPD and hence not covered under policy
• $1,000 deductible per claim

Overall liability will be limited to 50% of Sum Insured up to a max of Rs.20 lacs

Lifeline covers Worldwide Emergency Hospitalisation however it does not cover certain other benefitsrelated to travel inconvenience like Passport Loss, Loss of Baggage, etc. Hence, we suggest that if a customer is travelling abroad, they should also take an oversea travel insurance policy as per their travel itinerary.
Lifeline Elite plan is a suitable offering for HNI customers who are frequently travelling or want the best of class treatment across the globe. This plan will help them to get the treatment done across the globe

Yes, Lifeline also provide coverage for Ayush Treatment in case of Inpatient Hospitalisation. Please note that OPD treatment undertaken in Ayush is not covered

Organ Donor Expenses covers the expenses incurred on the hospitalisation 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-hospitalisation expenses, and treatment of associated medical complications will not be covered Organ Donor expenses are covered up to 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 sum insured of your policy at no extra cost. Reloaded sum insured will help you to settle those claims Reload of Sum Insured is similar to Recharge benefit of Religare as it is triggered when the claim amount exceeds the available sum insured including the NCB for a different illness or different person. In Optima Restore, sum insured is restored only when entire sum insured is exhausted (for e.g., if the SI is ₹3 Lakhs, and initial claim was of ₹2.5 Lakhs, Restore will not be triggered for second claim (of different illness or different person) of ₹1 Lakh and only ₹50,000 will be paid. Whereas, Reload will be triggered and entire ₹1 Lakh will be paid)

Pre Hospitalisation covers the medical expenses incurred before hospitalisation for Diagnostic Test, Medication, etc.

Post Hospitalisation covers the medical expenses incurred on follow up visit with doctor, medication, further investigative test, etc

Pre & Post Hospitalisation expenses are covered up to Sum Insured

Vaccination in case of Animal Bite covers the expenses incurred by you to take vaccination in OPD. For e.g., in case of Dog Bite, you need to take Rabies vaccination at regular interval which is an OPD procedure. Lifeline will cover the expenses incurred on vaccination up to the limit against your plan. It does not cover the medicines, bandages or other expenses incurred while taking the vaccination

Lifeline offers annual health check-up for Supreme & Elite Plan and once in 2 years for Classic Plan. Health check-up is offered to all the insured above the age of 18 years irrespective of claims status. Please refer to grid below for covered medical test

Plan List of Medical Tests

Classic: Complete Blood Count, Urine Routine, ESR, Fasting Blood Sugar, ECG, S Cholesterol, SGPT, Creatinine

Supreme: Complete Blood Count, Urine Routine, ESR, Fasting Blood Sugar, Lipid Profile, Kidney Function Test, ECG, Complete physical examination be Physician

Elite: Complete Blood Count, Urine Routine, ESR, Fasting Blood Sugar, Lipid Profile, Stress Test (TMT) or 2D Echo, Kidney Function Test, Complete physical examination be Physician

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 hospitalisation. It is covered up to R₹3000 in Classic, ₹.5000 in Supreme and ₹10000 in Elite.
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 Lifeline.

There are certain conditions for which customer can wait for treatment and does not need immediate medical treatment. Lifeline has 2 years waiting period for 17 conditions as mentioned below:

• Cataract
• Stones in biliary and urinary systems
• Hernia / Hydrocele
• Hysterectomy for any benign disorder
• Lumps / cysts / nodules / polyps / internal tumors
• Gastric and Duodenal Ulcers
• Surgery on tonsils / adenoids
• Osteoarthrosis / Arthritis / Gout / Rheumatism / Spondylosis / Spondylitis / Intervertebral Disc Prolapse
• Fissure / Fistula / Hemorrhoid
• Sinusitis / Deviated Nasal Septum / Tympanoplasty / Chronic Suppurative Otitis Media
• Benign Prostatic Hypertrophy
• Knee/Hip Joint replacement
• Dilatation and Curettage
• Varicose veins
• Dysfunctional Uterine Bleeding / Fibroids / Prolapse Uterus / Endometriosis
• Diabetes and related complications
• 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 might vary from 4 years in Classic to 2 years in Elite Plan. With each policy year, the pre-existing disease waiting period reduces by 1 year. Any claim related to pre-existing disease hospitalisation 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 (incl. 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:

ZONE Discount

Zone 1 0%

Zone 2 15%

Eg, Premium for a 35 year old for a Sum Insured of Rs.5lacs is Rs.5549 in Mumbai (Zone 1) and Rs.4717 in Nasik (Zone 2).

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

You can choose from one of six optional deductibles of ₹ 1 Lakh, ₹ 2 Lakhs, ₹ 3 Lakhs, ₹ 4 Lakhs, ₹ 5 Lakhs and ₹10 Lakhs. By doing so you will receive a discount in the premium calculation of your Policy. You can choose to the take the top up cover under Classic & Supreme plan. If a top-up plan (on annual aggregate deductible) is chosen, then the insured person shall bear all assessed claim amounts payable under the policy up to the deductible amount, under his policy for any Policy Year. Our liability to make payment under the Policy in respect of any claim made in that Policy Year will only commence once the Deductible has been exhausted In case of per claim deductible, top up plan is applicable if the claim amount exceeds the deductible amount. In Lifeline, deductible is on aggregate basis and not per claims basis.

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 Neuron 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 empaneled 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 e.g., 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.

This benefit is available for Supreme and Elite only. Any expenses beyond the limit (₹1Lakh for Supreme and ₹3 Lakh for Elite) has to be paid by you.

If a customer with diabetes or hypertension can be offered Lifeline 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 (covered only under Elite Plan) 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 (covered only under Elite Plan) is payable

Lifeline allows coverage for maximum of 2 Adults and 4 Children and relationship between the insured has to be Self, Spouse and Dependent Children.

56 UIN: IRDAI/NL-HLT/RSAI/P-H/V.I/32/14-15

However, you can take 2 different policies of Lifeline to cover all of them.

Policy 1 – Self, Wife and 2 Kids

Policy 2 – Parents in Law

Policy 3 – Aunt

Lifeline 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 Lifeline. You get a discount of 7.5% for 2 year policy tenure and 12% for 3 year policy tenure.

Lifeline 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 Lifeline or port the existing policy

Ventilator treatment is covered if the person is not brain dead

Any hospitalization due to these natural calamities like Hudhud is covered

If 2 individual policies of Lifeline are converted into Family Floater, the NCB transferred will be the lower of the 2 policies

Worldwide Emergency Hospitalisation covers treatment abroad due to any emergency. Treatment of Piles is not an emergency hospitalisation and customer can wait to return back to India and take treatment. Generally, Piles is under 2 year waiting period.

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 hospitalisation are normally not covered. Please refer to policy document for details of exclusion