Q: How will the Pay Out happen for this plan
A: The payout will depend upon the plan benefit(s) chosen. Daily Hospital Cash Benefit (DHCB) 1. In case of hospitalization, due to any injury, sickness or disease, you will receive 1% of Sum Insured as DHCB if admitted in Non ICU room and 2% of Sum Insured if admitted in ICU room. 2. The benefit will be payable as a lump sum amount after the completion of each continuous hospitalization for more than 24 hours as a result of injury, sickness or disease. The benefit amount payable will be calculated as mentioned below: Daily Hospital Cash Benefit * (Number of Days admitted - 1) 3. Daily Hospital Cash Benefit will be payable for a maximum of 20 days per year in case the Life Assured is admitted in Non ICU room and Twice the Daily Hospital Cash Benefit will be payable for a maximum of 10 days per year if admitted in ICU room. 4. Daily Hospital Cash Benefit will be payable subject to a maximum of 60 and 30 days if admitted in Non ICU and ICU rooms respectively, during the entire policy term. 5. The ICU and non ICU benefits will be independent of each other and subject to their respective limits 6. There is a waiting period of 60 days from the date of commencement or reinstatement of the cover. Waiting period will not be applicable for accidental injury. Surgical Benefit (SB) 1. Surgical Benefit will be payable if the Life Assured has undergone any of the 138 surgeries mentioned in Annexure 2 of the Sales Brochure, provided the surgery is done: a. by a qualified surgeon for a surgical operation and b. performed at a hospital due to injury or c. sickness for covered surgical procedures advised by an independent medical practitioner and the policy is in force during the policy term 2. In case the Life Assured has to undergo a surgery during the policy term, the benefit payable shall be ascertained on the basis of the Category of the Surgery as shown below: CATEGORY** SUM ASSURED (%) 1 100% 2 60% 3 40% 4 20% 3. You are entitled to make multiple claims up to a maximum of 100% of Sum Insured during the policy term. 4. The policyholder shall not be allowed to claim for the same surgery more than once. However, multiple claims from the same category can be made. 5. In case 100% of the Sum Insured has been used up, the cover for Surgical Benefit will cease for the Life Assured for the remaining policy term. However, other benefits (such as Daily Hospital Cash Benefit and Critical Illness Benefit, if applicable) will continue to be in force. 6. There is a waiting period of 60 days from the date of commencement / reinstatement of the cover. Waiting period will not be applicable in case of accidental injury. Critical Illness Benefit (CIB) 1. Lump sum benefit equal to 100% of the Sum Insured shall be payable in case the Life Assured is diagnosed with any of the 18 Critical Illness specified in the Sales Brochure. 2. A 30 day survival period is applicable for the Critical Illness Benefit. This refers to the period from the diagnosis of the Critical Illness that the Life Assured must survive for the Critical Illness Benefit to be payable. 3. Critical Illness Benefit will be payable only once during the entire policy term. 4. Once the Critical Illness Benefit is paid, the benefit will cease for the Life Assured for the remaining policy term. However, other benefits (such as Daily Hospital Cash Benefit and Surgical Benefit, if applicable) will continue to be in force. 5. There is a waiting period of 90 days for Critical Illness Benefit from the date of commencement/ reinstatement of the cover, except in cases where the Critical Illness occurs as a result of an accident (e.g., Major Head Trauma).