GOOD HEALTH MEDICLAIM  POLICY

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The claims which are otherwise admissible under this policy, will be restricted to 20% of the sum insured subject to a maximum limit of Rs.25,000/- per claim.

NOTE :

a) Hospitalisation expenses incurred for treatment of any one illness under agreed package charges will be restricted to 80% of the actual package charges or the sum insured whichever is less.

b) Hospitalisation expenses of a person donating an organ during the course of organ transplant will also be payable subject to the above sub limits applicable to the insured person within the overall sum insured of the insured person.

c) The limit per claim would apply to the overall total claim amount including pre and post-hospitalization claims and shall be subject to clause 2.5 pertaining to Any one Illness. 

d) Company's liability in respect of all claims admitted during the period of Insurance shall not exceed the Sum Insured for the insured person as mentioned in the Policy Certificate.

Liability of the Company under policy clause is restricted as below.

Note :  Plan options 5 to 12 do not have hospital cash benefits.
 

In respect of following specified ailments, Company’s liability in respect of each and every claim, admitted during the period of  insurance, subject to the policy terms, conditions and exclusions, shall not exceed the limits mentioned against the respective ailment or the sum insured available for the insured person, whichever is less:  

The expenses incurred on treatment of the following specified diseases are payable only after completion of continuous, period of insurance as specified against each disease.  

* All Pre Existing Diseases (PED) will be covered under the scope of the policy AFTER FOUR CONTINUOUS POLICY PERIOD ONLY, provided there had been no hospitalisation involved for the treatment of the PED during the said four years of insurance covered under the Good health Mediclaim Scheme.

** In case of Cataract/Total Knee/Hip replacements, where two eyes or two knees or two hips are replaced/operated in a single procedure, the limit per claim indicated as above will be reckoned at twice these limits.

The limit per claim would apply to the overall total claim amount including pre and post hospitalization claims and shall be subject to our policy terms and conditions pertaining to Any one illness mentioned.

This is a cash benefit offered  other than medical claim and sum insured.

Plan options 15 to 30 cover this benefits.

Plan options 15 to 22 cover 15 days benefits and plan options 23 to30 cover 30 days benefits.

Plan options 5 to 12 do not cover this benefits.

Per day eligible amount for disbursement is based on plan options as stated above.

Eligibility to claim this benefits:

1) Plan options between 15 and 30 should be opted.
2) Hospitalisation is required
3) Medical claim under the policy should be valid.

<< If the sum insured under the policy is exhausted and maximum no. of days for hospital cash benefits are not exhausted, then hospital cash benefits is still payable for eligible hospital cash benefits days.

 << If there is no balance days for hospitalisation cash benefits is available, then hospitalistion cash benefits will not be paid.

<< The payment in respect of this benefit will be made directly to the insured after discharge from the hospital upon submission of proof of hospitalization and the relevant claim form to the claim processing third party administrators.

<< As in the case of Good Health Mediclaim Section, all the claims under this benefit also, are to submitted to the Third Party Administrators, viz. TTK HealthCare TPA Private Ltd.

Cumulative Bonus will be available under this policy subject to the following conditions:

1. Sum Insured under the Policy shall be progressively increased by 5%, by way of cumulative bonus, in respect of each claim free year of  insurance, subject to a  maximum  accumulation of 10 claim free years.

2. This cumulative bonus is applicable to the sum insured, which is renewed continuously for a period of 3 years including the current year. In other words, the cumulative bonus will be applicable on the least of the sum insured during this 3 year period.

3.  For fresh customers who are already covered under any other mediclaim policy, the cumulative bonus, if any, earned by them earlier, shall be allowed upon continuous renewal under this policy subject to a maximum of 5% only.

4. For renewal customers of Good Health Mediclaim policy, this cumulative bonus would apply effective from Oct 2004 GH scheme only subject to a maximum of 5% in the first year provided there being no claim during 2003-04 policy.

5.  In case of any claim under this policy in respect of the insured person who has earned the cumulative bonus, the increased percentage will be reduced by 10 % at the next renewal. However basic sum insured will be maintained and will not be reduced.

6. Cumulative bonus will be lost if policy is not renewed on the date of expiry.

7. The Cumulative bonus shown in the policy certificate is provisional and it is subject to revision in the event of any claim under the earlier policy being reported after issuance of this policy.

INSURED means Citibank Credit Card members who have proposed for this insurance.

INSURED PERSON means Citibank Credit Card members and/or their family members covered by this policy

Persons between the ages of 61 and 70 years (No fresh policy will be issued for above 70 years) , who are proposed for this mediclaim insurance for the first time, can be covered subject to

1. their medical examination by a Medical Practitioner registered with the Indian Medical Association

2. the reports of specified diagnostic tests, such as ECG, Blood Sugar (Fasting and Post Prandial) and/or Urine Strip Test, etc., on them duly evaluated by such Medical Practitioner. 

 The findings of such Medical examination and evaluation of diagnostic test reports duly recorded in the prescribed format of Medical Practitioner’s Report and signed by such Medical Practitioner and also the insured person should be submitted to the Citibank along with the copies of diagnostic test reports at the time of submission of the Proposal form in respect of such persons. 

Such medical examination and diagnostic tests should have been done within a period of 60 days prior to the commencement of this mediclaim policy. The coverage of such persons for mediclaim insurance under this policy shall be solely at the discretion of the Company. Proposals accepted based on such Medical Practioner's Report does not prejudice the right of the Company to reject claims arising out of any pre-existing disease which has not been disclosed at the time of the proposal.

Card members who are all covered under the Feb 2003 scheme onwards, should contact our Third Party administrator, TTK Health Care TPA Pvt.Ltd., for claim purpose. For others, the procedure is given below:

1. Preliminary notice of claim with particulars relating to policy number, name of insured person in respect of whom claim is made, nature of illness/injury and name and address of attending medical practitioner/hospital/nursing home should be given by the Card Member to the Company within 7 days from the date of hospitalisation/domiciliary hospitalisation.

2. Final claim along with completed claim form (claim form can be downloaded from www.ttkhealthcareservices.com , Originals of all receipts, bills and cash memos, and documents (as listed in the claim form) such as Admission-cum-Discharge Summary from the Hospital, Attending Doctor’s Certificate (in the prescribed format), copies of diagnostic test reports, prescriptions for medicines purchased, police report/FIR (only in case of accidents) wherever applicable, etc., and the copies of policy copies of earlier years, should be submitted to the Company within 30 days from date of completion of treatment.  

3. Hospital/Diagnostic center bills should be supported by proper printed and revenue-stamped receipts and the receipts for Doctor's fees should have the name, address and registration number of the Doctor printed therein. (Receipts for Doctor's fees on plain paper with the rubber stamp of the Doctor affixed therein or on the letter head of the hospital will not be accepted).

4. Any medical practitioner or other representative authorised by the Company shall be allowed to examine the insured person, in the event of any claim for Hospitalisation or Domiciliary Hospitalisation being made on the Company, when and so often as the same may reasonably be required by or on behalf of the Company.

5. The Company shall not be liable to make any payment under this policy in respect of any claim if such claim be in any manner fraudulent or supported by any fraudulent means or device whether by the Insured Person or by any other person acting on his behalf. The insured shall forfeit all benefits under this policy and the policy shall become void.

6. All medical/surgical treatment under this policy shall have to be taken in India and admissible claims thereof shall be payable in Indian currency.

7. If the policy is to be renewed for enhanced sum insured, then the restriction as applicable to a fresh policy will apply to the additional sum insured, as if a separate policy has been issued for the same. Hence, claims for illnesses contracted during the previous policy period(s) shall be restricted to the old sum insured under the relevant previous policy period.

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         << Fill up the Proposal Form for Good Health Policy

Being a Citibank card member all you have to do is, simply call up your local Citiphone Officer for a Good Health Policy Proposal form. Fresh applicants aged 60 years and above for Mediclaim insurance have to submit a Medical Practitioner's Report Form together with the reports of specified diagnostic tests, in addition to the proposal form.

Each proposal form is designed to accommodate only 6 persons. Therefore if you wish to cover more than 6 persons, you may kindly fill up additional proposal forms.

          << Send in the completed Proposal form 

Kindly send in the duly completed proposal form(s) along with the Medical Practitioner's Report and the reports of specified diagnostic tests (wherever applicable) to CITIBANK CARD CENTRE, No.2 Club House Road, Anna Salai, CHENNAI-600 002, so as to reach on or before 20th of the month previous to the month in which you wish your Good Health policy to commence. For example, if you want coverage from 1st August, your application should reach above Citibank Card Centre on or before 20th July. Applications received after 20th July but before 20th August, will be taken up for coverage from 1st September only.

For the convenience of Citibank card members, we have 12 Good Health Policies in a year, one policy for every month, each commencing from the 1st day of the month. Each Good Health Policy is of 12 months duration.

            <<Payment of Premium

            <<Issuance of Goodhealth Policy Certificate

Good Health Policy certificates will normally be despatched  within 45 days of the commencement of the policy, by courier

Policy Benefits   |  Hospitalisation  | Domiciliary Hospitalisation  | Pre-Hospitalisation | Post-Hospitalisation | Insured/Insured Person |Age Limit | Medical Examination | Claims Procedure  | Premium Rates | IT Benefit  | I want to buy this policy | Renewal of Policy | Cancellation of policy |Cashless Access, Hospital Cash benefits