Royal Sundaram Health Insurance and all that it covers

Royal Sundaram General Insurance Co. Ltd was earlier known as Royal Sundaram Alliance Insurance Company Limited. This company offers comprehensive insurance plans. They also provide innovative insurance solutions to various categories like the families, individuals and businesses. This company offers different general insurance products like car, personal accident, health, home, two wheeler and travel insurance. Royal Sundaram General Insurance Company was the 1^st private insurance company to get its IRDAI license in October 2000 in India. In the beginning this Company was promoted as a collaboration of Sundaram Finance and Royal & SunAlliance Insurance Pvt Ltd Co. This Company was awarded the ‘Celent Model Insurer Asia Award’ in the year 2013 and 2014 for its efficient claims management system for improving their staff productivity and increased customer satisfaction!

Royal Sundaram’s Accident and Health Claims received the ISO 9001-2008 certification for the best and efficient customer service

Features – Royal Sundaram Health Insurance

The features of Royal Sundaram Health Insurance are mentioned below:

of members- The plan covers maximum 5 members of your family
Lifelong Renewal – The plans offered are lifelong renewable, hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
Room Rent – The room rent of 2% of the sum insured is applicable for Non ICU & 4% of sum insured on ICU
Pre & Post hospitalization cover– The plan covers medical expenses for 30 days prior to hospitalization and 60 days post hospitalization only for related medical expenses.
Health Check-ups – On successful completion of 4 claim-free years, the health check-up expenses are reimbursed subject to a maximum of Rs.750 per insured person
Pre-existing diseases– Pre-existing diseases are covered after 3 years of waiting period.
Co-payment– The plan has no co-payment policy.

Benefits – Royal Sundaram Health Insurance

The benefits of buying Royal Sundaram Insurance are mentioned below:

Discounts: Royal Sundaram Health Insurance provides a discount of 7.5% or 12% if you opt for a 2 years and 3 years plans respectively.
Coverage: Offers coverage to maximum 5 family members
Cashless facility: Offers cashless facility with a wide network of 3000 + empaneled hospitals across the country
Flexibility: Offers flexibility to make the premium payments via Netbanking, Debit/Credit card etc. as per your convenience
Cumulative Bonus – Offers cumulative bonus if you have don’t make a claim each year. This bonus ranges from 5% up to 50%
Mediclaim settlement: Offers quick and hassle-free claim settlement services
Reload– Offers 100% reload free of cost
Tax benefits: Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

Products offered – Royal Sundaram Health Insurance

Royal Sundaram Health Insurance offers pocket-friendly health insurance plans with a variety of benefits offering the best care to you and your family members. The plans offered are flexible and gives you an option to choose your sum insured as per your capability.

Lifeline Health Insurance Plans

This is a type of health insurance plan that can be bought as an individual as well as family floater plan for your spouse, self and children. There are total 3 variants offered by the Royal Sundaram Lifeline Health Insurance Plans. Let’s have a look at the features of each of these plans:

Classic Lifeline Health Insurance Plan

The features of this plan are mentioned below:

Basis	Self, spouse & dependent children – maximum of 2 adults and 4 children
Entry Age	For individual plan, the minimum entry age is 18 years and no maximum limit. For Family Floater plans, the age should be minimum 91 days and 25 years
Sum assured	Rs.2 lakh to Rs..5 lakh
Policy period	1, 2 or 3 years

Offers sum insured option from Rs.2 lakh to Rs.4 lakh
There is no room rent capping here and any disease specific limit
Offers no claim bonus of up to 50% of the amount of sum insured
Offers 100% reload of the sum insured absolutely free of cost for the treatment of different illnesses in the event of complete exhaustion of sum assured and NCB.
Offers free vaccination in case of animal bite
Offers free health check every 3^rd policy year
Offers coverage for treatment of Organ Donor covered up to the sum insured.
Covers all day care procedures
Inpatient Hospitalization expenses
The plan covers medical expenses for 30 days prior to hospitalization and 60 days post hospitalization only for related medical expenses.
Covers expenses of the Ambulance up to Rs.3,000.
Offers coverage for domiciliary hospitalization charges covered up to the sum insured
AYUSH Treatment – Inpatient hospitalization covered up to Sum Insured in Government Hospitals and up to Rs.20, 000 in other hospitals.
Offers preventive Healthcare and Wellness.

Exclusions:

Royal Sundaram Health Insurance would not be liable to settle the claim in case of the below situations. The complete list of the exclusions is mentioned herein:

Any pre-existing diseases would be covered only post completion of 4 year from the date of the policy issuance. These pre-existing conditions should be however declared during the policy issuance. Claims are void if there is any gap in policy renewal.
Any medical conditions except injuries occurred within 30 days of the policy issuance would not be covered.
Diseases such as Knee/Hip Replacement, Chronic Renal Failure/ End Stage Renal Failure Cataract, Benign Prostatic Hypertrophy, etc. will be covered only post completion of 2 policy years successfully

The below list mentions the permanent exclusions for coverage availed due to:

Convalescence and Rehabilitation
Wellness Clinics
HIV and AIDS
Hereditary Conditions
Drugs and Dressing for OPD Treatment
Health Hydros
Dental/Oral Treatment
Self-inflicted Injuries
Sexual problems and gender issues
Take-home use
Eyesight Treatment
Health Hydros
Nature Cure
Psychiatric and Psychosomatic conditions
Addictive Conditions and Disorders
Adventure or Hazardous Sports
Ageing and Puberty
Wellness Clinics
Hospitalization for Observation or Investigative purpose only
Items of personal comfort and convenience
Alternative Treatment (except AYUSH)
Artificial Life Maintenance, Charges for Medical Papers
Circumcision
Conflict and Disaster
Sexually Transmitted Diseases
Sleep Disorders
Speech Disorders
Stem Cell Implantation
Treatment for Developmental Problems
Treatment received outside India
Unrelated Diagnostic, or Injury due to Unlawful Activity
Cosmetic surgery
Congenital Conditions
Obesity
OPD Treatment
Preventive Care
Reproductive Medicine
Self-inflicted Injuries
Sexual problems and gender issues
Treatment for Alopecia
Unproven/Experimental Treatment
Treatment from Unrecognized Hospital or Physician

Supreme Lifeline Health Insurance

This plan is offered as both individual as well as family floater health insurance plan. The features of this plan are mentioned below:

Basis	Self, spouse & dependent children – maximum of 2 adults and 4 children
Entry Age	For individual plan, the minimum entry age is 18 years and no maximum limit. For Family Floater plans, the age should be minimum 91 days and 25 years
Sum assured	Rs.5lakh to Rs.50lakh
Policy period	1, 2 or 3 years

Offers sum insured option from Rs.5 lakh to Rs.50 lakh
Offers a good facility to double your sum insured amount in 5 claim free years
Offers 100% reload of the sum insured absolutely free of cost for the treatment of different illnesses in the event of complete exhaustion of sum assured and NCB.
Offers free emergency domestic evacuation of up to Rs.1 lakh
Offers free vaccination in case of animal bite of up to Rs.5,000
Offers second opinion for 11 critical illnesses
Offers free annual health checkup for any family member above 18 years
Offers coverage for treatment of Organ Donor covered up to the sum insured.
Covers all day care procedures
Covers Inpatient Hospitalization expenses
The plan covers medical expenses for 60 days prior to hospitalization and 90 days post hospitalization only for related medical expenses.
Covers expenses of the Ambulance up to Rs.5,000.
Offers coverage for domiciliary hospitalization charges covered up to the sum insured
AYUSH Treatment – Inpatient hospitalization covered up to Sum Insured in Government Hospitals and up to Rs.30, 000 in other hospitals.
Offers preventive Healthcare and Wellness by giving access to networks that offers discounts to Diagnostic Centers, Pharmacies, OPD centers, GYM/Weight Management center, etc.

Exclusions:

Royal Sundaram Health Insurance would not be liable to settle the claim in case of the below situations. The complete list of the exclusions is mentioned herein:

Any pre-existing diseases would be covered only post completion of 3 year from the date of the policy issuance. These pre-existing conditions should be however declared during the policy issuance. Claims are void if there is any gap in policy renewal.
Any medical conditions except injuries occurred within 30 days of the policy issuance would not be covered.
Any critical illnesses that the insured contracts within 90 days of the policy issuance
Diseases such as Knee/Hip Replacement, Chronic Renal Failure/ End Stage Renal Failure Cataract, Benign Prostatic Hypertrophy, etc. will be covered only post completion of 2 policy years successfully

The below list mentions the permanent exclusions for coverage availed due to:

Convalescence and Rehabilitation
Wellness Clinics
HIV and AIDS
Hereditary Conditions
Drugs and Dressing for OPD Treatment
Health Hydros
Dental/Oral Treatment
Self-inflicted Injuries
Sexual problems and gender issues
Take-home use
Eyesight Treatment
Health Hydros
Nature Cure
Psychiatric and Psychosomatic conditions
Addictive Conditions and Disorders
Adventure or Hazardous Sports
Ageing and Puberty
Wellness Clinics
Hospitalization for Observation or Investigative purpose only
Items of personal comfort and convenience
Alternative Treatment (except AYUSH)
Artificial Life Maintenance, Charges for Medical Papers
Circumcision
Conflict and Disaster
Sexually Transmitted Diseases
Sleep Disorders
Speech Disorders
Stem Cell Implantation
Treatment for Developmental Problems
Treatment received outside India
Unrelated Diagnostic, or Injury due to Unlawful Activity
Cosmetic surgery
Congenital Conditions
Obesity
OPD Treatment
Preventive Care
Reproductive Medicine
Self-inflicted Injuries
Sexual problems and gender issues
Treatment for Alopecia
Injury caused due to Unlawful activity
Unproven/Experimental Treatment

Elite Lifeline Health Insurance

This plan is offered as both individual as well as family floater health insurance plan. The features of this plan are mentioned below:

Basis	Self, spouse & dependent children – maximum of 2 adults and 4 children
Entry Age	For individual plan, the minimum entry age is 18 years and no maximum limit. For Family Floater plans, the age should be minimum 91 days and 25 years
Sum assured	Rs.25lakh to Rs.1 crore
Policy period	1, 2 or 3 years

Offers sum insured option from Rs.25 lakh to Rs.150 lakh
Offers a good facility to double your sum insured amount in 5 claim free years
Offers 100% reload of the sum insured absolutely free of cost for the treatment of different illnesses in the event of complete exhaustion of sum assured and NCB.
Offers free emergency domestic evacuation of up to Rs.3 lakh
Offers coverage to the new born and the maternity expenses for up to 2 deliveries
Offers OPD treatment up to Rs.10, 000
Offers world-wide emergency hospitalization
Offers free vaccination in case of animal bite of up to Rs.7, 500
Offers international treatment for 11 critical illnesses which are specified including the return airfare
Offers free annual health checkup for any family member above 18 years
Offers coverage for treatment of Organ Donor covered up to the sum insured.
Covers all day care procedures
Covers Inpatient Hospitalization expenses
The plan covers medical expenses for 60 days prior to hospitalization and 180 days post hospitalization only for related medical expenses.
Covers expenses of the Ambulance up to Rs.10,000.
Offers coverage for domiciliary hospitalization charges covered up to the sum insured
AYUSH Treatment – Offers coverage for inpatient hospitalization up to Sum Insured in Government Hospitals and up to Rs.50, 000 in other hospitals.
Offers preventive Healthcare and Wellness by giving access to networks that offers discounts to Diagnostic Centers, Pharmacies, OPD centers, GYM/Weight Management center, etc.

Exclusions:

Royal Sundaram Health Insurance would not be liable to settle the claim in case of the below situations. The complete list of the exclusions is mentioned herein:

Any pre-existing diseases would be covered only post completion of 2 year from the date of the policy issuance. These pre-existing conditions should be however declared during the policy issuance. Claims are void if there is any gap in policy renewal.
Any medical conditions except injuries occurred within 30 days of the policy issuance would not be covered.
Any critical illnesses that the insured contracts within 90 days of the policy issuance
Diseases such as Knee/Hip Replacement, Chronic Renal Failure/ End Stage Renal Failure Cataract, Benign Prostatic Hypertrophy, etc. will be covered only post completion of 2 policy years successfully

The below list mentions the permanent exclusions for coverage availed due to:

Convalescence and Rehabilitation
Wellness Clinics
HIV and AIDS
Hereditary Conditions
Drugs and Dressing for OPD Treatment
Health Hydros
Dental/Oral Treatment
Self-inflicted Injuries
Sexual problems and gender issues
Take-home use
Eyesight Treatment
Health Hydros
Nature Cure
Psychiatric and Psychosomatic conditions
Addictive Conditions and Disorders
Adventure or Hazardous Sports
Ageing and Puberty
Wellness Clinics
Hospitalization for Observation or Investigative purpose only
Items of personal comfort and convenience
Alternative Treatment (except AYUSH)
Artificial Life Maintenance, Charges for Medical Papers
Circumcision
Conflict and Disaster
Sexually Transmitted Diseases
Sleep Disorders
Speech Disorders
Stem Cell Implantation
Treatment for Developmental Problems
Treatment received outside India
Unrelated Diagnostic, or Injury due to Unlawful Activity
Cosmetic surgery
Congenital Conditions
Obesity
OPD Treatment
Preventive Care
Reproductive Medicine
Self-inflicted Injuries
Sexual problems and gender issues
Treatment for Alopecia
Injury caused due to Unlawful activity
Unproven/Experimental Treatment

Family Good Health Insurance Plan

This plan is offered as both individual as well as family floater health insurance plan. The features of this plan are mentioned below:

Basis	Self, spouse & dependent children – maximum of 2 adults and 3 children
Entry Age	Minimum 91 days and maximum 21 years
Sum assured	Rs.2lakh, 3 lakh or 4 lakh
Policy period	1 or 2 years

Offers sum insured option from Rs.2 lakh, Rs.3 lakh and Rs.4 lakh
There is no room rent capping here and any disease specific limit
Offers coverage for OT charges, charges for equipment and supplies, doctor’s charges etc.
Offers coverage for any pre-existing diseases post a waiting period of 48 months
Offers a daily cash allowance of Rs.500 per day of hospitalization
Offers benefit of convalescence
Offers access to specified day care procedures
Covers expenses of the Ambulance up to Rs.1,000.
The plan covers medical expenses for 30 days prior to hospitalization and 60 days post hospitalization only for related medical expenses.
Offers free health checkup charges of up to Rs.750 per insured member post a successful completion of 4 years
Offers cash allowance of Rs.10,000 per day post 21 days of hospitalization
Inpatient Hospitalization expenses

Exclusions:

Royal Sundaram Health Insurance would not be liable to settle the claim in case of the below situations. The complete list of the exclusions is mentioned herein:

The below list mentions the permanent exclusions for coverage availed due to:

Convalescence and Rehabilitation
Wellness Clinics
HIV and AIDS
Hereditary Conditions
Drugs and Dressing for OPD Treatment
Health Hydros
Dental/Oral Treatment
Self-inflicted Injuries
Sexual problems and gender issues
Take-home use
Eyesight Treatment
Health Hydros
Nature Cure
Psychiatric and Psychosomatic conditions
Addictive Conditions and Disorders
Adventure or Hazardous Sports
Ageing and Puberty
Wellness Clinics
Hospitalization for Observation or Investigative purpose only
Items of personal comfort and convenience
Alternative Treatment (except AYUSH)
Artificial Life Maintenance, Charges for Medical Papers
Circumcision
Conflict and Disaster
Sexually Transmitted Diseases
Sleep Disorders
Speech Disorders
Stem Cell Implantation
Treatment for Developmental Problems
Treatment received outside India
Unrelated Diagnostic, or Injury due to Unlawful Activity
Cosmetic surgery
Congenital Conditions
Obesity
OPD Treatment
Preventive Care
Reproductive Medicine
Self-inflicted Injuries
Sexual problems and gender issues
Treatment for Alopecia
Injury caused due to Unlawful activity
Unproven/Experimental Treatment

Royal Smart Cash Plan Insurance

This plan offers a regular health cover wherein a certain amount is made available for 24 hours of hospitalization. This amount could be utilized for travel expenses, accommodation of the attendant and related expenses.

The features of this plan are mentioned below:

Basis	Self, spouse & dependent children – maximum of 2 adults and 4 children
Entry Age	For individual plan, the minimum entry age is 91 days and the maximum limit is 70 years.
Sum assured	Varies

Offers coverage for a period of 180 days including any treatment to be taken abroad while on an official visit or on a holiday.
You can avail the Smart Cash Plan through different plans including daily benefits that range between Rs.500 to Rs.10, 000/- each day of hospitalization, beyond a period of 24 hours.
Offers a lump sum amount of Rs.10, 000 in case the hospitalization goes above 15 days.
The daily cash benefit is doubled in case the hospitalization involves due to air/road/ or rail accident, for a maximum period of 15 days.
The cost reimbursement benefit for health check-up is applicable depending upon the plan that is chosen.
Offers lump sum amount in case the insured gets diagnosed by critical illness listed as per the policy wordings
Offers coverage in case of a family member’s emergency visit from abroad depending on the specific plans
Offers parental accommodation in case the insured hospitalized is less than 12 years old. This benefit is offered in addition to the hospitalization benefit as per the selected plan.
Offers riders like personal accident benefit with an additional amount

Exclusions:

Royal Sundaram Health Insurance would not be liable to settle the claim in case of the below situations. The complete list of the exclusions is mentioned herein:

The below list mentions the permanent exclusions for coverage availed due to:

Convalescence and Rehabilitation
Wellness Clinics
HIV and AIDS
Hereditary Conditions
Drugs and Dressing for OPD Treatment
Health Hydros
Dental/Oral Treatment
Self-inflicted Injuries
Sexual problems and gender issues
Take-home use
Eyesight Treatment
Health Hydros
Nature Cure
Psychiatric and Psychosomatic conditions
Addictive Conditions and Disorders
Adventure or Hazardous Sports
Ageing and Puberty
Wellness Clinics
Hospitalization for Observation or Investigative purpose only
Items of personal comfort and convenience
Alternative Treatment (except AYUSH)
Artificial Life Maintenance, Charges for Medical Papers
Circumcision
Conflict and Disaster
Sexually Transmitted Diseases
Sleep Disorders
Speech Disorders
Stem Cell Implantation
Treatment for Developmental Problems
Treatment received outside India
Unrelated Diagnostic, or Injury due to Unlawful Activity
Cosmetic surgery
Congenital Conditions
Obesity
OPD Treatment
Preventive Care
Reproductive Medicine
Self-inflicted Injuries
Sexual problems and gender issues
Treatment for Alopecia
Injury caused due to Unlawful activity
Unproven/Experimental Treatment

Claims process – Royal Sundaram Health Insurance

There are two ways to make claim under a Health Insurance Policy:

a.) Cashless basis

b.) Reimbursement basis.

In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form.

In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.

Royal Sundaram Health Insurance has a well-defined claim processing system.

Important details required for claim intimation

Health Insurance Policy number
Phone no., email id, address, landmark etc. of the insured/claimant
Name of Insured/claimant who is admitted in the hospital
Relationship of insured with the person who is hospitalized.
Name of the hospital
Nature of ailment (For health claims)
Nature of accident, date, time and location of the incident (For accident cases)
Commencement date of the symptom of ailment

Contact details for Claim intimation

The contact details for successful, quick and hassle-frees claim settlement are mentioned below:

24 x 7 Toll Free: 1800-425-6645
Email: services@royalsundaram.in
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:

Europ Assistance India Pvt Ltd, 301, C Wing, Business Square, Andheri Kurla Road, Chakala, Andheri (East), Mumbai – 400093, Contact No: +91-22-67872035 Email: rsalifeline@europ-assistance.in

Claim Process – Cashless Service (For Domestic Claims)

In case of a planned hospitalization, kindly intimate the TPA. It is important to seek cashless authorization at least 72 hours prior to hospitalization.
In case of any emergency hospitalization, it is important to inform TPA within 24 hours of the hospitalization.
Fill in the cashless authorization form within 3 hours given by the TPA post checking your coverage. Your eligibility for the claim too would be verified. Attach your documents and send the form within 3 hours back to the TPA. The TPA would get in touch with you within 4 hours of your receipt of the documents in case of a deficiency
Immediately make the payment of the non-medical charges and expenses which are not covered to the hospital prior to the discharge
You would receive a rejection letter within 2 hours in case your ailment or treatment is not covered under the health insurance plan

Claim Procedure for Cashless facility (for Worldwide Emergency Hospitalization)

Inform the service provider within 24 hours of hospitalization.
Your eligibility as per the request made would be verified by the Service Provider and you will receive a call for more information or details, if required.
The Service Provider will get in touch with the hospital immediately in case the pre-authorization request has been approved or denied.
In case of approval of the pre-authorization request, your bill will be settled directly with the hospital by the service provider.
Any additional charges approved by the service provider would be paid by the insured

Claim Procedure for Reimbursement

The claim form duly filled and signed needs to be sent to the Royal Sundaram Health Insurance within 30 days from the date of discharge
In case of any discrepancy in the documents/information submitted by you, you will receive a deficiency letter within 7 days from the date of receipt of the documents from Royal Sundaram Health Insurance
If there is no deficiency of the received documents, Royal Sundaram Health Insurance would make the payment of your admissible amount within 30 days as per the policy terms and conditions
The payment will be made in the name of the proposer.
You need to send across the Claim documents to:

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

Claim Procedure for International Treatment for 11 specified Critical Illnesses

The insured should immediately inform the service provider post diagnosis of a Specified Critical Illness. The same needs to be informed also before travelling overseas for the treatment. You may call on the helpline number specified in the Schedule of Insurance Certificate requesting for a pre-authorization for the treatment.
Your eligibility as per the request made would be verified by the Service Provider and you will receive a call for more information or details, if required.
The Service Provider will get in touch with the hospital immediately in case the pre-authorization request has been approved or denied.
In case of approval of the pre-authorization request, your bill will be settled directly with the hospital by the service provider.
Any additional charges approved by the service provider would be paid by the insured

In case of any emergencies, you need to inform Royal Sundaram Health Insurance within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization.

Review

Royal Sundaram Health Insurance offers an array of reasonably priced health insurance policies. Their plans are made-to-measure to shield you against your mounting financial responsibilities towards your family during and after hospitalization and medical treatments. They boast of a very good claim settlement ratio amongst other private insurers. Their continuous efforts to offer excellent customer service is their ultimate performance. Royal Sundaram General Insurance Company was one of the first private insurance company to tie up with banks to sell their retail products.

Hence, if you are scouting for an insurer who will deliver dependability, competence and brilliant post sales services in consort with the products specific to your requirements, Royal Sundaram Health Insurance is a won over alternative.