Kavach Standard Individual Health

1.1 The Company hereby agrees, subject to the terms, conditions, exclusions and definitions contained herein, to indemnify the Insured Person for medically necessary hospitalisation expenses up to the Sum Insured of ₹5,00,000.

1.2 Coverage applies across India during the Period of Insurance specified in the Schedule.

2.1.1 Daily room boarding and nursing expenses are payable up to 2% of the Sum Insured per day, subject to a maximum of ₹5,000 per day.

2.1.2 If the Insured occupies a room with a tariff higher than the eligible limit, the Insured shall bear a proportionate share of all associated medical expenses.

2.2.1 Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses are payable up to 5% of the Sum Insured per day, subject to a maximum of ₹10,000 per day.

2.3.1 Pre-Hospitalisation medical expenses incurred up to 30 days immediately preceding the date of hospitalisation are covered.

2.3.2 Post-Hospitalisation medical expenses incurred up to 60 days immediately following the date of discharge are covered.

3.1.1 Expenses related to the treatment of a Pre-Existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the inception date.

4.1.1 Emergency Hospitalisation: Notice with full particulars must be given to the Company/TPA within 48 hours of admission.

4.1.2 Planned Hospitalisation: Notice must be delivered at least 72 hours prior to scheduled admission.

6.1.1 In case of grievance, the Insured may contact the Insurer's Grievance Redressal Officer at grievance@kavach-demo.in.

6.1.2 If unresolved within 30 days, dispute may be referred to the Insurance Ombudsman under the Insurance Ombudsman Rules, 2017.