RATE BOOKstate life

hospital and surgical benefit (H&S) rider

hospital and surgical benefit (H&S) rider

hospital and surgical benefit (H&S) rider can be attached to new Whole Life, Endowment  Insurance and Big Deal policies provided the sum assured of the basic policy is at least  Rs. 25,000 (one unit in case of big deal) The rider can also be attached to existing Whole Life and Endowment Assurance policies issued by the Corporation with sum assured Rs 25,000 or more subject to medical examination of the policyholder. The rider cannot be issued on its own.

 

hospital and surgical benefit (H&S) rider

The rider provides benefits in case of hospitalization, in State Life’s approved hospitals, as a  result of sickness or accident. It provides for the following three benefits;

(a)Room and Board Charges(Daily Limits Rs.90)

Actually daily charges, but not exceeding the Daily Limit will be payable up to 30 days for any hospitalization.  Successive periods of hospitalization due to the same cause or to any complications arising therefrom are considered as one hospitalization unless more than 90 days have elapsed between this hospitalization.

(b)  Hospital Services (maximum Rs. 610)

The actual amount charged for the following services rendered, but not exceeding the maximum for any hospitalizations.

-Use of operation room, treatment rooms, and equipment.

-Drugs and medicines,

-Dressing, ordinary splints, and plaster casts,

-Laboratory examination,

-Electrocardiograms

-Basal  metabolism tests,

-Physical therapy, Anaesthesia and oxygen,

-X-Ray examinations(cost of X-Ray therapy, radium therapy, radium and isotopes are excluded),

-Intravenous injections and solutions

-Administration of blood and blood plasma(cost of blood and blood plasma excluded) and

-Ambulance service to and/or from the hospital, not to exceeds the amount of the daily limit for anyone hospitalization.

(c)Surgical   Benefits(surgical maximum Rs.1,200)

The maximum amount payable for each operation is given in the schedule of operations mentioned in the policy. If more than one surgical operation is performed by the same hospitalization, the total reimbursement  will not  exceed the surgical maximum  payment and will be  limited to the reimbursement of the amount expended by the assured ,subject to the protection of the hospital’s  official  statement of account and receipts , together with a list of the item  claimed under (b) above.

hospital and surgical benefit (H&S) rider

Note:

On the payment of the double amount of premium specified for the rider, the above-mentioned benefits and their limits will also be doubled under this rider.

hospital and surgical benefit (H&S) rider EXCLUSIONS:

The rider does not cover any hospitalization for:-

(a)Any injury or illness caused directly or indirectly, wholly or partly by:

  • Self-destruction or intentionally self-inflicted injury or any attempted threat while sane or insane.
  • War, declared or undeclared strikes, riots civil war, revolutions or a warlike operation.
  • Military or naval services in time in the time of declared or undeclared war or while under orders for warlike operation or restorations of public order.
  • Any violation or attempted violation of the law of resistance to arrest.

(b)  1- mental or nervous disorder, chronic alcoholism, drug addiction  pulmonary tuberculosis after diagnosis

2-General check-up, physical therapy convalescence or custodial or reset care.

3- Injury or illness sustained or infirmity existent prior to. Or within four (4) weeks from, the date of commencement or the date of reinstatement of the rider.

hospital and surgical benefit (H&S) rider

Premium per Annum

Age nearest birthday                     Premium per annum

18-40 Years                                         Rs.330.00

41-45 Years                                         Rs.360.00

46-50 Years                                         Rs.4000.00

 

hospital and surgical benefit (H&S) rider general:

(A)At present, the scheme is limited to persons living in or near cities where Hospitals and doctors have been approved by state life for hospitalization and medical examination respectively. Changes in residence to any of the cities covered by the scheme will be permissible without affecting the benefits under the rider. In case, however, a policyholder changes his permanent residence to a city other than those covered by the scheme, he may, on request get the rider cancelled with a refund of the unearned portion of the premium on a rota basis.

(b)  All medical examination in connection with this rider will be performed by one of the doctors mentioned in the list of Examiners approved or this rider.

(c) This rider can be issued only to males and A Category Females between ages 18 and 50 years, who are classed as standard risks.

(d) This rider is not available with a policy on a quarterly or ordinary monthly payment. No action will be taken on the proposal if this condition is not fulfilled.

(e) A request for this rider should be made in the appropriate column under Questions  No.11 of the proposal  From.

(f) The rate of agency commission on additional premium for this rider would be the same as the basic policy to which is attached.

(g) The premium for this rider may be increased by state life with effect from any policy anniversary after the third by giving at least three(3) month’s notice.

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