Pre-Existing Coverage

 Eligibility

Travellers up to the age of 90 years can buy this plan without giving any medical reports

 Unique Benefits

  1. Coverage for pre-existing conditions in case of life-threatening up to 10% of Sum Insured
  2. Only declared pre-existing conditions are covered as per terms and conditions of insurance.
  3. Covers for a critical illness like a Liver disease, Cancer / Tumor, Coronary Artery Heart Disease, Kidney Disease, Paralysis / Stroke and other non-critical illness.

 SHM covers PEC as follows

If the claim is made for an emergency medical treatment rendered in case of a life-threatening medical condition, during the period of insurance for any sudden, unexpected, unforeseen development attributable to any pre-existing disease, the claim amount shall be 10% of the Sum Insured or the actual hospitalization expenses whichever is less, the deductibles being applied to the claim amount, provided that:

  1. The approval of the Company or the Assistance Service Provider is obtained within 24 hours of commencement of Hospitalization; and
  2. Any Claim under this Clause shall be admissible only till the Insured Person becomes medically stable or is relieved from Acute pain; and
  3. All further Medical Expenses including but not limited to those expenses related to maintaining the medically stable state or to prevent the onset of Acute pain or any further treatment would not be covered by the Company.

 Life-Threatening Medical Condition means a medical condition suffered by the Insured Person which has the following characteristics:

  1. Markedly unstable vital parameters (blood pressure, pulse, temperature and respiratory rate); or
  2. Acute impairment of one or more vital organ systems (involving brain, heart, lungs, liver, kidneys and pancreas); or
  3. Critical care is provided, which involves high complexity decision making to assess, manipulate and support vital system functions to treat single or multiple vital organ failures and requires interpretation of multiple physiological parameters and application of advanced technology; or
  4. Critical care being provided in critical care areas such as coronary care unit, intensive care unit, respiratory care unit, or the emergency department; and certified by the attending Medical Practitioner as a Life-Threatening Medical Condition.
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