bob Women Sapphire Savings Account

• Insurance Company will pay the Bank of Baroda Women Account Holder eligible customers for Cancer Care Treatment and hospitalization.
• Sum Insured: ₹10,00,000 per account.
• Eligibility: Women account holders (primary) aged 18 to 60 years who maintain a minimum monthly average balance of ₹100,000.
• Coverage Type: Cover including hospitalization (Inpatient, Daycare, and Outpatient), pre-hospitalization (30 days), and post-hospitalization (60 days).
• Included Treatments: Chemotherapy, Radiotherapy, Organ Transplants (for Cancer), and Onco-Surgeries.
• Special Provisions: No medical examination is required regardless of age. Detection of cancer prior to the policy inception is excluded.

Cancer Definition:

1. A malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy and confirmed by a pathologist.
2. The term cancer includes
   1. Leukemia, lymphoma, and sarcoma.
   2. Tumor’s showing the malignant changes of carcinoma in situ and tumours which are histologically described as pre-malignant or non-invasive, including but not limited to: Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN

The following are excluded:

1. Benign lesions
2. All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0;
3. Papillary micro - carcinoma of the thyroid less than 1 cm in diameter;
4. Microcarcinoma of the bladder;
5. All tumours in the presence of HIV infection.

Pre-Hospitalization and Post-Hospitalization Medical Expenses

The Company will indemnify the Insured Member for Relevant Medical Expenses incurred which are Medically Necessary, only through Reimbursement Facility, maximum up to the Coverage Amount, as specified in the Certificate of Insurance -

1. Under Relevant Pre-hospitalization Medical Expenses, for a period of 30 days immediately prior to the Insured Member’s date of admission to the Hospital, provided that the Company shall not be liable to make payment for any Pre-hospitalization Medical Expenses that were incurred before the Cover Start Date;
2. Under Relevant Post-hospitalization Medical Expenses, for a period of 60 days immediately after the Insured Member’s date of discharge from the Hospital.
3. The number of consultations covered by this benefit is limited to once per day.
4. This benefit does not cover follow-up consultation or treatment after the Insured Member is discharged from an in-patient rehabilitation facility.

OPD

Follow up care post treatment - up to INR 3,000 twice a year, after treatment for Cancer has been discontinued basis recommendation of Medical Practitioner for at least six months with "No evidence of disease (NED)"

Including but not limited to Chemotherapy, Radiotherapy, Organ Transplant (For Cancer), Surgeries, for Excision of Cancerous Tissue or Removal of Organs/Tissues (Once- Surgery) etc. or any advance treatment prescribed by medical practitioner. This shall also include medicine and medical equipment’s, if required.

Ambulance

The Company will indemnify the Insured Member, through Cashless or Reimbursement Facility, up to amount as specified in Certificate of Insurance, for the Reasonable and Customary Charges up to 2000 per hospitalization necessarily incurred on availing Ambulance services offered by a Hospital or by an Ambulance service provider for the Insured Member’s necessary transportation , provided that the necessity of such Ambulance transportation is certified by the treating Medical Practitioner and subject to the conditions specified below:

1. Transportation from the place of Medical Emergency to the nearest Hospital; and/or
2. Transportation from one Hospital to another Hospital for better Medical treatment to the Insured Member, following an Emergency.

Permanent Exclusions under the Policy:

Any Claim in respect of any Insured Member for, arising out of or directly or indirectly due to any of the following shall not be admissible unless expressly stated to the contrary elsewhere in the Policy.

• Any item or condition or treatment specified in List of Non-Medical Items (Annexure – II of Group Care 360). https://www.careinsurance.com/other-downloads.html Please find attached Annexures list at the end of this document.
• Any pre-existing injury / illness or disability and any complications thereof and its associated medical conditions unless we had agreed otherwise in writing;
• Excluded Providers - Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in its website / notified to the policyholders are not admissible.
• Any condition directly or indirectly caused by or associated with any sexually transmitteddisease, including Genital Warts, Syphilis, Gonorrhoea, Genital Herpes, Chlamydia, Pubic Lice and Trichomoniasis, Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV, Human T-Cell Lymphotropic Virus Type III (HTLV–III or IITLB-III) or Lymphadenopathy Associated Virus (LAV) or the mutants derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind;
• Treatment taken from anyone who is not a Medical Practitioner or from a MedicalPractitioner who is practicing outside the discipline for which he is licensed or any kind of self-medication;
• Charges incurred in connection with routine eye examinations and ear examinations, dentures, crowns, artificial teeth and all other similar external appliances and / or devices whether for diagnosis or treatment;
• Unproven Treatments: Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.
• Expense incurred on advanced treatment methods other than as mentioned in clause 2.1 (h) (Refer Group Care 360)
• Any expenses incurred on providing or fitting any external prosthesis or orthosis or applianceor medical aids or durable medical equipment of any kind, like wheelchairs, walkers, crutches, ambulatory devices, unless allowed under the Policy, cost of Cochlear implants;
• Treatment of any external Congenital Anomaly or Illness or defects or anomalies including their associated medical conditions or chronic medical conditions or vegetative state cover ( on the basis of declaration by the treating doctor) or treatment relating to external birth defects; We define vegetative state as a condition of profound non-responsiveness with no sign of awareness or consciousness or a functioning mind, even if the Insured can open their eyes and breathe unaided, and the person does not respond to stimuli such as calling their name or touching. This state must have remained for at least four (4) weeks with no sign of improvement or there could be no recovery;
• Treatment whilst staying in a hospital for more than ninety (90) continuous days for permanent neurological damage on the basis of declaration by the treating doctor.
• Cosmetic or plastic Surgery: Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner;
• Out-patient treatment;
• Treatment received outside India;
• Domiciliary hospitalization or treatment;
• Investigation & Evaluation
  1. Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
  2. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded;
• Rest Cure, rehabilitation and respite care -Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes –
  1. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
     
  2. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs;
• Professional fees charged by a member of the Insured Member’s immediate family or by a person normally resident in the household of the Insured or under his employment;
• The Insured Member serving in any branch of the military, navy, air force or any branch of armed forces or any paramilitary forces;
• Radioactive contamination whether arising directly or indirectly ionizing radiation, toxic, explosive or other hazardous properties of nuclear material;
• Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure
• Non-Allopathic Treatment or treatment related to any unrecognized systems of medicine;
• Any charges incurred to procure documents related to treatment or Illness pertaining to any period of Hospitalization or Illness or any administration costs or any other charges of a non-medical nature in connection with the provision and/or performance of medical supplies and/or services;
• Personal comfort and convenience items or services including but not limited to T.V. (wherever specifically charged separately), charges for access to cosmetics, hygiene articles, body care products and bath additives, as well as similar incidental services and supplies;
• Expenses related to any kind of RMO charges, Service charge, Surcharge, night charges levied by the hospital under whatever head or any room upgrades, menu items not included as standard or visitors meals;
• Continuous ambulatory peritoneal dialysis. Coverage for ‘Continuous ambulatory peritoneal dialysis’ is available on OPD basis and as part of Pre-Post hospitalization expenses;
• Charges for items not listed in the policy schedule applicable to the member or considered as not medically necessary or which may be considered as elective;
• Any medical or physical condition or treatment or service, which is specifically excluded under the Policy Schedule including the associated medical conditions shown on the endorsement;
• Cryopreservation or harvesting or storage of stem cells as a preventive measure against possible disease/illness/injury, or implantation or re-implantation of living cells or living tissue whether autologous or provided by a donor;
• Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.
• Charges for residential stays in Hospital which are not medically necessary or are incurred for social or domestic reasons or for reasons which are not directly connected with treatment or where the Hospital has effectively become the place of domicile or permanent abode;
• Any charges made by the medical practitioner, hospital, laboratory or any such medical services which are not reasonable and customary;
• Any charges for treatment incurred during a period for which the premium is not paid;
• All bank or credit or foreign exchange charges when the claims payment is made in a currency other than the policy currency upon the member’s request;
• Any other conditions at the discretion of Underwriter.

Cancer Care Insurance for Eligible Women Account Holder in BOB is Rs 10, 00,000 per account. (Sum Insured).

ANNEXURE –II

Claim intimation should be done to AON Risk Insurance Brokers India Limited, who will coordinate with insurer. Claim intimation should be done withing 30 days from the discharge.

Email id to intimate claim: arib.claim.affinity@aon.com

1. Contact No - +91 9321117362(Ms. Vaishnavi)
2. Landline No - +9122 66560500/505

OR

Claim can also be intimated to Care Health Insurance Company Limited on their WhatsApp no 8860402452 or their Customer App or their Claim Genie Portal.

Following information is required for intimation:

• Policy Number
• Name, and address of the female account holders in respect to whom claim is made
• Bank of Baroda Bank Account No.
• Customer ID
• Date of admission and date of discharge in case of planned hospitalization
• Nature of Illness or Injury
• Approximate Claim Amount

Procedure for submitting Reimbursement Claim/Cashless Claim in case of General Hospitalization.

1. Cashless Claim Process:

   The claim form can be downloaded from the website-link-
   https://www.careinsurance.com/health-insurance-claim-forms.html

   Claim can be intimated by filling in a Pre-Authorization Form for cashless.

   • For cashless claims, our usual TAT for Pre-Authorization approval is 2 hours, and after discharge from hospital - TAT is 3 hours subject to complete documents submitted.
     If the case is triggered for investigation, normal TAT is 24 hours and for depth investigation, it is 72 hours.
   • For cashless, we are available 8 AM to 10:30 PM, Monday to Sunday. Customer can connect with TPA desk in hospital to intimate for the cashless treatment. Hospital interacts directly with our cashless team.
2. Reimbursement Claim Process.

   The claim form can be downloaded from the website-link- https://www.careinsurance.com/health-insurance-claim-forms.html

   For reimbursement process submit below documents along with reimbursement claim form.

   • Duly filled and signed claim form
     • Original receipts/bills and discharge voucher of the hospital/nursing home
     • Original bills of chemists supported by prescriptions
     • Original Investigation reports and payment receipts
     • other case papers as mentioned in Claims Form
     • Doctor Consultation papers and bills
     • Any other document which is required by Us to adjudicate the claim
3. Anywhere cashless (Only for surgeries; and not for conservative management).

   Prior Intimation requirement: Please be advised that prior intimation is required for availing cashless anywhere facility. Ensure timely communication to facilitate a smooth process. For planned admission, kindly submit intimation 48 hours in advance. In case of emergencies, ensure claim intimation within 24hrs of admission

   Payment: Claims are disbursed directly into the claimant’s Bank of Baroda account.

• Network Hospital List https://www.careinsurance.com/health-plan-network-hospitals.html?bank=
• Blacklisted Hospital List https://cms.careinsurance.com/cms/public/uploads/download_center/Excluded_List.pdf

Check Claim Status by link or Scan the QR code

1) Escalation Matrix ( Insurer ) - Contact Details

2) Escalation Matrix (AON) – Contact Details

• Escalation Level 1
  1. If claimant is not satisfied with Insurance Company’s services, he/ she can lodge an online complaint on - https://www.careinsurance.com/rhicl/customer-grievance-redressal.html , or call us at - 1800-102-4488, or Connect with us on WhatsApp : 8860402452
  2. After investigating the matter internally and subsequent closure, the Insurance Company will send their response within a period of 15 days from the date of receipt of the complaint. In case the resolution is likely to take longer time, they will inform the claimant of the same through an interim reply.
• Escalation Level 2
  1. For lack of a response or if the resolution still does not meet Claimants expectations, Claimant can write to “Manager – Customer Service” on - https://www.careinsurance.com/rhicl/raise_complaint.html?step=2
  2. If still claimant did not get the resolution, he can further raise the grievance to the “Head – Customer Service” on – https://www.careinsurance.com/rhicl/raise_complaint.html?step=3
• Escalation Level 3
  1. Within 30 days of lodging a complaint with Care Health , if satisfactory response is not received from the Insurance Company, grievance may be raised to the Internal Ombudsman or Insurance Regulatory & Development Authority (IRDA) may be approached on address mentioned bellow:
     
     Insurance Regulatory & Development Authority
     United India Tower, 9th floor, 3-5-817/818, Basheerbagh, Hyderabad- 500 029.
     Contact Number: 040-66514888
     Email ID: nonlifecomplaints.pvt@irda.gov.in
     Toll Free Number: 155255
     Email ID: complaints@irda.gov.in
  2. If the claimant is not satisfied with the Insurer Company’s redressal of his grievance, through any of the above methods the claimant may approach the nearest Insurance Ombudsman for resolution of the grievance. The details of Insurance ombudsman are available on IRDA website: www.irda.gov.in. The complainant may register his grievance through IRDA (Insurance Regulatory and Development Authority) online, at http://www.igms.irda.gov.in. The guidelines for taking up the complaint with the Insurance Ombudsman, along with their address are available on the consumer education website of the IRDA, http://www.policyholder.gov.in/ombudsman.aspx.

Attach the Claim forms as per attachment under headings:

• Claim Form  
  1,511 KB