Plum · Watch & Learn
App & Policy Training Assistant
Policy coverage
What's covered, what's not
This is a summarized overview of the coverage terms under your policy and may not exhaustively represent all policy conditions. Final approval of a claim will be dependent on a detailed medical assessment of the documents submitted to the insurer, in line with complete policy terms and conditions. Source
✅ What's Covered
Hospitalization
Covered up to ₹5,00,000 when hospitalised for more than 24 hours as per policy terms and conditions.
Family Definition
Covers Employee, Spouse, and 4 children up to the sum insured during the policy period, only if dependents have been added to the policy.
Day Care Treatments
Procedures that don't require 24-hour admission are covered if listed under approved day care treatments (insurer dependent).
Room Rent Limit
Up to a Single AC Room for normal rooms; no room category restriction for ICU. Choosing a pricier room may mean a proportionate deduction.
Co-pay
Not applicable / zero co-payment — you don't share a percentage of the approved claim amount.
Maternity
Up to ₹50,000 for Normal Delivery and C-Section, for the first two children only.
Newborn Baby Coverage
Covered from day 1 (hospitalisation only — routine checkups/consultations aren't). Must be added to the policy within 30 days of birth.
Pre-existing Disease
Covered with no waiting period.
Pre and Post Hospitalisation
Expenses 60 days before admission and 90 days after discharge, tied to the main hospitalisation, are covered.
Pre and Post-Natal Expenses
Up to ₹5,000 on an IPD basis, within the maternity limit.
Ambulance Coverage
Road ambulance up to ₹2,500 per hospitalisation; air ambulance up to ₹1,00,000.
Lasik Surgery
Covered if the spherical value for the eye being treated is above +/- 6.5D.
Accidental Dental
Covered for accidents requiring 24+ hour hospitalisation, for injury to natural teeth or trauma-related dental treatment.
Internal Congenital Disease
Conditions present at birth affecting internal organs/systems are covered (e.g. a heart defect).
AYUSH Treatment
Covered, subject to treatment in government hospitals.
Psychiatric Ailments
Up to ₹30,000 if admitted for more than 24 hours.
Functional Endoscopic Sinus Surgery
Covered up to ₹35,000 (excludes Septoplasty).
Lucentis (Ranibizumab)
Up to ₹50,000 per family for this intravitreal injection drug.
Cataract
Diagnosis, treatment and surgery covered up to the sum insured, per eye.
LGBTQ+ / Live-in Partner
Covers individuals identifying as lesbian, gay, bisexual, or transgender, and live-in partners who may not be legally married.
Modern Treatments
E.g. Cyber-knife, Stem Cell — covered up to 50% of the sum insured.
Other Special Conditions
Terrorism: covered. Cochlear implant: covered up to 50% of the sum insured.
🚫 What's Not Covered
Consumables
Single-use items like tissue paper, gloves, masks, syringes, gowns, slippers.
Infertility Treatments
IVF and surrogacy are not covered.
Foreign Treatment
Treatment taken outside India is not covered.
Homecare Treatment
Treatment at home that doesn't require hospitalisation, e.g. home physiotherapy.
OPD
Outpatient consultations, diagnostics, X-rays and medications, unless they require 24-hour hospitalisation or qualify as day care.
Dental
Cosmetic dentistry, scaling/polishing, orthodontics and other routine dental care.
External Congenital Disease
Not covered, except in life-threatening situations.
Widow / Widower Cover
If the insured employee passes away, their spouse does not continue to receive coverage.
Hospicash Benefit
Not covered under the policy.
Domiciliary Hospitalisation
Treatment taken at home in lieu of hospitalisation is not covered.
Treatment in Blacklisted Hospitals
Expenses at hospitals blacklisted by the insurer are not covered.
Hi! I'm here to help you learn the Plum app — ask me about any screen, option, or flow, or what your policy covers, and I'll walk you through it using our training material. Where would you like to start?