The most popular Surgical and Hospitalization Insurance Scheme in Sri Lanka, which offers reimbursement of hospitalization and surgical expenses including benefits for treatment in government hospitals. Immediate cash settlements are made directly to hospitals paving the way for greater customer convenience.
01. HOSPITALIZATION BENEFITS
| A1 (Rs.) | Plan A (Rs.) | Plan B (Rs.) | Plan C (Rs.) | Plan D (Rs.) | |
|---|---|---|---|---|---|
| Annual Limit | 150,000 | 100,000 | 85,000 | 55,000 | 35,000 |
| Event Limit | 120,000 | 80,000 | 75,000 | 48,000 | 30,000 |
SECTION 1
| A1 (Rs.) | Plan A (Rs.) | Plan B (Rs.) | Plan C (Rs.) | Plan D (Rs.) | |
|---|---|---|---|---|---|
| Total Hospital Room charges including admission fees (per event) | 52,500 | 35,000 | 29,750 | 19,250 | 12,250 |
| Maximum Room charges per day | 8,000 | 7,000 | 5,000 | 4,000 | 3,000 |
| Intensive Care Unit charges per day up to a maximum of 10 days | 8,000 | 7,000 | 5,000 | 4,000 | 3,000 |
SECTION 2
| A1 (Rs.) | Plan A (Rs.) | Plan B (Rs.) | Plan C (Rs.) | Plan D (Rs.) | |
|---|---|---|---|---|---|
| Specialized Services per event 22,500 15,000 12,750 8,500 5,000 | 22,500 | 15,000 | 12,750 | 8,500 | 5,000 |
SECTION 3
| A1 (Rs.) | Plan A (Rs.) | Plan B (Rs.) | Plan C (Rs.) | Plan D (Rs.) | |
|---|---|---|---|---|---|
| All other expenses including surgeon’s and doctor’s charges, Operational expenses, Medical expenses and Emergency Transport per event | 75,000 | 50,000 | 42,500 | 28,000 | 18,000 |
02. OUTPATIENT BENEFITS
| A1 (Rs.) | Plan A (Rs.) | Plan B (Rs.) | Plan C (Rs.) | Plan D (Rs.) | |
|---|---|---|---|---|---|
| General Practitioner’s fees | 5,000 | 4,000 | 1,500 | 1,500 | 1,200 |
| Special Consultant’s fees | 5,000 | 4,000 | 1,500 | 1,500 | 1,200 |
| Cost of Drugs prescribed by a General Practitioner and/or a Special Consultant | 5,000 | 4,000 | 1,500 | 1,500 | 1,200 |
| Specialized Services (X-rays, Scans, Lab tests) | 5,000 | 5,000 | 2,500 | 2,500 | 2,000 |
03. CASH GRANTS
| A1 (Rs.) | Plan A (Rs.) | Plan B (Rs.) | Plan C (Rs.) | Plan D (Rs.) | |
|---|---|---|---|---|---|
| Birth ow Twins | 10,000 | 10,000 | 10,000 | 10,000 | 10,000 |
| Hospitalization in a non-paying ward of a Government Hospital per day | 1,000 | 750 | 500 | 400 | 300 |
| Expenses incurred on drugs purchased and tests, scans & X-rays undergone whilst being an in-patient in a non-paying ward of a Government Hospital | 14,000 | 11,000 | 10,000 | 6,000 | 4,000 |
04. MAJOR ILLNESS COVER
| A1 (Rs.) | Plan A (Rs.) | Plan B (Rs.) | Plan C (Rs.) | Plan D (Rs.) | |
|---|---|---|---|---|---|
| Reimbursement for Hospitalization expenses per annum maximum up to | 500,000 | 300,000 | 200,000 | 200,000 | 100,000 |
Subject to a waiting period of 90 days
ANNUAL PREMIUM
| A1 (Rs.) | Plan A (Rs.) | Plan B (Rs.) | Plan C (Rs.) | Plan D (Rs.) | |
|---|---|---|---|---|---|
| Per Individual | 21.395 | 14,410 | 8,855 | 6,985 | 4,840 |
| Per Family Unit | 32,780 | 20,680 | 14,245 | 10,450 | 7,040 |
Premiums quoted above are excluding IRCSL Admin fees + VAT.
There will be a waiting period of (06) six months in respect of all type of surgeries except surgeries performed due to an accident.
20% excess on Doctor’s charges and Medicines under section 3.
Age Limit : Proposer – 18-50 and could be continued up to 60 years., Children – 01 to 21 years
*Terms & Conditions apply.
