LIMITS OF LIABILITY

HOSPITALIZATION BENEFIT PLAN 1 PLAN 2 PLAN 3 PLAN 4

Annual Limit 250,000 200,000 150,000 100,000

Event Limit 250,000 200,000 150,000 100,000

Total Hospital Room Charges including Admission Fees

Maximum Room charges per day 7,500 7,000 6,500 6,000
Intensive Care Unit charges per day
Up to a Maximum of 10 days 8,000 7,500 7,000 6,500

CASH GRANT
a) Birth of Twins 10,000 10,000 10,000 10,000

b) Hospitalization in a non-paying ward of 2,000 1,600 1,200 800

a Government Hospital Per Day Maximum of 15 days

c) Expenses incurred on drugs purchased and

Test, Scans & X-Rays undergone whilst
Being an In-Patient in a non-paying ward of
A Government Hospital 27,500 22,000 16,500 11,000

d) Personal Accident cover ( 18-70 Yrs )

Accidental Death 1,500,000 1,500,000 1,500,000 1,500,000
Total Permanent Disablement Due to An Accident 1,500,000 1,500,000 1,500,000 1,500,000
Paralysis due to an Accident 1,500,000 1,500,000 1,500,000 1,500,000
Loss of Both Eyes 1,500,000 1,500,000 1,500,000 1,500,000
Loss of Both Hands 1,500,000 1,500,000 1,500,000 1,500,000
Loss of Both Limbs 1,500,000 1,500,000 1,500,000 1,500,000
Loss of One Eye 250,000 250,000 250,000 250,000
Loss of One Hand 250,000 250,000 250,000 250,000
Loss of One Limb 250,000 250,000 250,000 250,000

STANDARD TRANSPORTATION FEES

For any one Hospitalization 2,000 2,000 2,000 2,000

ANNUAL PREMIUM
Per Individual 23,460 15,960 10,710 6,960
Per Family Unit 43,460 28,960 18,960 11,960

(The above premiums are quoted without Admin Fee 0.35% + N.B.L. 2.0408% +Vat 12% )
TYPE OF COVER : Health Insurance

POLICY PERIOD : One year from the date of commencement of the policy

VALIDITY : 24 Hour Cover

GEOGRAPHICAL LIMITS : Within Sri Lanka Only

WAITING PERIOD : Any medical expenses incurred or any Claims made on illness
or sickness contracted within this period this Period will not be
entertained for reimbursement, in respect of the following:

 Illness/Sickness 30 days
 Accidents Immediate Cover
 Abnormal/Normal Childbirth 12 months
 Birth of Twins 12 months
 All types of surgeries except 06 months
Surgeries performed due to an accident
(If there is a continues insurance cover, the above “Waiting
period” will be waved off)

AGE LIMIT : 18-70 Years (Employee & Spouse)

00-25 Years (Unmarried Unemployed Children)
Employees exceeding 60 years will be accommodated Subject
to Medical Declaration

FAMILY UNIT : Employee, Spouse and any number of children

COVERAGE : (1) REIMBURSEMENT OF HOSPITAL/NURSING

HOME BILLS INCURRED AS AN IN-PATIENT
TREATMENT.
 Sustaining Accidental Bodily Injury
 Contracting any Sickness or Illness
 Undergoing any major or minor Surgery

BENEFIT GRANTED FOR GROUPS OVER 25 MEMBERS

COST OF RETURN AIR TICKET UPTO A MAXIMUM OF Rs. 30,000/- OR THE UNUTILIZED PORTION
OF THE ANNUAL LIABILITY WHICH EVER IS THE LESS
(Provided a member is compelled to be flown abroad to undergo treatment not available in Sri
Lanka)

OPTIONAL COVERS (GROUPS OVER 25 MEMBERS)

CLAIMS - ON THE SPOT HOSPITAL BILLS

We settle claims at the hospital within the limits stipulated

PROCEDURE

01. You will be able to admit yourself to the hospital without paying the deposit when you
produce your Suwa Sampatha card to the hospital at the time of admission.

02. Call us on our Hot Line 2399199 after the admission procedures has been completed by
the hospital and obtain a reference number.

03. An officer will visit you at the hospital once your admission has been intimated.

04. When the discharge is confirmed, call us on our Hot Line and inform the discharge.

05. Our Officer will call over to the hospital and settle the bill according to the limits
Stipulated in your policy, if there is any excess, the patient will be responsible in settling it
to the hospital.

A list of hospitals where this facility available is attached herewith.

CLAIM EXCESSES

25% Excess on payable amount on Abnormal Child birth claims

POLICY EXCLUSIONS

 As a result of an injury sustained or a sickness contracted outside the Geographical

limits of Sri Lanka.
 Occasioned by or happening through:
War, Invasion, Act of Foreign Enemies, Hostilities (whether war be declared or not),
Civil War, Rebellion, Revolution, Insurrection, Conspiracy Military or Usurped Power,
Mutiny, Direct participation in Strikes or Riots.
 Arising as a result of AIDS (Acquired Immune Deficiency Syndrome) and ARC (Aides
Related Complex) or any type of Venereal Diseases.
 Arising as a result of Medical Treatment obtained for which payment is not required or
to the extent which another Insurer is liable to make payment.
 Arising as a result of Cosmetic Surgery, Cosmetic treatment, Eyeglasses, Contact Lens
Refractive Laser Corneal Surgery (PRK & LASIK), Implants and Hearing Aids except
necessitated by injuries occurring wholly during the Period of Insurance.
 Arising as a result of an injury of disease arising out of consumption of Alcohol or
Narcotics or similar drugs or agents.
 Congenital conditions.
 Mechanical or Chemical contraceptive methods of Birth Control or treatment pertaining
to Infertility / Sub-fertility and Abortion.
 Professional fees charged by a member of the Insured's immediate family or by a
person normally resident in the household of the Insured.
 Psychotic, Mental or Nerves disorders, leading to Insanity.
 Routine physical examinations, health check-ups or tests not incidental to treatment or
diagnosis of a covered disability, or any treatment which is not medically necessary.
 Services of a non-medical nature provided by a Hospital such as television, telephones,
telex services, radios and other similar facilities.
 Sickness or injury arising from Hunting, Racing of any kind, water Skiing,
mountaineering, Underwater activities requiring breathing apparatus and illegal
activities.
 All pre-existing conditions except for disabilities that are declared to the Company in a
written from and which the Company may decide not to exclude or impose any
conditions.
 Suicide, attempted suicide or intentionally self-inflicted injuries.
 A Life insured suffering from any Physical Defect of Infirmity that existed prior to
enrollment under the Policy unless notice is given to and accepted by the Company.
 Eye Tests, Cost of Spectacles or Contact Lenses, Dental Treatment such as Extractions,
Fillings, Nerve Fillings, Root Fillings, Crowning, Cost of Dentures etc., excepting
repair or replacement of injured, sound unfilled natural teeth unless the policy has been
extended to cover dental and eye treatment/Spectacle on payment of an additional
premium.
 Pre-natal or post-natal care in connection with pregnancy and surgery.