Shikhar Swasthya Surakshya

SHIKHAR SWASTHYA SURAKSHYA

Your Trusted Partner for Comprehensive Health Security

SHIKHAR SWASTHYA SURAKSHYA offers a wide range of health coverage benefits, providing financial security and peace of mind for individuals and families. Our plan ensures access to quality healthcare through a streamlined network of hospitals.

Policy Coverage & Renewal
Your policy is active for a full 12 months (One Calendar Year) from the inception date. Renewal is subject to policy performance and the insured member's health status, with renewal terms communicated 30 days prior to the policy expiry.

Eligibility
This plan is designed for Nepali Citizens and foreigners residing in Nepal, with member ages from 5 to 65 years. A Medical Assessment Form is mandatory for all members. A medical checkup is required for members aged 45 years and above and for those opting for a Sum Insured of Rs. 500,000 or more.

Network Hospitals & Geographical Coverage
This policy provides Cashless Treatment at our selected network of premium hospitals within Kathmandu, including:

• Nepal Mediciti
• Frontline Hospital
• HAMS Hospital
• Kathmandu Medical College & Teaching Hospital (KMC)
• Norvic International Hospital

Sum Insured
Flexible coverage options are available, ranging from NPR 5,00,000 to NPR 20,00,000.

Coverage for Pre-Existing & Chronic Conditions
These conditions are fully covered after a standard waiting period of 2 years from the policy inception date.

Summary of Covered Benefits

In-Patient Treatment (Hospitalization)
Covers hospitalization expenses incurred as an in-patient for a minimum of 24 hours, which includes:

• Room and Boarding: Covered for a Single Standard AC room.
• Medical Fees: Fees for Consultants, Surgeons, and Anaesthetists.
• Treatment Costs: The cost of actual treatment, diagnostic tests, medicines, blood, oxygen, and other necessary medical appliances.
• Condition: The available Inpatient Benefit for the year is the total Sum Insured minus any Outpatient Benefits already utilized.

Day Care Procedures/Treatments (Hospitalization less than 24 hrs.)
Due to advancements in medical technology, hospitalization expenses for 150 named daycare treatments are covered even if the stay is for less than 24 hours, provided it is an Operation Theatre (OT) based procedure.

Pre-Hospitalization and Post-Hospitalization Expenses
The policy covers medical expenses incurred:

• 30 days immediately before hospitalization.
• 60 days immediately after hospitalization.

Out-Patient (OPD) Benefits
The policy includes an OPD benefit with an annual sub-limit of 10% of the Sum Insured (not exceeding Rs. 100,000). This benefit includes:

• Physician Consultation: Covered with a copayment of NPR 1,000 per visit. No costs are incurred for a second opinion for the same illness within 9 days.
• Diagnostics (X-Ray, MRI, CT-Scan, etc.): Covered up to a maximum of 50% of the total OPD limit.
• Pharmacy: Covered up to a maximum of 20% of the total OPD limit.
• OPD Copayment: A 10% co-pay is applicable on all OPD expenses and is payable by the insured member.

Important Overall Condition:
The total of all claims (IPD + OPD) in a policy year cannot exceed your total chosen Sum Insured.