Medicare - Personal Insurance - Swan Insurance - Swan Group

Home

Contact

Swan InsuranceSwan Group Centre
10 Intendance Street
Port-Louis

Tel (230) 207 3500
Fax (230) 211 2031

Search the site

MEDICARE

Scope of Cover
Special Conditions
Main Exclusion

MEDICARE for your peace of mind

You never know when you will need medical treatment for a major illness or a serious accident. If you are not well prepared, quality Health care can be very expensive.

Ensure your family's financial security by protecting them from the financial hardship that can follow as a result of an illness or an accident.

Our expertise as a specialist health insurer will provide you with the best medical protection cover you are looking for.

Key features of our MEDICARE Insurance policy

In-Patient Care cover up to Rs. 125,000.
Assisted Reproduction cover up to Rs. 75,000.
Psychological Trauma cover up to Rs 25,000.
Admission card facility/ guarantee of clinic bills following In-patient Treatment.
Out-Patient Medical Expenses Cover up to Rs 40,000 annually.
Chronic Illness cover.
Direct settlements of claims to Bank Account.
Catastrophe cover up to Rs. 5,000,000 including travel fare and accommodation costs.
New Born covered as from their date of birth.
Cover up to 75 years.

This information is intended as a general summary. Please refer to the insurance policy document for exact terms and conditions.

Scope of cover

		PLAN A	PLAN B	PLAN C	PLAN D
		Limit of indemnity (RS)
Part 1. IN-PATIENT COVER (Compulsory)

1.1	In-Patient Surgical Care	35,000	35,000	50,000	125,000
		being the annual limit for any one illness/ accident

1.2	In-Patient Medical Treatment	N/A	35,000	50,000	125,000
		being the annual limit for any one illness/ accident

1.3 (i)	In-Patient Obstetric Care (Excluding Pre-natal Care)	N/A	25,000	50,000	75,000
		being the annual limit
	Or
1.3 (ii)	Obstetric Cash Benefits	N/A	15,000	25,000	30,000
		being the annual limit

1.4	Road Ambulance	10,000	15,000	20,000	25,000
		being the annual limit

1.5 (i)	Assisted Reproduction	N/A	N/A	50,000	75,000
		once in a lifetime

1.5 (ii)	Psychological Trauma	N/A	N/A	15,000	25,000

1.5 (iii)	Congenital Operation	N/A	N/A	50,000	100,000
		once in a lifetime

1.5 (iv)	Funeral Benefit	5,000	10,000	15,000	20,000

NOTE:	Reimbursement of expenses shall be made in accordance with the Scale of Costs agreement with Clinics & Doctors in Mauritius.

ADMISSION CARD FACILITY		N/A	In Patient Surgical Care Only	FULL ADMISSION CARD	FULL ADMISSION CARD

Part 2. MEDICAL & SURGICAL CATASTROPHE COVER (Optional)

		Annual Limit (Rs)

			500,000

a)	In-Patient Surgical & Medical Treatment		1,000,000

			2,000,000

b)	Travel Fare & Accommodation Costs		3,000,000

			4,000,000

			5,000,000

			Being the Annual Limit in respect of any one illness/ accident

NOTE:	This section is in excess of Rs. 50,000 or Rs 125,000 anyone illness/ accident

Reimbursement of expenses shall be made in accordance with the Scale of Costs agreement with Clinics & Doctors in Mauritius

Part 3: OUT-PATIENT COVER (Optional)		Overall Annual Limit From 5,000 to 40,000

3.1	Medical Expenses	100% of annual limit

3.2	Dentistry	50% of annual limit

3.3	Optical Costs	20% of annual limit

3.4	Pre Natal	10% of annual limit

3.5	Hearing Aids & Artificial Appliances	100% of annual limit

3.6	Psychological Trauma (Counselling)	10% of annual limit

3.7	Chronic Illnesses	10% of annual limit

Excess applicable: 20% of costs subject to a minimum of Rs 250 for each & every claim

SPECIAL CONDITIONS

We may change the premium payable and/or the terms of the policy at any review date.
All expenses incurred abroad and not certified by your treating doctor and approved by our Chief Medical Officer will be compensated according to the scale of costs in respect of In-Patient cover/Catastrophe cover.
The maximum age at which we will accept an insured person is 50 years old and the maximum age limit at which cover will cease is 70 years old in respect of Catastrophe cover and 75 years in respect of In & Out patient cover.
All claims are to be submitted by the insured person and must be accompanied by a duly completed claim form signed by him, supported by original receipts or accounts and the treating doctor's reports and prescriptions.
Air tickets and accommodation costs will only be payable under the Medical and Surgical Catastrophe cover, when treatment abroad is necessary and certified as such by your treating doctor and approved by our Chief Medical Officer.

MAIN EXCLUSIONS

Any medical condition for which an insured person received treatment, medication or medical advice, or was aware existed prior to cover start date.
Routine physical, diagnostic or investigative examinations, medical check-ups, tests, vaccination and immunisation injections.
Any routine treatment or on-going medication given in connection with or given to manage any chronic or permanent medical condition.
Treatment/prescriptions by any person other than a registered medical practitioner.
All claims submitted after three months from the date the services were rendered.
Investigations, treatment, surgery for obesity or its sequelae or cosmetic surgery other than as a result of an accident.
Treatment for alcoholism, solvent abuse, drug abuse or addictive conditions of any kind and treatment of any illness or injury arising directly or indirectly from any such abuse or addiction.
War and kindred risks inclusive of terrorism.

		Medical Insurance Proposal Form		157 (kb)