Policy explained · United India
United India Family Medicare: what your policy covers
United India Family Medicare caps room rent at the higher of 1% of sum insured or single occupancy standard AC room charges on a ₹5 lakh cover. It has no co-pay and a 36-month wait for knee & hip replacement. For our example person, a typical ₹4,50,000 knee & hip replacement bill (estimate) is not covered yet: 36-month waiting period.
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At a glance
- 🛏️Set by sum insuredRoom rentThe higher of 1% of sum insured or single occupancy standard AC room charges (sum insured 5 lakh and above)Policy wordings, page 11, read 27 Sep 2026
- 🧾Set in your scheduleCo-payNo co-payCustomer information sheet (CIS), page 5, read 27 Sep 2026
- ⏳36 monthsKnee & hip replacement waitNot over at month 30Conditions apply, see the termsPolicy wordings, page 17, read 27 Sep 2026
- ⏳36 monthsPre-existing conditions waitNot over at month 30Policy wordings, page 16, read 27 Sep 2026
- 🩹Not coveredConsumablesThese are yours to payPolicy wordings, page 20, read 27 Sep 2026
Waiting periods, month by month
- Pre-existing conditions36 monthsNot over at month 30
- Knee & hip replacement36 monthsNot over at month 30Conditions apply, see the terms
- Spine surgery24 monthsOver by month 30
- Prostate surgery24 monthsOver by month 30
- Hysterectomy24 monthsOver by month 30
Worked example: a knee & hip replacement bill
The example person joined the policy before age 61, is treated at a network hospital in the zone their policy covers, has no add-ons, and has a ₹5,00,000 sum insured on a policy running 30 months.
Room rent ₹9,000 a day for 4 days (example), a semi-private room, on a typical NCR knee & hip replacement bill of ₹4,50,000 (estimate).
Not covered yet: 36-month waiting period. The insurer pays ₹0 and you pay ₹4,50,000 (estimate).
The terms, with the policy text
12 terms read from the United India Family Medicare documents (UIN UIIHLIP26046V072526). Open a source to read the policy text, its conditions and the page.
| Term | What it means | Policy text and source |
|---|---|---|
| Room rent limit | The higher of 1% of sum insured or single occupancy standard AC room charges (sum insured 5 lakh and above)Limit applies | Policy wordings, page 11Rs. 5 Lakhs and Above 1% of Sum Insured or Single Occupancy Standard AC Room Charges whichever is higher |
| ICU limit | Paid at actual cost (sum insured 5 lakh and above)No limit | Policy wordings, page 11Rs. 5 Lakhs and Above Actuals |
| Co-pay | No co-pay (No co-pay) | Customer information sheet (CIS), page 5ii. No co-pay |
| Proportionate deduction | Applies: if your room costs more than the limit, the insurer cuts the charges linked to the room in the same ratioCan cut your bill | Policy wordings, page 11Condition: Not applied at hospitals that charge the same for every room. The linked charges exclude pharmacy, implants and diagnostics. PROPORTIONATE PAYMENT CLAUSE: In case of admission to a room at rates exceeding the aforesaid limits in clause III.A.1.i, the reimbursement/payment of all associated medical expenses incurred at the Hospital shall be effected in the same proportion as the admissible rate per day bears to the actual rate per day of Room Rent. |
| Consumables (gloves, masks and other non-medical items) | Not covered: these are yours to payNot covered | Policy wordings, page 20Any item(s) or treatment specified in ‘ List of Non -Medical Expenses under this Policy’ as per clauses in Annexure - 1, unless specifically covered under the Policy. |
| Costs before and after the hospital stay | 30 days before admission, 60 days after dischargeCovered | Policy wordings, page 12Condition: Before and after costs together are capped at 10% of the sum insured. i. Pre-hospitalisation Medical Expenses incurred due to an Illness or Injury during the period up to 30 days prior to hospitalisation; and ii. Post- hospitalisation Medical Expenses incurred due to an Illness or Injury during the period up to 60 days after the discharge from the hospital, Subject to a maximum of 10% of Sum Insured for Pre- and Post-Hospitalisation combined, |
| Waiting period for pre-existing conditions | 36 months of continuous coverNot over at month 30 | Policy wordings, page 16Expenses related to the treatment of a pre -existing disease (PED) disclosed by the insured person and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy with Us. |
| Waiting period for knee & hip replacement | 36 months of continuous coverNot over at month 30 | Policy wordings, page 17Condition: Not applicable if the replacement follows an accident. Table B. 36 months waiting period Joint Replacement due to Degenerative condition, unless necessitated due to an accident. |
| Waiting period for spine surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 17Prolapse intervertebral Disc and Spinal Diseases unless arising from Accident |
| Waiting period for prostate surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 17Benign prostatic hypertrophy |
| Waiting period for hysterectomy | 24 months of continuous coverOver by month 30 | Policy wordings, page 17Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapse of uterus |
| Exclusion rule for bariatric surgery | Covered when the policy's conditions are metConditions apply | Policy wordings, page 186. Obesity/Weight Control (Code - Excl06) Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions: |
Questions
Does United India Family Medicare have a room rent limit?
At a ₹5 lakh sum insured: the higher of 1% of sum insured or single occupancy standard AC room charges. For a sum insured of ₹5 lakh and above. Below ₹5 lakh the limit is 1% of the sum insured a day. Source: Policy wordings, page 11, read 27 Sep 2026.
How is proportionate deduction calculated on United India Family Medicare?
If your room costs more than the room rent limit, the insurer divides the limit by your room's daily rent and pays that share of the charges linked to the room. Not applied at hospitals that charge the same for every room. The linked charges exclude pharmacy, implants and diagnostics. Source: Policy wordings, page 11, read 27 Sep 2026.
Check your own policy
Send your policy on WhatsApp. A person reads it and works out what your stay would cost you before you are admitted.
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Sources
- United India Family Medicare: policy wordings (accessed 27 Sep 2026)
- United India Family Medicare: customer information sheet (cis) (accessed 27 Sep 2026)