Coverage

What exactly is covered

No jargon. No surprises. Here's precisely what Prudential Shield does — and does not — pay for, with the sub-limits and waiting periods spelled out.

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Ask a coverage question and get a clause-backed answer.
Cited answer
Is cataract covered for my father?
AssistantYes. Cataract surgery is covered with a Rs 40,000 per-eye sub-limit under Sec 3.2(d). The two-year waiting period is satisfied for your father on this policy. § Policy clause
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Answers explain policy terms. They do not approve claims or replace medical advice.
Room rent
₹10,000 / day
Capped at 1% of sum insured per day. Upgrade? Proportionate deduction applies across all variable charges.
ICU rent
₹20,000 / day
Capped at 2% of SI per day. High-dependency units included.
Co-pay
Nil
All insured members are under 60. No mandatory co-pay on any claim this policy year.
What's covered
10 benefits
  • In-patient hospitalisation (≥24 hrs)
  • Pre-hospitalisation (60 days prior)
  • Post-hospitalisation (90 days after)
  • 405+ listed day-care procedures
  • Road ambulance (up to ₹2,000/event)
  • Restoration of sum insured (once / year)
  • Organ donor expenses (in-patient surgery)
  • AYUSH treatment at AYUSH-registered hospital
  • Modern treatments — robotic surgery, oral chemo
  • Annual health check-up (every policy year)
What's excluded
6
  • Cosmetic, aesthetic and dental (unless accidental)
  • Infertility, sterility & assisted reproduction
  • Self-inflicted injuries, substance abuse
  • Hazardous sports (unless rider opted)
  • IRDAI List-I non-medical expenses
  • OPD consultations (not IP, no surgery)
Waiting periods
You must complete these before claiming for the listed condition.
Initial waiting
30 days
For all illnesses (except accidental injuries).
Specific diseases
24 months
Cataract, hernia, gallstones, fibroids, varicose veins, knee replacement, etc.
Pre-existing disease
36 months
Any condition declared at proposal or diagnosed in the last 48 months.
Procedure sub-limits
Maximum admissible per claim, regardless of sum insured.
Cataract / eye
₹40,000
Knee replacement
₹1,60,000
Bariatric surgery
₹2,50,000
Worked example
Vinod's active case — cataract surgery at Fortis, ₹60,000 estimate
Hospital billed₹60,000
– Non-medical items (IRDAI List-I, ~4%)–₹2,400
– Cataract sub-limit / lens package gap–₹17,600
– Co-pay₹0
Admissible₹40,000
Prudential pays to hospital₹40,000
You pay at discharge₹20,000