PRUHealth Guardian

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PRUHealth Guardian

PRUHealth Guardian is a comprehensive health insurance plan thoughtfully designed for individuals with pre‑existing conditions.

Long Stay Allowance

Hospital Essentials Cover

Restoration

Virtual GP Consultations

Health insurance for your family's evolving health needs
Find the right plan in just a few steps.
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Key Features and Highlights of PRUHealth Guardian

PRUHealth Guardian is designed to provide stability for those with pre-existing conditions by focusing on continuity of care, financial predictability, and access to treatment.

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Long Stay Allowance

If your hospital stay extends beyond what you expected, you receive a lump sum to help manage extended hospital stays. So, you can focus on recovery, without worrying about the added costs of staying longer.
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Virtual GP Consultations

Get access to qualified doctors (General Practitioners) through audio and video calls, from the comfort of your home, whenever you need guidance or reassurance. It saves you time, effort, and unnecessary hospital visits while keeping your health on track.
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Modern Treatments

Eligible modern treatments are covered up to the sum insured, helping you access newer approaches to care when recommended by your doctor.
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Restoration

Your coverage gets renewed support during the policy year with a one-time restoration of up to 100% of your Base Sum Insured, available from the 2nd claim onwards. This gives you added protection for a new illness or condition, while the same illness is not covered under restoration.

Health Insurance Plan - Overview

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PRUHealth Guardian
Top Features
Long Stay Allowance
Hospital Essentials Cover
Restoration
Virtual GP Consultations

Understanding your Policy

To provide you with total transparency, we have outlined exactly how your plan coverage acts as your shield and where the boundaries of the policy lie.

In-Patient Hospitalisation

When hospital admission becomes necessary, this cover helps take care of treatment expenses for illness, surgery, or accident, so you and your family can focus on recovery instead of worrying about hospital bills.

Room Rent Eligibility

You know upfront which room category is covered, so you can plan your hospital stay with more confidence and avoid confusion at the time of admission. Depending on the option selected during policy purchase, you may be eligible for a Shared Room or a Single Private AC Room.

ICU Care

If your health needs closer monitoring or critical support, ICU expenses are covered, helping you receive the intensive medical attention you need without added financial stress.

Day Care Treatments

Many advanced treatments no longer need a full day in the hospital. This cover supports eligible day procedures, so shorter hospital stays do not come in the way of getting the right treatment.

Prudential Health Check-Up

Get a comprehensive health check-up based on your age and gender. These health check-ups are followed by a doctor consultation to help you read your reports and take informed next steps for your wellbeing.

Modern Treatments

When your doctor recommends treatment methods such as robotic, laser, targeted, or other specified modern procedures, this benefit helps you access eligible advanced treatment as per the plan.

Post-hospitalisation Expenses

Recovery continues even after discharge. Follow-up consultations, medicines, and tests linked to the same treatment are covered for 60 days, helping you complete your recovery with the right support.

Restoration Benefit

If you use up your base sum insured during the policy year, you can get a one-time restoration of 100% of the cover amount for a new illness or condition. This restored cover is available from the second claim onwards and cannot be used for the same illness.

Road Ambulance

In an emergency, getting to the hospital quickly matters. Road ambulance expenses are covered up to the sum insured within the network and up to ₹5,000 per hospitalisation outside the network.

Unlimited Virtual Consultations

Everyday health questions should be easy to address. You can consult a Doctor (General Practitioner) online for common health concerns, making medical guidance more accessible from home.

Mind Care Consultations

Your emotional wellbeing matters too. You get access to 4 virtual consultations with a psychologist, giving you a safe and convenient way to seek support when you need it.

Daily Hospital Cash

Hospital stays can bring small but frequent expenses. You receive ₹1,000 per day of hospitalisation to help manage incidental costs, up to 30 days in a policy year and up to 7 days per claim.

Long Stay Allowance

A longer hospital stay can bring extra expenses for the family. If continuous hospitalisation lasts for more than 10 days, you receive ₹15,000 to help manage additional needs during that time.

Mandatory Co-payment

To keep your coverage clear upfront, a 20% co-payment applies on every eligible claim. This means the insurer pays the covered portion and you contribute the remaining eligible share as per the plan terms.

Disease-Specific Treatment Limits

Some specified treatments have defined limits, so you know the scope of coverage in advance. Please refer to the Policy Wordings for the detailed limits applicable to these treatments.

Eligibility Criteria for PRUHealth Guardian Plan

Healthcare decisions are easier and quicker when the details regarding the policy are clear. PRUHealth Guardian eligibility has flexible norms, making it accessible across life stages while keeping long-term protection in focus.

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Entry Age

No matter where you are in life, there’s a plan for you. You can apply for the PRUHealth Guardian plan, with coverage starting from 18 years for adults and from just 91 days for children. This ensures that your entire family can get the protection they need, right from the start.

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Pre-existing Conditions

We understand that your health history matters. Some conditions may have a waiting period of 2 years, but taking the step to get insured now means you’re securing peace of mind for the future. Your past shouldn’t hold back your protection.

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Policy Tenure

Life doesn’t always follow a plan, and neither should your health cover. With flexible policy durations of 1 to 3 years and simple renewal options, you can keep your protection continuous without any interruptions. That way, no matter what changes come your way, you’re always safeguarded.

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Sum Insured Options

When you’re managing a pre-existing condition, having the right cover matters even more. With Sum Insured ranging from ₹5 lakh to ₹1 crore, you can choose the level of protection that makes you feel truly secure, no matter what life throws your way.

Optional Add-Ons Covers

Chronic Management Program

Chronic Management Program

Managing a chronic condition becomes easier when the right support is within reach. This cover gives you cashless access to doctor consultations, diagnostic tests, and ongoing support through a partner network for the chronic conditions selected by you.

Hospital Essentials Cover

Hospital Essentials Cover

Helps cover eligible non-medical expenses incurred during treatment, reducing out-of-pocket expenses. 

Cashless OPD

Cashless OPD

Covers outpatient expenses such as doctor consultations, diagnostic tests, and prescribed medicines within the Prudential network. 

Prudential Select Network

Prudential Select Network

You can lower your premium by choosing treatment within the Prudential Select Network. This option gives you a 15% premium discount, while a 20% co-payment applies on every claim if treatment is taken outside Prudential Select Network hospitals.

Prudential Healthy Discount

Prudential Healthy Discount

Your daily effort to stay active can reward you at renewal. Insured members aged 18 and above can earn up to 35% discount on renewal premium based on the number of healthy days completed during the policy year.

Cancer Guard

Cancer Guard

Get an additional sum insured equal to your base sum insured for inpatient cancer treatment, giving you extra support for specialized care.

Room Rent Flexibility

Room Rent Flexibility

Select a lower room category to reduce your premium costs. 

Personal Accident Cover

Personal Accident Cover

Offers added financial support if an accident leads to accidental death or specified disability. The fixed benefit amount is paid as per the policy schedule, helping you and your family feel more financially prepared for unexpected situations.

Child Protect

Child Protect

Helps your child’s health cover continue if an unforeseen event affects the parent. In case of accidental death or critical illness of the parent, the child’s base premium is waived for up to 5 renewal years or until the child turns 18.

Waiting Period in PRUHealth Guardian Medical Insurance Plan

Being aware of the PRUHealth Guardian waiting period helps you plan your healthcare with confidence and avoid surprises when you need support the most.

Initial Waiting Period

From the date your policy begins, a standard 30-day waiting period applies. During this time, claims for illnesses are not admissible. However, the plan offers immediate protection for accidental hospitalisation, ensuring you are covered for unforeseen emergencies right from day one.

Pre-Existing Disease Waiting Period

If you’re living with pre-existing conditions such as diabetes, hypertension, or other declared illnesses, PRUHealth Guardian policy offers coverage for these conditions after a waiting period of 2 years. This balanced approach ensures sustained coverage while supporting long-term healthcare needs. In select cases, you may also have the option to reduce this waiting period by choosing a higher premium.

Specific Disease Waiting Period

Certain common, non-urgent conditions, such as cataracts, hernias, or joint replacement surgeries, are covered after a predefined waiting period of 2 years. Even if these conditions are not present at the time of purchase, this waiting phase applies before related treatment costs can be claimed.

Accidental Injuries

Accidents are unpredictable, which is why coverage for accidental injuries starts from Day 1 with no waiting period. Whether it’s a fall, fracture, burn, or any covered accidental injury, PRUHealth Edge provides immediate protection when you need it most.

Your Essential Policy Toolkit

Having the right information at your fingertips brings a sense of calm and certainty when it matters most. These resources are designed to provide absolute clarity on your coverage, ensuring you and your family always feel fully informed and protected.

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Brochure
Download the Brochure to understand the plan
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Policy Wordings
Download Policy Wordings
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Claim Form
Download the Form
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Prospectus
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Our total health approach

We strive to deliver seamless experience by alleviating customer anxieties and building journeys that truly empathize with the customer.

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Our end-to-end assurance

We aim to build customised transformative solutions that address the ever-evolving health insurance needs of Indian customers powered by innovation and technology.

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Our human touch

We plan to invest in developing capable, service-driven teams across our ecosystem - from employees to agents and partners, ensuring every customer interaction reflects respect, transparency, and simplicity.

Claim Process of PRUHealth Guardian Plan  
To make a claim under PRUHealth Guardian health insurance plan, you can choose either cashless hospitalisation at a Prudential Select Network hospital or reimbursement after treatment. In a cashless claim, approved expenses are settled directly with the hospital. In a reimbursement claim, you can pay first and submit the required bills and documents after
Choose a Prudential Select Network Hospital
Select a hospital from the Prudential Select Health network to make the cashless claim process smoother and more convenient.
Inform Us in Advance 
For planned treatment, inform us at least 48 hours before admission. In an emergency, notify us within 24 hours of hospitalisation so the claim process can begin on time.
At the Hospital
Show your Health Card at the insurance or help desk during admission, so the hospital can start the cashless claim request.
Approval Process
The hospital sends a pre-authorisation request to our claims service provider or TPA, who reviews the details and confirms the eligible approval as per policy terms.
Smooth Discharge
Once approved, eligible covered expenses are settled directly with the hospital. Any expenses not covered under the plan will need to be paid separately.
Our Network 
Our strong hospital network really makes a difference when you need care the most. With thousands of trusted partner hospitals spread right across India, you can get quick cashless treatment nearby without the worry of huge upfront bills. It gives you real peace of mind, knowing help is close at hand whenever life throws a curveball.
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