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1. OBJECTIVE
2. ELIGIBILITY
3. ENTITLEMENT
4. POLICY DETAILS
a. This policy is applicable if an Insured Person suffers from any illness or disease or
sustains any bodily injury through accident and if such disease or injury shall require
the insured person to incur hospitalization/ Domiciliary Hospitalization expenses for
medical/surgical treatment at any Nursing Home/Hospital in India.
b. Maternity Expenses Benefit i.e. treatment taken in Hospital/ nursing home arising
from or traceable to pregnancy, childbirth including Caesarian section is also
covered under this policy.
c. The details of the scheme will be worked out by the HR department of the Company.
It will be the endeavor of the Organization to work out a scheme that provides
maximum benefit to the employees within the overall ambit of the schemes available
with the various insurance providers.
d. The policy will be renewed each year and the premium will be paid out by the
Organisation.
e. The employee can cover his spouse and dependent children under this policy.
g. The exclusions as agreed upon with the Insurance Company will apply to the
employees
h. Copies of the detailed policy (as provided by the Insurance Company) are available
with HR for information and use
5. OPERATING PROCEDURE
a. The Human Resources Department will ensure coverage of all new hires.
Intimation, furnishing details, including cadre and joining date, for each new hire will
be sent to the designated Insurance Company on a monthly basis (by the 10 th of
each month). Employees joining after the 10th of the month will be insured from the
10th of the following month.
b. It will be the employee’s responsibility to submit Annexure I with all details including
name of spouse, dependent children etc at the time of joining and / or in case of any
additions to the list already submitted. HR department will ensure that based on
this, the employee’s family will be covered under the policy by the 10 th of that
month. if the employee gives in his declaration after the 10 th of the month, the
coverage will be effected from the 10th of the following month.
c. An employee who needs to make a claim under this policy will need to furnish full
particulars to the company within 7 days from the date of Hospitalization.
d. The claim must be filed within 10 days of discharge form the Hospital in the
prescribed form which is available with the HR department.
e. The employee will obtain and furnish the company with all original bills, receipts
and other documents upon which a claim is based and such additional information
and assistance as the Insurance Company may require in dealing with the claim. A
checklist of documents required for filing a claim is available with the HR
department.
f. The Insurance Company may in certain situations depute its Medical Officer to
examine the insured person in case of any alleged injury or disease requiring
Hospitalization.