Group Mediclaim Insurance Policy

This insurance scheme is to provide adequate insurance coverage of employees and their families for expenses related to hospitalization due to illness, disease or injury
Dependent Coverage 1 + 5 (Self + Spouse + 2 Children + 2 Dependant Parents)

Standard Hospitalization TPA services Pre existing diseases Waiver on 1 year exclusion Waiver on 1 30 days excl. Room Rent 1 % & 2% of the Family floater Sum Insured (This capping is linked to the procedures within the hospital)
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Maternity benefits Baby cover day 1 within the maternity limit Pre-Post Hospitalization Exp. Ambulance Services Day Care 10% Co-Payment on each and every claim

*** The entire sum insured is floated among all the family members, so all the members can use the entire amount of the sum insured. Parental Sum Insured is restricted to 20 % of the total family floater subject to a minimum of INR 20,000/- per parent.

Mid Term enrollment of Dependents

Existing Employees

Not Allowed Allowed, provided dependants detail are declared in joining format Allowed (within 15 days from date of marriage) Allowed (within 15 days from date of birth)

New Joinees s Dependants Newly Married Spouse New Born Child

Reimbursement of expenses related to Room and boarding - Subject to 1% and 2 % of the family floater Sum Insured. This capping is linked to the procedures within the hospital Doctors fees Intensive Care Unit Nursing expenses Surgical fees, operating theatre, anesthesia and oxygen and their administration Physical therapy Drugs and medicines consumed on the premises Hospital allied services (such as laboratory, x-ray, diagnostic tests) Dressing, ordinary splints and plaster casts Costs of prosthetic devices if implanted during a surgical procedure Radiotherapy and chemotherapy Organ transplantation including the treatment costs of the donor but excluding the costs of the organ.

Reimbursement of expenses related to maternity. The maximum benefit allowable will 50,000/- (both normal & Caesarian) within the Sum Insured, max up to 2 instances of maternity. There are special conditions applicable to the Maternity Expenses Benefits as below These benefits are admissible only if the expenses are incurred in Hospital/Nursing Home as in-patients in India. Claim in respect of delivery for only first two children and/or operations associated therewith will be considered in respect of any one Insured Person covered under the Policy or any renewal thereof. Those Insured Persons who already have two or more living children will not be eligible for this benefit. Pre and Post hospitalization expenses are not covered for maternity.

Benefit Details Maximum Benefit allowable Restriction on no of children 9 Months waiting period INR 50000 for Normal and Caesarian

Maximum of 2 instances of maternity

waived

General Exclusions Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations. Circumcision unless necessary for treatment of disease Dental treatment of any kind unless requiring hospitalization Congenital external diseases or defects/anomalies HIV and AIDS Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol. Venereal diseases Injury or disease caused directly or indirectly by nuclear weapons Naturopathy Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, etc Cost of spectacles, contact lenses, hearing aids Any cosmetic or plastic surgery except for correction of injury Hospitalization for diagnostic tests only Vitamins and tonics unless used for treatment of injury or disease

Infertility treatment Voluntary termination of pregnancy during first 12 weeks (MTP)