Scope of Cover:

Ø       Hospitalization due to any disease or illness or accident

Ø       Only inpatient treatment

Ø       Room rent, boarding by Hospital

Ø       Nursing Expenses & Doctor fees

Ø       Medicines, diagnostic materials & expenses

Ø       Hospital charges

 Expenses incurred in the following heads are reimbursable: 

Ø       Room / boarding expenses as provided by the hospital/nursing home

Ø       Nursing expenses

Ø       Surgeon, anesthetist, medical practitioner, consultants, specialist’s fees

Anesthesia, blood, oxygen, OT charges, medicines, diagnostic charges, dialysis, chemotherapy, cost of organs, pacemaker and similar expenses

Ø       Hospital, Nursing Home charges.

  Requirements:

Ø       Any registered Hospital or Nursing Home or

Ø       Other Hospital with at least 10 beds in Class C towns in India

Ø       Minimum 15 beds in other towns and cities

Ø       Fully equipped operation theatre

Ø       Fully equipped Nursing Staff round the clock

Ø       Fully qualified Doctor(s) round the clock

Ø       It should not be a rest place, old age home, hotel etc

Ø       Hospitalization Benefits – Rules

Ø       Minimum 24 hours admission required

(Exceptions: Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Dental Surgery, Lithotripsy,  

   Exclusions: 

Ø       Any disease contracted during first 30 days of inception of policy

Ø       War, invasion and allied perils

Ø       Vaccination, inoculation, cosmetic surgery

Ø       Dental treatment of any kind [unless requiring hospitalization]

Ø       Routine eye check up, cost of glasses, contact lenses

Ø       Convalescence, general debility, run down condition, rest cure, congenital external disease

Ø       Charges incurred for any diagnostic x-ray/lab examination or otherwise not consistent with treatment

Ø       Expenses for vitamins/tonics unless forming part of the treatment

Ø       Nuclear weapons/material

Ø       Treatment arising due to pregnancy/childbirth

Ø       Naturopathy

Ø       First year exclusions: Cataract, prostatic hypertrophy, hysterectomy, hernia, hydrocele, congenital internal disease, piles, fistula, sinusitis and related disorder

Ø       Pre existing disease at the inception of cover.  

General Exclusions:

Ø       Diseases pre-existing at the time of taking the policy

Ø       Complications arising out of pre existing diseases

Ø       Injuries or diseases caused by war and war like operations.

Ø       Circumcision, vaccination, inoculation, cosmetic treatment, plastic surgery

Ø       Dental treatment without hospitalization

Ø       AIDS

Ø       Diagnostic expenses without any disease

Ø       Vitamins and tonics unrelated to treatment

Ø       Diseases by nuclear weapons

Ø       Maternity expenses unless covered

Ø       Naturopathy treatment 

Other Exclusions: 

Maternity  

Pre-Existing Diseases:

Any injury/disease that was in existence prior to the current policy being incepted is a pre-existing disease. The symptoms of such a disease also fall in the purview of pre-existing  

Child Day One Cover:

Newborn baby after 60 days from day of birth 

Waiver of 30 Days Exclusion:

Diseases that are not covered in the policy for the first 30 days, except accidents.  

First Year Exclusion:

A Standard Group Mediclaim Policy does not cover certain diseases in the first year after the inception of the policy.

Our Proposition: -

1) We have an experienced team, which will coordinate with the Insurance Company and the Third Party Administrator and ensure speedy settlement of Claims.

2) We will coordinate with the Insurance Companies in getting the endorsements for addition & deletion of employees.

Procedure for Addition & Deletion

·         Addition & Deletion of the names during the Currency of policy is allowed on prorata basis. However no refund premium will be allowed for deletion of insured person, if the claim is made in the policy. 

·         Addition/deletions during the month can be covered from the date of joining/exit provided a sufficient cash deposit is kept with the Insurance Company and the list of additions/deletions is sent to the Insurance Company on or before the 5^th of the succeeding month. Policy may be adjusted to include or delete any addition/deletion once a month

3) As an Insurance Broker, we will give appropriate suggestions in structuring your policies and get the best rates for you. 

4) With our experience in the field, we are confident, we can provide you best services not only for Group Mediclaim Policy but also for other products like Motor Insurance, Doctor’s/Hospital Professional Indemnity Policy, Public Liability policy, Group Personal Accident policy, Fire Insurance etc.