Group Health Insurance
Corporate Group Health Insurance provides adequate insurance coverage to the employees and their immediate family such (Spouse, Dependent children & Dependent Parents or Parent in Law), for expenses related to medically necessitated hospitalization due to an illness, disease or an accidental injury.
The basic criteria for the policy to trigger is Hospitalization for a minimum of 24 hours and administered with an active line of treatment advised by a Medical Practitioner.
The only exception being Day Care Procedures, which are covered even if the hospitalization is only for a few hours like Cataract, etc.
Who Can Opt For This Corporate Group Health Insurance Policy?
Any company/ institution can opt for Group Health Insurance Policy for its employees say minimum of at least 10 employees and their families.
Number of members covered in one family policy is:
- Employees (self)
- Parents in laws
Benefits Available In This Policy
- In Patient Hospitalization
- Room Rent and Accommodation
- Pre And Post Hospitalization
- All Day Care Procedures.
- Ambulance Charges.
In Patient Hospitalization- What is covered ?
- Medical Practitioners’ fees
- Diagnostics Tests
- Medicines, drugs and consumables
- Nursing Charges
- Intravenous fluids, blood transfusion, injection administration charges
- Operation theatre charges
- The cost of prosthetics and other devices or equipment if implanted internally during a Surgical Procedure.
- Intensive Care Unit charges.
Room Rent Or Hospital Accommodation
Hospital Room Rent/Accommodation Expenses means the amount charged by a hospital for the occupancy of a Bed/Room/ on per day (24 hrs basis) and shall include associated medical expenses and nursing charges .
The Company can decide the following options for Hospital Room Rent Coverage:
- Room rent capped to 1% and ICU Charges to 2%.
- Room rent capped to 2% and ICU Charges to 4%.
- Room Type - Single Private Room and ICU No Capping.
- No Capping on Room and ICU.
Pre and post Hospitalization Expenses
- Expenses which is incurred before getting hospitalized such as expenses like diagnostics expenses, doctor's consultation fees etc. will be covered under this policy.
- The insured can avail this benefit up to 30 days immediately before and 60 days immediately after an Insured Person’s admission to a Hospital for the same Illness.
- Pre and post hospitalization expenses can be claimed as reimbursement only.
- Covered up to sum insured.
All day care procedures
- Any procedures due to advancement in the technology and which is done with in a period of less than 12 hours is considered as day care procedures.
- If an medical practitioner declares that it is a day care procedure, the insured can avail this benefit.
- Few day care procedures are ,Chemotherapy, Radiotherapy, Hemodialysis, or any procedure which needs a period of specialized observation or care after completion of the procedure.
- Any procedure undertaken on an out-patient basis will not be covered.
- Covered up to sum insured.
- Reasonable and customary ambulance expenses following an Emergency to the nearest Hospital if:
The ambulance service is offered by a healthcare or ambulance service provider;
The Company has accepted an in-patient claim for the same illness or accident.
Covered up to Rs. 1,000 per claim.
- Waiting period: the insured can either choose for no waiting period or the insured can choose for waiting period of 30 days.
- Waiting period for pre existing disease: this policy have an option of choosing either waiting period for pre existing disease or can choose no waiting period for pre existing disease that is any pre existing disease will be covered from day one.
- Waiting period for specific disease: the insured can opt for no waiting period in which specific diseases are covered from day one or the insured can opt for no waiting period also.
- Expenses on vitamins and tonics etc. unless forming part of treatment for injury or disease as certified by the attending physician.
- Any Expenses on treatment of Insured person as outpatient in the Hospital.
- Naturopathy/Homeopathy treatment, unproven procedure or treatment, experimental or alternative medicine and related treatment including acupressure, acupuncture, magnetic and such other therapies etc.
- Any Expenses under Domiciliary Hospitalization
- Genetically disorders are not covered under this policy.
- External and or durable Medical / Non medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Infusion pump etc., Ambulatory devices i.e. walker, Crutches, Belts, Collars, Caps, splints, slings, braces, Stockings etc of any kind, Diabetic foot wear, Glucometer / Thermometer and similar related items etc and also any medical equipment which is subsequently used at home etc. If required during operation, it is covered.
- Change of treatment from one pathy to other pathy unless being agreed / allowed and recommended by the consultant under whom the treatment is taken.
- Treatment of obesity or condition arising there from (including morbid obesity) and any other weight control programme, services or supplies etc.
- Any treatment required arising from Insured’s participation in any hazardous activity as professional sportsmen including but not limited to scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing etc.