Health And AccidentalGroup Health Insurance
Table of ContentsGroup Mediclaim Insurance Policy
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Group Mediclaim Insurance Policy
The Group Mediclaim Insurance is most suitable to Employers to cover their employees, and is also suitable to Institutions, Societies and clubs to cover the registered members to cover hospitalisation expenses in case they contract any disease or sustain bodily injuries requiring hospitalisation the policy shall provide coverage against expenses incurred on Medical /surgical treatment at any qualified nursing home/hospital in India.
Definition of Family
- Dependent Children (i.e. legitimate or legally adopted children) up to the age of 21 years if the child above 18 years is employed or if the girl child is married, he or she shall cease to be covered under the policy, and no claim shall be admissible. However, the male child can be covered up to the age of 26 years if he is a Bonafede regular student and fully dependent on primary insured. A female child can be covered until she is unmarried
- Dependent parents /parents-in-law
- Lower premium costs than Individual Medicalim Policy
- Covers Persons Regardless of their age and health status
- Cover From day one of a member joining the group
- Covers without a medical examination
- Maternity Benefit
- Inclusion of Pre-Existing Disease
- Family Floater
- Waiver of the waiting period
In case any employee resigns from the services. The premium amount will be refunded on prorate or short period basis as agreed between the insured and insurer provided the employee has not claimed during the policy period.
- Hospitalization Expenses
- Medicine, Consumables and Diagnostic Expenses
- Domiciliary Hospitalization
- Day Care Treatment
- Pre- and Post-Hospitalization expenses
- Maternity coverage -- Option to Cover with Zero waiting period
- Baby cover from day one
- Pre-existing illness cover
- Ambulance charges
Add On Cover
- Family floater Coverage
- Waiver of the 30-day waiting period
- Waiver of first-year exclusions
- Room Rent Limit in case of normal bed -- specified % as per the policy of sum insured, in case of ICU- specified % as per policy sum insured.
- Addition & Deletion of Family Members during the Running Policy
- Room charges in hospital/ Nursing home
- Nursing expenses
- Medical Practitioner fee
- Treatment cost
- Medicines/ diagnostic cost
- Blood/ oxygen
- Cost of pacemaker/ artificial limbs/ cost of organs
- Operation theatre charges
- Surgical appliances
- Dialysis, chemotherapy, radiotherapy
- Pre and post hospitalisation expenses
- Surgical operation expenses
- War/ war group of perils
- Nuclear perils
- Plastic surgery
- Spectacles/ contact lens/ hearing aid
- Dental treatment-unless caused by an accident
- Expenses for the period of recovery beyond 60 days/general debility
- Sterility/ venereal disease / circumcision
- Intentional self injury
- Use of intoxicating drugs/ alcohol
- Diagnostic/ laboratory expenses not consistent with treatment
- Vitamins/ tonic inconsistent with treatment
- Alcoholism, drug abuse and AIDS
In case of any medical requirement, there are two methods to use your insurance card:
For Cashless Treatment
- Use Health card
- Planned - Take approval in advance
- Emergency -- Take approval within 24 hours
For Reimbursement Treatment
Please note the following documents are required for reimbursement Claim.
- Duly filled Claim form.
- Final Hospital bill with detail breakup and payment proof
- Medicals claimed- Medical bills, Prescriptions, Discharge summary (Original)
- For all miscellaneous charges-detail bills with supporting prescription of the Treating doctor
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