Health And AccidentalGroup Health Insurance

Group 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

  • Spouse
  • 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

Compensation Payable

  • 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
  • Naturopathy
  • Alcoholism, drug abuse and AIDS

Claim process

In case of any medical requirement, there are two methods to use your insurance card:

  • Cashless
  • Reimbursement
    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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Questions You Might Have

What are pre and post-hospitalization expenses in health insurance?

Pre-hospitalization expenses refer to the medical expenses incurred before getting admitted to a hospital. Post-hospitalization expenses refer to the cost of follow-up tests and consultation treatment charges incurred after getting discharged from the hospital. Health plans in India mostly cover pre-hospitalization expenses up to 30 to 60 days and post-hospitalization expenses up to 60 to 90 days, depending on the plan.

At what age can I include my children in my health insurance plan?

You can include your children in a family floater policy from day 1. In some health plans, children are covered from 91 days onwards. Nonetheless, you are advised to go through the terms and conditions of a health plan carefully to know about the entry age for children.

Which diseases are not covered in health insurance?

A health insurance policy usually does not cover HIV/AIDS treatment except for a few companies. Any claims arising out of congenital disorders, venereal diseases, general debility. sexually transmitted disease and dental treatment/surgery (unless required as a part of treatment) is excluded from health insurance coverage. But do check your policy wordings to know more about the detailed list of exclusions in a health insurance plan.

What is a Cumulative Bonus in a health insurance plan?

A cumulative bonus in health insurance implies monetary benefits that the insurer provides you as a reward for not filing a claim during the previous policy year. For instance, discount on premium or sum insured enhancement. It is also called a No Claim Bonus similar to that in car insurance. However, the policy benefits differ from one health insurance company to another.

What do you mean by No claim bonus in health insurance plans?

No claim bonus (NCB) is a discount on the base premium offered if no claim on the health policy is made during the previous policy term. This bonus is usually given in the form of a premium discount or enhancement of the sum insured amount.

What is the maximum number of health insurance claims allowed in a year?

The maximum number of claims allowed under health insurance during a policy year varies from one plan to another. While some plans allow you to raise only one or two claims per policy tenure, a lot of plans do not come with any limit to the number of claims that you can file during a policy year as long as the sum insured is not exhausted. You can contact your insurer to know about the number of claims that you are permitted to file during a policy year.

What to do if my health insurance policy renewal date is missed?

Ans: If you have missed the renewal date of your health insurance policy, you must renew your policy as soon as possible. You can renew it during the grace period preventing the policy from getting lapsed. But if you renew your policy after the grace period, it will get lapsed and you may have to undergo a medical test or pay a higher renewal premium.