insurance policy terms & conditions

8/2/2019 Insurance Policy Terms & Conditions

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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)

*** 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

ting Employees Not Allowedw Joinees s Dependants Allowed, provided dependants detail are declared

joining formatwly Married Spouse Allowed (within 15 days from date of marriage)w Born Child Allowed (within 15 days from date of birth)

Standard Hospitalization Maternity benefitsTPA services Baby cover day 1 within the maternity limit

Pre existing diseases Pre-Post Hospitalization Exp.Waiver on 1

styear exclusion Ambulance Services

Waiver on 1st

30 days excl. Day CareRoom Rent 1 % & 2% of the Family floater Sum Insured

(This capping is linked to the procedures within the

hospital)10% Co-Payment on each and every claim


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Reimbursement of expenses related to

Room and boarding - Subject to 1% and 2 % of the family floater Sum Insured. Thiscapping 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 SumInsured, 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/NursingHome as in-patients in India.

Claim in respect of delivery for only first two children and/or operations associatedtherewith will be considered in respect of any one Insured Person covered under thePolicy 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.


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Benefit DetailsMaximum Benefit

allowable INR 50000 for Normal and CaesarianRestriction on no of

children Maximum of 2 instances of maternity9 Months waiting period waivedGeneral Exclusions

Injury or disease directly or indirectly caused by or arising from or attributable to Waror 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


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

insurance policy terms & conditions

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