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Introducing Group MediClaim Policy

Introducing Group MediClaim Policy

 

Employees are the most important assets for an organisation. As an employer, your priority would be to ensure their well-being for financial and practical reasons.

Group Health Insurance covers the employees against expenses due to illnesses or accidental injury. The employees may belong to organizations with number of employees more than 20 like banking institutions, multi-nationals orSMEs including both financial and non-financial institutions.

The size of the group can be either small or large as per the requirement.The members can also be covered under different sub-groups with varying sum insured. The conditions for such classification of employees into sub-groups will be decided by the employer or group administrator based on their position or risk category.

 

Benefits for the employees

While the specifics of the group health insurance policy may vary from company to company, the general coverage comprises of:

Hospitalisation costs - Costs including room rent, boarding, nursing, doctor’s fees, anaesthetist’s fees, diagnostic tests medicines & drugs etc.

Pre-hospitalisation costs - Expenses prior to hospitalisation, up to certain number of days, as mentioned in the policy schedule

Post-hospitalisation costs - Up to pre-determined number of days, as fixed in the policy schedule, after discharge

 

Cashless hospitalisation - Cashless services through a Third Party Administrator based on the tie-ups with network hospitals

Protection at a low cost - The cost of buying an insurance policy is shared within the group or entirely by the employer

24x7 Coverage - Protection against unforeseen events at all times anywhere in India

 

Benefits for the Employer

Along with giving the benefit to the employees and their beneficiaries, Group MediClaim is also beneficial to the employer.

Strong employee retention tool: Builds loyalty among the employees for the organisation and can prove a morale booster

Greater control over benefits offered: Removing and adding employees from a group is easy

 

Exclusions

Subject to company-specific details, the insured will not be covered for the followingunder the GMC policy:

 Any claim within30 days of policy issuance, with the exception of accidental injury or period following policy renewal

 War-related injuries

 For the initial year(s) from the- 1yr, 3yr, 4yr waiting period from date of policy purchase for certain diseasesand surgeries - specific schedule according to the policy document for specific disease

 Pre-existing/congenital diseases

 Cosmetic or aesthetic treatment of any description or plastic surgery, other than as may be required as part of treatment post-accident or owing to any illness

 Naturopathy

 Treatment for injuries arising from intentional self-harm, suicide attempt, alcohol/drug abuse

 Sexually transmitted diseases, AIDS

 Costs involved in the diagnosis and treatment of infertility, sub-fertility and circumcision

 Treatment during a period of inactivity or rest cure for convalescence or rejuvenation purposes, general debility or ‘run-down’ condition

 Dental treatment or surgery of any kind unless requiring hospitalisation

 Expenditure on vitamins and tonics unless necessitated by the treatment

 Expenses during childbirth including caesarean section

 Voluntary medical termination of pregnancy during the first 12 weeks from the date of conception

 Diagnostic tests not consistent with positive existence of any illness, ailment or injury

Add-ons available

Riders or add-ons are extra covers through which a more comprehensive and customised protection can be provided to the employees.

Although several insurance providers offer different combinations of the above-mentioned add-ons as in-built benefits, it is crucial to comb through their scope and limitations before opting them.

Pre-existing cover for pre-ailments

Maternity cover for normal and caesarian delivery

Waiver of 9 month wait period for maternity coverage

Pre and post natal coverage

 

Coverage for new-born baby from day one

Corporate/organisational buffer

Ambulance costs

OPD expenses