Group Mediclaim Policy

Transcription

1 futurisk - Simplifying Insurance The information contained in this is not to be used for any other purpose apart from the purpose for which the document has been furnished by futurisk, nor is this document ( in whole or in parts) to be reproduced or furnished to any third parties or made public without the prior express written permission from futurisk

2 Insurer National Insurance Co Ltd TPA Mediassist India TPA Co Ltd Broker Futurisk Insurance Broking Co Pvt Ltd

3 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 Policy Start Date Policy End Date Coverage Type 16-Jun Jun-2018 Policy Parameter Family Floater Dependent Coverage (Employee + Spouse + up to 4 Children + 2 dependent Parents or In-laws or Sibling) Sum Insured Based on Level & Grade

4 Pre existing diseases Any ailment / disease / injuries / health condition which are pre-existing (treated / untreated, declared / not declared in the proposal form), when the cover incepts for the first time are excluded up to 24 months and 48 months of this policy being in force continuously. Waived off First 30 days waiting period Any hospitalization/treatment during the first 30 days from the commencement date of the policy is not allowed except treatment for accidental external injuries Waived off

5 1 st, 2 nd, 3 rd & 4 th Year Exclusions Any ailment / disease / injuries like Piles, Fistula, Cataract, Hypertension or Diabetes related treatments, Hysterectomy, Gall bladder related treatments etc will have waiting period which is excluded and covered from day 1. Waived off 9 Months waiting period for Maternity claims There is a clause where 9 months waiting period for any maternity claims Waived off

6 Benefits Coverages for GMC Policy New Employee coverage Midterm dependent inclusions Room Rent Limit Capped Aliment Maternity Coverage Pre & Post-natal expenses Baby Day 1 Cover Pre & Post Hospitalization CO Pay Reimbursement claim submission Covered from the date of Joining ( In a retail policy there will be 30 days waiting period to make any claims) Allowed only for newly married spouse or new born baby, should be declared within30 days from the date of event (In a retail policy there is no option to enroll parents in mid of the policy) INR 2,250 for Normal & INR 6750 for ICU sum insured INR 150,000 INR 3,000 for Normal & INR 9000 for ICU sum insured INR 200,000 INR 3,000 for Normal & INR 9000 for ICU sum insured INR 300,000 INR 5,000 for Normal & INR 15,000 for ICU sum insured INR 500,000 Cataract surgery is covered up to Rs. 35,000/- per eye INR 50,000 for Hernia, Piles, Fistula and Hysterectomy Infertility treatment is covered on OPD / IPD only for Employee/Spouse up to 1,00,000/- Lasik Surgery - Above +5 or -5 covered for employees up to 30,000/- Actual Expenses subject to a maximum of Rs. 50,000/- for Normal Delivery and Rs. 75, 000/- for caesarean delivery INR 5,000 each for pre & post natal within maternity limit for 60 days pre and 30 days post New born baby is covered from day one within family floater Sum Insured subject to declaration within 30 days from the date of birth 30 days pre & 60 days post Hospitalization expenses are covered 20% on dependent claims for cashless, 10% for dependent claims for reimbursement. Co-pay should be capped at INR 50,000 per instance Co pay is not applied on Maternity and capped ailments Co-pay is not applicable on Employee claims Within 30 days from the date of discharge

7 OPD Cover only for Employees OPD Coverage in case of Medical emergency within office Premises (Less than 24 Hrs) OPD treatment should be covered only for Employees in case of medical emergency within the office premises and capped subject to max INR 2,500/- per instance The claim can be processed on reimbursement basis only subject to HR approval. OPD cover only for Employees in case of RTA OPD Treatment is covered only for employees in case of RTA subject to a limit of Rs 10,000/- per instance (Only on reimbursement basis)

8 New benefits under group mediclaim policy Air Ambulance charges payable only for Employees up to the Sum Insured In case the new born baby have to be in NICU then the Mother boarding expenses will be covered (Baby age restricted up to 1 year) Psychiatric related treatment should be covered only for Employees with a cap limit of Rs 10,000 on IPD/OPD basis for entire policy period ORGAN TRANSPLANT (EMPLOYEES ONLY) Donor hospitalization charges should be covered up to the Sum Insured (In case of Employee is hospitalized) WIDOW COVERAGE - In case of Employee expires during the employment, the mediclaim policy should be extended to employee's immediate family up to 2 policy years or until the widow is employed or maximum up to 2 years which ever is lower

9 Escalation Matrix Level of Escalation Contact Person Contact Number / id First Level Shaik Imran (Asst Mgr-CS) Final Level Shafi S Md (Asst Mgr-CS) shafi@futurisk.in

10 Thank You