Health Insurance

Health Insurance Plan

Overview – Taking all health worries off you

• Comprehensive branded scheme offering value added features and complete solution for all health worries.
• A vital tool in hassle free delivery of health care services; we will be there when you need someone to help.
• Off setting huge medical expenses that have large bearing on health and its maintenance.
• Well conceived and customized plan uniquely designed to address all health exigencies requiring hospitalization.
• Among very few national companies to cover around the world with direct settlement of medical expenses worth $28,000 abroad.
• Fulfills all requirements envisioned in government policy of healthcare for all.
• Insurance arrangements with world’s top re insurers.

Benefits

• Curtails administrative and financial burden of the employer.
• Because of branding we offer more than the market.
• Employer wins loyalty of the employees thereby enhancing efficiency and productivity …motivating to work more proactively.
• Extensive nationwide branch network of over 95 branches; almost every reputable hospital is on our panel in every town.

Who is “Covered”

• Corporate sector employees up to the age of 65.
• Special modules are designed to cover dependent parents.
• Age of daughter can be relaxed up to her marriage.
• Age of son can be relaxed up to till 25.

What is “Covered” – OPD Benefits

1. G P and Specialist Consultation fees.
2. Prescribed medicines.
3. Laboratory and other Investigations. (e.g. X-Rays, ECGS & Ultrasound etc).
4. Dental care benefits.
5. Besides doctors, Consultations with registered Hakims and Practicing alternative medicine specialist is also admissible.

What is “Covered” – Hospitalization

1. Hospital Expenses Per Person Per Confinement Per Ailment. (Pregnancy & Dreaded Diseases excluded ).
2. Room Rent, Nursing expenses.
3. Hospital Expenses includes Surgical expenses, Anesthesia.
4. O.T. Charges, Consultation Fee, Nursing Charges etc.
5. Investigation and Medicines, Blood, Oxygen Supplies, Dialyses Chemotherapy / Radiotherapy cost of pacemakers ( subject to Hospitalization Unit).
6. Miscellaneous Expenses Pre & post hospitalization expenses.

Note: 24 Hrs. In-Patient confinement as a resident Patient is compulsory.

What is “Covered” – Specialized Investigation
Specialized investigation on outpatient basis on recommendation of a specialist only, which does not require hospitalization.

These include the following tests only:

1. CAT-SCAN.
2. MRI
3. NUCLEAR SCANS
4. ANGIOGRAPHIES.
5. EEG, EMG, ETT & ECHO

What is “Covered” – Dreaded Diseases

1. Management of acute Myocardial infarction (Heart Attack)
2. By-pass grafting
3. Cancer
4. CVA- Stroke
5. Kidney Failure
6. Renal and other major organ transplants
7. Major burns
8. AIDS
9. Knee joint replacement
10. Chemotherapy
11. Multiple Fractures
12. Hip bone Replacement

What is “Covered” – Dental Cover

Following are the benefits under ‘Dental Care’ cover.

• Dental care is included in the prescribed OPD (Per family).
• Dental Care include consultation and medicine, treatment of acute dental conditions and diseases of gums.
• All orthodontic procedures, making & placement of prosthesis (e.g. dentures), scaling & polishing are excluded.
• Total payable cumulative dental bills should not exceed 40% of the total OPD limit (per family).

What is “Covered” – Maternity Benefit

• Gynaecologist fee
• Anaesthetic fee
• Diagnostic tests
• Miscarriage
• Medicines
• Baby’s Nursing Care
• Labour Room charges
• Operation Theater charges etc.

Value added features

• Dreaded diseases.
• (Cancer, Heart Attack, Kidney Failure, Stroke, Cirrhosis, of Liver, AIDS – due to blood transfusion).
• Pre & Post hospitalization benefits – Any expenses incurred on medical consultation or tests within 15 days prior to or after Hospitalization would also be covered.
• Death repatriation within Canada.
• Funeral expenses and arrangements.
• Service at your doorstep with elaborate network of 105 branches.
• Win-win-win position —- employee-employer & company.

Claim Settlement Procedure

• All claims are filed on a simple easy to fill Performa by the employee duly endorsed by the employer or nominee.
• Original prescription bills, receipt etc should be attached.
• Direct settlement of claims with panel hospital.
• All claims should be filed within four (4) weeks.