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Group Mediclaim Policyfuturisk - Simplifying InsuranceThe information contained in this is not to be used for any other purpose apart from the purpose forwhich the document has been furnished by futurisk , nor is this document ( in whole or in parts) to bereproduced or furnished to any third parties or made public without the prior express writtenpermission from futurisk
Group Mediclaim PolicyInsurerTPABroker National Insurance Co Ltd Mediassist India TPA Co Ltd Futurisk Insurance Broking Co Pvt Ltd
Group Mediclaim Policy This insurance scheme is to provide adequate insurance coverage ofemployees and their families for expenses related to hospitalization dueto illness, disease or injuryPolicy ParameterPolicy Start Date16-Jun-2017Policy End Date15-Jun-2018Coverage TypeFamily FloaterDependent Coverage1 6 (Employee Spouse up to 4 Children 2dependent Parents or In-laws or Sibling)Sum InsuredBased on Level & Grade
Group Mediclaim PolicyPre existing diseasesFirst 30 dayswaiting periodAny ailment / disease / injuries / healthcondition which are pre-existing (treated /untreated, declared / not declared in theproposal form), when the cover incepts forthe first time are excluded up to 24 monthsand 48 months of this policy being in forcecontinuously.Waived offAny hospitalization/treatment during the first30 days from the commencement date of thepolicy is not allowed except treatment foraccidental external injuriesWaived off
Group Mediclaim PolicyAny ailment / disease / injuries like Piles,Fistula, Cataract, Hypertension or Diabetesrelated treatments, Hysterectomy, Gallstndrdth1 , 2 , 3 & 4 Year Exclusions bladder related treatments etc will havewaiting period which is excluded and coveredfrom day 1.Waived off9 MonthsThere is a clause where 9 months waitingwaiting period for Maternity claims period for any maternity claimsWaived off
Group Mediclaim PolicyBenefitsCoverages for GMC Policy 2016-17New Employee coverageCovered from the date of Joining ( In a retail policy there will be 30 days waiting period to make any claims)Midterm dependent inclusionsAllowed 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 150,000INR 3,000 for Normal & INR 9000 for ICU sum insured INR 200,000INR 3,000 for Normal & INR 9000 for ICU sum insured INR 300,000INR 5,000 for Normal & INR 15,000 for ICU sum insured INR 500,000Room Rent LimitCataract surgery is covered up to Rs. 35,000/- per eyeCapped AlimentINR 50,000 for Hernia, Piles, Fistula and HysterectomyInfertility treatment is covered on OPD / IPD only for Employee/Spouse up to 1,00,000/-Maternity CoverageLasik 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 caesareandeliveryINR 5,000 each for pre & post natal within maternity limit for 60 days pre and 30 days postPre & Post-natal expensesBaby Day 1 CoverPre & Post HospitalizationCO PayNew born baby is covered from day one within family floater Sum Insured subject to declaration within 30 daysfrom the date of birth30 days pre & 60 days post Hospitalization expenses are covered20% on dependent claims for cashless, 10% for dependent claims for reimbursement. Co-pay should be capped atINR 50,000 per instanceCo pay is not applied on Maternity and capped ailmentsCo-pay is not applicable on Employee claimsReimbursement claim submissionWithin 30 days from the date of discharge
Group Mediclaim PolicyOPD Cover only for EmployeesOPD Coverage in case ofMedical emergency within officePremises (Less than 24 Hrs)OPD treatment should be covered only forEmployees in case of medical emergencywithin the office premises and capped subjectto max INR 2,500/- per instance The claim canbe processed on reimbursement basis onlysubject to HR approval.OPD cover only for Employeesin case of RTAOPD Treatment is covered only for employeesin case of RTA subject to a limit of Rs 10,000/per instance (Only on reimbursement basis)
Group Mediclaim PolicyNew 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 expenseswill be covered (Baby age restricted up to 1 year) Psychiatric related treatment should be covered only for Employees with a cap limitof Rs 10,000 on IPD/OPD basis for entire policy period ORGAN TRANSPLANT (EMPLOYEES ONLY) Donor hospitalization charges should becovered up to the Sum Insured (In case of Employee is hospitalized) WIDOW COVERAGE - In case of Employee expires during the employment, themediclaim policy should be extended to employee's immediate family up to 2 policyyears or until the widow is employed or maximum up to 2 years which ever is lower
Escalation MatrixLevel ofEscalationContact PersonContact Number/Email idFirst LevelShaik Imran(Asst Mgr-CS)7022895170mediclaim.bng@247-inc.comFinal LevelShafi S Md(Asst Mgr-CS)9008396132shafi@futurisk.in
Thank You
Lasik Surgery - Above 5 or -5 covered for employees up to 30,000/- Maternity Coverage Actual Expenses subject to a maximum of Rs. 50,000/- for Normal Delivery and Rs. 75, 000/- for caesarean delivery Pre & Post-natal expenses INR 5,000 each for pre & post natal within maternity limit for 60 days pre and 30 days post Baby Day 1 Cover
