Employee, Spouse & Child only (no parents, other policies available for inclusion)
Sum insured as per member demography
18 years – 60 years
527 Day Care procedures covered
Pre & Post Hosptalization
Pre & Post – Hospitalization Medical Expenses are covered up to 30 days & 60 days respectively
No Co-Pay applicable
No disease sub-limits applicable
Room rent restricted to Single ac room for normal and all other charges in accordance with room rent limit. ICU at actuals.
Parents SI restriction
Not applicable (parents not included in this policy)
Not Covered (no coverage under this policy, other policies available for inclusion)
Baby Day 1
Applicable waiting period for any claims apart from claims arising from accidents
Pre Existing Disease Cover
Covered after a waiting period of 4 years.
Applicable waiting period for specific ailments
Outpatient Department (OPD)
Outpatient visits and costs not covered
Internal Congenital disease
Midterm Sum Insured Enhancement
Within 7 days from date of admission
Reimbursement claims should be submitted within 30 days from date of discharge.
Cost of stents in case of PTCA and cost of implant in case of joint replacement will be as per prices decided by National Pharmaceuticals Pricing Authority
Claim servicing in-house only by Aditya Birla Capital
Cashless claims from named 51 hospitals will not be entertained (will be included in the policy document)
1. No Individual (Employee or Dependant) can be covered more than once in a policy.
2. Any change in demography/Sum Insured will warrant a revision in Quote/ Rates.
3. Data for new joinees – Employees and dependant’s data to reach within 30 days of joining
4. New Joinees & names of all dependants to be submitted one time only along with the name of the employee.
5. Addition/ Deletion to be done subject to payments being made of basis balance with Wellmo.
6. In case of deletions, there will be no refund for the members who have claimed.
7. Maximum age of entry in policy is 60 Yrs.
8. No change of Sum insured allowed after commencement of the policy.
9. No addition of new slabs for Sum Insured allowed after commencement of the policy.
10. Midterm addition not allowed except for new joinees.
11. Additional premium to be collected for every new addition in the policy.
12. All insurable members in the group to be insured under GMC policy and there shall be no selection of members.
13. Members already employed but not declared by the employer at the time of providing the quote shall not be covered subsequently after commencement of the policy.
14. We shall provide Per member Premium for addition and deletion in the policy.
15. The basis of selecting the sum insured for the members shall be communicated to the insurance company prior to inception of policy. No individual member shall be allowed to choose his/her sum insured deviating from the basis provided.
16. The cover shall cease automatically for any member leaving the organization insured under our GMC policy.