Features of the Policy

What’s Covered

Zero Co-Pay

No cost is borne by patient if claim's compliant and falls within the coverages

Hospital Expenses

if hospitalization is required, the claims shall be processed

30 day pre-hosp

all costs paid 30 days prior to hospitalization is also covered

60 day post-hosp

all costs paid 60 days after hospitalization is also covered

Waiting Periods

Accident Cover

Covered from Day 1
No Waiting period for any hospitalization arising due to an accident

Hospital Expenses

Covered from Day 30
30 day Waiting Period from policy issuance date for any hospitalization

Pre Existing Diseases

Covered after 4 years
4 year Waiting Period from policy issuance date for any hospitalization arising from existing diseases

Coverage Description

Family definition
Employee, Spouse & Child only (no parents, other policies available for inclusion)
Sum Insured
Sum insured as per member demography
Age band
18 years – 60 years
Day Care
527 Day Care procedures covered
Pre & Post Hosptalization
Pre & Post – Hospitalization Medical Expenses are covered up to 30 days & 60 days respectively
Co-Pay
No Co-Pay applicable
Disease Sub-limits
No disease sub-limits applicable
Room Rent
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)
Maternity
Not Covered (no coverage under this policy, other policies available for inclusion)
Baby Day 1
Not Covered
30 days
Applicable waiting period for any claims apart from claims arising from accidents
Pre Existing Disease Cover
Covered after a waiting period of 4 years.
2 yrs
Applicable waiting period for specific ailments
Outpatient Department (OPD)
Outpatient visits and costs not covered
Internal Congenital disease
Covered
Midterm Sum Insured Enhancement
Not allowed
Claim Intimation
Within 7 days from date of admission
Claim submission
Reimbursement claims should be submitted within 30 days from date of discharge.
Special Condition1
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 Service
Claim servicing in-house only by Aditya Birla Capital
Non-network hospitals
Cashless claims from named 51 hospitals will not be entertained (will be included in the policy document)
  

Disclaimer & Operations

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.
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