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
Day Care Expenses
527 Day care procedures are covered
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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
Listed Conditions
Covered after 2 years
2 year Waiting Period for specifically listed conditions that would be covered
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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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