Group Health Insurance Policy

This is Your Group Health Insurance Policy, which has been issued by us, relying on the Information disclosed by you in Your Proposal for this Policy or its preceding Policy/Policies of which this is a Renewal. The terms set out in this Policy and its Schedule will be the basis for any claim or benefit under this Policy.

Coverage
We will cover Reasonable and Customary Charges for Medically Necessary Treatment taken by the Insured Person for a disease, Illness or Injury that occurs during the Policy Year under any of the below mentioned benefits subject to the terms, conditions and exclusions of this Policy and up to the Sum Insured specified in the Policy Schedule/ Certificate of Insurance.

In-patient Hospitalization
We will cover the Medical Expenses incurred for:
i) Room Rent & Nursing charges;
ii) Intensive Care Unit (ICU) charges;
iii) Operation Theatre charges;
iv) Fees of Medical Practitioner/ Surgeon / Anaesthetist / Specialists;
v) Physiotherapy, Investigation & Diagnostic procedures;
vi) Medicines, Drugs and Consumables;
vii) Blood, Oxygen, Surgical appliances;
viii) The cost of prosthetic and other devices or equipment recommended by the attending Medical
Practitioner and if implanted internally during a Surgical Procedure.

Modern Treatment Methods
The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment in a hospital up to the Sum Insured, specified in the policy schedule, during the policy period:

A. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
B. Balloon Sinuplasty
C. Deep Brain stimulation
D. Oral chemotherapy
E. Immunotherapy - Monoclonal Antibody to be given as injection
F. Intra vitreal injections
G. Robotic surgeries
H. Stereotactic radio surgeries
I. Bronchical Thermoplasty
J. Vaporisation of the prostrate (Green laser treatment or holmium laser treatment)
K. IONM - (Intra Operative Neuro Monitoring)
L. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.

Mental Illness:
We will cover Mental Illness as per the provisions of Mental Healthcare Act, 2017.However, in case of following mental illnesses the Inpatient Hospitalization benefit will be restricted to Policy Sum Insured or 3 lacs, whichever is Lower;
1. Schizophrenia (ICD - F20 ; F21;F25)
2. Bipolar Affective Disorders (ICD - F31; F34)
3. Depression (ICD - F32; F33)
4. Obsessive Compulsive Disorders (ICD - F42 ; F60.5)
5. Psychosis (ICD - F 22 ; F23 ; F28 ; F29)

HIV & AIDS
We will cover up to the Sum Insured in case Inpatient hospitalization (including Day Care Treatment) for the treatment arising out of HIV or any condition caused by or associated with Acquired Immuno Deficiency Syndrome (AIDS).

Pre-hospitalization
We will cover Pre-Hospitalization Medical Expenses incurred during thirty (30) days preceding the Hospitalization of the Insured Person including Day Care Treatment.

Note - The date of admission to Hospital for the purpose of this coverage shall be the date of the Insured Person's first admission to the Hospital in relation to Any One Illness.

Post-hospitalization
We will cover Post-Hospitalization Medical Expenses incurred during sixty (60) days immediately after the Insured Person is discharged from the Hospital including Day Care Treatment.

Note - In case of any one illness where insured person undergoes more than one hospitalization within 45 days, the cover for post hospitalization expenses cumulatively shall not exceed 60 days.

Day Care Treatment
We will cover the Day Care Treatment (including Pre-Hospitalization & Post-Hospitalization Medical Expenses). List of such treatment is available in Annexure II of this document.

Domiciliary Hospitalization
We will cover the Domiciliary Hospitalization if medical treatment is continuously required for at least three (3) days, in which case the cost of medical treatment for the entire period shall be payable. We will also cover the pre and post Hospitalization medical expenses.

Organ Donor
We will cover the Surgical Expenses incurred towards donor in case of major organ transplant for Harvesting of the organ provided that:

i. The organ donor is any person whose organ has been made available in accordance and in compliance with the Transplantation of Human Organs Act 1994 and amendments thereof and other applicable laws & rules.

ii. The organ donated is for the use of the Insured Person.

iii. The Insured Person (recipient) has been medically advised to undergo an organ transplant.

iv. We have accepted claim under In-patient Hospitalization

We will not pay for
i. Any expense other than specified above.

ii. Cost towards donor screening.

iii. Pre / post hospitalization Medical Expenses of the organ donor.

iv. Cost directly or indirectly associated with acquisition of the organ.

v. Any other medical treatment for the donor consequent to the Harvesting.

vi. Expenses related to organ transportation or preservation.

vii. Transplant of any organ/tissue where the transplant is experimental or investigational.

viii. Hospitalization or any related Medical Expenses if Insured Person is Hospitalized for donating organ.