• As the name suggests, the Group Mediclaim (GMC) Policy provides Mediclaim Coverage to a Group of Members like Employers Employee of an organization, Groups where the premium is to be paid by the Government, Members of a registered service clubs etc. The policy can be extended to cover Family Members of The Employee (Spouse+ Dependent Children + Dependent Parents).

  • Benefits to Purchase a Group Mediclaim Policy.

    1

    A GMC policy can be purchased since it benefits both Employer and the Employee. An Employer gets benefitted -:

    By Availing Tax Benefits

    By providing High Benefits at Low Costs as compared to Individual Health Policy

    By using this as tool to retain and motivate employees

  • 2

    An Employee Gets Benefitted:

    By including his Family Members

    Pre-Existing Diseases, Waiting Period for certain ailments can be covered from Day 1 under the policy.

    Policy Can be extended to cover Maternity Benefits and New Born Cover from Day 1 and without any waiting period.

    No Health Check Up Required irrespective of Age

    Includes wide range of illnesses/ diseases.

  • 3

    When does the Policy Get Triggered ?

    The Group Health Insurance policy gets triggered where at least 24 Hours Hospitalization is required for treatment of any disease or ailment. But there are certain ailments where due to Medical Advancements hospitalization may not be required for 24 hrs such as Cataract Surgery. Such treatments fall under Day Care Procedures and are covered under the policy/

  • 4

    How to avail claim under a Group Medicalim Policy ?

    Claim can be availed either through Cashless or Reimbursement Mode.

  • 5

    Cashless Settlement

    If Hospital is Empaneled by the Insurer, patient can opt for Cashless Mode, whereby the patient gets admitted and the claim is settled directly between the Hospital and the Insurance Company or the TPA. The patient need not pay anything except the charges that are otherwise not covered under the policy.

  • 6

    Reimbursement Settlement

    In case the insured opts for any other hospital which is not empaneled on the Insurers or the TPA’s network, the insured will have to pay the Hospital Bills from his own pocket and reimburse the same by sending all original documents to the Insurance Company for settlement.

  • 7

    Major Exclusions

    Congenital external diseases or defects/anomalies(covered if its life threatening)

    Hospitalization for only Diagnostic Purpose , intentional self-injury, use of intoxicating drugs/ alcohol.

    Injury or disease caused directly or indirectly by nuclear weapon

    Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, etc

    Cost of spectacles, contact lenses, hearing aids etc.

    Any cosmetic or plastic surgery except for correction of injury

    Vitamins and tonics unless used for treatment of injury or disease

    Voluntary termination of pregnancy during first 12 weeks (MTP)