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Hospitalization (In-Patient)

Benefits in Hospitalization

Group Hospitalization Insurance Scheme is a comprehensive scheme designed for coverage of hospitalization treatment expenses of an insured due to illness or injury sustained during the period of coverage. Hospitalization shall mean confinement in a hospital or clinic for at least 24 consecutive hours for proper treatment any ailment or injury. However, confinement less than 24 hours due to technological advances for surgical intervention like Cholecystectomy, Tonsillectomy, Fracture-dislocation bone & joints, Lithotripsy etc. shall be considered as hospitalization. All bodily injuries sustained in any one accident shall be considered as one Hospitalization.
Disability for a sickness or accidental injury caused individually or simultaneously requiring hospitalization & treatment thereof shall be considered as one Hospitalization. If a Hospitalization is due to causes which are same or related to the causes of a prior Hospitalization (including complication there from) shall be considered as continuation of the prior Hospitalization & not a separate Hospitalization. Successive Period of Hospitalization within 120 days due to same disability shall be considered as one Hospitalization. However, confinement after 120 days following latest discharge from hospital due to same cause shall be considered as separate Hospitalization. Confinement within 120 days due to different ailments shall be considered as separate hospitalization.

Salient Features:
  • Direct payment of treatment expense by the Company at designated hospitals.
  • Reimbursement of expenses for treatment at non-designated hospitals.
  • Treatment at any renowned hospital of the country by consultant of own choice.
  • Membership Card for each insured to facilitate preferential service.
  • Scope for inclusion of spouse & children under the Plan.
  • Scope for Overseas Treatment.
  • Scope to enjoy Maternity Benefit.
  • Coverage of Pre & Post Hospitalization expenses.
Overseas Treatment coverage:

The scheme shall cover reasonable and necessary treatment expenses of an insured member within his entitlement as per benefit schedule, at any Govt. Hospital as well as renowned private hospital/clinic registered as such with the legitimate authority of the country.

Pre-Hospitalization:

Coverage shall include expenses for the investigations done up to Three (03) days pre-confinement as per doctor’s advice at the time of referring a patient for Hospitalization.

Post Hospitalization:

Coverage shall include a post discharge consultation within Three (03) days of release from hospital.

Scope:

The scheme shall cover reasonable and necessary treatment expenses of an insured member within his entitlement as per benefit schedule, at any Govt. Hospital as well as renowned private hospital/clinic registered as such with the legitimate authority of the country.

Eligibility for coverage under the Scheme:

Any employee aged between 18 and 60 years & is in good health shall be eligible for coverage under the scheme. Similarly a new employee shall also be eligible to join the scheme during their good health upon intimation to the company and payment of premium. Besides, spouses up to the age of 60 years, dependent children from day 01 (one) up to the age of 25 (twenty five) years residing with the employee & is in good health may also be included under the scheme. Inclusion of dependant family members (Either spouse or spouse with children) should be on full participation basis (group concept).

Duration of the Contract:

One or Three years from the date of commencement. A contract shall be signed initially which may be renewed on mutual agreement.

Medical Requirement:

No medical examination is required. A “Membership Form” to be filled in by each employee containing a declaration of health status for him-self & dependants to be covered under the scheme shall suffice.

Coverage of treatment expenses shall include:
  • Hospital accommodation (Room & Board)
  • Surgical Operation
  • Consultation fee
  • Medicines & Accessories
  • Medical investigation
  • Ancillary Service 1

1Ancillary Services Comprises of : Registration or Admission, Labour Room Service, Blood Transfusion, Post Operative Care, Local ambulance Services to Hospital, Physiotherapy, Chemotherapy, Radiotherapy, Dialysis, procedural charge, Dressing, Nebulization, Oxygen inhalation, ventilator charge etc.