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Out-Patient Department (OPD)

Benefits in Out-Patient Department

Out-Patient Insurance Plan for Group is also suitable for Employees of an organization or Members of a group who desires insurance coverage of treatment expenses for minor ailments and injury that do not require hospitalization. Like Hospitalization insurance plan there is option for inclusion of “Dependant Family Members” (Spouse, Children, Parents) under insurance coverage of the plan, if desired. There are several benefit plans for out-patient Insurance.

Salient Features:
  • Out-Patient Insurance plan is offered as an adjunct to Group Hospitalization Insurance.
  • Insurance coverage is offered for General, Dental & Ophthalmic ailment and injury.
  • Benefit under Out-Patient plan is offered on “per insured per year” basis.
  • There is no scope for credit facility and treatment expenses are reimbursed to the insured.
  • An insured may enjoy discount at designated diagnostic center which consequently increases his/her benefit.
Expenses Covered under Group Out-patient Insurance:
  • Consultation Fee
  • Minor Surgical Operation
  • Medicines & Accessories
  • Medical investigation & Procedural Charges
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.

Plan Types:
  • General: For Treatment coverage of general ailments/injuries only
  • Dental: For Treatment coverage of dental ailments/injuries only
  • Ophthalmic: For Treatment coverage of ophthalmic ailments/injuries only
  • Combined: For Treatment coverage of any two or all of the above.