ZoloSure

Group Health Insurance

Summary
Features
The health insurance cover is provided by Onsurity’s partner insurance company ICICI Lombard
General Insurance Co. Ltd. on a group insurance basis. You are eligible for the following health
insurance benefits:

What’s covered?

In-patient hospitalisation [24 hours or Pre & Post hospitalization expenses

more] with Covid-19 covered (30 & 60 Days)

Ayurvedic treatment – up to the Sum Cataract – 25% of the Sum Insured or

Insured INR 40,000, whichever is lower

Ambulance charges are covered up to Room rent (proportional deductions

Rs. 2,500 per hospitalization applicable for higher room category)
- Normal room: 2% of the Sum Insured
Domiciliary Hospitalisation is covered
per day
as per policy terms
- ICU: 5% of the Sum Insured per day
Specific Day Care treatments

What’s not covered?

Maternity related hospitalisation Hospitalization less than 24 hours

Out-Patient Expenses Treatments related to cosmetics and

dental, unless necessitated due to
Other general exclusions of the group
health insurance policy accidental injury

COVID-19 Coverage Details

Covid-19 related expenses will be provided only in case of hospitalisation of more

than 24 hours. Benefit will not be provided in the following cases:

Self-quarantine. Quarantine / isolation at any

unauthorized centre.
Quarantine advised by any unauthorized
testing centre. Self-isolation during lockdown.
 Initial Waiting Period

0 days for the accidental 15 days for Covid-19 30 Days for any other
hospitalization hospitalization

Specific Illness Waiting

Pre-Existing Diseases

Period Waiting Period

None 4 Years

Co-pay and Deductible

None

Sub-Limits of Specific Treatment

Disease-wise sublimits Metro Cities Non-Metro Cities

Appendix ₹20,000 ₹18,000

Gall Bladder ₹22,000 ₹22,000

Hernia ₹20,000 ₹18,000

Hydrocele ₹15,000 ₹12,000

Hysterectomy ₹28,000 ₹25,000

Piles ₹18,000 ₹15,000

Kidney Stone (inc. DJ stent

₹35,000 ₹30,000
removal for same stone)

Joint Replacement including

₹85,000 ₹80,000
Vertebral joints

Metro cities are Delhi NCR, Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad and Pune
 Specific Exclusions

Lasik Surgery, Septoplasty, Infertility & Related Ailments incl.'Male sterility'

Treatment on trial/experimental basis

Admin/Registration/Service/Misc. Charges

Expenses on fitting of Prosthesis

Any device/instrument/machine contributing/replacing the function of an organ

Holter Monitoring

External Congenital Diseases

Annual Sum Insured (INR)

Silver Gold Diamond Platinum

₹1,00,000 ₹2,00,000 ₹3,00,000 ₹5,00,000

Claims Process
z
The claims intimation can be done for both reimbursement and cashless hospitali ation on the

Onsurity app. The Onsurity Good Doctor team will assist the member on availing the group

health insurance claim from the partner insurance company in case of a valid claim. The

process to raise a claim on Onsurity is provided as below :

Please log into the Onsurity app. On the Home Page, under the Insurance section, tap on

*Claim Now* button.

After tapping the *Claim Now* button, you can see the steps to raise the claim and claim type

process (reimbursement / cashless). Further, you can see the list of documents required and

claim form for reimbursement claims. You can track nearest network hospital in case of

cashless claim.

Tap on *Raise a Request* button.

Now select the *Claim Type* (Planned Cashless / Emergency Cashless / Reimbursement

claim) and tap on *Submit*. Your claim request will be successfully registered with Onsurity

and we will get back to you on your registered mobile number within 24 hours.
Cashless Claim Process
Cashless Facilities can be availed only at Onsurity’s partner insurance company’s network
providers
Onsurity’s partner insurance company reserves the right to modify, add or restrict any network
provider for Cashless Facilities at their sole discretion. Before availing cashless facilities,
please check the applicable updated list of network providers.

Planned cashless
Onsurity or Onsurity’s partner insurance company must be contacted to pre-authorise
cashless facility for planned treatment at least 72 hours prior to the proposed treatment. The
request for planned cashless claim could be raised on the Onsurity app.

Cashless request form which is available with Onsurity’s partner insurance company’s
network provider should be completed and sent to Onsurity or Onsurity’s partner insurance
company for authorization.

At the time of discharge, the member has to verify and sign the discharge papers, pay for
non-medical and inadmissible expenses
Onsurity’s partner insurance company / TPA upon getting cashless request form and related
medical information from the member/ network provider will issue pre-authorization letter to
the hospital after verification.

Emergency Cashless:
Onsurity’s partner insurance company / TPA upon getting cashless request form and related
medical information from the member/ network provider will issue pre-authorization letter to
the hospital after verification.
Cashless request form available with Onsurity’s partner insurance company’s network
provider should be completed and sent to Onsurity or Onsurity’s partner insurance company
for authorization.
Onsurity’s partner insurance company / TPA upon getting cashless request form and related
medical information from the member/ network provider will issue pre-authorization letter to
the hospital after verification.
At the time of discharge, the member has to verify and sign the discharge papers, pay for
non-medical and inadmissible expenses
Reimbursement Claim Process
Claim Intimation
For all the claims for which cashless facilities have not been pre-authorised or for which
treatment has not been taken at Onsurity’s partner insurance company’s network provider,
Onsurity’s partner insurance company should be given a written notice of the claim along with
the following details within 48 hours of admission to the hospital

A. Documents required to file a reimbursement claim.

Duly filled and signed Claim Form
Photocopy of PAN and Aadhar card
Original detailed discharge summary / day care summary from the hospital
Original consolidated hospital bill with break-up of each Item, duly signed by the insured

Original payment receipt of the hospital bill

Letter from treating Medical Practitioner stating the following
Complaints with duration and past history
First and all previous consultation papers indicating history and treatment details for current
ailment
All original diagnostic reports (including imaging and laboratory) along with Medical
Practitioner’s prescription and invoice / bill with receipt from diagnostic center
Original bills, original payment receipts and reports for investigation
Original medicine bills and receipts with corresponding prescriptions
Original invoice/bills for implants (viz. Stent /PHS Mesh / IOL etc.) with original payment
receipts
Cancelled cheque of the primary beneficiary with IFSC code for the account to which the
claim amount has to be transferred
KYC details if the claimed amount is more than 1 lac (address proof)
Medical history of co-morbidities e.g. Hypertension, heart ailment etc
Treatment detail with name of drugs and route of administration
Road Traffic Accident (In addition to document listed above under A)
Copy of the First Information Report (FIR) from police department / copy of the medico-legal
certificate
Treating doctor’s certificate giving details of injuries (How, when and where the injury was
sustained) including whether claimant was under the influence of any intoxicating material

In Non-Medico legal cases (In addition to document listed above under A)

Treating doctor’s certificate giving details of injuries (How, when and where the injury was
sustained) including whether claimant was under the influence of any intoxicating material.

For Death Cases (In addition to document listed above under A)

Original death summary from the hospital
Copy of the death certificate from treating doctor or the hospital authority
Copy of the legal heir certificate, if the claim is for the death of the principle insured
Viscera Report for death due to poisoning OR snake bite

Pre- and Post-hospitalisation expenses

Original medicine bills, original payment receipt with prescriptions
Original investigations bills, original payment receipt with prescriptions and report
Original consultation bills, original payment receipt with prescription
Copy of the discharge summary of the main claim

Important Terms
Onsurity will only provide assistance services during the claim as a group administrator. Final
authority for claims approval, validation and payment of the claim rests with Onsurity’s
partner insurance company.
In case of any emergency claim, please visit hospital’s TPA desk for cashless facility.
Important Terms

Please carry your E-health card and valid government approved identity card to the hospital
TPA desk for cashless claim.

Onsurity or Onsurity’s partner insurance company shall be provided the necessary

information and documentation in respect of all claims at the member’s expense within 30
days of discharge from the Hospital

Claims for Pre-hospitalisation Medical Expenses and Post-hospitalisation Medical Expenses

to be submitted to Onsurity or Onsurity’s partner insurance company within 30 days of the
completion of the post- hospitalisation treatment

Please keep all documents for claims handy every time.

The minimum entry age needs to be 15 years and maximum entry age shall be 55 years.

The Group Health Insurance for Onsurity members under ZoloSure is provided by ICICI
Lombard General Insurance Co. Ltd. The complete ICICI Lombard’s Group Health policy
wordings can be accessed here. Please note that the coverage and benefits applicable for
each Member shall be limited to those set out in this document. However, the benefits
provided by Onsurity to the Members shall be subject to the terms and conditions of the ICICI
Lombard’s Group Health policy wordings. In the event of any discrepancy between the
coverage or benefits provided in the ICICI Lombard’s policy wordings and this document, this
document’s terms shall prevail.

This document only summarizes the benefit of Group Health Insurance under the ZoloSure
membership. For complete terms of ZoloSure membership and understanding of other
healthcare benefits under the program, please visit here.