ISGEC HEAVY ENGINEERING LTD.

, NOIDA
Guidelines cum Benefit ‘manual’ of Group Mediclaim Policy
for the period 17‐June‐2021 to 16‐June‐2022
________________________________________________________________________________________ 

(1) POLICY FEATURES:

Name of Insurance Company  THE NEW INDIA ASSURANCE CO. LTD. (AMBALA) 
Respective Policy No.  35350034210400000013 (i.e. covering with Parents) &
(i.e. covering with parents)  35350034210400000014 (i.e. covering without Parents)
Third Party Administrator (TPA)  M/s Vipul MedCorp Insurance TPA Pvt Ltd. 
Jurisdiction of the Policy  INDIAN TERRITORY ONLY   

Employee, Spouse, Two dependent Children (up to 25 
Coverage of Policy covering with Parents  Years of age) & dependent Parents.  
 ‘Female’ Employee can opt either set of parents. 
Coverage  of  Policy  covering  without  Employee,  Spouse  &  Two  dependent  Children 
Parents  (maximum up to 25 Years of age). 
Sum Insured (Graded)   Graded between ₹ 2 Lac to ₹ 10 Lac (in the multiple of ₹1Lac) 
Room  Rent  Cap  (Normal/General)  including 
 1% of the Sum Insured or Actual, whichever is less. 
nursing & boarding expenses etc. 
Room  Rent  Cap  (ICU/CCU)  including  nursing  &  
 2% of the Sum Insured or Actual, whichever is less.              
boarding expenses etc. 
PROPORTIONATE DEDUCTION ON THE ENTIRE BILL
AMOUNT WILL BE MADE BY THE TPA/INSURER WHILE
FURTHER TO PL. NOTE ‐‐‐> APPROVING THE CLAIM IN CASE ACTUAL ROOM RENT
(including  nursing  &  boarding  expenses  etc.) IS MORE
THAN PERMISSIBLE ROOM RENT.
Pre‐existing (PED’s) diseases  Covered from day one in our GMC Policy. 
Maternity limit (if Sum Insured <=2 Lac)  ₹ 15 K in case of Normal, ₹ 25K for Caesarean delivery 
Maternity limit (if Sum Insured >2 Lac)  ₹ 25 K in case of Normal, ₹ 40K for Caesarean delivery 
Pre & Post Natal Expenses  Covered up to ₹ 5K BUT WITH IN MATERNITY LIMIT only 

Covered  from  day  one  subject  to  formal  information  to 

Insurance  Co.  immediately  after  birth  for  babyʹs  enrollment 
in GMC Policy to issue suitable endorsement. 
BABY EXPENSES  IN CASE NEW BORN BABY IMMEDIATE AFTER BIRTH (i.e. 
PRIOR  TO  DISCHARGE)  REQUIRE  ANY  TREATMENT 
THAN  SAID  TREATMENT  WILL  BE  COSIDERED  WITH  IN 
THE APPLICABLE MATERNITY LIMIT ONLY. 

1%  of  Sum  Insured  with  an  upper  side  cap  of  ₹  2,500/‐  only 
Ambulance Expenses 
subject to production of proper/formal/ justified Bill & Receipt. 
Pre & Post Hospitalisation Expenses  30 & 60 Days respectively covered. 

Inclusion / Exclusion  To  be  effective  from  Date  of  Joining  and/or  Relieving  on  pro‐
rata  basis  (provided  NO  CLAIM  preferred  till  exit),  subject  to 
(Addition & Deletion) 
the immediate/well in time information sent to Insurer / TPA. 

(This is not any legal document but broader GUIDELINES taken out from the expressed terms conditions
received from The New India Assurance Co. Ltd., Ambala)

Page - 1 ‐
 ISGEC HEAVY ENGINEERING LTD., NOIDA
Guidelines cum Benefit ‘manual’ of Group Mediclaim Policy
for the period 17‐June‐2021 to 16‐June‐2022
________________________________________________________________________________________ 

Only  in  case  of  new  Joinee,  Newly  Married  Spouse  &  New 
Mid‐term inclusion in the Policy  born  baby  only  i.e.  subject  to  immediate/timely  formal 
information / request to the Insurer & TPA, pl. 

(2) CASH LESS TREATMENT:

Treating  doctor  /  Hospital  at  least  48  Hours  prior  to  planed  Hospitalization,  must  complete  pre‐
authorization Form & Mail to TPA at gi@vipulmedcorp.com & noidaservice1@vipulmedcorp.com 
 

 TPA may approve cashless well within 4‐6 working hours, subject to prescribed protocol meeting 
policy coverage terms and conditions.  
 

 Treating  doctor  must  answer  the  Queries  (if,  any)  raised  by  TPA,  enabling  them  to  expedite  & 
approve Cashless hospitalization request at the earliest feasible. 
 

 Insured may speak to following TPA officials in case of any assistance required: 
 

 Mr. Pawan Rawat (AM) Noidaservice1@vipulmedcorp.com,7428296554 

 Ms. Khushboo Goel (AVP), Khushboo@vipulmedcorp.com, 7042479062  

(3) INTIMATION OF HOSPITALISATION TO TPA IN CASE OF NON-

CASHLESS cum RE-IMBURSEMENT CLAIM, PROVIDING EMP. CODE,
TPA ID, RESPECTIVE POLICY NO. & HOSPITAL ADDRESS:
(i) Advance Claim intimation in case of planned treatment, is required to be ensured Or 
(ii) To intimate immediately after Hospitalisation in case of sudden/emergency treatment Or  
(iii) To intimate latest within 24 Hours of Hospitalisation but in any case prior to Patient’s discharge.  
(iv) Claims will not be admissible / payable in case such intimation has not been ensured. 
 

 HOSPITAL OR  NURSING  HOME means  any  institution  in India  established  for indoor  care  and 
treatment  of  sickness  and  injuries  and  which  has  been  registered  either  as  a  hospital  or  nursing 
home with the local authorities and is under the supervision of a registered and qualified medical 
practitioner, or complies with minimum criteria, as follows: 

(i) Has a minimum of 10 beds if located in towns having a population of less than 10 lacs (Class ‘C’ 
towns) or a minimum of 15 in‐patient beds in other towns.  
(ii) Has a fully equipped operation theatre.  
(iii) Has a fully qualified doctor in charge and nursing staff around the clock, and  
(iv) Maintains a daily medical record for each of its patients. 
(v) Such Hospital/Nursing Home should have been approved by the Raksha TPA. 

(4) REIMBURSEMENT OF EXPENSES INCLUDES THE FOLLOWING:

 Entitled Room Charges (as applicable & discussed above). 
  Doctors’ Fees. 

(This is not any legal document but broader GUIDELINES taken out from the expressed terms conditions
received from The New India Assurance Co. Ltd., Ambala)

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 ISGEC HEAVY ENGINEERING LTD., NOIDA
Guidelines cum Benefit ‘manual’ of Group Mediclaim Policy
for the period 17‐June‐2021 to 16‐June‐2022
________________________________________________________________________________________ 

  Intensive Care Unit charges. 
 Surgical fees, operating theatre, anesthesia and oxygen and their administration. 
  Physical therapy. 
  Drugs and medicines consumed on the premises. 
  Hospital miscellaneous services (such as laboratory, X‐Ray, diagnostic tests). 
  Dressing, ordinary splints and plaster casts. 
  Costs of prosthetic devices if implanted during a surgical procedure. 
  Radiotherapy and chemotherapy. 
  Organ transplantation charges (excluding cost of organ) 

(5) SUBMISSION OF PRE & POST‐HOSPITALIZATION CLAIMS:

(i) Claim  of  Pre‐Hospitalization  expense  (including  Hospitalization  expense)  is  required  to  be 
submitted within ‘7’ days of discharge and all Post‐Hospitalization claim to be submitted within 
‘7’ days after completion of post hospitalization period of 60days or after completion of treatment 
whichever is earlier. 
(ii) Claim intimation is required to be done in advance or immediate after Hospitalisation or latest by 
within 24 Hours of Admission, in case of reimbursement and Pre‐Post Hospitalization Claims.  
(iii) Claims will not be admissible / payable in case such intimation has not been ensured. 

(6) FOLLOWING ORIGINAL DOCUMENTS REQUIRED TO BE SUBMITTED

FOR RE‐IMBURSEMENT CLAIM, AS UNDER:
(i) Bill, Receipt and Discharge Certificate / Card from the Hospital. 
(ii) Cash Memos from the Hospitals /Chemists, supported by proper prescriptions. 
(iii) Receipt and Pathological test reports from Pathologist supported by note from the  

 
       Medical Practitioner / Surgeon recommending such Pathological Tests. 
(iv) Surgeonʹs certificate stating nature of operation performed, Surgeons’ Bill & Receipt. 
(v) Attending Doctorʹs/ Consultantʹs/ Specialistʹs / Anaesthetist’s Bill and Receipt along with 
  the suitable certificate confirming the diagnosis. 
(vi) Certificate from attending Medical Practitioner / Surgeon that the patient is fully cured. 
 

(7) DAY CARE PROCEDURES COVERED UNDER GMC POLICY: 

 

HOSPITALISATION  means  admission  in  any  Hospital  /  Nursing  Home  in  India  upon  the  written 
advice  of  a  Medical  practitioner  for  a  minimum  period  of  24  consecutive  Hours  whereas  said  time 
limit of 24 Hours will not be applicable for following surgeries/procedures. 
(i)     Radiotherapy 
(ii)     Dialysis 

(This is not any legal document but broader GUIDELINES taken out from the expressed terms conditions
received from The New India Assurance Co. Ltd., Ambala)

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 ISGEC HEAVY ENGINEERING LTD., NOIDA
Guidelines cum Benefit ‘manual’ of Group Mediclaim Policy
for the period 17‐June‐2021 to 16‐June‐2022
________________________________________________________________________________________ 

(iii)     Kidney Stone removal 
(iv)     Cataract Surgery (maximum ₹ 24 K per person / Eye only) for each eye. 
 
(Limited to ₹ 24K Or Actual whichever is less, inclusive of all charges but excl. tax) 
(v)     Anti‐Rabies Vaccination. 
(vi)     Hysterectomy. 
(vii)   Appendectomy Inguinal/Ventral/Umbilical/Femoral Hernia repair.  
(viii) Coronary Angiography. 
(ix)     Lithotripsy (Kidney Stone Removal).  
(x)     Coronary Angioplasty. 
(xi)   Parenteral Chemotherapy. 
(xii)   Dental surgery following an accident. 
(xiii)   Piles / Fistula.  
(xiv) Dilatation & Curettage (D&C) of Cervix Prostate.  
(xv) Eye surgery Radiotherapy.  
(xvi) Fracture/dislocation excluding hair line fracture Sinusitis.  
(xvii) Gastrointestinal Tract system Stone in Gall Bladder, Pancreas, and Bile Duct.  
(xviii) Haemo‐Dialysis Tonsillectomy.  
(xix) Hydrocele Urinary Tract System Or  
(xx) Any other Surgeries/Procedures agreed by TPA / Insurer which require less than 24   
      Hours Hospitalisation due to subsequent advancement in Medical Technology. 
 

 WHEREAS IN OTHER CASE, CLAIM IS NOT ADMISSIBLE /PAYABLE

IN CASE STAY IN HOSPITAL IS LESS THAN 24 HOURS Or not justified.
 ADMISSION FOR THE PURPOSE OF INVESTIGATION/EVALUATION IS NOT
COVERED UNDER THIS MEDICLAIM POLICY.
(8) MAY NOTE THE FOLLOWING IMPORTANT INFORMATIONS:
 Any dental treatment arising out of accidents only are covered (otherwise not covered). 
 Pre and post‐hospitalization expenses is covered for the period of 30 days & 60 days. 
 

Whereas Pre & Post Hospitalisation expense is NOT PAYABLE in case of maternity related claims 
as maximum claim payable limit has been fixed in this case. 
 Pre‐existing diseases (PED’s) covered from the day one. 
 ROOM RENT (including nursing and boarding expenses etc.) is restricted up to 1% of Sum  
Insured per day for normal room & 2% of Sum Insured per day in case of ICU/ICCU/HDU. 
 

“PROPORTIONATE DEDUCTION NOT ONLY IN ROOM RENT PORTION BUT ON COMPLETE 
  BILL AMOUNT WILL BE DONE IN CASE ACTUAL ROOM RENT (including nursing & boarding    
  expense etc…) VALUE EXCEEDS THE PERMISSIBLE ROOM RENT”. 
 

 CAP/LIMIT OF MATERNITY (IPD) TREATMENT,  
In case of Sum Insured <= ₹ 2 Lac (restricted to ₹ 15K for Normal, ₹ 25K for Caesarean) 

(This is not any legal document but broader GUIDELINES taken out from the expressed terms conditions
received from The New India Assurance Co. Ltd., Ambala)

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 ISGEC HEAVY ENGINEERING LTD., NOIDA
Guidelines cum Benefit ‘manual’ of Group Mediclaim Policy
for the period 17‐June‐2021 to 16‐June‐2022
________________________________________________________________________________________ 

In case of Sum Insured   > ₹ 2 Lac (restricted to ₹ 25K for Normal, ₹ 40K for Caesarean) 
PRE & POST NATAL EXPENSE IN HOSPITAL IS COVERED UP TO ₹ 5K (WITH ‐ 
IN MATERNITY LIMIT)  
 Treatment of new born baby in case required (after birth but prior to healthy discharge), will  
be considered as part of Maternity & Claim will be paid within maternity limit only. 
 SURGICAL  OPERATION  means  manual  and/or  operative  procedures  for  correction  of  deformities 
/defects, repair of injuries, cure of diseases, relief of suffering and prolongation of life. Which means 
Robotic Surgery will not be covered under the Policy. 
 TREATMENT RELATED TO INFERTILITY WILL NOT BE COVERED. 
 Psychiatric related treatment is the permanent exclusion in any Mediclaim policy
hence not covered under our Mediclaim (GMC) Policy as well.
 NEEDLES  TO  SAY  THAT  TERMS  AND  CONDITIONS  OF  THE  POLICY  WILL  PREVAIL  IN 
CASE OF ANY KIND OF CONFLICT IN INTERPRETATION.

(9) FEW GENERAL EXCLUSIONS (for ready reference) ARE:

i) Any disease or injury caused due to use of Alcohol and / or intoxicating drug. 
ii) Cosmetic dental treatment / Corrective surgery for eyes (for power less than 7.5)  
iii) HIV and AIDS 
iv) Robotic Surgery 
v) Hospitalization for convalescence, general debility, rest cure, intentional self‐injury,  
use of intoxicating drugs / alcohol. 
vi) Venereal diseases 
vii) Circumcision unless necessary for treatment of disease 
viii)Injury or disease caused directly or indirectly by nuclear weapons 
ix) Naturopathy any non‐allopathic treatment  
x) Infertility treatment 
xi) Congenital external diseases 
xii) Any non‐medical expenses like registration fees, admission fees, charges for medical    
Records, Cafeteria charges, Telephone charges and disposable items etc. 
xiii) Any cosmetic or plastic surgery except for correction of injury caused by accident 
xiv) Charges incurred primarily for diagnostic, X‐Ray or laboratory examinations or other diagnostic 
studies not consistent with or incidental to the diagnosis and treatment of any ailment, sickness or 
injury.  
xv) Vitamins and tonics unless used for treatment of injury or disease. 
xvi) Injury or disease directly or indirectly caused by or arising from or attributable to War or War‐like 
situations. 
xvii) All Psychiatric / Psychosomatic illness. 
xviii) Genetic disorder 
xix) Unproven treatment
 GENERAL EXCLUSIONS LIST IS ILLUSTRATIVE/INDICATIVE ONLY NOT EXHAUSTIVE.

(This is not any legal document but broader GUIDELINES taken out from the expressed terms conditions
received from The New India Assurance Co. Ltd., Ambala)

Page - 5 ‐
 ISGEC HEAVY ENGINEERING LTD., NOIDA
Guidelines cum Benefit ‘manual’ of Group Mediclaim Policy
for the period 17‐June‐2021 to 16‐June‐2022
________________________________________________________________________________________ 

(10) DO'S (Cashless Services):

(i) We must have our tpa cards (soft copy) handy with us in our Mobile/
/Email/WhatsApp etc.
One can visit Vipul Medcorp ‘TPA’ site, www.vipulmedcorp.com to check
status of TPA Card, Cashless /Re-imbursement Claim as under:
 Go to the Page:  http:// www.vipulmedcorp.com 
 May refer the various titles in the left side for various services, as under: 
i) ‘Guidelines’ to understand various terms. 
ii) ‘Mobile / Email registration’ to register yourself. 
iii) ‘PPN Network (Preferred provider network) for discounted rates in Hospital. 
iv) ‘Claim intimation’ to intimate any Claim (if, any). 
 

 May also take help of respective HR official (in‐case of any problem) as complete ‘Dump’ of all these 
TPA Cards have been shared with them as well. 
 

(ii) Pre‐authorisation  Cash  less  request  should  be  sent  along  with  insured/attendant’s  Mobile  No.  duly 
signed by treating doctor / hospital to the TPA for getting their approval. 
(iii) Must  avail  cashless  treatment  at  any  PPN  or  network  hospital  for  the  covered  ailments  within 
eligible amount under the policy. 
(iv) Leave back all the original documents and signed claim Form with the network hospitals at the time 
of discharge for their onward submission to TPA/Insurer. 
(v) We  should  make  payment  to  network  hospital  for  the  expenditure  over  and  above  Sum  Insured/   
specified limit for any disease and for the expenses / treatment not covered as per norms of Policy. 
 

(11) DONT'S (Cashless Services):

(i)    Do not insist upon admission for investigations or evaluation or health check‐ups. 
(ii) Do not carry back any original document at the time of discharge from the hospital. 
(iii) Do not forget to sign on the Claim Form. 
 

(12) DOCUMENTS along with complete Claim ‘FORM’ SHOULD BE SENT AT

THE ADDRESS MENTIONED BELOW:
Mr. Pawan Rawat (Asst. Manager)
M/s Vipul MedoCorp Insurance Pvt. Ltd.
C-3, Sector-3, Quantum Building, Basement,
Noida – 201301, Uttar Pradesh, India
 +91 ‐ 98715 93642 

(This is not any legal document but broader GUIDELINES taken out from the expressed terms conditions
received from The New India Assurance Co. Ltd., Ambala)

Page - 6 ‐
 ISGEC HEAVY ENGINEERING LTD., NOIDA
Guidelines cum Benefit ‘manual’ of Group Mediclaim Policy
for the period 17‐June‐2021 to 16‐June‐2022
________________________________________________________________________________________ 
 

(13) Officials to be contacted in case of any assistance required :

 

 Contact details of Officials of Vipul Medcorp TPA:

 Mr. Pawan Rawat (AM) Noidaservice1@vipulmedcorp.com,7428296554 
 Ms. Khushboo Goel (AVP), Khushboo@vipulmedcorp.com, 7042479062  

 CONTACT OFFICIALS of Then New India, Ambala:

 Ms. Rashmi Sachdeva, AM+91‐94643 29776, rashmi.sachdeva@newindia.co.in 
 Ms. Sarika Gupta, DM +91‐90233 30515, sarika.gupta@newindia.co.in 
 Mr. K. K. Sachdeva, Sr. DM+91‐99885 64060, kk.sachdeva@newindia.co.in

(14) “Vipul Selfcare” Mobile application’ is requested to download

from Google Play/Apps store, as under:

Policy i.e. covering Policy No. SELF CARE LINK & USER ID PASSWORD
https://www.vipulmedcorp.com/selfcare
Emp., Spouse, Two
dependent children 35350034210400000013 User Name : NODA + Employee Code
[

& dependent parents Password : NODA + Employee Code

(i.e. as written in TPA Card)
https://www.vipulmedcorp.com/selfcare
Emp., Spouse & Two User Name : NODA + Employee Code
35350034200400000014
[

dependent children Password : NODA + Employee Code

(i.e. as written in TPA Card)
 

(15) Further to clarify & summarise the following as under:

 

i) Policy  covers  valid/justified  minimum  24  Hours  hospitalisation.  ‘HOSPITALISATION’  means 

admission  in  any  hospital/nursing  home  in  India  upon  written  advice  of  a  medical  practitioner 
for minimum period of 24 consecutive hours” 
 

ii) In  case  of  Hospitalisation,  maximum  permissible  Room  Rent  (including  nursing  &  boarding 
expenses  etc.) is @1% of Sum Insured in case of General (i.e. Non‐ICU/ CCU) whereas it is @ 2% in 
case of ICU / CCU. 
 

iii) In case higher category room rent (including nursing & boarding expenses etc…) is taken then 
the total medical expense is proportionately reduced by TPA/Insurer while passing the claim.      If 
any insured person intends to avail a room over & above the entitlement (as above) the expenses are 
proportionately reduced according to the room rent / ICU benefit.  
In view of the same, it is advisable to opt for maximum / adequate sum insured while confirming 
the  participation  in  the  policy  else  we  can  confine  ourselves  to  our  entitlement  to  avoid  future 
complication at the time of claim.  

(This is not any legal document but broader GUIDELINES taken out from the expressed terms conditions
received from The New India Assurance Co. Ltd., Ambala)

Page - 7 ‐
 ISGEC HEAVY ENGINEERING LTD., NOIDA
Guidelines cum Benefit ‘manual’ of Group Mediclaim Policy
for the period 17‐June‐2021 to 16‐June‐2022
________________________________________________________________________________________ 

May pl. have a look on the table given below: 
 

ELEMENTS OF ROOM CHARGE    
(Particular's) (Remarks)
LUXURY TAX   Actual tax levied by government is payable.  
Part of room charge for sub limits  
HVAC   Part of room charge, Not Payable separately  
HOUSE KEEPING CHARGES   Part of room charge, Not Payable separately  
SERVICE CHARGES WHERE NURSING CHARGE  Part of room charge, Not Payable separately  
ALSO CHARGED  
TELEVISION & AIR CONDITIONER CHARGES   Part of room charge, Not Payable separately  
SURCHARGES   Part of room charge, Not Payable separately  
ATTENDANT CHARGES   Part of room charge, Not Payable separately  
IM IV INJECTION CHARGES   Part of nursing charge, Not Payable separately  
CLEAN SHEET   Part of Laundry / Housekeeping, Not Payable 
separately  
EXTRA DIET OF PATIENT (OTHER THAN THAT  Patient Diet provided by Hospital is payable  
WHICH FORMS PART OF BED CHARGE)  
BLANKET/ WARMER BLANKET   Part of room charge, Not Payable separately  
   
ADMINISTRATIVE OR NON - MEDICAL CHARGES
ADMISSION KIT   Not Payable  
BIRTH CERTIFICATE   Not Payable  
BLOOD RESERVATION CHARGES AND ANTE  Not Payable  
NATAL BOOKING CHARGES  
CERTIFICATE CHARGES   Not Payable  
COURIER CHARGES   Not Payable  
CONVENYANCE CHARGES   Not Payable  
DIABETIC CHART CHARGES   Not Payable  
DOCUMENTATION / ADMINISTRATIVE EXPENSES   Not Payable  
DISCHARGE PROCEDURE CHARGES   Not Payable  
DAILY CHART CHARGES   Not Payable  
ENTRANCE PASS / VISITORS PASS CHARGES   Not Payable  
FILE OPENING CHARGES   Not Payable  
INCIDENTAL EXPENSES / MISC. CHARGES (NOT  Not Payable  
EXPLAINED)  
MEDICAL CERTIFICATE   Not Payable  

(This is not any legal document but broader GUIDELINES taken out from the expressed terms conditions
received from The New India Assurance Co. Ltd., Ambala)

Page - 8 ‐
 ISGEC HEAVY ENGINEERING LTD., NOIDA
Guidelines cum Benefit ‘manual’ of Group Mediclaim Policy
for the period 17‐June‐2021 to 16‐June‐2022
________________________________________________________________________________________ 

MAINTENANCE CHARGES   Not Payable  
MEDICAL RECORDS   Not Payable  
PREPARATION CHARGES   Not Payable  
PHOTOCOPIES CHARGES   Not Payable  
PATIENT IDENTIFICATION BAND / NAME TAG   Not Payable  
WASHING CHARGES   Not Payable  
MEDICINE BOX   Not Payable  
MORTUARY CHARGES   Payable up to 24 Hrs, shifting charges not payable  
MEDICO LEGAL CASE CHARGES (MLC CHARGES)   Not Payable  
   
EXTERNAL DURABLE DEVICES  
WALKING AIDS CHARGES   Not Payable  
BIPAP MACHINE   Not Payable  
COMMODE   Not Payable  
CPAP/ CAPD EQUIPMENTS   Device not payable  
INFUSION PUMP – COST   Device not payable  
OXYGEN CYLINDER  (USAGE OUTSIDE HOSPITAL)   Not Payable  
PULSEOXYMETER CHARGES   Device not payable  
SPACER   Not Payable  
SPIROMETRE   Device not payable  
SP02 PROBE   Not Payable  
NEBULIZER KIT   Not Payable  
STEAM INHALER   Not Payable  
ARMSLING   Not Payable  
THERMOMETER   Not Payable  
CERVICAL COLLAR   Not Payable  
SPLINT   Not Payable  
DIABETIC FOOT WEAR   Not Payable  
KNEE BRACES ( LONG/ SHORT/ HINGED)   Not Payable  
KNEE IMMOBILIZER/SHOULDER IMMOBILIZER   Not Payable  
LUMBOSACRAL BELT   Payable for surgery of lumbar spine.  
AMBULANCE COLLAR   Not Payable  
AMBULANCE EQUIPMENT   Not Payable  
MICROSHEILD   Not Payable  
 

iv) Admission  in  the  Hospital  only  for  the  purpose  of  investigation/evaluation  NOT 
COVERED under insurance policy. 
   

(This is not any legal document but broader GUIDELINES taken out from the expressed terms conditions
received from The New India Assurance Co. Ltd., Ambala)

Page - 9 ‐
 ISGEC HEAVY ENGINEERING LTD., NOIDA
Guidelines cum Benefit ‘manual’ of Group Mediclaim Policy
for the period 17‐June‐2021 to 16‐June‐2022
________________________________________________________________________________________ 

v) Dependent  child  up  to  maximum  age  of  25  years  can  only  be  covered  under  this  policy  and 
maximum entry age of parents allowed is up to 80 years only. 
 

vi)  In  case  of  Cataract  Surgery,  there  is  cap  (maximum  claim  amount  payable)  of  Rs.  24,000/‐  only  per 
head per Eye (irrespective of Sum Insured opted by insured). 
 

vii) If higher category room rent is taken then the total/ mostly medical expenses are proportionately 
deducted  /  reduced  by  TPA/Insurer  while  passing  the  claim  hence  it  is  advisable  to  opt  adequate 
Sum insured. 
 

viii) Maximum maternity  benefits  payable under  the Policy  is  ₹15K  /  ₹25K  if  the Sum  Insured  is  up  to   
₹2 Lac & ₹ 25K/ ₹ 40K if Sum Insured is above ₹ 2 Lac in case normal/Cesarean case respectively. 
 

ix)   Psychiatric  related  treatment  is  the  permanent  exclusion  in  all  the  Mediclaim  policy  hence  not 
covered under this Policy as well. 
 

x)   Inclusion  of  new  entrants  or  newly‐wed  spouse  &  new  born  baby  is  allowed  subject  to  immediate 
intimation (but in any case not later than 3‐4 days) to the Insurer. 
 

xi)   Mid‐term inclusion/ exclusion (of existing employees) / change in sum insured or switch over from 
one Policy to the other will not be possible. 
 
 
 

 Intimation of Hospitalization is mandatory for Re-imbursement (Non-

Cashless) Claim hence one must ensure the same.
 New Born ‘Baby’ will be covered from day one subject to formal
information/request to the Insurer (Insurance Co.) for his/her inclusion
in respective Policy immediately after the ‘birth’ for issuing suitable
endorsement/enrolment in GMC Policy.
 Terms & conditions which are contained in this document are the broader
GUIDELINES taken out from the expressed terms conditions attached
which are received from The New India Assurance Co. for all kind of
interpretations & applications, the versions explained in the NEW INDIA
booklet will hold good. Intention behind the exercise of providing this
information is just to inform our Employees the broader heads of
coverage’s which is not to be treated as exhaustive & comprehensive.
Instead of going by the letters only we request you to understand our
spirit as well.

 TERMS & CONDITIONS OF THE POLICY WILL PREVAIL IN CASE OF ANY KIND
OF CONFLICT IN INTERPRETATION.
[   

           Your kind co-operation in this regards is highly solicited.

 
 
 
 
 
 
 
 
 
 
 
 
 

  (KC)   
 
Ps: ‘Room Rent’ means Room Rent including nursing/boarding expenses etc.

(This is not any legal document but broader GUIDELINES taken out from the expressed terms conditions
received from The New India Assurance Co. Ltd., Ambala)

Page - 10 ‐