GROUP HEALTH (FLOATER) INSURANCE
KEY INFORMATION SHEET
DISCLAIMER NOTE: The information mentioned below is illustrative and not exhaustive. The
information must be read in conjunction with the policy wordings. In case of any conflict between the
Key Information Sheet and the policy wordings, the terms and conditions mentioned in the policy
wordings shall prevail.
S. NO. TITLE
1 Product Name
2 What is covered under the policy?
3 Optional Add On Covers
DESCRIPTION
GROUP HEALTH (FLOATER) INSURANCE
The policy provides indemnification of medical
expenses incurred by the Insured during the
hospitalization, domiciliary hospitalization, for
any illness or injury suffered during the Policy
Period.
❖ Cover for Pre-Existing Diseases 
❖ Maternity Expenses 
❖ Out Patient Department (OPD) Expenses 
❖ Cost of Prescribed External Medical Aid 
❖ Baby Day One Cover 
❖ Critical Illnesses Cover 
❖ Travel Expenses for Medical Treatment 
❖ Dental Expenses 
❖ Cover for Alternate Methods of Treatment 
❖ Donor Expenses 
❖ Ambulance Charges 
❖ Pre and Post Hospitalization 
❖ Health Check-Up 
❖ Disease-Wise Sub-Limit 
❖ Domiciliary Hospitalization 
❖ Treatment Outside India 
❖ Convalescence Benefit 
❖ Loss of Wages/Salary Due To Hospitalization
(Hospital Daily Cash
❖ Allowance) Wellness & Preventive Care 
 ❖ Limit on Room Rent, Nursing Charges,
Consultation Fees, Diagnostic Charges, OT
Charges etc. 

Cashless or Reimbursement claims of covered

4 Payout Basis medical expenses up to specified Sum Insured
as per the scope of cover

The Policy can be renewed as a separate

contract under the then prevailing ICICI
Lombard Group Health Insurance product or its
nearest substitute (in case the product ICICI
Lombard Group Health Insurance is withdrawn
5 Terms of Renewal
by the Company) approved by IRDA.The policy
shall ordinarily be renewable except on
grounds of fraud, moral hazard or
misrepresentation or non- cooperation by the
insured.

The Policy shall be void and all premium paid

hereon shall be forfeited to the Company, in the
event of misrepresentation, mis description or
non-disclosure of any material fact.

Insured or the Company may cancel this Policy

6 Cancellation by giving the Company or the insured, as the
case may be, 15 days written notice for the
cancellation of the Policy, and then the
Company shall refund premium on short term
rates (if initiated by the insured) or pro rata
rates (if initiated by the Company) for the
unexpired Policy Period. The Company shall
follow the below short period scale unless
otherwise mutually agreed.
 COVERAGE
1 Policy Type : Floater
2 Policy Construct : Employer Employee
3 Service Category : Both Cashless & Reimbursement
4 OPD/IPD : IPD
5 Third Party : ICICI Lombard Healthcare
Administrator
6 OTC/Non-OTC : OTC
7 Physical Health Card : yes
8 30 Days waiting period,9 : Waived Off
months waiting period
,1st Year waiting period
9 AOY Clause : Total claims in any one year cannot be greater than 5 crores
10 Age Band : 1 day - 80 yrs
11 Family Definition : Employee, Spouse and 3 dependent children upto 25yrs of Age
12 Sum Insured : Sum Insured Per Family 'Rs.' -----300000--------- during the policy
period as per annexure attached herewith.
13 C o r p o r a t e F l o a t e r, O NA
P D C o v e r:
(Reimbursement), OPD
Cashless Cover
(Consultations only), Health
Assistance, Tele
Health, Emergency Support
Services,PPN Option
14 Room Rent : No Capping
15 Maternity Benefit for For Metro & For Non-Metro 80000-80000 for First 2 children
Normal & C-Section :
16 Pre-Existing Diseases : Pre-Existing Diseases Expenses Covered
17 Pre - Post Hospitalization : Pre-Hospitalization and Post Hospitalization for 30 days & 60 days
respectively are covered.
18 Baby Day 1 : Within Family SI

19 Pre/Post Natal Expenses : Pre-Post Natal Expenses to the limit of Rs 5000 is covered Within
Maternity Limit
20 Ambulance Service : Ambulance Charges limited to 'Rs.' 2000 Per Person

21 Health Check Up : 50 employees can avail benefit of Health Checkup

22 Domiciliary : Excluded
Hospitalization
23 Exclusion : 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 are outside the scope of the policy.
24 Special Condition : Policy also covers hospitalization arising out of Psychiatric ailments
within a limit of 'Rs.' 30,000 as well as treatment of Functional
Endoscopic Sinus Surgery within a limit of 'Rs.' 35,000.
25 Co-Payment
26 Day Care Procedures
27 Special Condition
28 Special Condition
29 Mid-Term Inclusion
30 Reasonable and
Customary Charges
31 Special Condition
32 Add-Del of Lives
33 Disclaimer
34 Diseases Wise Sublimit
35 1st year Exclusion
36 30 Days Waiting Period
37 9 months waiting period
38 Domiciliary
Hospitalization
39 Pre-Post Hospitalization
: No Copay
: Day Care Procedures are Covered as per the standard list
: 50% Co-Pay for cyberknife treatment/Stem Cell Transplantation.
Cochlear Implant treatment shall be restricted to 50% of the SI.
: Claim must be filed within 30 days from the date of completion of
treatment. However, the Company may at its absolute discretion
consider waiver, of this Condition in extreme cases of hardship
where it is proved to the satisfaction of the Company that under the
circumstances in which the insured was placed it was not possible
for him or any other person to give such notice or file claim within
the prescribed time-limit. The claim would invite additional 10%
co-payment over and above payable amount as per policy terms
and conditions.
: Mid term inclusion of dependents will be possible only in case of:a)
spouse (on account of marriage during the policy term)b) children
(childbirth during the policy term but after the the child has
completed 91 days of age) subject to not more than three children
: The Policy covers Reasonable and Customary Charges incurred
towards the medical treatment taken by the Insured Person during
the Policy Period following an Illness or Injury that occurs during
the Policy Period, subject to availability of the Sum Insured and any
specific limits specified in the Schedule of Benefits and the terms,
conditions and exclusions specified in the Policy document.
: No Refund for deletion-if lives less than minimum required & if
insured has claimed during policy
: Premium to be charged on Pro-Rata for addition/deletion
endorsement.
: This policy is underwritten as a assumption of a fresh policy
: No Limit
: Waive off
: Waive off
: Waive off
: Excluded
: 30-60 days