GROUP PARENT MEDICAL INSURSNCE POLICY DETAILS

Includes:
✓ Only “in-patient” hospitalization expenses.
✓ Active treatment with minimum 24 hours hospitalization.
✓ Pre-hospitalization expenses of 30 days before admission
✓ Post hospitalization expenses for 60 days after discharge for an eligible hospitalization

Excludes:
Non - Medical Expenses - Registration/Admission fees, hospital surcharge, food bills for attendants, telephone
charges, pharmacy charges for non-medical items etc.
Other standard exclusions
 SUM ASSURED SINGLE PARENT SET OF PARENTS

INR 12,800 (Plus INR 17,800 (Plus taxes

INR 2LACS
taxes as applicable) as applicable)

✓Sum Insured: 2 lacs

✓Pre-Existing diseases covered
✓Maximum Entry Age - 80 years
✓Room rent : 2% of SI of Normal Room & 4% of ICU( For Metro City),
1% of SI of Normal Room & 2% Of ICU( For Non-Metro City)
✓Cataract limit up : As per GIPSA Rate.
✓Ambulance charges on Emergency Maximum of INR 2000 per claim.
✓Domiciliary Hospitalization Cover: No
✓Pre & Post hospitalization covered for 30 – 60 days respectively.
✓1st 30 days/ 1st year/ 2nd year/ 4th year waiting period waived off.
✓10% Copayment applicable on each and every claim
✓Claim intimation within 2 days from date of admission and claim submission within 30 days from date of discharge.
✓Premium will be added or refunded on pro-rata basis for new joining & deletions, respectively.
Circumcision unless necessary for treatment of disease
Dental treatment of any kind unless requiring hospitalization
Congenital external diseases or defects/anomalies
HIV and AIDS
Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.
Venereal diseases (Sexually Transmitted Diseases)
Injury or disease caused directly or indirectly by nuclear weapons
Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations
Naturopathy
Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, etc
Cost of spectacles, contact lenses, hearing aids
Any cosmetic or plastic surgery except for correction of injury
Hospitalization for diagnostic tests only
Vitamins and tonics unless used for treatment of injury or disease
Infertility treatment
Voluntary termination of pregnancy during first 12 weeks (MTP)
Administrative Expenses
▪ Admission Charges
▪ Registration Charges
▪ Medical Records/Medico
legal charges
▪ Attendant Stay charges
▪ Relative Stay charges
▪ Additional Stay
▪ Gate Pass/Attendant pass
▪ Overhead charges
▪ Establishment Charges
▪ Tax
▪ Surcharge
▪ Incidental charge
▪ Waste disposal Charge
Documentation Expenses Services
▪ Documentation charges ▪ Private nurse charges
▪ Medical records charges ▪ Telephone Charges
▪ Discharge summary ▪ Fax Charges
▪ Birth Certificate ▪ Food/Beverages
▪ Death Certificate ▪ Diet
▪ Medical Certificate ▪ Electricity Charges
▪ Water Charges
▪ T.V/Internet Charges
Consumables
▪ News Paper/Magazines
Charges
▪ Antiseptic/disinfectant
▪ Stationery Charges
solutions
▪ Linen/Laundry Charges
▪ Soaps
▪ Mortuary/Coffin Charges
▪ Powder
▪ Oil/Cream
▪ Sanitary pads/Diapers
▪ Cassette/CD/Film charges
▪ Oxygen Cylinder
▪ Health Foods
✓ Admission for investigations/ observation / evaluation only .
✓ Admission beyond a certain no. of days apart from the normal package stay.
✓ Treatment not matching with disease mentioned on pre-auth form.
✓ Any treatment which otherwise could have been taken on OPD basis.
✓ Any congenital external disease.
✓ Hospital not sending proper query reply raised by TPA on time.
✓ Active line of treatment not mentioned in the pre-auth form.
✓ Less than 24-hour admission.
✓ Submit the Reimbursement claim documents to Emedlife office within 21 days from date of Discharge

✓ Always carry photo ID proof along with your medical card of the patient. Photo ID proof can be
Driving license / Pan Card / Passport / Voters ID.

✓ In case of planned hospitalization, take approval before getting admitted in hospital

✓ For Reimbursement cases, always collect all originals from Hospital including final bill with break up
and payment receipt.

✓ Please keep with you Photocopy of claim document.

✓ Any issues in getting cashless approval, please contact the account manager of Emedlife.
Name Designation Mobile No. E-Mail ID
Saurav Kundu Deputy Manager +91-8826692948 Saurav_kundu@emedlife.in
Associate Vice
Manu Sharma +91-8826692944 Manu_sharma@emedlife.in
President
PROCEDURE OF DISCHARGE & CLAIM AT NON - NETWORK HOSPITAL

✓ The employee is requested to arrange for the admission and all other payments required by the hospital.

✓ Collect and submit the following documents (in original) after discharge.
✓ Signed Claim Form.
✓ Discharge Summary.
✓ Main Hospital Bill (with proper split up, ie. Itemized).
✓ Prescriptions, reports and bills for all investigations done.
✓ Prescriptions and bills for medicines consumed during hospitalization.
✓ Cancelled Cheque Leaf
✓ Break-up of the bills.
✓ Hospital’s registration number is required and Mandatory
✓ Net work hospital Detail Link:-https://www.ericsontpa.com/GIPSANetwork.aspx

NOTE: A claim will not be assessed if the documents mentioned in red are not submitted.

• Claim Submission Timeline - All claims to be submitted to TPA within 21 days from date of discharge. In case of post hospitalization, the timeline
would be 30 days from - treatment completion or completion of 60 days post hospitalization, whichever is earlier.

Address: Emedlife Insurance Broking Services Limited-618, 6th Floor, DLF Tower A, Jasola Vihar, New Delhi-110025.

NOTE : Any delayed submission beyond the timeline mentioned above will not be processed. In such cases, letter from the employee would be
required with a valid reason for delay in submission. It is at the discretion of the Insurer to provide the approval for such cases.
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THANK YOU