#Emergency Ambulance:Covered Subject to a maximum of Rs.

2500 or actual expenses

whichever is less Per Occurrence on admission only and Air Ambulance charges,
maximum of Rs. 50,000 in case of Emergency. #Room rent restriciton:Proportionate
Deduction clause applicable where Insured member has opted for room rent higher
than eligible room rent category. #Infertility treatment:INR 75,000 per Family
within Maternity limit. Only 30 such cases during the policy period as Overall
policy terms #Corporate buffer:Total Corporate buffer is INR 40,00,000. Restricted
to family floater sum insured Listed Critical Illness including the below : 1.
Cancer of specified severity 2. Coma of specified severity 3. End stage renal
disease presenting as chronic irreversible failure of both kidneys to function as a
result of which renal transplantation is carried out. Diagnosis has to be confirmed
by a specialist Medical Practitioner. 4. MAJOR ORGAN/BONE MARROW TRANSPLANT: (Over
and above the floater
sum insured, we shall reimburse the Insured Person such usual and necessary medical
expenses incurred in-hospital for a period of minimum 24 hours for the treatment of
the Critical Illness named above, after exhausting the family floater Sum Insured
as covered under the policy. The Company shall provide additional Sum Insured over
and above family floater Sum Insured upon written request from HR. An additional
buffer within the overall buffer limit provided is considered subject to the
condition that 1)It will be restricted to max of FSI 2)It will be used only for
employee claims 3)Only 4 such claims in the policy period . 4)It will be used only
for Critical Illness as defined. Our aggregate liability in respect of all such
claims under Corporate Buffer shall not exceed Rs.50 Lakhs which will be the
maximum benefit limit for the policies Policies of White collar Volvo Group and
Volvo CE in respect of all the Insured members as applicable during the period of
insurance
#Parental co-pay:10% co pay Applicable for All parental Claims
#Special Conditions:Dependent family members of the deceased employee will be
covered up to expiry of the running policy
#Surrogacy Cover:Surrogacy expenses to be covered within maternity sub limit :
Covered Upto Maternity Limit In case where surrogate mother is not an Insured
Beneficiary and acting thus for the Insured biological Mother, such cases have to
be specially confirmed by HR for release of benefit. This benefit will be released
through and on behalf of the Insured Biological Mother. Non Insured surrogate
mother cannot independently claim benefit under the policy
#Other Conditions 4:INTRAVETRIAL INJECTION : Covered for 10 lives with a max limit
of INR.50,000/- per case #Physiotherapy:Covered up to 90 days post hospitalization
subject to submission of doctor advice letter #Other Conditions 6:Bioabsorbable and
next generation cardiac stents: BIO-DEGRADABLE STENT : No Restriction, Covered up
to Balance Family Floater Sum Insured
#Co Share Pattern:Digit: 70% Iffco Tokio GIC Ltd : 30%
#Air Ambulance Cover:Covered upto 1L
#Wellness Mother Expenses:Coverage for Room Rent for Mother whose required to Feed
the baby post birth if the new born baby is hospitalized covered up to Baby's age
of 2 years within the Maternity Limit
#Wellness baby expenses on OPD and/or IPD:Covered upto maternity Sum Insured
#Oral Chemotherapy:Covered upto Family SI in such cases where normal chemo therapy
cannot be administered. It cannot be a matter of choice of the beneficiary but
should be a medical necessit
#Twin Delivery:150% for Twins & 200% for Triplets maternity limit only 3 cases in
year
#Bereavement Cover:In-case of death during hospitalization when an employee /
member has availed for cashless facility, complete hospital bill will be paid
(Subject to availability of the SumInsured) to facilitate quicker release of the
mortal remains
#Air Ambulance Cover:Covered upto 1L
#Psychiatric ailments:Covered in case of inpatient hospitalization upto INR 25000
#Package1:Room Rent 5000
#Package 2: Room Rent 7500
#Package 3:Room Rent:7500
#Package 4:Room Rent:7500
#Package 5:Room Rent:10000
#Package 6:Room Rent:7500
#Package 7:Room Rent:5000
#Package 8:Room Rent:7500 #Package 9:Room Rent:10000 #Package 10:Room Rent:10000
#Package 11:Room Rent:7500 #Package 12:Room Rent:10000 #Package 13:Room Rent:10000
#Package 14:Room Rent:10000 #Package 15:Room Rent:10000 #Package 16:Room Rent:10000
#Package 17:Room Rent:10000 #Package 18:Room Rent:12000 #Package 19:Room Rent:12000
#Package 20:Room Rent:12000 #Package 21:Room Rent:12000 #Package 22:Room Rent:12000
#Package 23:Room Rent:12000 #Package 24:Room Rent:12000 #Package 25:Room Rent:12000

================================================

Room/ICU Rent restriction - Custom as per package #For Package 1, Package 2 and
Package 3 - Normal Room Rent - 6,000 and ICU 12,000 #Special Conditions - Below
conditions override any contradictory conditions mentioned elsewhere on the policy
schedule: #1) Deductible for employee spouse and child will be INR 4,00,000 and
deductible for parents will be INR 3,00,000. #2) Claim for capped ailment (Like
maternity) that is payable under the base policy, will be payable in top-up policy
only if the entire base sum insured has been exhausted before the claim for capped
ailment is made. If the claim for capped ailment has been partially paid in base
policy, then no amount will be payable under top-up policy. Limit on the ailment
will be same as the limit applicable in base policy. #3) For package 4 (top-up sum
insured of 10L, 12L and 15L), any co-payment paid by insured in base policy can be
claimed back in top-up policy. Room rent is enhanced to 10K for normal/single room,
ICU 12,000 and anyd
eductions in room rent can be claimed in top up. the insured has to be exhausted
the entire applicable sum insured under base policy. Deductible is mentioned as 4
lakhs in policy/quote. Deductible here means base policy applicable SI i.e. 4 lakhs
for ESC and 3 lakhs for parent -----Deductible for employee spouse and child will
be INR 4,00,000 and deductible for parents will be INR 3,00,000. #Bereavement Cover
- Existing dependent shall be allowed to continue till the end of policy period
even after the unexpected demise of the employee, subject to the company willing to
continue the policy #Modern Treatments - Inj Avastin/Macugen, covered upto 50%
SI.#All other terms are as per base policy. #4.Cross selection of parents and in-
laws allowed subject to Employees can cover either set or a mixed set of parents
i.e. either one set of Parents or Parents-in-law or 1 Parent and1 Parent-in-law
---- as per base policy only #5. Premium charging and co-pay to be applicable as
per below mentioned p
ackage. #6 Package Structure and premium chart. #Package Name-Sum Insured -Room
Rent Restriction (Normal/ICU)-Co-payment-Employee Category #A. Package 1-100000 -
6,000 / 12,000-No Copay-4523-Category 1 #b. Package 1-200000 -6,000 / 12,000-No
Copay-4884-Category 1 #c. Package 1-300000 -6,000 / 12,000-No Copay-5275-Category 1
#d. Package 2-100000 -6,000 / 12,000-10% Co-pay-4523-Category 2 #e. Package 2-
200000 -6,000 / 12,000-10% Co-pay-4884-Category 2 #f. Package 2-300000 -6,000 /
12,000-10% Co-pay-5275-Category 2 #g. Package 2-400000 -6,000
/ 12,000-10% Co-pay-6145-Category 2 #h. Package 3-400000 -6,000 / 12,000-5% Co-pay-
6145-Category 1 #j. Package 3-500000 -6,000 / 12,000-5% Co-pay-8005-Category 1&2
#k. Package 3-600000 -6,000 / 12,000-5% Co-pay-13472-Category 1&2 #l. Package 3-
700000 -6,000 / 12,000-5% Co-pay-21621-Category 1&2 #m. Package 3-800000 -6,000 /
12,000-5% Co-pay-30305-Category 1&2 #n. Package 3-900000 -6,000 / 12,000-5% Co-pay-
37411-Category 1&2 #o. Package 4-1000000 -10,000/12,000-No Copay-50160-Category 1&2
#p. Package 4-1200
000 -10,000/12,000-No Copay-57684-Category 1&2 #. Package 4-1500000 -10,000/12,000-
No Copay-66337-Category 1&2
====================================================

#41. Corporate buffer: Total Corporate buffer is INR1,00,00,000. Maximum

utilization per family is limited to the family floater sum insured. Corporate
buffer can only be utilized for all claim excluding maternity claims and Capped
ailments post exhaustion of base Sum Insured after due approval of company HR. Sum
Insured Per Family- Graded SI 2 lakh, 4 lakh, 6 lakh & 10 lakh #1. Self +any 7
dependents can include: 1. Spouse 2. Up to 4 dependent children up to age 30. 3rd
and 4th Children covered 3. 2 parents 4. 2 parents-in-law 5. Dependent brother
(unemployed and under the age of 21) 6. Dependent sister (unemployed and unmarried,
no age restriction) #2. AYUSH treatment -Covered only for inpatient hospitalization
in Government ad Govt registered hospital up to 25% SI, pre and post
hospitalization expenses are not covered. #3. Infertility treatment- IVF and
Infertility treatment Covered upto Rs 1,00,000/- on both IPD and OPD #4. Other
Conditions 2- #1) Self+ Spouse+ 2 Dependent chil
dren’s + 2 Dependent Parents/ Parents In law Cross Combination Allowed /Dependent
Brothers (unemployed below 21yrs) / Sisters (unemployed & unmarried) . No Age
Restrictions #2) Pre and post hospitalization expenses will be payable up to 60
days and 90 days respectively for employees. For dependents,pre-post will be
payable for 30 and 60 days respectively only. #3) Children with disability to be
covered even above 25yrs #4) Medical Termination of Pregnancy is allowed as per
Indian law. #5) IVF and Infertility covered upto Rs 1,00,000. Infertility and
Maternity to be covered if in case both the events occur for individual in any
particular policy year. In such case both the events to be considered
separately ) .Infertility would have max limit of INR 1 Lac and maternity would be
covered upto 1 Lac for Normal and C Section #6) Intravitreal injection: Covered
upto INR 50 K per person per injection #7) Mucor Mycosis: Covered #8) Well Baby
Expenses: Covered upto INR 10,000 within m
aternity limit #9) Macular Degeneration: Covered upto Rs 25000 #10) Hormone or all
other Adjuvant therapy cover: covered with restricted only to Breast and Prostate
cancers #11) Pre & Post Hospitalization Expenses: 60-90 days for employees. 30-60
Days for dependents #12) Reasonable and Customary Charges Clause: Waived #13) Sub
Limit for Cataract: Unifocal lens - no capping. Multifocal lenses - avg cost of
unifocal lens #14) Oral & Subcutaneous Chemotherapy: Covered #15) Air Ambulance:
covered INR 2,50,000 #16) Portability Cover in case of Employee Resigned: Shall be
Applicable , Employee should be covered under the Royal Enfield Policy for Minimum
4 Yrs with continuity in GMC #17) Mid-term revision of SI due to designation
changes: Allowed (premium to charged on annual basis) #18) Accident Fracture /
Injury: Accident fracture / Injury covered under outpatient up to INR 10,000 if it
is less than 24hrs hospitalization without any copay #19) IRDA Modern Treatments
Covered upto 50%
of the SI as per Digit policy #20) Septoplasty: Covered upto Rs 25,000/- #21) HIV /
AIDS : Covered upto 10 cases with in overall policy limit #22) Food Charge for
Patients : Cover included within the Room Rent #23) For Employees who are existing
members ( at the inception of the policy ) of the Group and areleft out out of the
policy at inception, Such left employees to be declared within 15 Days of the
incpeiotn of the policy #24) Pandemic : any pandemic announced by the WHO/ GOVT of
India to be covered within Floater Sum Insured #25) Medical expenses incurred in
harvesting of the donated organ will be covered in accordance with the relevant
ACT. Cost of Organ Not covered #26)Pre and post natal expenses are covered upto
maternity limit within maternity sum insured for both IPD and OPD #27) No Deduction
applicable incase of Death during Hospitalization with in floater Sum Insured #28)
Animal & Serpent attack: To be covered upto INR 5,000 #29) Genetic treatment
covered #30. Wellness
baby expenses on OPD and/or IPD- Covered upto INR 10,000 within maternity limit
#31. Dental Treatment (Due to accident only)- Covered upto SI in case of accidental
hospitalisation only #32. Modern Treatments – Covered. #33. Domiciliary
hospitalization- Not covered#34. PROPORTIONATE DEDUCTION CLAUSE-Waived off #35.
Addition Endorsements- Midterm additions allowed only for natural additions subject
to intimation received within 45 days. Any additions for new employee/spouse /
children would be allowed within 45 days of date of joining/ marriage / birth
respectively. Backdation of 45 days from date of intimation shall not be allowed.
Any endorsements will be from the date of addition and not from the inception of
the policy. Prorated premium will be charged for each member added during the
policy term. #36- Claim Submission- Within 45 days from the date of discharge and
no co-pay applicable. #37- Domiciliary Treatment- Not covered. #38- Cashless
Facility- Applicable in All Hospital
s listed with the TPA. #39- GIPSA PPN Clause- Shall Not be Applicable. #40. Mid-
term Addition of Dependents- Allowed only in case of newly wed spouse, new born
baby , Parents IN Laws & new joiners parents Declaration within 45 Days of the
event. #41. Corporate buffer: Total Corporate buffer is INR1,00,00,000. Maximum
utilization per family is limited to the family floater sum insured. Corporate
buffer can only be utilized for all claim excluding maternity claims and Capped
ailments post exhaustion of base Sum Insured after due approval of company HR. #41
- Claim Intimation - Claim intimation clause not applicable #42 . Lasik Surgery -
Covered only when power of the lens is more than +/-5

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