• Modern treatments - Uterine artery embolization and HIFU balloon Sinuplasty deep brain

stimulation Oral chemotherapy immunotherapy intra vitreal injections robotic surgeries

stereotactic radio surgeries bronchical thermoplasty Vaporization of the prostrate ( Green laser
treatment or holmium laser treatment) IONM ( intra operative neuro monitoring) stem cell therapy
In addition to these treatments other modern treatment menthods are also covered as prescribed
by treating doctor.
• IRDA Circular for inclusion of these exclusions - Injury or illness associated with hazardous
activities puberty and menopause related disorders conditions arising due to use of prescribed
drugs age related macular degeneration behavioural/neurodevelopmental disorders disease with
unknown etiology/ cause admission for enteral feedings mental illness treatment artificial life
maintenance genetic disease.
• Differently abled/disabled children to be covered - Definition Any of the family member mental,
physical or developmental disorder that leads to disability ( See list below) will be provided cover
under medical insurance without any age brrier, and certain special elements ( mentioned below)
will be provided to aid their function. FOLLOWING DISABILITIES TO BE COVERED. . Vision
cataract, squint .Hearing deafness for any reason. .Speech and language mutism, speech
apraxia, dysarthria. . Neuromuscular muscular dystrophy, cerebral palsy, spinal muscular
atrophy, muscular dystrophy, myopathy and related conditions. . Neurodevelopmental autism
spectrum disorders. . Inttelectual mental retardation. . Psychiatric Psychosis, bipolar disorder,
attention deficit hyperactivity disorder. . Multiple i.e two or more of above mentioned. SPECIAL
ELEMENTS NEEDED. . Correction correction of disability of any etiology. . Rehabilitation
occupational therapy/physiotherapy/speech therapy/psychotherapy/behavioural therapy. .
Supporting aids braces/splints/crutches/walkers/wheel chairs/low vision aids/hearing aids. . Home
modifications shower grab bars, commode chair, ramp.
• Lock-in period - 2 years lock-in on downward plan selection, upward selection allowed for
employees opting for higher SI.
• Home Quanatine - Covered up to INR 50,000 per family ( per member, limit up to INR 10,000).
• COVID claims - Covered within family SI.
• Co-payment - 10 % co-payment on each parental claim.
• Other ailment wise capping - Not applicable.
• Cyber knife/stem cell treatment - Covered.
• Sterlization expenses Excluded if incurred at the time of C-section then an amount of INR 2500
will be deducted from total expenses incurred.
• Lasik surgery Covered if the number is beyond +/-7.
• Autism coverage Autism covere upto INR 50,000 on both IPD and OPD basis.
• Ayush treatment Ayurvedic/Homeopathic/Naturopathy/Unani are covered.
• Chemotherapy coverage - Oral chemotherapy expenses forming part of hospitalization treatment
/daycare /domicliary is covered hormonal/immune/palliative forms of chemotherapy for cancer
patients covered upto family sum insured.
• Special conditions .No deductions in case of death during hospitalization , .GMC coverage to
continue for dependents in case of employee’s death during mid-term of policy dependents can
utilize the GMC plan only upto the end of policy terms.
• Infertility treatment - infertility treatment /IVF/IUI assisted treatments covered on both IPD and
OPD basis :- 4 lacs SI – INR 75,000, 6 lacs SI –INR 100,000 , 8 lacs SI –INR 100,000 , 10 lacs SI
–INR 150,000.
• Room rent - Single Ac private room for normal and ICU at actuals.
• Ambulance charges - Covered upto INR 2500 per annum per employee.
• Terrorism - Not covered.
• Day care procedures - Covered.
• New born baby coverage - covered from Day 1 within family sum insured.
• Maternity related complications - covered up to family SI under higher modular SI palns otherwise
for base plan covered within maternity limit.
• New born baby expenses - Covered within maternity limit for 4 lacs SI for highler SI plans( 6, 8,
10 lacs) covered within maternity additional 10,000 from sum insured
• Pre & post natal - Covered within maternity limit.
• 9 month wating period - Waived off in case of maternity.
• Maternity benefit - For 4 & 6 lacs SI – INR 75,000 for both normal & C –section, For 8 lacs SI -
INR 85000 for both , For 10 lacs INR 100,000 for both, for a maximum of 2 children in case of
hospitalization OPD not covered sterlization expenses are excluded but if incurred at the time of
C-section then an amount of.
• Pre & post hospitalization - Pre & post hospitalization covered for 30 and 60 days respectively.
• Waiver of time exclusion for disease (30 days, 1-4 Year) - Waived off.
• Pre existing disease - Covered from Day 1.
• Standard hospitalization - Covered.
• Parental Sub-limit within family Sum insured . Sublimit of INR 2,50,000 in INR 4,00,000 family SI.
.Sublimit of INR 4,00,000 in INR 6,00,000 family SI. .Sublimit of INR 6,00,000 in INR 8,00,000
family SI. .No sublimit in INR 1000,000 family SI.
• Important Not . Employee is allowed to cover either set of parents in law & not in combination.
.Inclusion of third child under policy within definition of 1+5 is allowed in lieu of a parent. .Under
immediate family & immediate family-option, emplyees are allowed to cover upto 5 dependents
(spouse, children). .No age cap for dependent parents. .Max age for dependent children is 25
years Self + any 5 dependents from spouse, children, parents/parents-in-law.
• Family Definition Self+ Any 5 dependents from spouse, children, parents/ parents-in-law 2 Family
structures ESC (employee, spouse, children)/ESCP (exployee, spouse, children, parents/in laws).
• Family Sum insured INR 4,00,000 , INR 6,00,000 , INR 8,00,000 , INR 1000,000 (New SI Plan).