Group Mediclaim Insurance

(GMC), GMC Top-Up Policy FY 24

Management Employees

Group refers to the Aditya Birla Group in this document. This policy is meant exclusively for the perusal of, and strictly
for circulation within, the Aditya Birla Group. Please note that sharing of information contained in this policy, other
than with employees of the Aditya Birla Group without written consent from Group Human Resources, would be
construed as a breach of the Group’s Code of Conduct
 Group Mediclaim Insurance (GMC) Base and GMC
FY 2023-24 Top-Up Policy –Management Employees

Group Mediclaim (GMC) and GMC Top-up Policy FY 24

1. Purpose:
Adequate health insurance is an important need for our employees and their family members. To
cater to this need, Medical Insurance Benefit is provided via a Group Mediclaim Policy (GMC). Group
Mediclaim Top Up Policy (GMC Top Up) is provided as a choice to employees to enhance their medical
cover based on their families’ requirements by paying an additional premium.
2. Key changes applicable for the Policy Year 2023-24
GMC & Top Up Policy
 Medical Complications of obesity and vaccination which requires treatment is now covered
under policy, for e.g., Hernia due to obesity and abscess due to vaccination.
 Medically indicated treatment of external congenital ailments like but not restricted to anal
imperforation, syndactyly, inguinal hernia, spina-bifida, meningomyelocele, hydrocephalus etc.
is now covered. if the treatment is for non-cosmetic purpose.
 Oral adjuvant chemotherapy for cancer treatment is now covered up to ₹1 lac per family per
policy period with threshold limit of ₹ 25,000. (This does not include expenses incurred during
pre & post hospitalization period.)
GMC Top Up Plus - Sum Insured of ₹ 7,00,000 and above.
 Cochlear implant with a maximum limit of ₹ 5 lacs to one person utilizing once in 3 years.
 Extended physiotherapy covers up to 90 days post discharge for accident and joint replacement
cases.
 Lasik & similar treatment for correction of refractive error more than or equal to +/-5.5 diopters
is now covered.
Same-gender partner can be covered in the GMC and Top Up policy.
3. Eligibility: All Management Cadre Employees in JB 11 and above.
4. Sum Insured: 5 Lacs
5. Effective Date: 1st April 2023 to 31st March 2024.
6. Family definition: A maximum of 6 family members, including employee can be covered. (Self,
Spouse/ Same-Sex Partner, Children, Siblings and up to 2 Parents/Parent in Laws).
7. Room Eligibility:
JB 5 & above A/C Deluxe Single room
JB 6 to 9 A/C Single room
JB 10 and 11 AC Sharing room

8. Policy Coverage and Exclusions: The policy primarily covers hospitalization expenses with an
active line of treatment and a defined list of day care treatments. Any claims less than 1% of the
sum insured is not covered in the policy. The details of sub limits for Maternity, IVF, Dental and
other treatments are provided in the Annexure. Refer Annexure 1 for details.

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 Group Mediclaim Insurance (GMC) Base and GMC
FY 2023-24 Top-Up Policy –Management Employees

GMC Policy Details

9. Policy Sum Insured: ₹ 5 Lacs per annum.

10. Premium per family: ₹ 33,663+ GST. (Company paid)

11. Employee Premium Contribution: (Amounts below + GST)

 ₹ 3,366 (10% of the Total Premium) for participating in the policy. This is waived on opting
for GMC Top Up Policy.
 ₹ 4,208 for 1 Parent, ₹ 8,416 for 2 Parents (50% of Per Member Premium for 1 parent
assuming a family size of 4)
 ₹ 8,416 for dependent children above or equal to 30 Years and siblings above or equal to 25
years. (100% of Per Member Premium each assuming a family size of 4)
 Total employee contribution towards co-pay shall be limited to 50% of family premium +
GST extra.

12. Claims Co-Payment:

 10% of the claim up to max of ₹ 25,000 for all claims except parents per hospitalization.
 15% of the claim up to max of ₹ 45,000 for all claims of parents per hospitalization.

13. Corporate Buffer: A corporate buffer is available for listed critical ailments. Buffer Limit is
maximum ₹10 Lacs per family, with sub limit of ₹5 Lacs for all family members and ₹10 Lacs for
employee. Buffer is subject to overall limit at Group Level. Employees are advised to take
adequate GMC Top Up cover. Refer Annexure 2 for ailments covered in Corporate Buffer.
14. Employee Life Cycle Events:

 On Resignation: Policy ceases on the last working day.

 On Retirement: Policy continues till the end of the policy period. Employee can port the policy
at the end of the policy period. Ref. Annexure 3 for Retiree Portability Options.
 On Promotion during the Policy Year: No change in the policy benefits/room entitlements
during the policy year.
 On Death: In case of an unfortunate event of death of the employee Policies will continue till
the end of the policy period for the declared dependents.

3 | © 2023 Group Human Resources, Aditya Birla Group Strictly for Internal Circulation
 Group Mediclaim Insurance (GMC) Base and GMC
FY 2023-24 Top-Up Policy –Management Employees

GMC Top Up and Top Up Plus Policy

15. Policy Sum Insured: Default Sum Insured of ₹ 3 Lacs with choice to the employee to change the
sum insured.

 GMC Top Up Sum Insured Options: ₹ 2, 3, 4, 5, 6 Lacs.

 GMC Top Up Plus Sum Insured Options: ₹ 7, 10, 15, 20, 25 Lacs.
The sum insured chosen is continued in future years unless changed. Employee may choose to opt
out of the policy, in which case, the employee cannot enrol in the policy for a period of 3 years.
16. Premium per family: (Amounts below + GST)
₹ 3,660 for ₹2 Lacs cover and ₹ 403 for every additional Lac of sum insured. On Opting to the policy,
the 10% employee premium contribution for GMC Policy is waived. Net Premium per family is ₹ 294
for ₹ 2 Lacs cover.

For Top Up plus: ₹ 8,164 for ₹7 Lacs cover and ₹ 403 for every additional Lac of sum insured. On
Opting to the policy, the 10% employee premium contribution for GMC Policy is waived. Net Premium
per family is ₹ 4,798 for ₹ 7 Lacs cover.
17. Additional Cover on GMC Top Up Plus Policy: The following additional covers are available on
opting for Top Up Plus Sum Insured.

 Maternity and IVF Treatment limit sub limit of ₹1,50,000, non-IVF treatment sub limit of ₹75,000
with the overall limit of ₹150,000.
 Dental for ₹ 25,000 with sub limit of ₹ 10,000 per person.
 Cochlear implant with a maximum limit of ₹ 5 lacs to one person utilizing once in 3 years.
 Extended physiotherapy covers upto 90 days post discharge for accident and joint replacement
cases.
 Lasik & similar treatment for correction of refractive error more than or equal to +/-5.5 diopters
is now covered.
18. Employee Life Cycle Events:

 On Resignation: Only Topup Policy continues till the end of policy period.
 On Retirement: Policy continues till the end of the policy period. Employee can port the policy
effective 1st April of the following year of retirement. Refer Annexure 3 for Retiree Portability
Options.
 On Promotion during the Policy Year: No Change in policy benefits during the policy year.
 On Death: In case of an unfortunate event of death of the employee policy continues till the
end of the policy period.

Annexures:
1. Policy coverage and exclusions
2. Corporate buffer

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