Introduction

It is a customizable health insurance plan for a group of people with the same interest. It can be a tailored made for organizations and corporations according to their requirements and needs.

Coverage

• Standard Hospitalization: 24 hours

Standard hospitalization coverage requires a minimum stay of 24 hours. This ensures the treatment is significant and medically necessary. Shorter stays, often for minor procedures, may not be covered under this rule, depending on your insurance policy.

• Room Rent and ICU Boarding

Typically, policies impose limits on daily room rent based on the room type (e.g., general ward, private room) and may cap ICU boarding expenses. Coverage often depends on policy terms and may require prior authorization. Review your policy details for specific limits and conditions related to room and ICU costs

• Pre existing ailments covered under the policy

Most policies impose a waiting period, often 1 to 4 years, before such conditions are covered. After this period, coverage may apply, though limitations and exclusions may still exist.

• New born baby covered from day 1

Some plans provide immediate coverage for newborns, often requiring the baby to be added to the policy shortly after birth. Other policies may have waiting periods or specific conditions.

• Comprehensive Maternity benefit

It covers a wide range of pregnancy-related expenses, including prenatal care, delivery, postnatal care, and newborn care. This typically includes hospital expenses, doctor's fees, and sometimes additional services like maternity consultations. Policies vary, so it’s essential to review your plan’s details to understand coverage limits, waiting periods, and any exclusions.

ADD ON: COMPLETE HEALTH CHECK UP

• Health Care Package

Health check-up (74 parameters) covering all essential test including Lipid Profile, Blood glucose, Kidney Function Test, Liver Function Test, Complete Hemogram, Urine Profile, Iron Studies and Electrolyte Profile

• Healthcare Plus Package

Health check-up (85 parameters) covering all essentials tests included in IMT Healthcare Package + Thyroid Profile and Widal Profile

• Healthcare Supreme Package

Health check-up (87 parameters) covering all essentials tests included in IMT Healthcare Plus Package + HbA1c

• Healthcare Comprehensive Package

Health check-up (85 parameters) covering all essentials tests included in IMT Healthcare Package 1+ Thyroid Profile and Widal Profile

ADD ON: MENTAL WELLNESS

• Unlimited Emotional Health Assessment Test
• Check in calls with Mental Wellness expert after assessment
• 4 Counselling sessions per employee per year

Cashless Claim

The claim allows you to receive medical treatment without paying upfront. Instead, the hospital directly bills the insurance company or its Third Party Administrator (TPA). To use this facility, ensure the hospital is part of the insurer’s network. For planned treatments, obtain pre-authorization by providing necessary details to the insurer or TPA. Present your insurance card and ID at the hospital. After treatment, the insurer reviews the bill for settlement. In emergencies, inform the insurer promptly. If treated at a non-network hospital, you must pay first and then seek reimbursement.

Day Care Procedure

It refers to treatments or surgeries that require less than 24 hours of hospitalization. These include minor surgeries and diagnostic procedures. Most group health insurance policies cover these procedures due to advancements in medical technology. To access coverage, ensure the procedure is done at a network hospital and obtain pre-authorization if required. Present your insurance card and ID at the hospital. The hospital will bill the insurer directly, but you may need to pay for any non-covered expenses. Always check your policy details for specific coverage and claim procedures.

Pre and Post Hospitalization

In group medical insurance, pre-hospitalization and posthospitalization expenses are typically covered to ensure comprehensive care around the period of hospitalization.

Pre-Hospitalization

This covers medical costs incurred before hospitalization, such as diagnostic tests, doctor consultations, and medications. Coverage usually starts 30 days prior to the hospitalization date. To claim these expenses, you must provide relevant medical records and bills to your insurer.

Post-Hospitalization

This covers expenses incurred after discharge, including follow-up consultations, further diagnostic tests, and medications. Coverage generally extends up to 60 days after discharge. Similar to prehospitalization, you’ll need to submit bills and medical records for these expenses.

Post-Hospitalization

This covers expenses incurred after discharge, including follow-up consultations, further diagnostic tests, and medications. Coverage generally extends up to 60 days after discharge. Similar to prehospitalization, you’ll need to submit bills and medical records for these expenses.

Exclusions And Limitations

Understanding these can help manage expectations and avoid unexpected out-of-pocket expenses.

Exclusions

• Pre-Existing Conditions: Many policies exclude coverage for conditions diagnosed before the policy start date or during the waiting period.
• Cosmetic Procedures: Treatments or surgeries aimed at enhancing appearance, rather than treating medical conditions, are generally excluded
• Experimental Treatments: New or experimental procedures not yet approved by medical boards or insurers may not be covered. Self-Inflicted Injuries: Injuries resulting from intentional self-harm are usually excluded.
• Substance Abuse: Treatment for drug or alcohol abuse may be limited or excluded.

Limitations

• Coverage Limits: Policies often have a maximum limit on the amount payable per year or per condition.
• Sub-Limits: Specific treatments or categories of expenses, like room rent or certain surgeries, may have individual caps
• Waiting Periods: Certain conditions may only be covered after a waiting period, typically ranging from a few months to a year
• Deductibles and Co-Payments: Policyholders may need to pay a portion of the costs, such as co-payments or deductibles, before insurance coverage kicks in.

Policy Related Terms and Conditions

In group health insurance, key policy-related terms include:

• Sum Insured: Maximum coverage amount per policy year
• Waiting Period: Time before certain conditions are covered, typically from a few months to a year.
• Co-Payment: Percentage of costs the insured pays out-of-pocket.
• Deductible: Amount paid before insurance coverage starts
• Network Hospitals: Hospitals where cashless treatment is available