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How do I buy a Group Health Insurance policy?

A group health insurance policy is taken to cover a group of individuals under a single plan. The policy can be taken by registered and recognized groups for their members, the most common group being the employer-employee groups. Employers buy employee health insurance plans as part of their employee benefit programs. Generally group health insurance […]

Buying process of Group Health Insurance – Infographic

Group Health Insurance policy provides medical coverage to members of a group against unforeseen medical costs due to health issues. This policy can be availed online and offline. Below infographic explains the buying process of group health insurance online.

Definitioner

Policy

"Policy" means this document of Policy describing the terms and conditions of this contract of insurance, including the company's covering letter to the insured if any, the Schedule attached to and forming part of this Policy, the Insured's Proposer form and any applicable endorsement thereon. The Policy contains details of the scope and extent of cover available to the Insured/Insured Person, the exclusions from the scope of cover and the terms and conditions of the issue of the Policy.

Illness

"Illness" means sickness or disease first diagnosed during the period of insurance for which immediate treatment by a Medical Practitioner is necessary.

Hospitalisation expenses

"Hospitalisation expenses" mean expenses on hospitalization incurred in India for minimum period of 24 hours incurred in India, which are admissible under this Policy. However, this time limit will not apply for specific treatments defined under Day Care treatment taken in a Hospital / Nursing Home.

Day Care treatment

"Day Care treatment" means treatment undertaken in a Hospital/ Nursing Home on the recommendation of a Medical Practitioner for the following diseases, illness or injury which requires hospitalisation for less than 24 hours and includes such of those treatments which require hospitalisation for less than 24 hours due to technologically advanced treatment protocol.

a) Dialysis
b) Radiotherapy
d) Eye surgery
e) Dental surgery
f) Lithotripsy (kidney stone removal)
g) Tonsillectomy
h) Dilatation & Curettage
i) Cardiac Catheterization
j) Hydrocele surgery
k) Hernia repair surgery
l) Surgeries/procedures that require less than 24 hours’ hospitalization due to medical/ technological advancement and infrastructural facilities.
m) TURP (Prostate Surgery)

Critical Illnesses

Critical Illnesses means diseases/illnesses limited to the following:

Cancer represented by a malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissue.
First Heart Attack involving death of a portion of the heart muscle arising from inadequate blood supply to the relevant area.

Coronary Artery Disease involving narrowing of the lumen of at least one coronary artery by a minimum of 75% and of two others by a minimum of 60%, as proven by coronary arteriography, regardless of whether or not any form of coronary artery surgery has been performed. Coronary arteries herein refer to left main stem, left anterior descending circumflex and right coronary artery.

Coronary Artery bypass surgery involving the actual undergoing of open-chest surgery to correct the narrowing or blockage of one or more coronary arteries with bypass grafts.
Heart Valve Surgery involving the actual undergoing of open heart surgery to replace or repair heart valve abnormalities.
Surgery to Aorta involving actual undergoing of major surgery to repair or correct aneurysm, narrowing, obstruction or dissection of the aorta through surgical opening of the chest or abdomen. For the purpose of this definition aorta shall mean the thoracic and abdominal aorta but not its branches.

Stroke referring to a cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid hemorrhage, cerebral embolism, and cerebral thrombosis.
Kidney Failure involving chronic irreversible failure of both kidneys requiring either permanent renal dialysis or kidney transplantation

Aplastic Anemia involving Chronic persistent bone marrow failure which results in anemia, neutropenia and thrombocytopenia requiring treatment
End Stage Lung Disease causing chronic respiratory failure
End Stage Liver Failure evidenced by Permanent jaundice ascites and Hepatic Encephalopathy.

Coma that persists for at least 30 days.
Major Burns representing third degree (full thickness of the skin) burns covering at least 30% of the surface of the Insured / Insured person's body.
xiv) Major Organ/Bone Marrow Transplantation involving human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or any one of the human organs limited to heart, lung, liver, kidney or pancreas, that resulted from irreversible end stage failure of the relevant organ.

Multiple Sclerosis

Fulminant Hepatitis involving sub-massive to massive necrosis of the liver by the Hepatitis virus, leading precipitously to liver failure
Motor Neuron Disease characterized by progressive degeneration of corticospinal tracts and anterior horn cells or bulbar efferent neurons which include spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis.
Primary Pulmonary Hypertension with substantial right ventricular enlargement confirmed by investigations including cardiac catheterization, resulting in permanent physical impairment due to cardiac impairment resulting in not being able to engage in any physical activity without discomfort. Symptoms may be present even at rest
Terminal Illness involving conclusive diagnosis of an illness that is expected to result in the death of the insured person within 12 months.

Bacterial Meningitis involving bacterial infection causing in severe inflammation of the membranes of the brain or spinal cord resulting in significant, irreversible and permanent neurological deficit. The neurological deficit must persist for at least 6 weeks.

Accident

"Accident" means a sudden, unforeseen and unexpected physical event beyond the control of the Insured/Insured Person resulting in bodily injury, caused by external, visible and violent means.

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How do I buy a Group Health Insurance policy?

Buying process of Group Health Insurance – Infographic

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How do I buy a Group Health Insurance policy?

Buying process of Group Health Insurance – Infographic

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