Group Health Insurance Policy Archives

You may include in-laws in family floater plans but not domestic helps

Publiahed in Mint on 28th May, 2017. Written by Abhishek Bondia Can I buy a family floater medical insurance policy for my wife, children, parents as well as my in-laws? I live in Ghaziabad and as my wife is an only child, I share the responsibility of her parents as well. Also, for the purposes […]

Co-pay in group health insurance

Co-pay in group health insurance For many young establishments, the costs associated with group health insurance might be daunting. So, if you want to provide your employees the security of medical insurance without a considerable cost burden, you might want to consider co-pay. This post attempts to help you better understand co-pay in group mediclaim […]

Definitioner

Co-payment

Co-payment - is a cost-sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claim amount. A co-payment does not reduce the Sum Insured.

Claim

Claim - means a demand made by You or on Your behalf for payment of Medical Expenses or any other expenses or benefits, as covered under the Policy

Doctor

Doctor means a person who holds a qualification in medicine from a recognized institution and is registered by state council, governed by the Medical Council of India in which he operates and is practicing within the scope of such license and will include (but is not limited to) physicians, specialists and surgeons who satisfy the aforementioned criteria.

Deductible

Deductible means, in respect of each and every claim, the amount stated in the Schedule which will first be paid by each Insured Person or apply for the period of time stated in the Schedule.

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.

Insured

"Insured" means the individual who has a permanent place of residence in India and on whose name the Policy is issued.

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.

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You may include in-laws in family floater plans but not domestic helps

Co-pay in group health insurance