Group Health Insurance

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With disease-wise capping, an insurer can reduce claims out-go and hence its risk for the GMC. Though you can select the list of diseases and respective capping for a group policy insurers have pre-defined slabs of lower limits, default limits, and higher limits. Below is an illustration of these slabs –

 

  1. Lower Limits –

 

DISEASE-WISE SUB LIMITSMETRONON-METRO
Appendix12,00010,000
Eye related17,00015,000
Gall Bladder15,00015,000
Hernia12,00010,000
Hydrocele7,0005,000
Hysterectomy20,00017,000
Piles10,0007,000
Urinary Stone (incl DJ stent removal for same stone)30,00025,000
Joint Replacement including Vertebral joints (Per knee)75,00070,000

 

  1. Default Limits –

 

DISEASE-WISE SUB LIMITSMETRONON-METRO
Appendix20,00018,000
Eye related25,00022,000
Gall Bladder22,00022,000
Hernia20,00018,000
Hydrocele15,00012,000
Hysterectomy28,00025,000
Piles18,00015,000
Urinary Stone (incl DJ stent removal for same stone)35,00030,000
Joint Replacement including Vertebral joints (Per knee)85,00080,000

 

  1. Higher Limits –

 

DISEASE-WISE SUB LIMITSMETRONON-METRO
Appendix24,00019,200
Eye related30,00025,200
Gall Bladder30,00025,200
Hernia24,00019,200
Hydrocele18,00014,400
Hysterectomy33,60028,800
Piles19,20015,600
Urinary Stone (incl DJ stent removal for same stone)40,00035,000
Joint Replacement including Vertebral joints (Per knee)1,02,00090,000

 

Premiums for higher disease-wise capping are more competitive among the lot in GMC.

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