🏥 Employee Health Insurance – Coverage Summary
Our company provides Group Health Insurance coverage for employees and eligible family members.
1. 👨👩👧👦 Family Coverage
- Employee is covered.
- Spouse is covered.
- Up to 4 dependent children up to 25 years of age are covered.
- Newborn baby is covered from Day 1.
- Parents have 0% co-payment as mentioned in the policy.
2. 💰 Sum Insured
- Family Floater options: ₹2,00,000 / ₹5,00,000.
- The Sum Insured is applicable to the entire family and is not a separate amount for every member.
3. 🏥 Hospitalisation
- Hospitalisation expenses are covered as per policy terms.
- No room-rent capping for ₹2 lakh and ₹5 lakh Sum Insured.
- Eligible ICU and hospitalisation expenses are covered.
4. 💳 Cashless & Reimbursement
- Cashless treatment is available at network hospitals.
- Reimbursement facility is also available.
5. 🩺 Pre & Post Hospitalisation
- Pre-hospitalisation expenses: 60 days.
- Post-hospitalisation expenses: 90 days.
- Expenses must be related to the admissible hospitalisation.
6. 🤰 Maternity / Delivery
For the first 2 children:
| Location | Normal Delivery | C-Section |
|---|---|---|
| Metro | ₹35,000 | ₹40,000 |
| Non-Metro | ₹30,000 | ₹35,000 |
- Pre/Post Natal Expenses: up to ₹5,000 within maternity limit.
- Maternity waiting period: 9 months.
7. 👶 Newborn Baby
- Baby is covered from Day 1.
- Coverage is within the family Sum Insured.
8. 🚑 Ambulance
- Road Ambulance: up to ₹2,000 per person.
- Air Ambulance: up to ₹1,00,000 or Family Sum Insured, whichever is lower.
9. 🧠 Mental Health / Psychiatric Treatment
- Psychiatric hospitalisation is covered.
- Mental illness treatment: up to ₹30,000.
- FESS Surgery: up to ₹35,000.
10. 👁️ LASIK Surgery
LASIK surgery is covered if the correction index is +/- 6.5.
11. 👁️ Lucentis
Lucentis treatment is covered up to ₹50,000 per family, within the family Sum Insured.
12. 🏥 Day-Care Procedures
Day-care procedures included in the standard list are covered.
13. 🧬 Congenital Disease
- Internal congenital disease is covered.
- External congenital disease is covered in life-threatening situations.
14. 👴 Parents
- 0% co-payment for parents is mentioned in the policy.
- Employee-wise eligibility should be checked in the insured-member list.
15. 👨⚕️ Attendant Charges
- If hospital stay is more than 5 days, attendant charges are covered up to ₹5,000.
16. 🧑⚕️ Health Assistance Service
- Specialist assistance
- Hospital assistance
- Doctor appointment
- Nutritionist
- Second opinion
17. ☑️ Co-Payment
- Employee – 0% Co-Pay
- Spouse – 0% Co-Pay
- Children – 0% Co-Pay
- Parents – 0% Co-Pay
18. ⚠️ Special Treatments
- Cyberknife Treatment – 50% Co-Pay
- Stem Cell Transplantation – 50% Co-Pay
- Cochlear Implant – restricted to 50% of Sum Insured
❌ Important Exclusions
- Normal OPD treatment is not covered.
- Domiciliary Hospitalisation is excluded.
- Infertility and related ailments are excluded.
- Male sterility is excluded.
- Experimental / trial treatments are excluded.
- Administrative, registration, service and miscellaneous charges are excluded.
- Prosthesis fitting expenses are excluded.
- Holter Monitoring is excluded.
⚠️ Waiting Period
- General 30-day waiting period is waived.
- Maternity waiting period: 9 months.
- Some specific diseases/procedures may have a 12-month waiting period.
- Pre-existing disease conditions should be confirmed with the TPA/insurer for the specific claim.
📌 Simple Message for Employees
Our company provides Group Health Insurance covering employees and eligible family members. The policy provides ₹2 lakh or ₹5 lakh family floater coverage, with cashless and reimbursement facilities. Hospitalisation, pre- and post-hospitalisation, maternity, newborn baby, day-care procedures, ambulance, mental health treatment, LASIK and several other treatments are covered, subject to the applicable limits, waiting periods and policy terms.
🏥 कर्मचारी Health Insurance – Coverage Summary
हमारी Company की Group Health Insurance Policy में Employee और Eligible Family Members के लिए Health Insurance Coverage उपलब्ध है।
1. 👨👩👧👦 परिवार की Coverage
- Employee यानी कर्मचारी कवर है।
- Spouse यानी पति/पत्नी कवर है।
- अधिकतम 4 Dependent Children, जिनकी उम्र 25 वर्ष तक है, कवर हैं।
- Newborn Baby Day 1 से कवर है।
- Parents के लिए 0% Co-Payment दिया गया है।
2. 💰 Sum Insured
- Family Floater Coverage: ₹2,00,000 / ₹5,00,000
- यह राशि पूरे परिवार के लिए है। प्रत्येक सदस्य को अलग-अलग ₹2 लाख या ₹5 लाख नहीं मिलेंगे।
3. 🏥 Hospitalisation
- Policy के नियमों के अनुसार Hospitalisation का खर्च कवर है।
- ₹2 लाख और ₹5 लाख दोनों Plans में Room Rent की कोई Capping नहीं है।
4. 💳 Cashless और Reimbursement
- Network Hospital में Cashless Treatment की सुविधा है।
- Reimbursement की सुविधा भी उपलब्ध है।
5. 🩺 Pre & Post Hospitalisation
- Hospital में भर्ती होने से पहले के खर्च: 60 दिन तक
- Hospital से Discharge होने के बाद के खर्च: 90 दिन तक
6. 🤰 Maternity / Delivery
पहले 2 बच्चों के लिए:
| जगह | Normal Delivery | C-Section |
|---|---|---|
| Metro | ₹35,000 | ₹40,000 |
| Non-Metro | ₹30,000 | ₹35,000 |
- Pre/Post Natal Expenses: ₹5,000 तक।
- Maternity Waiting Period: 9 महीने।
7. 👶 Newborn Baby
- Baby Day 1 से कवर है।
- Coverage Family Sum Insured के अंदर होगी।
8. 🚑 Ambulance
- Road Ambulance: ₹2,000 प्रति व्यक्ति तक
- Air Ambulance: ₹1,00,000 तक या Family Sum Insured, जो भी कम हो।
9. 🧠 Mental Health / Psychiatric Treatment
- Psychiatric Hospitalisation कवर है।
- Mental Illness Treatment: ₹30,000 तक
- FESS Surgery: ₹35,000 तक
10. 👁️ LASIK Surgery
Correction Index +/- 6.5 होने पर LASIK Surgery कवर है।
11. 👁️ Lucentis
Lucentis Treatment ₹50,000 प्रति Family तक कवर है।
12. 🏥 Day-Care Procedures
Standard List में शामिल Day-Care Procedures कवर हैं।
13. 🧬 Congenital Disease
- Internal Congenital Disease कवर है।
- External Congenital Disease Life-Threatening Situation में कवर है।
14. 👴 Parents
- Parents के लिए 0% Co-Payment है।
- प्रत्येक कर्मचारी के Parents Policy में enrolled हैं या नहीं, यह Insured Member List से confirm करना जरूरी है।
15. 👨⚕️ Attendant Charges
- अगर Hospital Stay 5 दिनों से अधिक है, तो Attendant Charges ₹5,000 तक कवर हैं।
16. 🧑⚕️ Health Assistance Service
- Specialist ढूँढने में सहायता
- Hospital ढूँढने में सहायता
- Doctor Appointment
- Nutritionist
- Second Opinion
17. ☑️ Co-Payment
- Employee – 0% Co-Pay
- Spouse – 0% Co-Pay
- Children – 0% Co-Pay
- Parents – 0% Co-Pay
18. ⚠️ Special Treatments
- Cyberknife Treatment – 50% Co-Pay
- Stem Cell Transplantation – 50% Co-Pay
- Cochlear Implant – Sum Insured के 50% तक सीमित
❌ महत्वपूर्ण Exclusions
- सामान्य OPD Treatment कवर नहीं है।
- Domiciliary Hospitalisation कवर नहीं है।
- Infertility और संबंधित ailments कवर नहीं हैं।
- Male Sterility कवर नहीं है।
- Experimental / Trial Treatment कवर नहीं है।
- Administrative, Registration, Service और Miscellaneous Charges कवर नहीं हैं।
- Prosthesis Fitting Expenses कवर नहीं हैं।
- Holter Monitoring कवर नहीं है।
⚠️ Waiting Period
- General 30 Days Waiting Period Waived है।
- Maternity Waiting Period – 9 महीने।
- कुछ Specific Diseases/Procedures पर 12 महीने का Waiting Period हो सकता है।
- Pre-Existing Disease के specific claim के लिए TPA/Insurer से confirmation लेना चाहिए।
📌 कर्मचारियों को समझाने के लिए
हमारी Company की Group Health Insurance Policy में Employee और Eligible Family Members के लिए Health Insurance Coverage है। Family के अनुसार ₹2 लाख या ₹5 लाख तक का Family Floater Cover है। Cashless और Reimbursement दोनों सुविधाएँ उपलब्ध हैं। Hospitalisation, Pre/Post Hospitalisation, Maternity, Newborn Baby, Day-Care Procedures, Ambulance, Mental Health Treatment, LASIK और कई अन्य Medical Treatments कवर हैं। हर Treatment पर Policy की निर्धारित Limit, Waiting Period और Terms & Conditions लागू होंगी।
🏥 কর্মীদের জন্য Group Health Insurance – Coverage Summary
আমাদের Company-এর Group Health Insurance Policy-এর মাধ্যমে Employee এবং Eligible Family Members-এর জন্য Health Insurance Coverage প্রদান করা হয়েছে।
১. 👨👩👧👦 Family Coverage
- Employee কভারড।
- Spouse কভারড।
- সর্বোচ্চ ৪ জন Dependent Children, বয়স ২৫ বছর পর্যন্ত, কভারড।
- Newborn Baby Day 1 থেকেই কভারড।
- Parents-এর জন্য 0% Co-Payment উল্লেখ করা হয়েছে।
২. 💰 Sum Insured
- Family Floater Coverage: ₹2,00,000 / ₹5,00,000
- এই Coverage পুরো পরিবারের জন্য প্রযোজ্য। প্রত্যেক সদস্যের জন্য আলাদা ₹2 লাখ বা ₹5 লাখ নয়।
৩. 🏥 Hospitalisation
- Policy-এর নিয়ম অনুযায়ী Hospitalisation-এর খরচ কভারড।
- ₹2 লাখ এবং ₹5 লাখ উভয় ক্ষেত্রেই Room Rent-এর কোনো Capping নেই।
৪. 💳 Cashless এবং Reimbursement
- Network Hospital-এ Cashless Treatment-এর সুবিধা রয়েছে।
- Reimbursement Facility-ও রয়েছে।
৫. 🩺 Pre & Post Hospitalisation
- Hospitalisation-এর আগে: ৬০ দিন পর্যন্ত
- Hospitalisation-এর পরে: ৯০ দিন পর্যন্ত
৬. 🤰 Maternity / Delivery
প্রথম ২টি সন্তানের জন্য:
| স্থান | Normal Delivery | C-Section |
|---|---|---|
| Metro | ₹35,000 | ₹40,000 |
| Non-Metro | ₹30,000 | ₹35,000 |
- Pre/Post Natal Expenses: ₹5,000 পর্যন্ত।
- Maternity Waiting Period: ৯ মাস।
৭. 👶 Newborn Baby
- Baby Day 1 থেকেই কভারড।
- Coverage Family Sum Insured-এর মধ্যে থাকবে।
৮. 🚑 Ambulance
- Road Ambulance: প্রতি ব্যক্তির জন্য ₹2,000 পর্যন্ত
- Air Ambulance: ₹1,00,000 পর্যন্ত অথবা Family Sum Insured, যেটি কম।
৯. 🧠 Mental Health / Psychiatric Treatment
- Psychiatric Hospitalisation কভারড।
- Mental Illness Treatment: ₹30,000 পর্যন্ত
- FESS Surgery: ₹35,000 পর্যন্ত
১০. 👁️ LASIK Surgery
Correction Index +/- 6.5 হলে LASIK Surgery কভারড।
১১. 👁️ Lucentis
Lucentis Treatment প্রতি Family-এর জন্য ₹50,000 পর্যন্ত কভারড।
১২. 🏥 Day-Care Procedures
Standard List-এর মধ্যে থাকা Day-Care Procedures কভারড।
১৩. 🧬 Congenital Disease
- Internal Congenital Disease কভারড।
- External Congenital Disease Life-Threatening Situation-এ কভারড।
১৪. 👴 Parents
- Parents-এর জন্য 0% Co-Payment উল্লেখ করা হয়েছে।
- প্রত্যেক Employee-এর Parents Policy-তে enrolled আছেন কি না, Insured Member List থেকে নিশ্চিত করতে হবে।
১৫. 👨⚕️ Attendant Charges
- Hospital Stay ৫ দিনের বেশি হলে Attendant Charges ₹5,000 পর্যন্ত কভারড।
১৬. 🧑⚕️ Health Assistance Service
- Specialist খুঁজে পেতে সাহায্য
- Hospital খুঁজে পেতে সাহায্য
- Doctor Appointment
- Nutritionist
- Second Opinion
১৭. ☑️ Co-Payment
- Employee – 0% Co-Pay
- Spouse – 0% Co-Pay
- Children – 0% Co-Pay
- Parents – 0% Co-Pay
১৮. ⚠️ Special Treatments
- Cyberknife Treatment – 50% Co-Pay
- Stem Cell Transplantation – 50% Co-Pay
- Cochlear Implant – Sum Insured-এর 50% পর্যন্ত সীমিত
❌ গুরুত্বপূর্ণ Exclusions
- সাধারণ OPD Treatment কভারড নয়।
- Domiciliary Hospitalisation কভারড নয়।
- Infertility এবং related ailments কভারড নয়।
- Male Sterility কভারড নয়।
- Experimental / Trial Treatment কভারড নয়।
- Administrative, Registration, Service এবং Miscellaneous Charges কভারড নয়।
- Prosthesis Fitting Expenses কভারড নয়।
- Holter Monitoring কভারড নয়।
⚠️ Waiting Period
- General 30 Days Waiting Period Waived।
- Maternity Waiting Period – ৯ মাস।
- কিছু Specific Diseases/Procedures-এর ক্ষেত্রে ১২ মাসের Waiting Period থাকতে পারে।
- Pre-Existing Disease-এর নির্দিষ্ট claim-এর জন্য TPA/Insurer-এর confirmation নেওয়া উচিত।
📌 কর্মীদের জন্য সহজভাবে
আমাদের Company-এর Group Health Insurance Policy-এর মাধ্যমে Employee এবং Eligible Family Members-এর Health Insurance Coverage রয়েছে। Family অনুযায়ী ₹2 লাখ অথবা ₹5 লাখ পর্যন্ত Family Floater Cover রয়েছে। Cashless এবং Reimbursement উভয় সুবিধাই পাওয়া যাবে। Hospitalisation, Pre/Post Hospitalisation, Maternity, Newborn Baby, Day-Care Procedures, Ambulance, Mental Health Treatment, LASIK এবং আরও কিছু Medical Treatment কভারড। তবে প্রতিটি Treatment-এর ক্ষেত্রে Policy-এর Limit, Waiting Period এবং Terms & Conditions প্রযোজ্য হবে।