Insurance policy

1. INSURANCE
POLICY

2. Policy
• Employee health insurance policy cover medical benefits for
insured(self), Spouse, children, dependent and parents
• Cashless hospitalization at network hospitals.
• Our health insurance covers ancillary charges such as ambulance
costs too.
• Employee health insurance policies provide fee reimbursements of
specialists and other medical practitioners for follow checkups

3. How to File A Claim Through a Cashless Network
Hospital
• In the event that a claim is to be filed, the following procedure is to be followed:
• In the case of planned surgeries, the insurance company is to be notified so as to
authorise the cashless treatment.
• In the event of an emergency surgery or procedure, the insurance company is to
be notified within 24 hours of the policyholder being admitted to hospital.
• In certain cases, the policyholder is given an identity card, which can be used to
avail of the cashless facility at any of the partner hospitals.
• The policyholder can undergo treatment at the partner hospital without having to
pay.
• The insurance company would then send the policyholder a summary of the
charges, and any exclusions would have to be paid for by the policyholder

4. List of Procedures covered
• Operation on eyes- this includes the following procedures: Cataract
operation.
• Eyelid incision.
• Corneal incision.
• Tear duct operations.
• Removal of foreign body.
• Corrective surgery for entropion, ectropion.
• Operation on nose and sinus:Operation on nasal concha.
• Nasal sinus aspiration.
• Other operations on the nose.
• Foreign body removal.

5. • Operations on the ear:Stapedotomy.
• Stapedectomy.
• Operations on the auditory ossicles.
• Operations on the middle ear.
• Tympanoplasty.
• Reconstruction of the middle ear.
• Incision of the inner ear.
• Other operations on the inner ear.
• Operations on the tongue:
• Reconstruction of the tongue.
• Glossectomy.
• Other operations on the tongue

6. • Operations of the bones:
• Ligament tear and meniscus tear surgery.
• Dislocation surgery.
• Orthopaedics and trauma surgery.
• Fractures and sutures on tendons.
• Other joint and bone surgery.
• Operations on skin and subcutaneous tissue:
• Chemosurgery to skin.
• Skin transplantation and restoration.
• Excision of diseased skin and subcutaneous tissues.
• Incisions to skin and subcutaneous tissue.
•

7. • Operations:
• Coronary angiography.
• Haemodialysis.
• Lithotripsy.
• Radiotherapy (for cancer).
• Chemotherapy.
• Operations on the face:
• Plastic surgery to the mouth.
• Incisions to the mouth, jaw and face.
• Other operations to the mouth and face.

8. Exclusions Under Cashless Network Hospital
Services
• While a number of procedures and treatments are treated under cashless
cover, there are a list of exceptions under which the insurance company
will not pay for treatment. These are listed below:
• Hospitalisation due to war, chemical or biological weapons or radiation.
• Treatment arising out of self-injury, self-harm or suicide when sane or
insane.
• Hospitalisation arising out of abuse of psychotropic substances or alcohol.
• Treatment due to complications arising out of HIV/AIDS, unless specified in
the policy document.
• Congenital diseases and mental disorders as defined in the policy brochure.
• Items of personal comfort and convenience.
• Additional costs like special diets.

9. Thanks
For more details log on to our
website.