The employee health insurance policy covers medical benefits for insured individuals including employees, spouses, children, dependents and parents. It provides cashless hospitalization at network hospitals and covers ancillary charges such as ambulance costs. When filing a claim through a cashless network hospital, the insured must notify the insurance company in advance for planned surgeries or within 24 hours of emergency admission to authorize cashless treatment. The policy also provides reimbursement for follow up checkups with specialists.

1. 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
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