Group Mediclaim Policy for DNPL employees and their dependents

Items

All sorts of pre-existing Diseases Covered

Waiver of Time exclusion for diseases (30 days / 1 year / 2 years / 3 years / 4 years)

Room Rent: Rs.5000/- per day in case of Hospital within the state of Assam. Rs. 7500/- per day in case of hospital outside the Assam. (In case if insured opts for Higher room category than his/her eligibility there will be no proportionate deduction. Incremental charges are not applicable.) A) Service charge, R.M.O, Service Tax, Boarding, Nursing including Room rent.

ICCU: Actual

Pre-& Post hospitalization period for claim up to 60 days & 90 days respectively.

Maternity Benefit up to INR 70,000 – both normal delivery and c-section (for first 2 living children only) with waiver of 9 months waiting period. A) Pre & Post Natal covered within maternity limit on IPD & OPD basis. B) Ectopic Pregnancy Covered up to Sum Insured Limit C) In case of post-delivery complications for mother restriction amount waived off and it will cover up to family S.I. D) Infertility claim is covered up to maternity limit

New born baby cover from day one under floater policy.

Ambulance Costs for transportation- Maximum INR 3000 per hospitalization.

Day care surgeries to be covered for any other (undefined day care surgeries) treatment as inpatient

Corporate buffer Rs.30 Lac during the policy period for entire group (without per member/family limit) for all diseases.

No other sub limit or disease wise capping is applicable.

Internal Congenital Diseases are covered.

External Congenital Disease Covered in case of Life-threatening situation

Lasik Treatment- if power of eye is above (+/-) 6.5 is payable.

Dental and vision are payable in case of accident only (IPD Basis).

Special Conditions

In case of deletion of member from the Group the cover will be suspended from the date of separation from the group. Refund of premium on account of deletion will be allowed from the date of separation. Midterm additions of Employee / Employee's dependents: Risk premium on prorate basis on each inclusion of Employee/ Employee's dependent. In case of CD balance available new joinee will be covered from day one/date of joining/date of marriage/new born baby.

Day one cover for New Joinee and their dependents as per maximum stipulated family size subject to receipt of premium / maintenance of CD balance.

Mid-term inclusion of Existing Employee's newly acquired dependent (Newly Married Spouse/ New born baby/ newly adopted child), subject to maintenance of sufficient CD Balance.

Any medical condition arising due to Terrorism will be covered.

No mid-term cancellation of the policy

50% Co-Pay for cyber knife treatment

Cochlear Implant treatment shall be restricted to 50% of the SI.

All Advance /Modern treatment Approved by IRDA covered up to Sum Insured. Advance Procedures Covered Wherever Medically Indicated either as in patient or as part of day care treatment in a hospital up to 100% of Sum Insured for below mentioned procedure- A. Uterine Artery Embolization and HIFU (High Intensity Focused Ultrasound) B. Balloon Sinuplasty C. Deep Brain Stimulation D. Oral Chemotherapy E. Immunotherapy - Monoclonal Antibody to be given as injection. F. Intra Vitreal Injections G. Robotic Surgeries H. Stereotactic Radio Surgeries I. Bronchial Thermoplasty J. Vaporisation of the Prostrate (Green Laser Treatment or Holmium Laser Treatment) K. Intra Operative Neuro Monitoring (IONM) L. Stem Cell Therapy: Hematopoietic Stem Cells for bone marrow transplant for haematological conditions to be covered only.

Hormonal Therapy Covered.

Organ Transplantation including treatment cost of Donor to be covered excluding the cost of Organ.

Multi focal lenses & Femto Laser surgery, Torric lenses / Similar Lenses should be covered.

Psychiatric ailment – Rs.50 K. Counselling Fees for Psychiatric disorder should be covered.

Air Ambulance – Rs.1 Lakh within family sum insured.

24hrs Hospitalization not required in case of death.

PPN Clause /Reasonable Customary charge not applicable in policy.

In case hospital tariff deduction the difference amount payable through Reimbursement claim.

In case of Surgeon /Consultant/Anesthetist/Medical Practitioner/Specialist fees outside of hospital final bill then also it should be payable.

Functional Endoscopy / Sinus Surgery – Covered up to Sum Insured

Ayush treatment is covered.

Any Consumable/Non-Medical item not listed under IRDA should be covered.

Condonation for Non-Intimation& Delay Submission of Claim Documents is not required from insurance company.

If email from HR is received for utilization of Corporate Buffer, then insurance company’s approval is not required.

Treatment of Mental illness covered within a limit of Rs. 40,000.

Sleep Aponia covered.

Cataract is no limit.

Well baby expenses covered.

Genetic Disorder is covered as per IRDA Guidelines

IVF coverage – (Maximum 2 procedures in entire policy year for all lives combined with maximum amount sub-limited to maximum Rs. 1 lac per case.)

Vaccination or Inoculation is covered.

Domiciliary hospitalization is covered as below – [Domiciliary hospitalization means medical treatment for an illness/disease/injury which in the normal course would require care and treatment at a hospital but is actually taken while confined at the home under any of the following circumstances - (I) The condition of the patient is such that he/she is not in condition to be removed to a hospital, or (II) The patient takes treatment at home on account of unavailability of room in a hospital.]

Tata-AIG General Insurance Co Ltd (BID ID -286114)