Maternity Benefit shall mean benefit for any condition exclusively related to pregnancy or childbirth and any complications there from. Pregnancy commencing before the member is enrolled under insurance coverage however, shall not be covered. For any one pregnancy, the payable benefit shall not exceed the maximum maternity benefit limit mentioned in the schedule, inclusive of all eligible treatment expenses related to pregnancy. Maternity benefit shall not be paid for more than one pregnancy in a contract year. Maternity benefit should be taken for all married female members of child bearing age group (18-45 years).
- Direct payment of treatment expense by the Company at designated hospitals.
- Reimbursement of expenses for treatment at non-designated hospitals.
- Treatment at any renowned hospital of the country by consultant of own choice.
- Membership Card for each insured to facilitate preferential service.
- Scope for inclusion of spouse & children under the Plan.
- Scope for Overseas Treatment.
- Scope to enjoy Maternity Benefit.
- Coverage of Pre & Post Hospitalization expenses.
The scheme shall cover reasonable and necessary treatment expenses of an insured member within his entitlement as per benefit schedule, at any Govt. Hospital as well as renowned private hospital/clinic registered as such with the legitimate authority of the country.
Eligibility for coverage under the Scheme:
Any employee aged between 18 and 60 years & is in good health shall be eligible for coverage under the scheme. Similarly a new employee shall also be eligible to join the scheme during their good health upon intimation to the company and payment of premium. Besides, spouses up to the age of 60 years, dependent children from day 01 (one) up to the age of 25 (twenty five) years residing with the employee & is in good health may also be included under the scheme. Inclusion of dependant family members (Either spouse or spouse with children) should be on full participation basis (group concept).
Duration of the Contract:
One or Three years from the date of commencement. A contract shall be signed initially which may be renewed on mutual agreement.
No medical examination is required. A “Membership Form” to be filled in by each employee containing a declaration of health status for him-self & dependants to be covered under the scheme shall suffice.
Coverage of treatment expenses shall include:
- Hospital accommodation (Room & Board)
- Surgical Operation
- Consultation fee
- Medicines & Accessories
- Medical investigation
- Ancillary Service 1
1Ancillary Services Comprises of : Registration or Admission, Labour Room Service, Blood Transfusion, Post Operative Care, Local ambulance Services to Hospital, Physiotherapy, Chemotherapy, Radiotherapy, Dialysis, procedural charge, Dressing, Nebulization, Oxygen inhalation, ventilator charge etc.