Group Health Insurance 499 views June 7, 2021

Care Group Health Insurance

Care Health Insurance offers a wide range of health insurance plans to take care of people’s health. As far as group health insurance plans are concerned, the insurer has ‘Group Care’ that covers all the necessary and reasonable medical expenses of employees working in an organization. The policy remains valid till the time you are with your workplace. Read this page further and know more about the coverage, exclusions and terms and conditions of this Care Group Health Insurance plan.

Group Care Insurance Base Cover

If any of the insured members get sick or injured during the policy period, the said Care Group Health Insurance Plan will cover the following medical expenses:

  1. In-patient hospitalization expenses
  2. 541 day care treatments/procedures as specified in the policy schedule
  3. Modern treatments such as – Uterine artery Embolization and HIFU, Balloon Sinuplasty Deep Brain Stimulation, Oral Chemotherapy, Immunotherapy-Monoclonal Antibody to be given as an injection, Intra Vitreal injections, Robotic surgeries, Stereotactic radio surgeries, Bronchial Thermoplasty, Vaporisation of the prostate (Green laser treatment or holmium laser treatment), IONM-(Intra Operative Neuro Monitoring), Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions.

Sub-Limit On Room Rent

The insurer shall cover the room rent for in-patient hospitalization as follows:

  1. Room rent limit – 1% of the sum insured per day
  2. ICU Charges – 2% of the sum insured per day

Note: If the room rent is higher than the limit set by the insurer, the insured member has to bear the extra amount.

Optional Covers Available Under Group Care Insurance

Your employer can choose any of the following optional covers to provide extra coverage against medical expenses:

  1. Pre & Post-hospitalization Expenses
  2. Domestic Road Ambulance
  3. Maternity Expenses – Delivery Only
  4. Maternity Expenses – Comprehensive Benefit
  5. Donor Expenses
  6. OPD Treatment
  7. Second Opinion
  8. Domiciliary Hospitalization
  9. Dental Treatment
  10. Alternative Treatment (IPD Basis)
  11. Patient Care
  12. Major Diagnostics
  13. Comprehensive STD Cover
  14. Durable Equipment
  15. Maternity Complications
  16. Domiciliary Treatment
  17. Cover Extended Outside India
  18. Corporate Floater
  19. Health Check-up
  20. Alternative Treatment (OPD Basis)
  21. Additional Services
  22. Floater
  23. Sub-Floater
  24. Modification of Waiting Period
  25. Premium Installment Facility
  26. Network Limited to Specified Geographies
  27. Network Limited to Preferred Providers
  28. Sub-limit on Medical Expenses
  29. Deductible
  30. Hospital Accommodation – Twin sharing Room
  31. Hospital Accommodation – Single Private Room
  32. Sub-Limit on Illness/Surgeries/Procedures
  33. Co-Payment
  34. STD Cover

Waiting Period Applicable to Group Care Insurance

The following waiting period shall apply to this policy individually to each insured member:

  1. Initial Waiting Period – 30 days (Applicable to Treatment of Illness)
  2. Pre-existing Disease – 48 months
  3. Specific Illnesses/Treatments – 24 months

Exclusions from Group Care Insurance

The insurer shall not pay for the medical expenses arising out of the following:

  1. Investigation & Evaluation
  2. Rest Cure, rehabilitation and respite care
  3. Obesity/Weight Control Programs
  4. Change-of-Gender treatments
  5. Cosmetic or Plastic Surgery
  6. Self-inflicted injuries or attempted suicide
  7. Participation in hazardous or adventure sports
  8. Breach of law
  9. Treatments received by excluded providers
  10. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and its consequences
  11. Treatments received in health hydros, nature cure clinics, spas or similar establishments
  12. Unprescribed dietary supplements and substances
  13. Treatment for correction of eyesight due to refractive error < 7.5 diopters
  14. Unproven treatments
  15. Sterility and infertility treatment
  16. Medical treatment expenses traceable to childbirth, miscarriage and lawful medical termination of pregnancy
  17. Circumcision unless necessary for the treatment of a disease or injury
  18. Cost of spectacles, contact lenses and hearing aids
  19. Dental treatment or surgery unless requiring hospitalization
  20. Convalescence, general debility, ‘run-down’ condition venereal disease
  21. Medical expenses arising out of Human T-Cell Lymphotropic Virus Type III (HTLV III), Lymphadenopathy Associated Virus (LAV), the Mutants Derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind
  22. Disease or injury caused by nuclear weapons/materials.
  23. Any non-medical expenses as specified in the policy schedule
  24. War and warlike occurrence or invasion
  25. Out-patient Treatments
  26. Non-allopathic treatments

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