Group Health Insurance 224 views June 3, 2021

Navi Group Health Insurance

Navi Group Health Insurance Policy will cover all the reasonable and customary charges for medically necessary treatment. This policy is available to employers, so they can safeguard their employees financially. Read this page below and learn more about the coverage of the Navi Group Health Insurance Policy.

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Navi Group Health Insurance Base Cover

The insurer provides coverage against the following medical expenses to the employees of an organization/company –

In-patient Hospitalization: Medical expenses incurred during hospitalization due to an illness/injury –

  1. Room Rent & nursing charges
  2. ICU charges
  3. Operation theatre charges
  4. Fees of the medical practitioner, surgeon, anesthetist, specialists
  5. Physiotherapy
  6. Investigation & Diagnostic procedures
  7. Cost of medicines, drugs and other prescribed consumables
  8. Cost of blood, oxygen, surgical appliances such as prosthetics and other devices or equipment if recommended by the attending medical practitioner.

Modern Treatment: The following procedures will be covered under this policy:

  1. Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
  2. Balloon Sinuplasty
  3. Deep Brain stimulation
  4. Oral chemotherapy
  5. Immunotherapy – Monoclonal Antibody to be given as an injection
  6. Intra vitreal injection
  7. Robotic surgeries
  8. Stereotactic radio surgeries
  9. Bronchial Thermoplasty
  10. Vaporization of the prostate (Green laser treatment or holmium laser treatment)
  11. Intra Operative Neuro Monitoring (IONM)
  12. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions

Mental Illness: If the insured is diagnosed with any of the following mental illnesses during the policy period, the insurer will pay the sum insured or INR 3 Lakhs, whichever is less

  1. Schizophrenia
  2. Bipolar Affective Disorders
  3. Depression
  4. Obsessive-Compulsive Disorders
  5. Psychosis

HIV & AIDS: The insurer will cover inpatient hospitalization or daycare treatment for HIV or any condition caused by or associated with AIDS, up to the sum insured.

Pre-hospitalization: Medical expenses incurred thirty days before hospitalization or daycare treatment shall be covered under this policy.

Post-hospitalization: The insurer will pay for the medical expenses incurred during sixty days post-discharge from the hospital, including daycare treatments.

Day Care Treatment: You’ll get coverage for daycare treatment as specified in the policy schedule.

Domiciliary Hospitalization: The insurer will cover the medical expenses incurred due to treatment at home, provided the treatment continues for at least three days.

Organ Donor: Medical expenses incurred towards donors in case of major organ transplants shall be covered under this policy. However, the insurer will not pay for –

  1. Donor screening.
  2. Pre and post-hospitalization expenses of the organ donor
  3. Cost of the organ
  4. Any other medical treatment for the donor consequent to the harvesting of the organ
  5. Expenses of organ transportation or preservation
  6. Transplant of any organ/tissue where the transplant is experimental or investigational
  7. Medical expenses where the insured is hospitalized for donating organs

Vaccination (Post-bite treatment): Medical expenses incurred for vaccination, such as inoculation and immunizations due to post-bite treatment, shall be covered up to INR 5,000.

Family Transportation Benefit: The insurer covers the transportation expenses for one immediate family member of the insured if he/she is hospitalized in a hospital far from the city with no family members.

Emergency Ambulance, Repatriation of Mortal Remains (RMR), Funeral Expenses: The insurer will cover the following expenses incurred towards transportation –

  1. Transportation from the place of incident to the hospital or from one hospital to another for advanced diagnostic treatment if advised by the treating medical practitioner.
  2. Transportation of mortal remains from hospital to home or the cremation ground for the funeral purpose

Note: This cover also includes cremation and coffin charges.

Waiting Period Applicable to Navi Group Health Insurance

The following waiting period applies to this policy from the date of inception –

  1. Initial waiting period – 30 days (applicable to the treatment of any illness)
  2. Mental Illness – 24 month
  3. Internal Congenital Anomaly – 24 month

Exclusions from Navi Group Health Insurance

The insurer will not pay for the medical expenses if they arise due to the following –

  1. Breach of Law
  2. Chemical & Nuclear Exposure
  3. War
  4. Alcoholism, drug or substance abuse
  5. Cosmetic or Plastic Surgery
  6. Circumcision
  7. Rest Cure, Rehabilitation and Respite Care
  8. Hazardous or Adventure Sports
  9. Unproven Treatments
  10. Change of Gender Treatments
  11. Non-prescribed dietary supplements and substances
  12. Non-Medical Expenses
  13. Obesity / Weight Control Programs
  14. Preventive Vaccinations
  15. Sterility and Infertility Treatment
  16. Self-inflicted injuries or attempted suicide
  17. Treatment by medical practitioner outside the discipline
  18. Investigation & Evaluation
  19. Treatments received by excluded providers
  20. Treatments received in health hydros, nature cure clinics, spas or similar establishments
  21. Non-Allopathic Treatment
  22. Refractive Error < 7.5 diopters
  23. Eyesight, Hearing Aids & External prosthesis
  24. Dental Treatment and Surgery of any kind
  25. External Congenital Anomaly

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