Group Health Insurance 567 views June 9, 2021

Royal Sundaram Group Health Insurance

Royal Sundaram Group Health Insurance covers all the reasonable and customary charges incurred towards hospitalization for treatment of illness or injury contracted or sustained to the insured person (employee) during the policy period. Here, employers remain the policyholders and pay the premium to secure the health insurance of their employees against unforeseen medical contingencies. Continue reading this page to know more about the policy coverage and exclusions.

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Royal Sundaram Group Health Insurance Base Coverages

The insurer shall pay for the following medical expenses incurred during the policy period:

  1. In-patient Hospitalization Expenses: This will include room boarding expenses that are limited to 1% of the sum insured per day and Intensive Care Unit (ICU) charges restricted to 2% of the sum insured per day, nursing expenses, fees of Surgeon, Anaesthetist, Medical Practitioner, Consultants & Specialist, cost of anaesthesia, blood, oxygen, Operation Theatre charges, medicines and drugs, diagnostic materials and X-ray, dialysis, chemotherapy, radiotherapy, donors medical expenses towards organ transplant, cost of pacemaker, artificial limbs, cost of organs, etc.
  2. Day care treatments: Dialysis, Chemotherapy, Radiotherapy, Eye surgery, Cataract, Lithotripsy (kidney stone removal) Tonsillectomy, D&C, Cardiac Catheterization, Hydrocele Surgery, Hernia repair surgery, Treatments for Fracture and such other surgical operations where the hospitalization remains less than 24 hours due to medical/technological advancement.
  3. Treatment for Cataract: Coverage under this benefit is limited to 30% of the sum insured or INR 30,000, whichever is lower, during the period of insurance
  4. Cover for pre and post-hospitalization expenses provided the claim has been accepted by the insurer in respect of in-patient hospitalization.

Royal Sundaram Group Health Insurance Additional Covers

The insurer provides access to the following benefits to employees:

  1. Waiver of waiting period for Pre-existing Diseases
  2. Waiver of a 1-year waiting period for critical illnesses
  3. Waiver of a 30-day initial waiting period
  4. Maternity cover
  5. Day one cover for newborns
  6. Hospital Cash benefit
  7. Convalescence benefit
  8. Outpatient treatment
  9. Corporate floater
  10. Emergency Ambulance expenses
  11. Domiciliary Hospitalization expenses
  12. Critical Illness cover
  13. Terrorism exclusion waiver

Note – The waiting period means the time for which you need to wait to get covered against diseases. As it’s been pointed out that this plan does not have any waiting period, you can get covered from Day 1.

Royal Sundaram Group Health Insurance Exclusions

The company 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 Program
  4. Change-of-Gender Treatments
  5. Cosmetic or plastic Surgery
  6. Participation in Hazardous or Adventure sports
  7. Breach of law
  8. Treatments by ‘Excluded Providers’
  9. Treatment for Alcoholism, drug or substance abuse
  10. Treatments received in health hydros, nature cure clinics, spas or similar establishments
  11. Non-prescribed dietary supplements and substances
  12. Treatment for correction of eyesight due to refractive error less than 7.5 dioptres
  13. Unproven Treatments
  14. Sterility and Infertility
  15. Maternity Expenses
  16. Cost of spectacles and other durable items
  17. Dental treatment or surgery of any kind
  18. Congenital External Disease or Defects or Anomalies
  19. Venereal disease
  20. Tubectomy, Vasectomy, any treatment related to sterilization
  21. Intentional self-injury or attempted suicide.
  22. Sexually Transmitted Diseases such as AIDS/HIV
  23. Wa or similar acts
  24. Routine or preventative examinations
  25. Vaccinations or inoculation
  26. Outpatient treatment
  27. Hormone replacement therapy
  28. Any treatment received outside India
  29. AYUSH treatment.
  30. Any surgery, therapy or treatment not prescribed by a registered medical  practitioner

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