United Group Health Insurance offers medical coverage to the employees of an organization or company. With this health insurance, an employer will need to pay the premium to secure the health of their employees. If any of the insured members contract any disease or suffer from any illness or sustain any bodily injury due to an accident during the policy period and the medical practitioner has thus advised hospitalization, the insurer will cover such expenses. Read this page below and learn more about the United Group Health Insurance coverage and exclusions.
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United Group Health Insurance Base Cover
The insurer shall cover the in-patient hospitalization expenses incurred during the policy period, provided the hospitalization is for more than 24 hours. However, the 24-hour hospitalization restriction shall not apply to the following:
- Ascitic/Pleural tapping
- Coronary angiography
- Coronary angioplasty
- Dental surgery
- Dilatation & Curettage
- Excision of Cyst/Granuloma/Lump
- Eye surgery
- Fracture/dislocation excluding hairline fracture
- Incision and drainage of abscess
- Wound suturing
- Fissurectomy / Fistulectomy
- Inguinal/ventral/ umbilical/femoral hernia
- Parenteral chemotherapy
- Liver aspiration
- Varicose Vein Ligation
This condition shall also not apply in case the insured seeks medical treatment under General or Local Anesthesia in a hospital/daycare center due to technological advancement. Procedures/treatments done on an outpatient basis shall not be payable under this policy even if converted to an in-patient in the hospital.
Domiciliary Hospitalization: If the insured person is receiving medical treatment for a period exceeding three days for an illness/disease/injury at home under any of the following circumstances:
- The patient condition is not such that he/she can be moved to a hospital
- Treatment at home due to non-availability of room in a hospital
the insurer shall cover such medical expenses incurred during the policy period.
Ayurvedic Treatment: Hospitalisation expenses are admissible for ayurvedic treatment if the insured receives the same in a Government Hospital or any Institute recognized by the Government or accredited by the Quality Council of India/National Accreditation Board on Health.
Exclusions from United Group Health Insurance
The company shall not be liable to make any payment under this policy in respect of any claim arising out of the following:
- Any Pre-existing condition until 48 months of continuous coverage
- Any disease contracted during the first 30 days from the commencement date of the policy.
- Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia, or Fibromyoma, Hernia, Hydrocele, Congenital internal disease, Fistula in the anus, Piles, Sinusitis and related disorders, Gallbladder Stone removal, Gout & Rheumatism, Calculus Diseases shall not be covered until 48 months of continuous coverage
- Joint Replacement due to Degenerative Condition and age-related Osteoarthritis & Osteoporosis
- Injury/disease directly or indirectly caused by or arising from war or warlike operations
- Circumcision unless necessary for the treatment of a disease or necessitated due to an accident
- Vaccination or inoculation of any kind unless it is for post-animal bite treatment.
- Change of life, cosmetic or aesthetic treatment of any description
- Cost of spectacles, contact lenses and hearing aids.
- Dental treatment or surgery of any kind unless necessitated due to an accident
- Convalescence, general debility; run-down condition or rest cure
- Obesity treatment and its complications including morbid obesity
- Congenital external disease/defects or anomalies
- All psychiatric and psychosomatic disorders
- Infertility and Sterility
- Venereal disease
- Intentional self-injury
- Abuse of intoxication such as drugs/alcohol
- Expenses arising out of Human T-Cell Lymphotropic Virus Type III (HTLV – III) or lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.
- Charges incurred at Hospital or Nursing Home primarily for diagnosis
- Expenses on vitamins and tonics unless prescribed by the attending physician
- Injury or Disease directly or indirectly caused by nuclear weapons/ materials
- Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or its complications
- Naturopathy Treatment, acupressure, acupuncture, magnetic therapies, experimental and unproven treatments/therapies.
- External or durable medical/non-medical equipment of any kind
- Genetic disorders and Stem Cell implantation/surgery
- Change of treatment from one system of medicine to another unless recommended by the consultant/hospital
- Treatment for Age-related Macular Degeneration (ARMD) such as Rotational Field Quantum Magnetic Resonance (RFQMR), Enhanced External Counterpulsation (EECP), etc.
- All non-medical expenses including convenience items for personal comfort such as charges for telephone, television, etc.
- Any kind of Service charges, Surcharges, Admission Fees/Registration Charges, Luxury Tax and similar charges levied by the hospital
Maternity Benefit Expenses Benefit Extension
This optional coverage can be obtained on payment of 10% of the total basic premium. Employers can add this optional cover at the inception of the policy period and no refund is allowable in case of cancellation of this optional cover. Under this extension, hospitalization expenses for the newborn child shall also be covered up to INR 50,000 or the sum insured opted by the employer, whichever is lower.
Conditions Applicable to Maternity Expenses Benefit Extension:
- Maternity expenses are admissible only if the expenses are incurred in Hospital /Nursing Home as an in-patient in India
- A waiting period of 9 months applies to normal delivery, cesarean section or abdominal operation for extra uterine pregnancy. The waiting period may be relaxed in case of delivery, miscarriage or abortion induced by an accident or other medical emergency.
- Under this extension, the insured member can file a claim for only the first two children. If the insured person already has two or more living children, he/she will not be eligible for this benefit.
- Expenses incurred in respect of voluntary medical termination of pregnancy during the first 12 weeks from the date of conception are not covered.
- Pre and post-natal expenses are not covered unless the insured member is admitted to a Hospital /Nursing Home and seeks treatment there.
- If the employer adds Maternity Expenses Benefit Extension to this policy, the maternity exclusion stands deleted.