Group Insurance 403 views May 21, 2021

Digit Illness Group Insurance Plan covers you and your family members against medical expenses. There are two coverage options available under Digit Illness Group Insurance Plan –

  1. Hospitalization Cover
  2. Virus Detection & Quarantine Allowance

Read this page further and know more about the benefits of the Digit Illness Group Insurance Plan.

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Digit Illness Group Insurance Plan Hospitalization Cover

If you choose this cover and get hospitalized during the policy term, the insurer shall cover the following medical expenses –

  1. Accommodation/Room Rent
  2. ICU charges
  3. Fees of specialists, physicians, nurses, surgeons and anesthetists
  4. Cost of drugs, medicines, consumables prescribed by a specialist or medical practitioner
  5. Cost of Anaesthesia, Blood, Oxygen, Patient’s Diet, Surgical appliances & cost of prosthetic and other devices or equipment if implanted during the Surgical Procedure
  6. Necessary procedures such as x-rays, pathology, brain and body scans (MRI, CT scans), etc.
  7. Operation Theatre Fees
  8. Pre and post-hospitalization expenses incurred before the date of admission and discharge from the hospital, respectively
  9. Road ambulance cover
  10. Second medical opinion

You can receive the above-mentioned coverage only if you are tested positive for the below-mentioned illnesses/diseases –

  1. Cholera
  2. Amoebiasis
  3. Typhoid
  4. Viral Hepatitis
  5. Tuberculosis
  6. Plague
  7. Diphtheria
  8. Typhus
  9. Leptospirosis
  10. Dengue
  11. Malaria
  12. Filariasis
  13. Kala Azar
  14. Chikungunya
  15. Japanese Encephalitis
  16. HIV
  17. Zika Virus
  18. Nipah Virus
  19. EBOLA
  20. Swine Influenza Virus
  21. H1N1 Virus
  22. COVID-19
  23. SARS
  24. MERS

The claim can be made under this benefit up to the sum insured as mentioned in your policy schedule/certificate.

Digit Illness Group Insurance Plan Virus Detection & Quarantine Allowance Cover

If you have opted for this cover, the insurer will pay you the following benefits –

Full Fixed Benefit: 100% of the sum insured will be payable if you are tested positive for any of the covered viruses during the policy period. To claim this benefit, you need to submit a certificate from a registered medical practitioner along with a positive virology report from ICMR – National Institute of Virology Pune, India or any other laboratory authorized by ICMR, to the insurer.

Part Fixed Benefit: If the result comes negative, a percentage of the sum insured will be paid if you are quarantined in a dedicated government authorized hospital for a minimum period as mentioned in the policy schedule. This benefit will be paid only once during the policy period, subject to a maximum of 50% of the sum insured.

Note: The insurer will not pay any benefit for self-quarantine in any facility other than a government-authorized hospital. 

You can choose to get covered against any of the following viruses:

  1. Zika Virus
  2. Nipah Virus
  3. EBOLA
  4. Swine Influenza Virus
  5. H1N1 Virus
  6. COVID-19
  7. SARS
  8. MERS

Waiting Period

You cannot make claims for any treatment, positive diagnostic results or quarantine if detected during the waiting period. There is an initial waiting period as mentioned in your policy schedule from the commencement date of this policy. However, this waiting period shall be waived if you are insured under this policy without any break.

Exclusions from Digit Illness Group Insurance Plan

The following medical expenses are excluded under this policy

  1. Pre-Existing Diseases (PED) treatment and its direct complications until the expiry of a 48-month waiting period
  2. This policy shall not cover treatments and quarantine received outside India
  3. Non-medical expenses such as cosmetics, hygiene articles, body care products and bath additives, etc.
  4. Rest Cure, rehabilitation and respite care
  5. Insufficient documentation for any claim
  6. Preventive treatment such as inoculations, vaccinations or any other treatment
  7. Unproven treatments
  8. Unjustified or Unwarranted hospitalization where the hospital stay is only for physiotherapy, evaluation, investigations, diagnosis or observation service
  9. Unprescribed vitamins or other nutritional supplements
  10. Treatment of any Illness caused due to abuse of alcohol, opioids, nicotine or drugs
  11. Any claim in respect of Cancer of Oral, Oropharynx and respiratory system is specifically excluded if the insured is a tobacco user.
  12. Artificial life maintenance such as life support machine
  13. Non-Allopathic treatment
  14. Maternity treatment expenses
  15. Sexually Transmitted Infections & Diseases
  16. Sleep Disorders and Sleep Problems
  17. Cost of spectacles, hearing aids and other expenses
  18. Claim arising due to war and such similar acts
  19. Cost of prosthetics and other devices
  20. Specific treatments including but not limited to Predictive Genome testing
  21. Dental treatment
  22. Organ donor expense
  23. Accidental injury

Digit Illness Group Insurance Plan Claim Process

To file a claim under this policy, follow the procedure mentioned below –

Cashless Claim

  1. Intimate the insurer 72 hours before any planned hospitalization or within 24 hours in case of emergency hospitalization.
  2. Show your Health Card/Copy of E-Cards along with ID Proof at the network hospital 
  3. Collect the pre-authorization form from the hospital, fill it and submit it to the hospital counter.
  4. Later, the hospital will send the duly filled pre-authorization form to the TPA/insurer for further processing
  5. TPA/insurer will inform its decision to the hospital, and once the request for pre-authorization has been granted, the treatment will take place

Reimbursement Claim

  1. Intimate the insurer within 30 days from the date of discharge by submitting all the original documents of your hospitalization to it
  2. On receipt of your intimation, the insurer will investigate the information

All claims shall be settled/repudiated within 30 days from the date of receipt of the last necessary claim document. In case there is any delay in payment beyond the stipulated period, a penalty interest of 2% shall be added to it. In case of your death, the insurer shall reimburse the claim amount to your nominee as named in the policy schedule/certificate.

List of Documents Required for Reimbursement Claim

You need to submit the following documents to the insurer –

  1. Duly Filled and Signed Claim form
  2. Discharge Summary
  3. Medical Records such as Indoor case papers, OT notes, PAC notes, etc.
  4. Hospital Main Bill
  5. Hospital Bill Break Up
  6. Pharmacy Bills
  7. Prescriptions for the purchased medicines except for hospital supply
  8. Consultation Papers
  9. Investigation Reports
  10. Positive Diagnostic Report for the Conditions
  11. Digital Images/CDs of the investigation procedures if required
  12. Invoice/Sticker if applicable
  13. Attending Physician Certificate if applicable
  14. Death Certificate if applicable
  15. KYC Proof
  16. Bank Details with Cancelled Cheque

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