Group Health Insurance(GHI)

Call +91 9900113820 for

more information

Who said I need health Insurance

My clients don’t fall sick!! How do I tell

them importance of GHI??

Health insurance is needed more now than ever before because of -

Why Health Insurance?

Skyrocketing medical costs

Need for routine medical

check ups and care

Expensive trips to

specialist doctors

Possibility of hospitalizatio

n and treatment

USP of Group Health Insurance

Cheaper than individual

Health plans

No physical examination

Covers people regardless of their

age or present state of health

Customized health care

Helps to reduce a company’s liability and

decrease risks

Having such a great benefit boosts morale

among employees

Scope/ Coverage

Illness can be from anything.. Thought of serve the client entire life is giving me stress

attack!!

Scope of cover Disease/ Injury

Treated medically/ surgically

By Hospitalisation/ Domiciliary hospitalisation

At Nursing home/ hospital in India as in-patient

Age limit 90 days – 80 years

Pre hospitalisation Relevant medical

expenses 30 days prior to hospitalisation

Post hospitalisation Relevant medical

expenses 60 days after hospitalisation

Compensation payable Reasonable and

necessarily incurred Room expenses in

hospital/ nursing home

Nursing expenses Medical

practitioner fee

Treatment costMedicines/ diagnostic

cost Blood/ oxygenCost of pacemakerOperation theatre

chargesSurgical appliancesDialysis,

chemotherapy, radiotherapy

Compensation payable contd.… Pre and post

hospitalisation expenses

Max of SI Surgical operation Manual operative

procedure for Deformity Defect correction Diagnosis cure Prolongation of life

Hospitalisation Min period of 24 hrs Time limit not applicable for specific

treatment Dialysis Chemotherapy Tonsillectomy D & C Cataract

Pre & post hospitalisation Pre hospitalisation

Relevant medical expenses 30 days prior to hospitalisation

Post hospitalisation Relevant medical expenses 60 days after

hospitalisation Any one illness

Continuous Period of Illness Relapse within 45 days of the earlier

treatment

Domiciliary hospitalization Treatment exceeding 3 days at

Residence Serious condition of patient

does not allow removal to hospital

Lack of accommodation in nursing home

Pre / post hospitalisation expenses not covered

Specified diseases excluded - Asthma/ Diabetes/ Dysentery/ Hypertension/ Flu/ Epilepsy/ Arthritis

My No Service Areas..

Ok.. Lot of things are covered under GHI…Is there anything left that

we don’t cover???

First year exclusionsCataractBenign prostratic hypertrophyHysterectomy for menonhargia or fibromyomaHernia/ hydroceleCongenital internal diseaseFistula in anus/ pilesSinusitis & related disorder

General exclusions War/ war group Nuclear perils Plastic surgery Spectacles/ contact lens/

hearing aid Dental treatment Convalescence/ general

debility Sterility/ venereal

disease / circumcision Intentional self injury

General exclusions contd.… Use of intoxicating

drugs/ alcohol Aids Diagnostic/ laboratory

expenses not consistent with treatment

Vitamins/ tonic inconsistent with treatment

Pregnancy Naturopathy

Extensions Pregnancy

9 months from inception

Pre and post natal care not covered

Max liability Rs. 50,000 First two children Abortion within 12

weeks not covered Day one cover Pre existing disease

covered

Mediclaim…No Money

What if client has emergency. Can we

provide service without cash??

Cashless mediclaim Claim handled by both ICICI Lombard

Health care & Outside TPA depending upon Client

Planned treatment in notified hospital Inform TPA & get treatment post

approvalCashless / Hassle free claims

settlement Emergency – What to do???

Give TPA membership no Intimate TPA & approvalCashless / Hassle free claims

settlement

Reimbursement

Process of Reimbursement and claims is giving me

Nausea.. I think I am sick..

Reimbursement – mediclaim Planned / Emergency

treatment in non-notified hospital Notice to TPA & approved Submit

Duly completed claim form Bills, receipts and discharge

certificate/card from the Hospital

Bills from Chemists supported by proper prescription.

Test reports and payment receipts

Settlement within a week on complete submission

Information to be taken from client for quote generation

Age Band /Sum Insured Rs. 100,000 Rs. 200,000 Rs. 300,000 3 months - 18 yrs.19 yrs. - 35 yrs.36 yrs. - 45 yrs.46 yrs. - 55 yrs.56 yrs. - 60 yrs.61 yrs. - 65 yrs.>65 years

1. No of lives to be covered

2. No of employees & No. of dependents

3. Add on covers required

4. Past 3 years claims data

Thank you

Call +91 9900113820 for

more information