Group Health Insurance Policy

Purpose :

To provide financial support to the employees for unforeseen hospitalization expenditure and to ensure smooth interaction with the medical authorities during such emergency in terms of quality, speed and payments.

Scope :

This policy is applicable to all the permanent / Confirm employees of Jainam Broking Limited and it’s other group of companies who has completed 06 months from the date of joining. This policy is applicable for reimbursement of hospitalization expenses incurred within India.

Policy Period :

This policy will be applicable for one year duration from the date of issuance of policy.

Insurance Company :

This Mediclaim policy has been issued by United India Insurance Co. Ltd

Sum Insured :

The maximum sum insured is Rs.300000 per employee.

Premium :

The Premium for Mediclaim Policy will be paid by the organization.

Coverage :

In case the expenses are more than the insured amount I.e. 300000/-, balance will be payable by the employee to the hospital directly and reimbursement of the said shall not be borne by the organization or the insurance company.

Renewal :

The policy will be subject to annual renewal and any changes to the terms and conditions will be communicated to employees prior to the renewal date.

Cashless Facility :

A facility where the employee, need not to pay cash for all expenses.

If it is Network hospital they will be entertained but need to inform insurance company within 24 hours to avail cashless benefit.

Reimbursement :

If it is Non Network hospital, the employee has to pay himself and claim it by filling the claim reimbursement form and attach all the documents related to hospitalization. The claim must be submitted to HR within 02 days from the date of discharge from the hospital.

Separated Employee :

This medical facility is not extended to separated employees after the date of relieve from the organisation.

Prior Intimation :

This prior intimation is compulsory for all claims. This intimation should be received within 24 hours of hospitalization as instructed by Insurance Company.

All original bills, reports, receipts, films, discharge summary and all related documents should be submit to HR within 02 days from date of discharge.

Both the information is very important to process any claim, missing or delay of any one may cause rejection of the claim.

Guidelines :

Policy is being issued on individual basis. The coverage of medical expense is limited to single employee only.

Policy does not cover dependant ( parents, spouse and children of employee )

Policy covers the employee of Jainam Broking Limited. Employees from other group of companies are not

covered under this policy. Organization will pay the approx premium to those employees separately.( Premium will be based on group health insurance policy )

In case of emergency hospitalization, the employees can directly approach any hospital either network hospitals or non network hospitals.

At the time of any medical emergency, the employee should inform the HR department within 24 hours of the accident/ medical event. HR will be the first point of contact. Thereafter HR will escalate the information to

Wealth Guardians Department through Ticket on immediate basis.

The claim settlement shall take 30-40 days to get deposited in the Company's Bank AC and company will credit the same amount as reimbursement in employee's bank account.

Letter of policy information is issued to at the enrollment of employee under group health insurance. The letter shall comprise of insurance company information, contact details of HR.

List of network hospitals and cashless facility are attached below.

Employee residing in Surat city has to submit the claim file hand to hand. While the employee residing out of Surat can send the claim file through courier / post.

If an employee has opt for loan from the organization in medical emergency circumstance then organization will recover the loan from the reimbursement receive through insurance company.

Inclusions :

The policy covers a single headcount i.e. only the employee.

Cashless claims settlement, is possible with all the network hospitals.

Exclusions :

Domiciliary Hospitalization is not covered. Any medical treatment that patient receive at their home under

professional care is known as a domiciliary treatment. In such cases, the patient cannot be taken to the hospital due to their inability to leave the house. In such cases claim will not processed.

Any disease, condition or medical treatment that your insurance plan does not cover is listed as the policy’s exclusions. Do not forget to check the exclusions

Medical expenses incurred in foreign lands/Outside India shall not be covered under the policy.

This policy also do not cover any maternity/paternity expenses.