Description
Policy Conditions
1. The quote is valid for 30 days which is effective from the date proposal is sent to the customer.
2. Pricing is based on the assumptions of 15 principal lives and above.
3. The age limit on the plan is 65 years.
4. Maximum family size of 6 (principal, spouse, and max. of 4 children).
5. The premium computed is paid annually and additional charges may apply for periodic premiums
•Graded access to benefits:
•6 months waiting period for chronic illness , related chronic diseases, surgeries and cancer care
•9 months waiting period for Obstetrics & Gynaecology including antenatal, delivery and post natal care
6. Roaming is allowed within applicable networks on the plan
7. All individual and family members registered at onboarding are required to pay full premium regardless of when the dependents of the family registered during the policy period
8. New/Additional individual and family members can be added and deleted during the policy tenure and applicable prorated premiums and credit balances is shared with client.
9. Replacement is only allowed within the first 30 days of policy commencement if the initial member has not accessed care on the plan.
10. Plan upgrade is allowed only within the first 3 months of the policy subject to policy utilization and if member have not accessed care on the initial plan. The upgrade is not automatic, and the HMO can either accept or reject this request.
11. Plan downgrade is not allowed during the policy period until policy renewals
12. Policy agreement must be executed on or before the policy start date.
13. All benefits are subject to their respective sectional limits which is described as: Inpatient Limit and Outpatient Limit. However, within the respective sectional limit, there are specific benefit limits as well. Consequently, in the event that any specific benefit limit under the sectional limit is exhausted, the remaining limit in that section will only cover other benefits within the section apart from the one that the specific benefit limit has been exhausted
14. Final contract/negotiations are subject to IHMS’s terms and condition
Policy Exclusions
•Cosmetic surgery or treatment
•Pre-existing conditions
•Auto immune diseases
•Epidemic and Pandemic
•Domestic Violence
•Civil Disobedience
•Dental Prothesis
•Dental & Surgical Implants
•Alternative /Un-orthodox medicine
•Domiciliary/Hospice care
•Advanced and complex investigation
•Neonatal care not listed under neonatal services
•Self inflicted injuries
•Congenital abnormalities for children not born on the plan
•Second opinion abroad
•Reimbursement of delivery abroad
•Services primarily for weight reduction or treatment of obesity
•Global refund on the treatment abroad
•Treatment of substance abuse
•Professional Sports and willful exposure to needless danger
•School admission test
•Stem cell transplant or bone marrow transplant
•Serum cholesterol, ALT/AST, ECG, E/U/Cr, annual mammogram, cervical smear, PSA
•Rotavirus, Pneumococcal, Typhoid, HPV vaccine
•Lifestyle management; Gym and SPA membership
•All procedures, management and investigations not written/stated and covered by the plan
•Personal health equipment – BP machine, Glucometer, Trackers
•Conditions caused by an act of war, an epidemic or enrollee participating in a riot
•Second opinion abroad
All types of dental or orthodontic cosmetic procedures including cost of consultation, examination, medication, procedures, follow-up visits
Teeth whitening, Braces,Veneers, Aligners, Crowns, Tooth replacement,Cosmetic dental surgical and non-surgical procedures
