Benefits
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General Consultation
• Specialist Consultation
-
**Second Opinion Care
-
Health awareness program
-
Drugs and medications for acute illnesses and injuries
-
Prescription drugs for pre-existing cases(cases declared pre-enrollment)
• Covered within network only -
Concierge Pharmacy (Medication pick-up and door to door delivery for Chronic and rare medications)
• Covered
-
Laboratory
• Basic
• Comprehensive ( Lipid profile, EUC ( Electrolyte urea cretinin),LFT( liver function test), -
X-ray
• Basic.
• Comprehensive -
Ultrasound Scan
• Basic.
• Comprehensive -
Hospitalization
• Standard ward - Covered 42 hospital days
• 3-4 bedded ward
• Semi-Private /standard private Ward
• Executive Private Ward -
Dental Care ***
• Primary dental care - treatment for pain with PCP.
• Surgical Dental Care - within a limit.
• Non-surgical Dental Care (All dentist visits require appointment authorization) - limited annually. -
Eye Care
• Primary eye care - treatment with PCP.
• Drugs/Eye Tests/Refraction(Require appointment authorization) - within a limit yearly
• Lens and Frame - within a limit.
• Ophthalmological surgery - covered with a limit in our network. -
Emergency
• Accident/Emergency Stabilization - first 24 hrs post emergency. subsequent cover is to benefit limit
• Emergency road Ambulance Services
• ***Intensive Care Unit - covered for first 14 days. -
Maternity Care
• Antenatal Care
• Medical expenses for delivery(normal, assisted delivery, caesarian section only) - Normal Delivery
• Post natal check-up, first 6wks( for family plan holder only).
• Child Welfare Clinic Circumcision, ear piercing.
• Routine Neo-natal immunization (NPI)-TO LIST
• ***Preterm/premature babies - within a limit.
• Ceasarean section - Up to surgery limit
• Local Travel Care -
Surgeries ***
• Minor (Primary suture, lipoma excision, ganglion excision, incision and drainage, keloid excision, minor burns, wound debridement etc.).
• Intermediate--(Hernioraphy, colostomy, tenoplasty, diaphragmatic hernia repair, gastroenterostomy, splenorraphy etc.).
• Major (Laparotomy, urethrectomy adrenalectomy etc.) Surgical appliances , e.g crutches, collars etc.
-
Special Procedures ***
• Blood Transfusion - Covered (up to 2 pints)
• P.O.P - 1st cast
• Physiotherapy - Covered
• HIV Counselling, testing and drugs from local centers - Covered in Govt. NACA Centers only
• Dialysis - 5 Sessions
• Cancer Therapy: oncology tests, drugs, chemotherapy - covered within network with a limit. -
Extra Radiological
• CT Scan, MRI -
Immunization
• Basic (NPI) - Tetanous only
• Additional(Typhoid, Rotavirus MMR, HiB, Pneumococcal,) -
Preventive and promotive health
• Adult wellness Check(Annually) - Executive check up. -
Disease management program
• Health information
• Treatment and monitoring of Chronic Illnesses. -
Elective Evacuation (for illnessesnot treated locally) Africa and India only on commercial flight economy class
• Accompanying family for elective evacuation (one economy class return ticket) - within a limit weekly.
• Repatriation of mortal remains - within a limit.
Exclusion
-
• Occupational/Industrial injuries are excluded and continue to be covered under the workman compensation Act.
• Cosmetic surgery
• Brain surgery
• High technology investigation e.g. MRI, unless covered by your chosen plan.
• Injuries resulting from Natural disasters, Conflicts, Social unrest, riots, wars and injuries from nuclear disasters.
• Epidemics
• All forms of Family planning
• Injuries arising from extreme sports
• Injuries related to intoxication
• Drug abuse/addiction
• Terminal illness including cancers, stroke (cancer treatment may be covered by your plan up to a limit).
• All cases of infertility
• All prostheses
• Optional abortion or Pregnancy termination, other than miscarriage