Group Medical Insurance Policy for the existing employees and their dependants. 1.TITLE OF THE SCHEME The scheme is known as "Group Medical Insurance Policy" for the employees and their dependants. 2. OBJECTIVE OF THE SCEHEME Objective of the scheme is to meet the expenses, incurred by the insured persons during the inpatient medical treatment. 3. APPLICABILITY OF THE SCHEME This scheme is applicable to all the Permanent employees on the rolls of the CCI Ltd. and their family members, effective from 01.06.2022. DEFINITIONS 4. Regular Employee -- means an employee whose name is borne on the rolls of the company including probationers, Management Trainees, Junior Management Trainees, Worker Artisan Trainees, Adhoc staff, Fixed Term Contractual staff. 5. Insured Person --means Person(s) named on the schedule of the policy. 6. In-Patient - An insured person who is admitted to hospital and stays for at least 24 hours for the sole purpose of receiving treatment for suffered ailment/illness/disease/injury/accident during the currency of the policy. 7. Cashless Facility -- means the TPA may authorize upon the Insured persons' request for direct settlement of admissible claim as per agreed charges between approved hospital and the insured person may not have to pay any bill after the end of the treatment at hospital to the extent the claim is covered under the policy. 8. Medical I.D. Card --means the card issued to the Insured Person by the TPA to avail Cashless Facility in the approved hospital. 9. Approved Hospital - means hospitals that have agreed with the TPA to participate for providing cashless health services to the insured persons. The list of empanelled hospital is enclosed. 10.Recognized Hospital-means hospitals that are approved by the insurance company for providing treatment for the insured persons other than those which are providing cashless health services. 11. Referral Hospital - means hospitals having facilities for providing super specialty treatment for the insured persons and duly approved by insurance company. 12. Coverage of the Scheme -This Medical Insurance Policy is to extend coverage to Existing employees, not covered under ESIC, on the rolls of CCI. The facilities under this policy to be extended to Few of the salient features of the Medical Insurance Policy are as follows: Existing employees 1Corporate Details 1.1 |Full Name of the Insured Cement Corporation of India Limited 1.2 [Corporate Office New Delhi 1.3 Business / Industry Type Cement Business 1.4 Geographical Limits India (no location barrier) Master policy to be issued in the name specified above. CCIL will keep Insurers notified of any future listing & delisting of entities including those entities for which the insured has assumed an obligation to arrange insurance for their respective rights, titles & 1.5 [Entity Coverage interests and Insurer to give CCIL extension of same coverage as per agreed rates. All such listing & delisting to be given same effect as additions & deletions in the Master Policy & premium accounting to be done on pro rata basis. 2Member Information Self Spouse Children 2.1 |Total No. of Members for sourcing quote 3|Sum Insured (INR) INR 500,000 4Benefits Terms and Condition 4.1 |Family Floater Yes Employee + Spouse + Kids + set of parent (parents / Parents in- laws). Family Unit Definition Parents-in-laws can be covered only in case of female employees only. Sum Insured Approach INR 500,000 Cap on Sum Insured if Applicable for any NA Relation Option to Increase Sum Insured NA Dependent children in case of: Age Limit of dependent children i) Son - upto 25 years ii) Daughters -- No age limit for unmarried /widow 4.2 Maternity Benefit Covered Sub Limit on Normal Delivery INR 50K Sub Limit on Caesarean Delivery INR 1 lakh 9 months waiting period for maternity Waived Off Maternity benefit limit for no of children 02 children Expense incurred for Medical termination of pregnancy under Medical advice to save the Covered life or prevent serious damage to the health of the mother Abortion if performed legally & under medical advice within first 20 weeks on confirmation of substantial risk that if the child were born it would suffer from such Covered physical or mental abnormalities as to be seriously handicapped. 20 weeks to be extended as per amendment in MTP Act, 1971 in due course of time. 4.3 Baby Cover From day one within family sum insured 4.4 |Pre-existing Disease Covered Covered from day one for existing and new joiners both 4.530 days waiting period is Applicable Waived Off 1/2/4 waiting period for specified ailments 4.6 Waived Off is Applicable 4.9 Ambulance Services INR 3K per incidence 4.10 Co-payments (mention limits, if applicable) Not Applicable 4.11 Deductibles (mention limits, if applicable) Not Applicable Category CMD & Directors Others Metro Cities 3% 4.12 Room Rent Restrictions if any State Capitals 4% 3% Other Cities 2.5% INR 30 Lac 4.13 Corporate Buffer (To be utilized as per the wishes of the Corporation. There will not be any employee-specific limit.) 4.14 Day Care procedures Covered 4.15 Terrorism Related Hospitalisation Covered 4.16 Clause on Advancement of Medical Science Covered 4.17 Coverage for cost of dentures Covered Donor & Receiver Expenses covered in case 4.19 [ Covered of organ transplant 4.21 Waiting Period for any ailment Waived Off 4.22 Cancellation Clause Not Applicable Below clauses should be incorporated based on specific 5POLICY OPERATING GUIDELINES requirement of client 5.1 [Coverage to New Joiners Covered from day one 5.2 Coverage to Family Members Covered from day one 5.3 For family members of New Joiners Covered from day one New Borns & Spouse in the event of 5.4 [ Covered from date of event Marriage during the year 14. Coverage of all Pre-existing diseases or ailment / injuries: All ailments / diseases / injuries / health condition which are pre-existing (treated/untreated, declared / not declared in the proposal form), shall be covered under the Policy. Newly born babies will be covered from day one within overall limit of the family. 15. Pre-hospitalization and Post-hospitalization Expenses: a) Pre-Hospitalization: Relevant medical expenses incurred during the period upto 30 days prior to hospitalization on diseases / illness / injury sustained will be considered as part of claim. b) Post-Hospitalization: Relevant medical expenses incurred for the period of 60 days after hospitalization on diseases / illness / injury sustained will be considered as part of claim. c) Special provision for Day Care: The insurance policy should provide day care coverage for specific treatment taken in network specialized day care centres where the insured is discharged on the same