DR'S PRESCRIPTION REQ FR AL TREATMENT
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1 FAMLY DEF: E+ SP +2C+2P MAX AGE FR CHILD UPTO 25 YRS. COVRGE FR ESC: SUM INSRED: INR 10 L FAMLY FLTR CORPORATE BUFER: 1. RS 25 LKHS BLANKET APPROVAL RECEIVED. 2. APPLICABLE ONLY FOR ESC 3. BUFFER FOR PARENTS NOT ALLOWED UNLESS SPECIFIED BY AM CASE TO CASE BASIS. MATERNITY: NO CAP NO RESTRTION ON NO. OF MATERNITY EVENTS BABY COVR DAY 1, BABY EXPS COVR UNDR MATERNITY BNEFITS PRE PST NATAL EXPS: AL EXPS RELTED TO PRE 30 & PST 60 DAYS COVR UNDR MATERNITY BNEFITS. EXPS FALING OUTSIDE PRE 30 & PST 60 DAYS WLL B COVR UNDR OPD WHICH INCLDES GYNAC VISITS, USG, INVESTIGATION, CONSULTATION. INFERTILITY LMTS: 1.5 LAC PER CYCLE (COVRING UPTO 2 CYCLES) INCLUDING PRE & PST TREATMENTS WID NO TIME LMT& MEDICINES ALSO PART OF IVF TREATMENTS STEM CELL BANKING: 50% OF THE COST SUBJECT TO MAX 50000/CHILD FR MAX 2 CHILDRN, INCLUDING EXPS INCURRED TOWARDS STEM CELL BANKING BFRE DELIVERY & ALSO MATERNITY EVENT DOES NT NEED TO OCCUR TO CLAIM THE EXPS. IF NO RECEIPT AVAILABLE: E-BILL WID CONTRACT/AGREEMENT COPY TO CONSIDERED FR CLAIM PROCESSING:PLS REFER HUL PAYABLE LIST PT NO 74 FR MORE DETAILS. AMBULANCE CHRGS: ON ACTUALS HOME TO HOSPITAL & HOSPITAL TO HOSPITAL WHEREVER PRESCRIBD BY DR. DONOR EXPS COVR: MEDICAL EXPS NLY UNDR INSURED SUM INSURED VISION: ACCIDENTS & REFRACTIVE ERROR >5 LASIK SURGERY COVR DENTAL LMT: RS 10000/MEM/YR. No Limit on type of caps include braces, implants & othr treatments alng with prescribed medical justification All dental procedures covered including but not limited to dentures/ bridges, crowns / caps, scaling, cleaning, polishing etc. Any cosmetic treatment not covered under policy.treatment related to consultation, Investigation, hospitalization covered OPTICAL LMT: RS 3000/MEM/YR, COVRS AL TYPE OF LENSES COVR. BNEFIT INCLUDING SPECTACLES, LENS COST (BIFOCAL / MULTIFOCAL LENS COST), FRAMES. DAY CARE PROCEDURE COVR (170+PROCEDURES INCLUDING FRACTURE CSES.) ORAL CHEMOTHERAPY, HYSTEROSCOPY, CYSTOSCOPY, HAIR LINE FRACTURES COVR UNDR DAY CARE PROCEDURE. HEALTH CHECKUPS COVR UNDR OPD. CONSULTATION COVR UNDR OPD AYURVEDA, HOMEOPATHY, NATUROPATHY NT COVR. COUNSELLING, PSYCHIATRIC TREATMENT, PYSCHOMETIC DISORDERS, HEREDITARY & GENETIC DISORDERS, DIABATESE RELATED DISEASE & TREATMENTS, SLEEP APNEA, COVR. PHYSIOTHERAPY: COVR UNDR IPD & OPD BASIS, HOSPITALIZATION CSES TO B COVR UPTO 60 DAYS PST TREATMENT & NON HOSPITALIZATION CSES TO B COVR UNDR OPD. BARIATRIC TREATMENT COVR NLY IN LIFE THREATING SITUATIONS & IF APPROV BY HUL DRS TEAM. CATARACT COVR INCLUDING AL TYPES OF LENSES & FEMTO LASER TREATMENT PRE ADOPTION TESTS TO B COVR NLY IF THE ADOPTION PROCESS IS COMPLETE & CHILD BCOMES LEGALY ADOPTED CHILD TO PARENTS SUBJECT TO FAMILY DEFINITION OF 2 DEPENDANT CHILDREN.
2 HEARING AIDS( INCLUDING COCHLEAR IMPLANTS) COVR.IN CSE COST ABOVE 5 LALKS APPROVAL REQ FRM HUL DRS. INTERNAL PROSTHESIS COVR INCLUDING AL INTERNAL PROSTHESIS DEVICES LIKE PACEMAKER, STENTS, BIODEGRADABLE STENTS,ETC. APPLIANCES COVR WHICH INCLUDES: DIABTES MONITOR & STRIPS HEARING AIDS: MAINTAINENCE /BATTERY COST NT COVR AMBULATORY DEIVICES - WALKER, CRUTCHES, BLTS, COLLARS, CAPS, SPLINTS, SLINGS, BRACES, STOCKINGS, ELASTROCEPE B&AGES, EXTERNAL ORTHOPEDIC PADS, UROKIT - SALVAGE CYSTECTOMY LUMBAR ROLL & ORTHO BLT LUMBAR ROLL & ORTHO BLT CPAP MACHINE - APNEA CSES COMMODE CHAIR KNEE CAP ANKLE BRACE NEGATIVE PRESSURE WOUND THERAPY KIT & ELBOW SPLINT INSOLE INSULIN PUMP GLOVES & MASKS BASED ON ACTUALS HEARING AID FR CHILDREN(COCHLEAR) ADULT DIAPERS: COVR ON HOSPITALIZATION & OPD/DOM HAIR & SKIN PRODUCTS MEDICALY REQ & HUL DRS APPROVAL IS ASCERTAIN & IN LINE OF TREATMENT COVR UNDR DR S PRESCRIPTION. VITAMINS & TONICS MEDICALY REQ & HUL DRS APPROVAL IS ASCERTAIN & IN LINE OF TREATMENT COVR UNDR DR S PRESCRIPTION. VACCINATIONS & EYE DROP COVR UNDR OPD. FESS & KIDNEY STONE TREATMENT INJ LIKE LEUCENTIS, AVASTIN, ETC, WHICH ARE USED FR CANCER TREATMENT & CRITICAL ILLNESS TO B COVR ON OPD & IN PATIENT. CLAIM INTIMATION 30 DAYS & CLAIM SUBMISSION 90 DAYS FR FEMALE EMP ON MATERNITY LEAVE CLAIM INTIMATION 30 DAYS, CLAIM SUBMISSION 180 DAYS FRM DATE OF DISCHARGE. NURSING, RMO CHRGS TO B COVR IF BILL PROVIDED SEPARATELY. DR/ SURGEON/ ANESTHETIST/MEDICAL PRACTITIONER/CONSULTANTS & SPECIALIST FEES IF BILLS SUBMITTED BY EMP ON DR LETTER HEAD OR SEPARATE BILL & NT PART ON MAIN HOSPITALIZATION BILL TO B PAID IN THE POLICY. AILMENT SUB LMTS NT APPLICABLE OPD COVR (INCLUDING PHARMACY) : COVR UPTO FUL SUM INSURED & INSURER REVIEW FR CSES WHERE FAMILY USAGE ABOVE INR 1.5 LACS DR'S PRESCRIPTION REQ FR AL TREATMENT FR OPD CLAIM NO INTIMATION REQ & CLAIM SUBMISSION WIDIN 90 DAYS IN CSE OF REJECTION, CSE TO B REFERRED TO HUL DRS FR DISCUSSION& DECISION
3 ON DEATH OF THE EMP, THE DPNDNTS WLL CONTINUE TO B COVR UNDR THE POLICY TILL EXPIRY HORMONE REPLACEMENT THERAPY: PAYABLE - IF PRESCRIBD BY DR TREATMENT OF SEXUALY TRANSMITTED DISEASES:PAYABLE HOSPITALISATION FR DIAGNOSTIC PURPOSE :PAYABLE EXPS FR INVESTIGATION/TREATMENT IRRELEVANT TO THE DISEASE FR WHICH ADMITTED OR DIAGNOSED: PAYABLE COVRAGE FR INTRACORNEAL LENS IMPLANTATION FR CORRECTION OF REFRACTIVE ERROR: FR ESC IT IS COVR UNDR VISION BNEFIT FR REFRACTIVE ERROR >=5 COVRAGE FR ADJUVANT CHEMOTHERAPY & HORMONAL THERAPY IN CSES OF CANCER: FR ESC CAN B COVR UNDR OPD BNEFIT.ROOM RENT & NURSING COVRAGE PAYABLE COVRAGE FR ELECTROCHEMOTHERAPY: FR ESC CAN B COVR UNDR OPD BNEFIT.ROOM RENT & NURSING COVRAGE PAYABLE CLS NO 1.2.1B & 1.3 NT APPLICABLE. HOME ATTNDNT CHRGS / PVT NURSING: FR ESC: NO SUB-LMTS & NURSES NLY FRM NURSING AGENCY COVRAGE FR PARENTS: SUM INSURED OF INR 1 LAKH PER PARENT RESTRICTION OF CORPORATE BUFFER UPTO 2 LAKHS. CO-PAYMENT : 25% ON ADMISSIBLE CLAIM AMOUNT. AMBULANCE : ON ACTUALS HOME TO HOSPITAL & HOSPITAL TO HOSPITAL WHEREVER PRESCRIBD BY THE DR. DONOR EXPS COVR: MEDICAL EXPS NLY. VISION: ACCIDENTS & REFRACTIVE ERROR >5( NLY IN CSE OF ACCIDENTS) OPD: NLY CONSULTATIONS, INVESTIGATION & ANNUAL HEALTH CHECK UP. DAY CARE PROCEDURE COVR (170 + PROCEDURES INCLUDING FRACTURE CSES.) ORAL CHEMOTHERAPY, HYSTEROSCOPY, CYSTOSCOPY, HAIR LINE FRACTURES COVR UNDR DAY CARE PROCEDURE. HEALTH CHECKUPS COVR UNDR OPD. CONSULTATION COVR UNDR OPD AYURVEDA, HOMEOPATHY, NATUROPATHY NT COVR. COUNSELLING & PSYCHIATRIC TREATMENT, PSYCHOMETRIC DISORDERS, HEREDITARY & GENETIC DISORDERS, DIABATESE RELATED DISEASE, HOME ATTNDNT/ PVT NURSING COVR. PHYSIOTHERAPY COVR UNDR IPD BASIS NLY, COVR NLY UNDR HOSPITALIZATION UPTO PST 60 DAYS & CO PAYMENT OF 25 %. CATARACT COVR INCLUDING AL TYPES OF LENSES & FEMTO LASER TREATMENT INTERNAL PROSTHESIS COVR INCLUDING AL INTERNAL PROSTHESIS DEVICES LIKE PACEMAKER, STENTS, BIODEGRADABLE STENTS,ETC APPLIANCES COVR WHICH INCLUDES : DIABTES MONITOR & STRIPS HEARING AIDS : MAINTAINENCE /BATTERY COST NT COVR AMBULATORY DEIVICES - WALKER, CRUTCHES, BLTS, COLLARS, CAPS, SPLINTS, SLINGS, BRACES, STOCKINGS, ELASTROCEPE B&AGES, EXTERNAL ORTHOPEDIC PADS, UROKIT - SALVAGE CYSTECTOMY LUMBAR ROLL & ORTHO BLT : COVR INCSE OF INJURY OR HOSPITALIZATION. COMMODE CHAIR : COVR IN CSE OF HOSPITALIZATION. KNEE CAP : COVR IN CSE OF HOSPITALIZATION. ANKLE BRACE : COVR IN CSE OF HOSPITALIZATION.
4 NEGATIVE PRESSURE WOUND THERAPY KIT & ELBOW SPLINT : COVR IN CSE OF HOSPITALIZATION. INSULIN PUMP : COVR PART OF PHARMACY CAPPING GLOVES & MASKS BASED ON ACTUALS: COVR IN CSE OF HOSPITALIZATION. ADULT DIAPERS: COVR ON HOSPITALIZATION & OPD/DOM: VACCINATIONS & EYE DROPS COVR UNDR OPD. FESS & KIDNEY STONE TREATMENT INJ LIKE LEUCENTIS, AVASTIN, ETC, WHICH ARE USED FR CANCER TREATMENT & CRITICAL ILLNESS TO B COVR ON OPD & IN PATIENT. CLAIM INTIMATION 30 DAYS & CLAIM SUBMISSION 90 DAYS NURSING, RMO CHRGS TO B COVR IF BILLS PROVIDED SEPARATELY. DR/ SURGEON/ ANESTHETIST/MEDICAL PRACTITIONER/CONSULTANTS & SPECIALIST FEES IF BILLS SUBMITTED BY EMP ON DR LETTER HEAD OR SEPARATE BILL & NT PART ON MAIN HOSPITALIZATION BILL TO B PAID IN THE POLICY. AILMENT SUB LMTS NT APPLICABLE OPD COVR: NLY CONSULTATION, INVESTIGATIONS & ANNUAL HEALTH CHECK UP DR'S PRESCRIPTION REQ FR AL TREATMENT FR OPD CLAIMS NO INTIMATION REQ & CLAIM SUBMISSION WIDIN 90 DAYS IN CSE OF REJECTION, CSE TO B REFERRED TO HUL DRS FR DISCUSSION. DECISION TAKEN BASIS MUTUAL CONSENT & POLICY COVRAGE ON DEATH OF THE EMP, THE DPNDNTS WL CONTINUE TO B COVR UNDR THE POLICY TILL EXPIRY HORMONE REPLACEMENT THERAPY: NT PAYABLE TREATMENT OF SEXUALY TRANSMITTED DISEASES: NT PAYABLE. HOSPITALISATION FR DIAGNOSTIC PURPOSE: PAYABLE EXPS FR INVESTIGATION/TREATMENT IRRELEVANT TO THE DISEASE FR WHICH ADMITTED OR DIAGNOSED: PAYABLE CLS NO 1.2.1B & 1.3 NT APPLICABLE. HOME ATTNDNT CHRGS / PVT NURSING: NO SUB-LMTS, NURSES NLY FRM NURSING AGENCY & VALID NLY PST 60 DAYS FRM HOSPITALIZATION HUL MANAGER PARENT TOP UP POLICY SPECIAL NOTES: Sum insured voluntary option ((1/2/3/4/5 Lakhs) Ailment Sublimit: Not applicable Ambulance charges: Normal Ambulance coverage in standard insurance policy. Home to Hospital, Hospital to Hospital wherever prescribed by doctor External congenital to be considered on Life threatening cases. Donor expenses covered within the sum insured. Cost of organ not covered. Vision treatment covered ( only in case of accidents) : Only IPD covered DAY CARE PROCEDURE Covered (170+PROCEDURES INCLUDING FRACTURE CSES.) PHYSIOTHERAPY COVR UNDR IPD BASIS NLY, COVR NLY UNDR HOSPITALIZATION UPTO PST 60 DAYS. Physiotherapy recommended by doctor following a certain ailment/accident and under hospitalization benefit only. Diabatese related Diseases and Treatments covered.
5 HOME ATTENDENT CHRGS / PVT NURSING: NO SUB-LMTS, NURSES NLY FRM NURSING AGENCY & VALID NLY POST 60 DAYS FROM HOSPITALIZATION. All types of lenses covered for cataract surgery. Femto Laser not covered Internal Prosthesis Covered (All internal prosthesis devices like Pacemaker, Stents etc), All types of stents including Biodegradable stents to be covered Doctor's prescription required for all treatment CLAIM INTIMATION 30 DAYS & CLAIM SUBMISSION 90 DAYS Nursing/RMO charges should be part of hospitalisation bill. HORMONE REPLACEMENT THERAPY: 50% to be paid TREATMENT OF SEXUALLY TRANSMITTED DISEASES: 50% pay ADMISSION/REGISTRATION CHARGES: Payable HOSPITALISATION FOR DIAGNOSTIC PURPOSE: Payable, if recommended by doctor To refer the non-payables list provided separately for this policy Lasik surgery : not covered Ayurveda, homeyopathy & naturopathy not covered Sleep apnea : not covered Photocopies to be attested by hospital for Hospitalizations. Injections like Leucentis, avastin etc. which are used for cancer treatments and critical illnesses: not covered Doctor/ Surgeon/Anesthetist/Medical practitioner/consultants and Specialist fees if bills submitted by the employee are on the doctor s letter head or separate bill and not a part of the main hospitalization bill : not payable it should be part of hospitalization bill
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