Group Medical Insurance

Policy & Guidelines

Confidential
 Table of Contents
1.
Purpose
1

2.
Applicability
1

3.
Types of Policies
1

4.
Policy Period, Coverage, Premium
1-2

5.
Prominent Inclusions / Exclusions
2-3

6.
Additional Benefits
3

7.
Cashless Claims Process
4

8.
Reimbursement Claims Process
4

9.
Mid-term Inclusions / Corrections
4

10. Point of contact

4

Confidential
 Purpose
The purpose of this document is to help employees understand the process,
benefits and terms of the Group Medical Insurance Coverage policy.

Applicability
All full-time employees of the company
All direct contractors associated with the company

Types of Insurance Policies

GMC 1+3: Employee + Spouse + Children (2)
GMC Parental Policy: Only Parents / Parents-in-law

Policy Period, Coverage & Premium

Sum Insured
Policy Type Policy (Coverage Policy Period Premium
Floater Policy)

8-Jan-2022 to 100% premium

GMC 1+3 INR 5 Lakh 07-Jan-2023 sponsored by the
company

100% premium for

GMC Parental INR 5 Lakh 8-Jan-2022 to Parents / Parents-in-
07-Jan-2023 law to be borne by
the employee

Confidential .1
 Premium applicable for Parents / Parents-in-law for

the year 2021.

Flat premium of INR 16700 per person, irrespective of the age of Parents /

Parents-in-law.

Insurance Vendor / TPA Details

Broker / Insurance
Policy Type Policy Insurer TPA
Provider

New India
GMC 1+3 PLUM Medi Assist
Assurance

New India
GMC Parental PLUM Medi Assist
Assurance

Prominent Inclusions

(1+3 & Parental Policy)

Age group Premium per person/year

Covid-19
(Only Hospitalisation)

Covered from Day 1

Pre-existing diseases
Covered from Day 1

Maternity
₹1,00,000 for both Normal and C-Section.

Baby Cover
Covered from Day 1

Pre and post-natal

Covered up to ₹5,000 within the maternity limit

Normal room-rent sublimit

No limit

ICU sublimit
No limit

Lasik Surgery
Covered above +/- 4.5D

Disease-wise capping
No capping

Pre and Post hospitalisation

3 0 days, 60 days

Addition / Deletion
Pro-rated

Claims Submission
15 days from the date of discharge

Mid-term Inclusion Applicable only for newly born / newly married

Note : Minimum 24 Hours hospitalisation is required to claim medical insurance benefit

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Prominent Exclusions (1+3 & 1+5 Policy)
Cost of spectacles, hearing aids, dental treatment, crutches or any external

implants

Vaccinations

Infertility treatment, circumcision etc.

Intentional self-injury and use of intoxication drugs / alcohol

Non allopathic treatment

Any kind of cosmetic surgery

Admission/ hospitalisation should be for active medical treatment and should

not be for consultations, check-ups and observations.

Pure diagnosis / preventive treatments

Accident related to drunken driving or any other intoxicating agent cases will

not be covered

Additional Benefits Introduced

in the year 2022

Added benefits for all (Employee + Spouse + Child +

Parents / Parents-In-law)

Lasik surgery (+/- 4 and above

Organ donor expense

Home quarantine treatment expense

Multiple births (150% of twins and 200% fro triplets

Coverage of disabled children / siblings without any upper age limit

Additional benefits for Parents / Parents-In-law

No waiting perio

Pre-existing diseases are covered from day

Sum insured of INR 5 Lakh coverag

Flat premium per life (INR 16,700/-) irrespective of the age of parents /

parents-in-law

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 Cashless Claims
Government ID proof

Covid-19 positive test report from ICMR authorised labs

Doctor’s advice for hospitalisation

Hospital details

Consultation papers

The above will be processed via the hospital management.

Reimbursement Claims
Government ID proof

Covid-19 positive test report from ICMR authorised labs

Consultation papers with pharmacy advisory

All original bills (consultant, tests, pharmacy etc)

Test reports

Copy of Employee ID proof

Bank details (Cancelled cheque)

The above to be uploaded onto the claims request through Plum login

Mid-term Inclusion / Corrections

Mid-term inclusion for the policy is allowed during the policy period only for the

below events:

Marriage (Spouse name, Date of marriage, Gender, Date of birth)

Child birth (Child’s name, Date of birth, Gender)

Details of such events must be shared with the respective HRBP for the inclusion

within 15 days of the event.

Point of Contact

Policy POC 1 Escalation 1 Escalation 2

GMC
: 1 +3 care @plumhq.com shashank.dwivedi @unacademy.com @unacademy.com
vani.bn

GMC
+5
: 1
care @plumhq.com shashank.dwivedi @unacademy.com @unacademy.com
vani.bn

Confidential .4