Employee Benefits Guide
Think and Learn Pvt Ltd
(BYJU’S)
2021 – 2022
Group Health Insurance
G&L SCIENTIFIC INDIA PRIVATE LIMITED
POLICY DETAILS
Particulars Policy Parameter
Insurer ICICI Lombard
Third Party Administrator
Medi-Assist
(TPA)
Insurance Broker Policy Bazaar
Policy Start Date 30-July-2021
Policy End Date 29-July-2022
Family Definition 1+4 (Self + Spouse + 3 Dependent Children)
Sum Insured-Primary 4 lakh
Optional Add-Ons Parental Cover, Sibling Cover, Sum-Insured Top-up
STANDARD HOSPITALIZATION: 24 HOURS
Reimbursement of Expenses Related to
• Room and boarding
• Doctors fees
• Intensive Care Unit expenses
• Nursing expenses
• Surgical fees, operating theatre, anesthesia
and oxygen and their administration
• Physical therapy rugs and medicines
consumed on the premises
• Hospital miscellaneous services (such as
laboratory, x-ray, diagnostic tests)
• Dressing, ordinary splints and plaster casts
• Costs of prosthetic devices if implanted
during a surgical procedure
• Radiotherapy and chemotherapy
• Organ transplantation charges
Hospital or nursing home means any institution in India established for indoor care and treatment of sickness and injuries and which has been registered
either as a hospital or nursing home with the local authorities and is under the supervision of a registered and qualified medical practitioner, or complies
with minimum criteria, as follows:
Has a minimum of 10 beds if located in towns having a population of less than 10 lacs (Class C towns) or a minimum of 15 in-patient beds in other
towns, 2) Has a fully equipped operation theatre, 3) Has a fully qualified doctor in charge and nursing staff around the clock, and 4) Maintains a daily
medical record for each of its patients.
Any treatment that requires hospitalization for more than 24 hours is termed as standard hospitalization
BOARDING COVERAGE
NORMAL ROOM ICU
Single Standard AC Room for Normal ICU at Actuals
Hospitalization cases
PRE & POST HOSPITALIZATION EXPENSES
30 days 60 days
DAY CARE PROCEDURES
Expenses on hospitalization for minimum period of 24 hours are normally
admissible. However this time limit will not apply for specific treatments –
• Dialysis
• Chemotherapy
• Radiotherapy
• Eye surgery
• Lithotripsy (kidney stone removal)
• Tonsillectomy
• D & C taken in the Hospital/Nursing home and the insured is discharged on
the same day of the treatment will be considered to be taken under
Hospitalization Benefit.
COMPREHENSIVE MATERNITY
Maternity Treatment
Waiting Period – Waived Off
In Metro Cities: Cover of ₹ 70,000 for both Normal and C-Section deliveries
In Non-Metro Cities: Cover of ₹ 60,000 for both Normal and C-Section deliveries
Maternity benefit is applicable only for First Two Deliveries
In case of Twins, the Maternity Coverage will increase to:
• ₹ 1,00,000 for metro cities
• ₹ 90,000 for non-metro cities
NEW BORN BABY COVERAGE
Baby Cover
New Born Child of the Employee is covered from Day 1 for illness related Hospitalization
under the Family Floater Sum Insured from the date of birth.
CUSTOMIZED BENEFIT:
AMBULANCE SERVICES
Particulars Ambulance Services(Road)
Definition Road Ambulance – to hospital, or transfer from one hospital to
other hospital where medically necessitated only in case of
emergency hospitalization
Sub-limit ₹ 2,000 for intra-city
₹ 5,000 for inter-city
ADDITIONAL BENEFITS
OTHERS BENEFITS
Details Benefit
Day Care Procedure Covered as per day care list
Covid Hospitalization Covered
Nasal Sinus Surgery Covered Up to INR 35,000/- each claim
Cyber Knife treatment Covered with 50% Co-Payment
Stem cell therapy Covered with 50% Co-Payment
Cochlear Transplant Covered with 50% Co-Payment
LGBT (Addition of same gender partner) Allowed
Internal Congenital Diseases Covered
External Congenital Diseases
Covered (only for life threatening cases)
AYUSH Treatment up to Sum Insured where
Covered
treatment is taken in Govt. hospital
Lasik Surgery Covered if Eye correction index up to +/- 5
Physiotherapy up-to 50K in accidental cases, Applicable up-to 60 days from date of
Physiotherapy
discharge
OTHERS BENEFITS
Details Benefit
Dental Treatment Covered in case of accidental claims
Organ Donor Expenses Covered, but the cost of Organ is not covered
Mental Illness/ Psychiatric Treatment Mental illnesses and psychiatric treatments are covered up to 1 lac
Peritoneal Dialysis Covered
Infertility Treatment Infertility Treatment covered up to maternity sub-limit
Surrogacy covered up to Maternity limit- Surrogacy Cover applicable up to Maternity sum
insured. Only available to those who take help of a surrogate mother for childbirth
Surrogacy
Subjected to infertility having been medically established in either of the partners, Subject
to Documentary Requirements as per ILGIC
Disease Wise Capping/Sub-Limits No Capping/No Sub-Limits
Oral Chemotherapy Covered
Age Related Macular Degeneration Covered
Any hospitalization due to an emergency situation at workplace followed by diagnostics
however on further evaluation no abnormality/anomaly detected and hence no
No Active Line of Treatment (for employees only;
hospitalization or active line of treatment required. Shall be payable up to a maximum limit
dependents excluded)
of INR 10,000 per year within sum insured. Covered if the claim is less than 24 hours of
hospitalization as well
SPECIAL CONDITIONS
Details Benefit
Special condition 1 No deductions in case of Death if the claim is admissible
Coverage for one dependent sibling under the age of 25 years – to be included at
Special condition 2 inception of the policy (no mid-term inclusion allowed). It is Optional and self-
sponsored by the employee
Special condition 3 COVID Home quarantine is Covered
• Injury or disease directly or indirectly caused by or arising from or attributable to War or War-
like situations
• Circumcision unless necessary for treatment of disease, Vaccination, Cosmetic Treatment,
Plastic Surgery other than necessitated due to accident
• Cost of Spectacles, contact lenses and hearing aids
• Congenital external diseases or defects/anomalies that are not life-threatening
• Dental Treatment or surgery unless necessitated by accident and requiring hospitalization
• HIV and AIDS
• Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating
drugs/ alcohol, Obesity Treatment
• Psychosomatic disorders, Sterility, Venereal Disease
• Rotational Field Quantum Magnetic Resonance, Enhanced External Counter
GENERAL • Pulsation
• Injury or disease caused directly or indirectly by nuclear weapons
EXCLUSIONS • Any non-medical expenses like registration fees, admission fees, charges for medical records,
cafeteria charges, telephone charges
• Personal comfort charges, baby food, diaper, toiletry items, tissue paper, ayah charges
• Ambulatory devices like Walker, crutches, belts, collars, caps, splints, slings, braces,
stockings, elastocrepe bandages, external ortho-paedic pads, subcutaneous insulin pumps,
diabetic footwear, Glucometer, Thermometer, Alpha/Water Bed and similar related items or
Any medical equipment which is used at home
• Genetic Disorders
• Vitamins and tonics unless used for treatment of injury or disease
• Voluntary termination of pregnancy during first 12 weeks (MTP)
INSURANCE POCs & ESCALATION MATRIX
Contact Matrix
POC Name Mobile Email ID
Thank you & Stay Healthy
