Group Mediclaim

We at K Raheja Corp provide a cushion just incase of any medical difficulties that may arise for you and your family through our Group Mediclaim Policy. Group Mediclaim is provided by All India Insurance. This policy covers Employee and 3 additional members of his / her family i.e. spouse, children, dependent parents, and dependent In-laws.

All India Insurance will provide an insurance card for all eligible family members. The Group Mediclaim Policy covers an insured person contracting any disease or suffering from any illness or sustaining any bodily injury through accident and requiring hospitalization and incurring hospitalization expenses in India as an in-patient. The Insurance company, in that event, will pay to the Hospital / Nursing Home / Day Care Centre or reimburse the Insured person through Company / Third Party Administrator amount of such expenses as would fall under different heads respect thereof by or on behalf of such insured person but not exceeding in any one period of insurance the amount stated.

Premiums are paid for by K Raheja Corp.

HOSPITAL / 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 under:

  • Must have a minimum of : 10 in-patient beds if located in towns having population of less than 10 lacs or 15 in-patient beds if located in other towns.
  • Fully equipped operation theatre of its own wherever surgical operations are carried out.
  • Fully qualified Nursing Staff under its employment round the clock.
  • Fully qualified Medical Practitioner should be in-charge round the clock.
  • Maintains daily medical record for each of its patients.

Note: In case of Ayurvedic / Homeopathic / Unani Treatment (b) is not applicable, In case of Day Care Centre, (a) is not applicable

For the purpose of this definition the term Hospital/Nursing Home / Day Care Centre shall not include an establishment, which is a place of rest, a place for the aged, a place for drug addicts or place for alcoholics, a hotel or any other like place.

HOSPITALIZATION means admission in any Hospital / Nursing Home in India upon the written advice of a Medical Practitioner for a minimum period of 24 consecutive hours.

The time limit of 24 hours will not be applicable for following surgeries / procedures.

  • Anti Rabies Vaccination Hysterectomy
  • Appendectomy Inguinal / Ventral/Umbilical / Femoral Hernia repair
  • Coronary Angiography Lithotripsy (Kidney Stone Removal)
  • Coronary Angioplasty Parenteral Chemotherapy
  • Dental surgery following an accident Piles / Fistula
  • Dilatation & Curettage (D & C) of Cervix Prostate
  • Eye surgery Radiotherapy
  • Fracture / dislocation excluding hairline fracture Sinusitis
  • Gastrointestinal Tract system Stone in Gall Bladder, Pancreas, and Bile Duct
  • Haemo-Dialysis Tonsillectomy
  • Hydrocele Urinary Tract System

OR any other Surgeries / Procedures agreed by TPA / COMPANY which require less than 24 hours hospitalization due to subsequent advancement in Medical Technology.

Any medical expenses incurred for or arising out of :

  • War, Invasion, Act of foreign enemy, Radioactive material nuclear fuel or nuclear waste.
  • Circumcision, cosmetic or aesthetic treatment, plastic surgery unless required to treat any injury or illness.
  • Vaccination & Inoculation.
  • Cost of braces, equipment or external prosthetic devices, non-durable implants, eyeglasses, Cost of spectacles and contact lenses, hearing aids including cochlear implants and durable medical equipments.
  • All types of Dental treatments except arising out of an accident.
  • Convalescence, general debility, ‘Run-down’ condition or rest cure, obesity treatment and its complications, congenital external disease/defects or anomalies, treatment relating to all psychiatric and psychosomatic disorders, infertility, sterility, use of intoxicating drugs/alcohol, use of tobacco leading to cancer.
  • Bodily injury or sickness due to wilful or deliberate exposure to danger (except in an attempt to save a human life), intentional self-inflicted injury attempted suicide and arising out of non-adherence to any medical advice.
  • Treatment of any Bodily injury sustained whilst or as a result of active participation in hazardous sports of any kind.
  • Treatment of any bodily injury sustained whilst or as a result of participating in any criminal act.
  • Sexually transmitted diseases, any condition directly or indirectly caused due to or associated with Human T-Cell
  • Lymphotropic Virus Type III (HTLB-III) or Lymphotropathy Associated Virus (LAV) or the Mutants Derivative or Variation
  • Deficiency syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.
  • Diagnostic, X-Ray or Laboratory examination not consistent with or incidental to the diagnosis of positive existence and treatment of any ailment, sickness or injury, for which confinement is required at a Hospital/Nursing Home.
  • Vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.
  • Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any of these including caesarean section, except abdominal operation for extra uterine pregnancy (Ectopic Pregnancy), which is proved by submission of Ultra Sonography Report and Certification by Gynecologist that it is life threatening one if left untreated.
  • Any Naturopathy Treatment
  • Instrument used in treatment of Sleep Apnoea Syndrome (C.P.A.P.) and Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.) and Oxygen Concentrator for Bronchial Asthmatic condition.
  • Genetical disorders and stem cell implantation / surgery.
  • Any Domiciliary Hospitalization / Treatment.
  • Treatment taken outside India.
  • Experimental and unproven treatment (not recognized by Indian Medical Council).
  • Change of treatment from one system of medicine to another unless recommended by the Consultant / Hospital under whom the treatment is taken
  • All non-medical expenses including convenience items for personal comfort such as telephone, television, Aya, Private Nursing / Barber or beauty services, diet charges, baby food, cosmetics, tissue paper, diapers, sanitary pads, toiletry items and similar incidental expenses.
  • Service charges or any other charges levied by hospital, except registration/admission charges.