Page 14 - Policy Handbook For DDU Employee -V-1

INDO-DDU-V1

has already availed a cashless from a hospital which is later on delisted by the company, in such
case the company will continue to provide cashless to that insured for the same treatment.
12. Following charges levied by the hospital will not be payable under the policy :
13. Admission charges/ Surcharge/ Service charge/ Miscellaneous charges/ Registration fee/
Admission fee/ other non-medical or non-treatment related expenses.
14. Existing group may not split into multiple groups to obtain multiple benefit levels.
15. Excluding a class within a group from coverage is not permitted.
16. Ineligible employees include : Contractors/ Temporary/ Seasonal/ Substitute/ Uncompensated
employees/ Volunteers/ Silent partners/ Shareholders or investors only, Owners, Officers or
managing members who are not active, permanent or full time employees.
17. Any hospitalization to undergo contraception is excluded from the policy.
18. Septoplasty, Infertility and related ailments including male sterilit , treatment on
trial/experimental basis, expenses on fitting of prosthesis ,any device/ insrument/ contributing
machine/ replacing the functions of an organ, holter monitoring & nbsp;are outside the scope of
this policy.
19. 50% co-pay for cyberknife treatment/robotic surgery/Bio absorbale stent / FAMETO laser
surgery/ Toric lens/ KT Laser prostate.
20. No continuity benefit would be offered from Group(GHI) to Individual (Retail) or proposal
received from members covered under this group policy for conversion to retail plan vide.
Portability guidelines shall be dealt with as per laid down guidlines.
21. Claim for lasik treatment - if power of eye is above +/- 7.5, is payable.
22. Subject otherwise to terms, conditions and exclusions of group care policy terms and
conditions.
Disease wise Sublimit:

Cataract, Appendix, Hernia, Piles, Gall Bladder, Hydrocele restricted to Rs. 20,000, Hyserectomy,
Kidney stones restricted to Rs. 30,000, Joint replacement restricted to Rs. 80,000

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