{"id":87,"date":"2023-11-19T21:04:05","date_gmt":"2023-11-19T21:04:05","guid":{"rendered":"http:\/\/localhost\/blogs\/?p=87"},"modified":"2025-02-13T11:24:38","modified_gmt":"2025-02-13T11:24:38","slug":"how-to-manage-group-mediclaim-policy-effectively","status":"publish","type":"post","link":"https:\/\/riskbirbal.com\/blogs\/how-to-manage-group-mediclaim-policy-effectively\/","title":{"rendered":"How To Manage Group Mediclaim Policy Effectively?"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"87\" class=\"elementor elementor-87\">\n\t\t\t\t<div class=\"elementor-element elementor-element-afc7435 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"afc7435\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d9428cd elementor-widget elementor-widget-heading\" data-id=\"d9428cd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_81 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title ez-toc-toggle\" style=\"cursor:pointer\">Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/riskbirbal.com\/blogs\/how-to-manage-group-mediclaim-policy-effectively\/#How_To_Manage_Group_Mediclaim_Policy_Effectively\" >How To Manage Group Mediclaim Policy Effectively ?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/riskbirbal.com\/blogs\/how-to-manage-group-mediclaim-policy-effectively\/#What_is_covered_in_the_Group_Mediclaim_Insurance_Policy\" >What is covered in the Group Mediclaim Insurance Policy?<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/riskbirbal.com\/blogs\/how-to-manage-group-mediclaim-policy-effectively\/#A_Group_Mediclaim_Insurance_Policy_covers_all_the_following_aspects\" >A Group Mediclaim Insurance Policy covers all the following aspects-<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/riskbirbal.com\/blogs\/how-to-manage-group-mediclaim-policy-effectively\/#A_Group_Mediclaim_Insurance_is_applicable_only_if_the_below-mentioned_criteria_are_followed\" >A Group Mediclaim Insurance is applicable only if the below-mentioned criteria are followed:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/riskbirbal.com\/blogs\/how-to-manage-group-mediclaim-policy-effectively\/#What_is_not_covered_in_the_Group_Mediclaim_Insurance_Policy\" >What is not covered in the\u00a0Group Mediclaim Insurance Policy?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/riskbirbal.com\/blogs\/how-to-manage-group-mediclaim-policy-effectively\/#Process_To_Be_Followed_In_Planned_And_Unplanned_Hospitalization\" >Process To Be Followed In Planned And Unplanned Hospitalization<\/a><\/li><\/ul><\/nav><\/div>\n<h2 class=\"elementor-heading-title elementor-size-xl\"><span class=\"ez-toc-section\" id=\"How_To_Manage_Group_Mediclaim_Policy_Effectively\"><\/span>How To Manage Group Mediclaim Policy Effectively ?<span class=\"ez-toc-section-end\"><\/span><\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-39aeff5 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"39aeff5\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3b44c0a elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"3b44c0a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">A group Mediclaim policy is a kind of <a href=\"https:\/\/riskbirbal.com\/services\/wellconnect\">health insurance<\/a> that provides coverage for individuals who are employed by the same company. Given that the business pays the cost, it is frequently provided as a useful benefit to employees. In some circumstances, the employee&#8217;s family may be covered by the group health insurance.<\/span><\/p><p><span style=\"font-family: Axiforma, serif; font-size: 12pt; font-weight: var( --e-global-typography-text-font-weight ); text-align: var(--text-align);\">However, the cost is significantly lower than individual health <a href=\"https:\/\/riskbirbal.com\/services\/insurance_policies\">insurance plans<\/a>, and companies also benefit from tax breaks, making it advantageous for both the employer and the employee.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-51f761b e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"51f761b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6a9fbcd elementor-widget elementor-widget-image\" data-id=\"6a9fbcd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1384\" height=\"808\" src=\"https:\/\/i0.wp.com\/riskbirbal.com\/blogs\/wp-content\/uploads\/2023\/11\/medicalim_policy.png?fit=1384%2C808&amp;ssl=1\" class=\"attachment-full size-full wp-image-88\" alt=\"Group Mediclaim Policy\" srcset=\"https:\/\/i0.wp.com\/riskbirbal.com\/blogs\/wp-content\/uploads\/2023\/11\/medicalim_policy.png?w=1384&amp;ssl=1 1384w, https:\/\/i0.wp.com\/riskbirbal.com\/blogs\/wp-content\/uploads\/2023\/11\/medicalim_policy.png?resize=300%2C175&amp;ssl=1 300w, https:\/\/i0.wp.com\/riskbirbal.com\/blogs\/wp-content\/uploads\/2023\/11\/medicalim_policy.png?resize=1024%2C598&amp;ssl=1 1024w, https:\/\/i0.wp.com\/riskbirbal.com\/blogs\/wp-content\/uploads\/2023\/11\/medicalim_policy.png?resize=768%2C448&amp;ssl=1 768w\" sizes=\"(max-width: 1000px) 100vw, 1000px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1f2ada6 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"1f2ada6\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0dfaf25 elementor-widget elementor-widget-text-editor\" data-id=\"0dfaf25\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h2 style=\"background-color: #ffffff;\"><span class=\"ez-toc-section\" id=\"What_is_covered_in_the_Group_Mediclaim_Insurance_Policy\"><\/span><strong><u>What is covered in the Group Mediclaim Insurance Policy?<\/u><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2><p>\u00a0<\/p><h3 style=\"margin: 0in; background-color: white;\"><span class=\"ez-toc-section\" id=\"A_Group_Mediclaim_Insurance_Policy_covers_all_the_following_aspects\"><\/span><span style=\"font-family: Axiforma, serif; color: black; padding: 0in; border: 1pt none windowtext;\"><b>A Group Mediclaim Insurance Policy covers all the following aspects-<br \/><\/b><\/span><span class=\"ez-toc-section-end\"><\/span><\/h3><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Room and boarding<br \/><\/span><\/span><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Doctors\/Medical Practitioner fees<br \/><\/span><\/span><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Intensive Care Unit<br \/><\/span><\/span><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Nursing expenses (within the room rent charges)<br \/><\/span><\/span><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Surgical fees, operating theatre, anesthesia and oxygen, and their administration<br \/><\/span><\/span><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Drugs and medicines consumed on the premises<br \/><\/span><\/span><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)<br \/><\/span><\/span><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Costs of prosthetic devices if implanted during a surgical procedure<br \/><\/span><\/span><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Radiotherapy and chemotherapy<\/span><\/span><\/p><p>\u00a0<\/p><h3><span class=\"ez-toc-section\" id=\"A_Group_Mediclaim_Insurance_is_applicable_only_if_the_below-mentioned_criteria_are_followed\"><\/span><strong><span style=\"font-family: Axiforma, serif; color: black; padding: 0in; border: 1pt none windowtext;\">A Group Mediclaim Insurance is applicable only if the below-mentioned criteria are followed:<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">They occur in India and are covered by the policy&#8217;s time frame.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Hospitalization costs for a minimum of 24 hours are allowable.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-family: Axiforma, serif;\"><span style=\"font-size: 12pt;\">If a covered member chooses a room with a higher rent category than what is allowed for him, the corresponding deductions will be made.<\/span><\/span><span style=\"font-family: Times New Roman; font-size: xx-small;\"><br \/><\/span><\/span><span style=\"text-indent: -0.25in; text-align: var(--text-align);\"><span style=\"font-family: Times New Roman; font-size: xx-small;\"><br \/><\/span><span style=\"font-family: Axiforma, serif;\"><span style=\"font-size: 12pt;\">\u00a0<\/span><\/span><\/span><\/p><h3 style=\"margin: 0in; background-color: white;\"><span class=\"ez-toc-section\" id=\"What_is_not_covered_in_the_Group_Mediclaim_Insurance_Policy\"><\/span><strong><span style=\"font-family: Axiforma, serif; color: black; padding: 0in; border: 1pt none windowtext;\">What is not covered in<\/span><span style=\"font-family: 'Axiforma',serif; color: black; mso-color-alt: windowtext;\"> the\u00a0<span style=\"padding: 0in; border: 1pt none windowtext;\">Group Mediclaim Insurance Policy?<\/span><\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Nuclear dangers, war, and war groups<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Birth control methods, hormone replacement therapy, medically assisted pregnancy termination during the first 12 weeks following conception, and treatments resulting from or linked to pregnancy.\u00a0<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Circumcision unless required for a disease, illness, or injury not excluded hereunder, or as may be required as a result of an accident Vitamins and tonics unless part of treatment for a disease, illness, or injury as certified by the attending Medical Practitioner Ectopic pregnancy proven by diagnostic means and certified to be life-threatening by the attending Medical Practitioner<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Routine medical, eye, and ear exams, the cost of glasses, laser eye surgery, contacts, or hearing aids, the issuance of medical certificates, and tests to determine eligibility for employment or travel<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Self-medication, family member treatment, or any other kind of treatment not approved by science<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Sex change or any form of treatment that arises from or is connected to sex change<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Following the use of intoxicating substances and alcohol, medical treatment may be necessary. It also applies to drug abuse, solvent abuse, any addiction, or other medical conditions caused by or connected to such misuse or addiction.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Any medical care received in nursing homes, hospitals, hydrotherapy centers, natural medicine practices, or other comparable facilities<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Any medical care received outside of the hospital without being admitted as a patient.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><span style=\"text-indent: -0.25in; text-align: var(--text-align); font-size: 10pt; font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/span><span style=\"text-indent: -0.25in; text-align: var(--text-align); font-size: 12pt; font-family: Axiforma, serif;\">Costs associated with donor selection or care.<\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Treatment with naturopathy.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Treatment received from individuals who are not medical practitioners as defined by the relevant medical bodies.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 <\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Any hospital stay during which no treatments are received, or the medical practitioner is not providing active regular treatment.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Aesthetic procedures, cosmetic surgery, and plastic surgery, unless they are required as a result of an accident or as part of a condition that is not specifically prohibited.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Ionizing radiation or radioactive pollution from any type of nuclear fuel or nuclear waste that results from burning nuclear fuel.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Nuclear weapons, nuclear materials, or radioactive contamination can cause or<br \/>contribute to disease, illness, or injury either directly or indirectly.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Unproven and experimental therapies.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Expenses incurred for medications that were not prescribed by a physician.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Prosthetics, corrective equipment, and medical devices that are not necessary during surgery or for the condition, illness, or injury for which the insured or insured person was hospitalized and that are not otherwise excluded under this clause.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">All illnesses, injuries, and diseases brought on by or connected to HIV, including the Acquired Immune Deficiency Syndrome (AIDS), the AIDS-related complex syndrome (ARCS), and others.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Orthodontic Care.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\">Treatment for obesity, general sluggishness, recuperation, ailing condition or rest cure, venereal disease or purposeful self-harm, and usage of intoxicating substances such as alcohol.<\/span><\/span><\/p><p style=\"margin: 0in 0in 4.5pt 62.25pt; text-indent: -0.25in; line-height: normal;\"><!-- [if !supportLists]--><span style=\"font-weight: normal;\"><span style=\"font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;\">\u00a0 \u00a0 \u00a0 \u00a0\u00b7<span style=\"font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/span><\/span><span style=\"font-size: 12.0pt; font-family: 'Axiforma',serif;\"><span style=\"font-weight: normal;\">Any type of vaccination or immunization.<\/span><\/span><\/p><p>\u00a0<\/p><h2 style=\"margin-top: 0in; background-color: white;\"><span class=\"ez-toc-section\" id=\"Process_To_Be_Followed_In_Planned_And_Unplanned_Hospitalization\"><\/span><strong><span style=\"font-size: 12pt; line-height: 115%; font-family: Axiforma, serif; color: black; padding: 0in; border: 1pt none windowtext;\">Process To Be Followed In Planned And Unplanned Hospitalization<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2><p><span style=\"font-weight: normal;\"><span style=\"font-size: 12pt; font-family: Axiforma, serif; padding: 0in; border: 1pt none windowtext;\">In case of a planned authorization, all non-emergency hospitalization situations require prior authorization from the Help Desk. This is done to guarantee that the insured member receives the best treatment available and is not inconvenienced when seeking admission into a Network Hospital.<\/span><\/span><\/p><p><span style=\"font-weight: normal;\"><span style=\"font-size: 12pt; font-family: Axiforma, serif; padding: 0in; border: 1pt none windowtext;\">You must get hospital admittance after your hospitalization has been pre-authorized. Raksha TPA will give the hospital a letter of credit or a cashless approval letter. Please provide your government-issued health ID cards at the hospital entrance desk. In the event of a network hospital, the insured member does not need to pay the hospitalization bill. <br \/>The invoice will be issued to and paid for by <a href=\"https:\/\/www.rakshatpa.com\/\">Raksha TPA<\/a>, but the employee or patient must cover any disapproved amounts. However, in case of an unplanned hospitalization, employees can get up to seven days before the entrance to request cashless approval. The cashless authorization form is accessible at the hospital&#8217;s TPA assistance desk. When visiting TPA, the employee must have a TPA Card and a valid ID. Once the hospital has given you all the necessary information, it takes no longer than three hours to approve cashless claims.<\/span><\/span><\/p><p style=\"margin: 0in 0in 15pt; line-height: 30pt; background-color: white;\"><span style=\"font-family: Axiforma, serif; font-size: 12pt; text-align: var(--text-align);\">\u00a0<\/span><span style=\"font-family: Axiforma, serif; font-size: 1.8rem; text-align: var(--text-align);\">\u00a0<\/span><\/p><p><span style=\"font-size: 12.0pt; line-height: 115%; font-family: 'Axiforma',serif;\">\u00a0<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>How To Manage Group Mediclaim Policy Effectively ? A group Mediclaim policy is a kind of health insurance that provides coverage for individuals who are employed by the same company. Given that the business pays the cost, it is frequently provided as a useful benefit to employees. In some circumstances, the employee&#8217;s family may be covered by the group health insurance. However, the cost is significantly lower than individual health insurance plans, and companies also benefit from tax breaks, making it advantageous for both the employer and the employee. What is covered in the Group Mediclaim Insurance Policy? \u00a0 A Group Mediclaim Insurance Policy covers all the following aspects- \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 Room and boarding\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Doctors\/Medical Practitioner fees\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Intensive Care Unit\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Nursing expenses (within the room rent charges)\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Surgical fees, operating theatre, anesthesia and oxygen, and their administration\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Drugs and medicines consumed on the premises\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Costs of prosthetic devices if implanted during a surgical procedure\u00b7\u00a0 \u00a0 \u00a0 \u00a0 Radiotherapy and chemotherapy \u00a0 A Group Mediclaim Insurance is applicable only if the below-mentioned criteria are followed: \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0They occur in India and are covered by the policy&#8217;s time frame. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Hospitalization costs for a minimum of 24 hours are allowable. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0If a covered member chooses a room with a higher rent category than what is allowed for him, the corresponding deductions will be made. \u00a0 What is not covered in the\u00a0Group Mediclaim Insurance Policy? \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Nuclear dangers, war, and war groups \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 Birth control methods, hormone replacement therapy, medically assisted pregnancy termination during the first 12 weeks following conception, and treatments resulting from or linked to pregnancy.\u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Circumcision unless required for a disease, illness, or injury not excluded hereunder, or as may be required as a result of an accident Vitamins and tonics unless part of treatment for a disease, illness, or injury as certified by the attending Medical Practitioner Ectopic pregnancy proven by diagnostic means and certified to be life-threatening by the attending Medical Practitioner \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Routine medical, eye, and ear exams, the cost of glasses, laser eye surgery, contacts, or hearing aids, the issuance of medical certificates, and tests to determine eligibility for employment or travel \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 Self-medication, family member treatment, or any other kind of treatment not approved by science \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 Sex change or any form of treatment that arises from or is connected to sex change \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Following the use of intoxicating substances and alcohol, medical treatment may be necessary. It also applies to drug abuse, solvent abuse, any addiction, or other medical conditions caused by or connected to such misuse or addiction. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 Any medical care received in nursing homes, hospitals, hydrotherapy centers, natural medicine practices, or other comparable facilities \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 Any medical care received outside of the hospital without being admitted as a patient. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 \u00a0Costs associated with donor selection or care. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 Treatment with naturopathy. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 Treatment received from individuals who are not medical practitioners as defined by the relevant medical bodies. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 Any hospital stay during which no treatments are received, or the medical practitioner is not providing active regular treatment. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Aesthetic procedures, cosmetic surgery, and plastic surgery, unless they are required as a result of an accident or as part of a condition that is not specifically prohibited. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 \u00a0Ionizing radiation or radioactive pollution from any type of nuclear fuel or nuclear waste that results from burning nuclear fuel. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 \u00a0Nuclear weapons, nuclear materials, or radioactive contamination can cause orcontribute to disease, illness, or injury either directly or indirectly. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 \u00a0Unproven and experimental therapies. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 \u00a0Expenses incurred for medications that were not prescribed by a physician. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 \u00a0Prosthetics, corrective equipment, and medical devices that are not necessary during surgery or for the condition, illness, or injury for which the insured or insured person was hospitalized and that are not otherwise excluded under this clause. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0 \u00a0 \u00a0 \u00a0 \u00a0All illnesses, injuries, and diseases brought on by or connected to HIV, including the Acquired Immune Deficiency Syndrome (AIDS), the AIDS-related complex syndrome (ARCS), and others. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Orthodontic Care. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Treatment for obesity, general sluggishness, recuperation, ailing condition or rest cure, venereal disease or purposeful self-harm, and usage of intoxicating substances such as alcohol. \u00a0 \u00a0 \u00a0 \u00a0\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Any type of vaccination or immunization. \u00a0 Process To Be Followed In Planned And Unplanned Hospitalization In case of a planned authorization, all non-emergency hospitalization situations require prior authorization from the Help Desk. This is done to guarantee that the insured member receives the best treatment available and is not inconvenienced when seeking admission into a Network Hospital. You must get hospital admittance after your hospitalization has been pre-authorized. Raksha TPA will give the hospital a letter of credit or a cashless approval letter. Please provide your government-issued health ID cards at the hospital entrance desk. In the event of a network hospital, the insured member does not need to pay the hospitalization bill. The invoice will be issued to and paid for by Raksha TPA, but the employee or patient must cover any disapproved amounts. However, in case of an unplanned hospitalization, employees can get up to seven days before the entrance to request cashless approval. The cashless authorization form is accessible at the hospital&#8217;s TPA assistance desk. When visiting TPA, the employee must have a TPA Card and a valid ID. Once the hospital has given you all<\/p>\n","protected":false},"author":1,"featured_media":88,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[4],"tags":[],"class_list":["post-87","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>How to Manage Group Mediclaim Policy Effectively?<\/title>\n<meta name=\"description\" content=\"Learn effective ways to manage a Group Mediclaim Policy, streamline claims, and optimize employee health benefits.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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A group Mediclaim policy is a kind of health insurance that provides coverage for individuals who are employed by the same company. Given that the business pays the cost, it is frequently provided as a useful benefit to employees. 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