Edelweiss Group Health Insurance

In search for a Group Health Insurance Policy Plan to keep you and your family members safe and sound? Here are we with the Edelweiss Health Insurance Policy Plan.

Edelweiss Group Health Insurance

Edelweiss Group Health Insurance is a sister formative of Edelweiss Financial Services Limited. It came in to working since the year 2017 with a straight aim of providing the customers with insurance products designed to fulfill the actual needs and services which are swift, smooth, and satisfactory.

Edelweiss Group Health Insurance feels immensely proud in providing health insurance policy plans for individuals and families at an extremely affordable price.

Inclusion and Exclusion in the Group Health Insurance and Group Total Protect

Inclusions

The inclusion of the Edelweiss Group Health Insurance Plan are as mentioned below:-

1. All the expenses that might arise because of the traveling in the ambulance are covered in this policy.

2. The cost of expenses which is up there in case of maternity hospitalization and birth of a newborn baby are all included in the plan.

3. Diseases that is there with an individual either since birth or before applying for the policy plan.

4. All the expenses of all the daycare processes and procedures are included in the policy plan.  

5. Not only this, but all the expenses related to the pre and post hospitalization are also taken care of under this policy plan.

6. All the cost of operation theatre are also covered.

7. Cost of pacemaker, process of dialysis, expenditure that might arise because of organ transplant procedure, radiotherapy, and the most expensive process of cancer treatment the chemotherapy are also covered.

Exclusions

There are few of the exclusions are mentioned below:-

1. Costs that is ready for you to pay in case if you have opted for a naturopathy treatment is not covered by this group insurance policy.

2. The costs of spectacles, hearing aids, and contact lenses are also not included and covered under the policy plan.

3. The group mediclaim policy plan does not cover the process of inoculation, vaccination and cosmetic surgery. The procedure of cosmetic surgery is only included and considered if it is highly recommended by the doctor to save an individual’s life.

4. This policy plan does not cover the expenses which are incurred for the treatment of sterility, fertility or any assisted conception procedure, self-harm or an attempt of suicide, psychosomatic disorders, and any type of diseases or injuries caused because of intoxication or drugs.

5. All the expenses that up there because of your diagnostic tests are also not taken care of by the policy plan.  

6. Treatment for conditions waving up to you because of obesity, weight management issues, and more is strictly not offered by the Edelweiss Group Health Insurance Plan.

10. Stay in hospitals for domestic reasons where no active treatment has been provided by the hospital to the insured person or persons will not be covered by us.

11. Costs that might have gathered because of the process of sex change, out-patient diagnostic operations, usage of non-recommended drugs and medicines, replacement of hormone therapy, and more is not be covered by the policy.

12. Pre-hospitalization and post-hospitalization expenses in terms of doctor’s home visits, nurses and attendants is also not covered under the group insurance policy plan.

Edelweiss Group Health Insurance Policy Plan’s Major Benefits 

Edelweiss Group Health Insurance Policy Plan provides the below mentioned benefits along with their plans and policies:-

1. The Edelweiss Health Insurance provides protection to the policyholders that fall above the age group of 3 months. Ik general, individuals should not worry about the age limit to get enrolled in the Edelweiss Health Insurance Policy Plan.

2. An individual can purchase a health insurance plan and protect a maximum of 8 members of the family which includes self, spouse, 3 children, and some other relatives.

3. The Edelweiss Health Insurance Platinum Plan provides health insurance coverage for up to 2 Crores.

4. By owing any of the plans offered by the Edelweiss Health Insurance Company, an individual is eligible to avail benefits like- Medical Monitoring Coverage, Medical Repatriation, Compassionate Visit, Medical Emergency, the Return of Mortal Remains and Taking Second Opinion.

Pre-hospitalization Medical Expenses and Post-hospitalization Medical Expenses

The pre and post-hospitalization covers are available under the Edelweiss Health Insurance Policy Plan.

1. Pre-hospitalisation: Silver Plan:- 30 days, Gold Plan:- 60 days, Platinum Plan:- 90 days.

2. Post-hospitalisation: Silver Plan:- 60 days, Gold Plan:- 90 days, Platinum Plan:- 180 days.

The Claim Settlement Process of Edelweiss Group Health Insurance 

Network Hospital 

1. Claim Intimation

      Emergency hospitalisation requires intimation within the time span of 48 hours and for in case of a planned hospitalisation intimation is needed to be done within 72 hours prior to the hospital visit.

2. Claim Processing

An individual need to fill in the pre-authorisation form and submit it to the hospital’s TPA desk to begin with the claim request.

3. Claim Settlement

After your request is approved by the Insurance Company, the claim is considered to be settled. In case your application is rejected then go for reimbursement after the discharge.

Non-Network Hospital

1. Claim Intimation

Emergency hospitalisation requires intimation within the time span of 48 hours and for in case of a planned hospitalisation intimation is needed to be done within 72 hours prior to the hospital visit.

2. Claim Processing

An individual is required to submit the claim settlement form along with the original documents of doctor’s reports, hospital bills, diagnostic tests, and more.

3. Claim Settlement

After your request is approved by the Insurance Company, the claim is considered to be settled.

FAQs – Edelweiss Group Health Insurance