Group Medical Insurance Policy
With rising cost of medical every day, it is imperative that we are adequately protected by a good medical insurance plan. You would know that individual medical policies are costly, carry a three year waiting period for pre-existing diseases and are denied/ premium loaded in cases of diabetes, hypertension etc. We have, therefore, harnessed our collective strength and negotiated a group medical insurance policy for us. Please note all medical policies from various players can be clubbed together.
SANTOBAWestern Region took this initiative. Ramesh Pathak, President, SANTOBAWestern Region constituted a Core Committee of insurance sector experts from among Santoba members from various locations. The Santoba Insurance Committee worked really hard and have finally presented to us a Santoba Group Medical Insurance Policy. The Committee may not have been able to fulfil all demands but rest assured, it is just the beginning. We will come up with many more such plans in immediate future.
Join the programmefor the health and happiness of your family and continue ensuring solidarity of SANTOBA.
Brief Details:
| SANTOBA Group Mediclaim Insurance Policy | |
| Scope of Coverage: | The New India Insurance |
| Family Definition | Self, Spouse and two dependent children upto 25 years of age |
| Sum Insured Per Family | Rs. 5,00,000.00 |
| Premium | Rs 14,990/= |
| Type of Cover | Family Floater |
| Age band | 1 day to 80 Years |
| Pre Existing Disease Exclusion | Waived Off |
| First 30 days waiting period | Waived Off |
| 1 / 2/ 3 year exclusion | Waived Off |
| New Born Baby Coverage | Covered from Day 1 within Family Sum Insured |
| Pre & Post Hospitalisation Expenses | Pre & Post Hospitalisation Expenses (30-60 Days respectively) |
| Room Rent Restriction | 1% of Sum Insuredand 2% of Sum Insured for ICU. Proportionate charges applicable |
| Internal Congenital Ailments cover | Covered |
| External Congenital Ailments cover | Covered in life threatening situation |
| Emergency Ambulance Charges | Rs. 2000/- per hospitalisation |
| Sub-limit of Ailment | No sub-limit |
| Special condition | Psychiatric ailments within a limit of Rs. 30,000/= as well as treatment of Functional Endoscopic Sinus Surgery within a limit of Rs. 35,000/=. The coverage for treatment of mental illness is also covered up to Rs. 30,000 within the sum insured. |
| Cyber-knife treatment/Stem Cell Transplantation | 50% Co-Pay |
| Cochlear Implant treatment | Restricted to 50% of the sum insured |
| Lasik Surgery | Covered if correction index is +/- 7.5 D |
| AYUSH treatment | Covered |
| Co-Payment | No copay |
| GIPSA Clause | Shall be applicable |
| Terrorism Cover | Covered |
| Day Care Procedures | Covered |
| Dental Treatment | Covered if due to accident and requiring Hospitalisation |
| Cashless Facility | Yes |
| Addition-Deletion on pro-rata | After the inception of the Policy, no mid-term inclusion of any member unless he/ she is a new joinee and dependents of the already insured employee unless they are newly married spouse and new born child and such inclusion is also subject to payment of additional premium on pro rata basis. |
| Mid-term Addition of Dependents | Allowed only in case of new born baby and spouse in case of marriage |
| Maternity Benefit | Not Covered |
| Claim intimation | Within 07 Days of Hospitalisation |
| Claim submission | Within 30 Days of Discharge From Hospital |
Santoba Group Personal Accident Policy
SANTOBA Western Region started this policy three years back and this is running with all success. This is coming up for renewal on 2.8.2021. Last year, we had insured 288 members, mainly from Mumbai (paid from the corpus for all west members) and Delhi. This year, we should all get insured.
Brief Details
| Group Personal Accident Policy | |
| Value of Insurance | Rs. 6 Lakhs |
| Premium | Rs. 600/- |
| Death | Covered |
| Permanent Total Disability | Covered |
| Permanent Partial Disability | Covered |
| Temporary Disablement | Covered |
| Medical Treatment | Upto Rs. 1.2 Lakhs post an accident only |
Group MedicaiL Policy FAQ |
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| Question1: I already have a policy. Is it advisable to have one more? |
| Answer: that would depend on the amount of cover you have. Nonetheless, if you have a group policy claim it under it and earn bonus in your personal policy, Plus very distinct advantage in group policy. |
| Question2: What is covered under pre- existing diseases? |
| Answer: All diseases are covered. Some insurers make exceptions but it all depends on no of participants, age & bargaining power. |
| Question3: Whether Porting of existing Medical Insurance possible to this cover ? |
| Answer: Portability from individual to group or viseversa is not possible. |
| Question4: This limit has been kept for the larger interest of members. |
| Answer: Generally, no staggered limit is permitted. We will try depending on response though, on Final Numbers received. |
| Question5: How much minimum premium need to pay in a month/ quarterly/half yearly/yearly ? |
| Answer: It is yearly payments. |
| Question6: Any pharmacy / clinic / hospital bills will be valid or subject to t & c. . ? |
| Answer: 10 bedded hospital & any registered pharmecy is valid. |
| Question7: On joining, the policy letters will be issued ? |
| Answer: Individual certificates will be issued. |
| Question8: Can we track online / or any given mode ? |
| Answer: Possibility exists ,can be explored. |
| Question9: Is it transferrable? |
| Answer: Group medical policies are not transferable. |
| Question10: Place few people for consultation / customer support, this is real important as people need to give time !! |
| Answer: We will try once we finalise the policy. |
| Question11: Make an universal mail ID, and other communicative gateways..! |
| Answer: Will be done post data collection on participants. |
| Question12: Capping on room rent n ICU to be removed. |
| Answer: In corporate policy it can be done. In a heterogeneous group it is not possible. Will try for 2% n 4% & evaluate the cost implications. |
| Question13: May I know which documents are required to avail Mediclaim policy? |
| Answer: Hardly few which we will let you know once we move forward. |
| Question14: Is it possible to take policy on the basis of foreign passport? |
| Answer: This is for person of indian origin residing anywhere in the world. |
| Question15: Can the cost of treatment outside india payable? |
| Answer: No only treatment in india is payable. |
| Question16: Can I take policy in the name of my wife or son….using their ID/ passport? |
| Answer: No it has to be a santoba member. His sch no is the identity. |
Group Personal Accident FAQs |
| Question1: Can my wife n children be covered ? |
| Answer: Possibility is there but as of now western region decided to take it for members only. |
| Question2: Is there a rule that Pilots & Serving army,police personnel are not covered? |
| Answer: they are covered when off duty. |
| Question3: If Acc cover can be of Rs.10 lcs premium Will be under 1000 , if possible ?? |
| Answer: It is decided to increase it every year. Moreover, it is free to western friends, so cost implications are to be considered. (West team has annual contribution plan in place) |
| Question4: Can this be merged with term life? |
| Answer: We started with this product & will have to continue as this has paved way for other product launches/initiatives. |