This pandemic has taught us many things- insuring ourselves is one. Under the leadership of Ramesh Pathak, SANTOBA West has done it again. An Insurance Team was formed led by Rajesh, ex NIA, to negotiate on our behalf. In these difficult times, the team was able to clinch an unparallel deal. It would be improved year on year, though.

SANTOBA Group Medical Insurance Policy (21-22) 

Brief Details:

Insurer The New India Assurance Co Ltd


Broker Alliance Insurance Brokers Pvt Ltd
Policy Period 9.8.21 to 8.8.22
Family Definition Self, Spouse and 2 dependent children upto 25 yrs of age + 2 Dependents Parents/inlawsupto 90 Years (no cross selection)
Sum Insured Per Family Rs. 5,00,000.00
Premium Rs 14,990/= including GST
Type of Cover Family Floater
Age band 1 day to 90 Years
Pre Existing Disease Exclusion Waived Off (i.e covered from day one)
First 30 days waiting period Waived Off (i.e covered from day one)
1 / 2/ 3 year exclusion Waived Off (i.e covered from day one)
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
Lucentis Not covered
External Congenital Ailments cover Covered in life threatening situation
Emergency Ambulance Charges Rs. 2000/- per hospitalization
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
GIPSA Clause Applicable
Terrorism Cover Covered
Day Care Procedures Covered
Dental Treatment Covered if due to accident and requiring Hospitalization
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 pass out of the school and dependents of the already insured employee unless they are newly married spouse and new born child. Such inclusion is subject to payment of additional premium on pro rata basis and immediate intimation to the broker
Maternity Benefit Covered (35000/- Normal delivery and 60000/- cesarean)
Home Quarantine 20000/- per family. Policy limit is 10L
Attendant charges Not covered
Claim intimation Within 07 Days of Hospitalization
Claim submission Within 30 Days of Discharge From Hospital

Santoba Group Top-up Medical Policy (21-22)

Sum Insured                            5L (Five Lacs)

Minimum participation            35% of those enrolled for Medical policy of SANTOBA

Policy period                           9.8.21 to 8.8.22

Premium                                  7000/- including GST(seven thousand only)

Condition                                It has to be purchasedtogether with base SANTOBA medical policy


Santoba Group Personal Accident Policy (21-22)

SANTOBA Western Region started this policy four years back and this is running with all success. All Western Region members are covered and their premium is paid by the corpus of west.

Brief Details

Sum Insured Rs. 10 Lakhs
Premium Rs. 600/- including GST
Death Covered
Permanent Total Disability Covered
Permanent Partial Disability Covered
Temporary Disablement Covered
Medical Treatment 40% of claim amt or actual medical bill or 10% of individual SI whichever is less


 Group Mediclaim Policy FAQ

Question1: I already have a policy. Is it advisable to have one more?
Answer: that would depend on the amount of cover you have. In today’s circumstances more is less. Cost of treatment is going high every day. Further,earn bonus in your personal policy by claiming in SANTOBA group policy. Also, in case of higher claim amount insured can take claim in multiple policies once the SI gets exhausted in a particular policy subject to T&C.
Question2: What is covered under pre- existing diseases?
Answer: All diseases are covered.There are certain standard exclusions in the policy.
Question3: Whether Porting of existing Medical Insurance possible to this cover ?
Answer: Portability from individual to group or viseversa is not possible.
Question4: Can we have staggered SI?
Answer: As on date insurers are not giving staggered limit in Association policies.
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 E cardswill be issued which can be downloaded from TPA portal.
Question8: Can we have with parents and without parents premium?
Answer: To a heterogeneous group where voluntary participation is there, it is not available as on date.
Question9: Is it transferrable?
Answer: Group medical policies are not transferable.
Question10: Can a NRI take the policy?
Answer: Any Indian with Indian Aadhar& PAN card is allowed to take policy
Question11: Can treatment be taken out side India?
Answer: No it cannot be taken.

Group Personal Accident FAQs

Question1: Can my wife n children be covered ?
Answer: Not as of now in this policy.
Question2: Is there a rule that Pilots & Serving army,police personnel are not covered?
Answer: they are covered when off duty.
Question3: Can this be merged with term life?
Answer: This policy can not be clubbed with any other policy.