What is the maximum age of entry?

The maximum age of entry is 60 years old.

How many network hospitals are there?

More than 7500 cashless network hospitals are there.

What happens if my hospital is not there in the network?

Our Partner Insurance Company has 7500+ hospital network across India. Still if the
Team Member takes the treatment in any non-network hospital, then the Team
Member can provide us with the details of the treatment and hospital bills for
Claiming purpose. If the Team Member's claim is valid, then our Partner Insurance
Company will reimburse the amount for the treatment taken.

Does Group Health Insurance under the Healthcare

Membership cover Covid-19?
Yes, after the initial waiting period of 15 days from the date of enrollment.
Covid-19 related expenses will be provided only in case of hospitalization of more
than 24 hours. Also, there is a waiting period of 15 days for Covid-19. The benefit will
not be provided in the following cases:
●​ Self-quarantine.
●​ Quarantine advised by any unauthorized testing center.
●​ Quarantine/isolation at any unauthorized center.
●​ Self-isolation during the lockdown.

What are all the waiting periods under the Group Health
Insurance?
For each Team Member and their family covered under the group health insurance:
●​ There is an initial waiting period of 15 days for Covid-19 from the date of
enrollment of each member.
 ●​ There is an initial waiting period of 30 days for any other hospitalization than
Covid-19 (not applicable in the case of accidental hospitalization) from the
date of enrollment of each member.
●​ Pre-existing diseases are not covered for 4 years from the date of enrollment.

What is not covered under the Group Health Insurance?

●​ Maternity related hospitalisation
●​ Hospitalization less than 24 hours
●​ Out-patient expenses
●​ Treatments related to dental, unless necessitated due to injury
●​ Other general exclusions of the group health insurance policy

How many claims are allowed under the Group Health

Insurance?
There is no limit on the number of claims under the group health insurance. Team
Member can make claims admissible up to the Sum Insured during the span of 12
months, provided they continue to remain members under the TeamSure program. In
the case of the Team Member and Family membership type, the specified limit of
Sum Insured is considered for the family (spouse and children), and not each
individual Team Member.

Are my pre-existing diseases covered?

Pre-existing disease for each Team Member and their family is covered under the
group health insurance, after 4 years from the date of enrolment

Can I purchase the plan for my family members?

At the time of onboarding, a member can subscribe to the membership for their
spouse and children.
What is the discount on the medicines and health check-up
plan?
The discounted medicines delivery and health check-ups are provided by our partner
network. There is a discount up to 20% in medicine delivery and up to 65% in health
check-ups/ diagnostic tests.

Do I need a doctor's prescription for ordering medicine?

Apart from Over-the-Counter (OTC) medicines, a doctor's prescription will be
necessary to order the medicine online.

What personal health data is accessible to my

organization?
We do not provide any of yours or your family's personal health data to your
organization. We only provide your enrollment details. Hence, any of your private
records is safe with us!

What are the tests covered in the Lab tests?

Our partner network provides around 140+ tests as well as necessary health
check-up packages to continually monitor your health.

On which medicines are discounts available?

Apart from OTC medicines, a discount is available on the medicines prescribed by a
certified doctor, subject to availability of medicine in stock.
What is the difference between Team Member only and
Team Member & Family Membership?
Under the Team Member Only membership, healthcare features and benefits are
availed only by an individual team member in the organization. Under the Team
Member & Family membership, healthcare features and benefits are extended to
your team member as well as his/her spouse and two children aged up to 25 years.

Is there a limit on the number of children a team member

can add?
If you have selected Team Member & Family membership, benefits are provided to
your team member, his/her spouse and up to two children aged up to 25 years.

Insurance Glossary
What is the meaning of Cashless Treatment?
Insurance companies team up with hospitals. If you visit one of these partnered
hospitals for treatment, you won't need to pay the full amount upfront.
Instead, you'll only need to cover certain costs like co-pay, deductible, refundable
deposit, any room charges beyond eligibility, and non-medical expenses. Also, the
insurance company will handle the bill directly with the hospital.

To avail of this cashless treatment, you need to inform your insurance company that
you'll be getting admitted to one of their network hospitals. Additionally, you'll need to
provide your policy details at the hospital.
Remember, though, that insurance companies sometimes change their list of
network hospitals. So, if you're planning a treatment, it's always a good idea to check
with your insurer for an updated list and the hospital you are planning to get admitted
to whether they are in network with the insurer.
What is the meaning of Copay?
A copay is when the policyholder needs to pay a certain percentage of the total claim
amount. The insurance company will cover the remaining portion.
For example, if you have a 20% copay, you must pay 20% of the expenses, and the
insurance company will cover the rest. Generally, the copay element ranges between
0% and 20%.

What is the meaning of Daycare Treatment?

Daycare treatment refers to any medical treatment where you stay in the hospital for
less than 24 hours. Even though these treatments don't require long hospital stays
due to technological advancement, they can still be quite expensive and have a
significant financial impact.
Some common examples of daycare treatments include cataract surgery, dialysis,
chemotherapy, radiation therapy, and more.
It's important to note that many insurance policies only cover hospitalizations that
last more than 24 hours. As a result, daycare treatments may not be included in your
policy's coverage. Therefore, it's recommended to choose an insurance policy that
also covers daycare treatments.
It's worth mentioning that each insurance provider has a different list of eligible
daycare treatments, and this list may change over time. It's advisable to check the
specific.
coverage details before starting any treatment or hospitalization to ensure you have
the necessary coverage.

What is the meaning of Deductibles?

A deductible is the amount of money you need to pay for your healthcare expenses
before your health insurance kicks in.
If your insurance policy includes a deductible clause, it means you have to cover a
certain amount of your medical bills before the insurance company starts paying.
For example, if your plan has a deductible of ₹20,000, you must pay for all your
medical expenses until they reach ₹20,000. After that, your insurance company will
start covering your bills.
It's important to note that the deductible is a one-time fee. So, if your first treatment
costs ₹50,000, you pay ₹20,000, and your insurer pays ₹30,000. You won't have to
pay any deductible for any future treatments in the same policy year.
However, if your first treatment costs ₹15,000, you need to pay the entire ₹15,000 for
that treatment and ₹5,000 for your second treatment. After that, your insurer will take
care of the payment.

What is the meaning of Exclusions?

Exclusions are specific treatments and conditions that are not included in your
insurance policy's coverage. One common exclusion you may come across is for
pre-existing diseases.
For example, if you have diabetes and your insurance policy excludes pre-existing
diseases, any medical condition or treatment related to diabetes will not be covered
by your insurance company.
There are also "permanent exclusions" that are never covered by insurance, such as
injuries caused by war, HIV, intentional injuries, and certain congenital diseases.
For exclusions like pre-existing diseases, you may have the option to get coverage
after a waiting period, usually around 4 years. However, permanent exclusions are
not eligible for coverage under any circumstances.
Group health insurance policies may have specific exclusions related to
non-life­threatening procedures or cosmetic surgeries, and these exclusions can vary
from one insurance company to another.

What is the meaning of ICU Limit?

An ICU limit is the maximum amount that your insurance company will cover for ICU
expenses during hospitalization each day.
This limit is often a percentage of your total coverage (typically 1-3% ). If your ICU
charges go beyond this limit, you will be responsible for paying the difference.
Additionally, the amount the insurance company covers for other expenses, such as
surgeon fees, consultations, diagnostics, and doctor visits, will also be
proportionately reduced based on the ICU limit.
What is the meaning of Inclusions?
When you review your policy document, you'll come across a section called
'inclusions'. Inclusions refer to the treatments, illnesses, and healthcare services that
your insurer will cover under the policy.
These are the medical expenses that will be paid for by the insurance company,
regardless of the specific treatment or condition.
Some common inclusions in health insurance policies include hospital
accommodation, ICU fees, prescription medicines, and medical treatments received
during a hospital stay.
To make policies more comprehensive, insurance providers have also added
coverage for AYUSH treatment (Ayurveda, Yoga, Unani, Siddha, and Homeopathy),
pre and post­hospitalization expenses, and other similar services to their list of
inclusions, particularly for group health insurance.

What is the meaning of Network Provider?

A network provider is a healthcare professional, doctor, hospital, or institution that
has an agreement with the insurance provider to offer medical services to
policyholders.
When you choose to receive treatment from a network provider or at a cashless
hospital, you can benefit from a cashless facility and a smoother claims process.
It's important to be aware that the list of network providers is subject to frequent
changes as insurance companies continuously work on expanding their network.
Therefore, it is always recommended to request or check for an updated list before
undergoing any treatment.

What is the meaning of Non-network Provider?

A non-network provider refers to a doctor, healthcare provider, or hospital that does
not have a partnership with your insurance company. In simpler terms, they are not
directly connected to your insurance provider.
However, this does not mean that your insurance coverage will not apply to these
providers. You will still receive coverage for the treatment you receive at a
non-network provider or hospital.
The main difference is that you will need to pay the hospital upfront for the services
you receive. Afterward, you need to collect all the necessary bills and payment
receipts.
You can then submit these documents to your insurance company for
reimbursement. The insurance company will review the bills and reimburse you for
the amount you spent on the treatment.
PED, which stands for pre-existing diseases, refers to health conditions or illnesses
that you have been diagnosed with before joining a particular health insurance plan.
Common examples of PED include cancer, heart ailments, and diabetes.
In most insurance policies, there is a waiting period of 2-4 years before the coverage
for treatments related to pre-existing diseases begins. This means that during the
waiting period, the insurance company will not provide coverage for treatments
specifically related to your pre-existing conditions
After the waiting period is over, the insurance coverage will extend to include these
conditions as well.

What is the meaning of Post-hospitalization coverage?

After being discharged from the hospital, there are many healthcare expenses that
you need to handle. This includes follow-up visits, medical tests, and medications.
To provide more comprehensive coverage, insurance policies include
post­hospitalization coverage. This coverage takes care of the expenses you incur for
diagnostics and medications after you leave the hospital.
Since these expenses occur outside of the hospital, you will usually need to pay for
them upfront and then seek reimbursement from your insurance company.
With Onsurity's membership, post-hospitalization coverage applies for up to 60 days
after your discharge, helping you manage your medical costs during this period.

What is the meaning of Pre-hospitalization coverage?

Before you are hospitalized, there are often significant expenses involved in
diagnosing and determining the need for hospitalization.
A good insurance policy will cover these medical expenses incurred before you are
admitted to the hospital.
Since these expenses occur before you enter the hospital, you will usually need to
pay for them upfront and then seek reimbursement from your insurance company.
This coverage is only applicable once you are officially admitted to the hospital.
With Onsurity's membership, the pre-hospitalization coverage extends for a period of
30 days.

What is the meaning of Proportionate deduction?

When you choose a room or an ICU in a hospital that exceeds the allowed limit
specified in your insurance policy, a proportionate deduction is applied.
This means that not only will you have to pay the additional room charges, but also a
proportionate amount of all other expenses.
For instance, if your insurance policy covers only 25% of the actual room charges
you choose, the insurer will only pay 25% of the total bill, excluding the cost of
medicines.
Let's say your bill amounts to ₹2,00,000. In this case, the insurer will only pay
₹50,000, and you will be responsible for paying the remaining ₹1,50,000, even if your
policy coverage is more than ₹2,00,000.
In summary, choosing a room or ICU that exceeds the agreed-upon limit in your
policy can result in a proportionate deduction, requiring you to bear a portion of the
expenses incurred.

What is the meaning of Room Rent Limit?

The room rent limit is the maximum amount that your insurance company will cover
for expenses related to a non-ICU room during hospitalization each day.
Usually, this limit is a percentage of your total coverage (typically 1-4%). If the cost of
your hospital room exceeds this limit, you will have to pay the extra amount.
Additionally, the insurance company will also reduce the coverage for other
expenses, such as surgeon fees, consultations, diagnostics, and doctor visits, in
proportion to the room rent limit.
What is the meaning of Sub-Limit?
A sub-limit is a restriction set by insurance companies on the maximum claim
amount for specific diseases, treatments, or provisions.
It can be a certain percentage of the total sum insured or a predetermined fixed
amount agreed upon by the company.
For example, ICU limits and room rent limits are common sub-limits imposed by
insurance companies. These sub-limits result in proportionate deductions being
applied to your claims, which means you may receive a reduced coverage amount
for certain expenses related to these limits.
In simpler terms, sub-limits put a cap on how much you can claim for certain things,
like intensive care or room charges, which can affect the total amount you receive
from your insurance company.

What is the meaning of Sum Insured?

The sum insured is the maximum amount that your insurance company will pay for
all your healthcare expenses in a year. It is essentially the coverage limit stated in
your insurance policy.
In simple terms, it refers to the total amount of money you can claim from your
insurance company for your medical costs within a specific time period.

What is the meaning of Waiting Period?

A waiting period is the time you have to wait before your health insurance coverage
becomes effective. In health insurance, there are different types of waiting periods.
The initial waiting period means that if you get hospitalized within the first 30 days of
the policy, you won't be able to claim any benefits from your insurance. However, this
doesn't apply to hospitalization due to accidents.
The pre-existing disease waiting period is when insurance policies don't cover pre
existing diseases. If they do provide coverage, there is a waiting period of 2-4 years
of continuous policy coverage before you can claim for treatments related to
pre-existing conditions.
There can also be specific waiting periods for certain diseases, which means you
must wait for a certain period before you can claim benefits for those illnesses.