Group Mediclaim Insurance Policy

1. Purpose

This policy outlines the process for inclusion and deletion of employees and their dependents under the GSIS Group Tailor-Made Health Insurance Policy and provides details of coverage, premium structure, and responsibilities.

2. Employee Addition & Deletion Process

Step 1: Monthly Update Cycle

• New employees will be included in the Mediclaim policy at the beginning of every month (between the 1st and 5th).
• Additions and deletions will be processed strictly based on the official list shared by the HR Department.

Step 2: Inclusion & Removal

• New employees who have joined GSIS will be added to the policy from the first day of payroll.
• Employees who have separated from the institution will be removed from the policy on the last day of payroll.

Step 3: Dependent Coverage (Optional)

• Employees may opt to include eligible dependents under the policy.
• Inclusion will be done only after confirmation from the employee.
• The premium payable for dependents will be deducted from the employee’s salary.

Step 4: Endorsement & Activation

• Endorsements for additions and deletions will be prepared and submitted to the Insurance Company for processing.
• Coverage for employees and approved dependents will be effective from Day 1, as per the group policy terms.

Step 5: Insurance E-Cards

• Insurance E-Cards will be issued by the TPA (Medi Assist) and shared with employees via official email.

3. Treatments Covered under the Group Tailor-Made Health Policy

The policy provides comprehensive coverage including:

• Pre-existing disease cover (except exclusions under Clause 2.6 – Hazardous/Adventure Sports and Clause 3.1.4 – Mental Illness)
• Day 1 cover with no waiting period
• Sub-limit waiver, except:
  • Room Rent: 2% of Sum Insured
  • ICU Charges: 4% of Sum Insured
• Maternity Cover up to ₹50,000 (Normal & Caesarean)
• Newborn baby cover from Day 1
• Day Care Treatments (24-hour hospitalization not mandatory)
• Coverage for Hemodialysis, Chemotherapy, and Radiotherapy
• Coverage for 12 Modern Treatments and HIV/AIDS
• AYUSH treatments covered
• Dental and Eye treatments covered (excluding routine check-ups/examinations)

4. Sum Insured & Premium Structure (AY 2025–2026)

5. General Conditions

• The employer bears the cost of the employee’s base coverage.
• Dependent coverage is voluntary and chargeable to the employee.
• Any changes to coverage must be routed only through the HR Department.
• The policy is subject to the terms and conditions of the Insurance Provider and TPA.

Conclusion

This Group Mediclaim Policy reflects GSIS’s commitment to the health, safety, and well-being of its employees while ensuring clarity, transparency, and consistency in administration.

Confidentiality

• This policy is a confidential document of GSIS.
• No part may be reproduced or transmitted in any form, electronically or mechanically, without prior written permission from School Management.
• Unauthorized reproduction or transmission may lead to civil or criminal liability.

Amendments

The School reserves the right to modify, amend, or alter this policy, wholly or partially, at any time as deemed appropriate.