Royal Sundaram has launched this Health Premium Platinum plan which is a group health/employee health insurance plan. It is a comprehensive package plan that an employer can buy for its employees and their family members. The plan covers hospitalization cost and medical expenses arising out of an illness or injury. Family members include spouse and two dependent children.

The various other benefits of Health Premium Platinum plan are listed below:

Features of Royal Sundaram Group Health Plan

  • With the Health Card, employees are permissible to avail cashless facility in the network hospitals.
  • There are more than 2200 network hospitals across 16 cities where insured employees can avail cashless treatment for his/her ailments without having to pay the hospital bills. If the insured employee fails to take admission in a networke hospital, then the amount will be reimbursed within 15 days of document submission
  • Coverage is provided for outpatient expenses in certain cases
  • The insured employees can have access to 24-hour helplines and free ambulance services
  • The insurer offers access to patients’ medical history and their family members including all the details related to medical history, illness, hospitals, and medicines

Inclusions of Royal Sundaram Group Health Plan

  • Hospitalization Expenses: The insured employees are offered compensation for in-patient hospitalization expenses in the event of an accident or illness up to the sum insured amount. It is applicable on hospitalization for more than 48 hours or 2 days.
  • Pre and Post Hospitalization Expenses: It covers all the medical expenses (as covered under the plan) that were incurred 30 before the hospitalization and also the cost of treatment after 60 days of hospitalization.
  • Out-patient care Expenses: It also covers out-patient treatment costs such as kidney stone removal; eye surgery; tonsillectomy, and D & C.
  • Hospital Cash Allowance: This plan also offers a fixed compensation for each day of hospitalization.
  • Convalescence Benefit:  A fixed amount is compensated if the hospitalization exceeds 21 days.

Additional Benefits of Royal Sundaram Group Health Plan

The coverage can be further enhanced on payment of additional premium. However, this will depend on claim track record and the Company’s profile :

  • Coverage for Maternity
  • Waiver of 30 day waiting period
  • Waiver of first-year exclusions

Exclusions of Royal Sundaram Group Health Plan

This plan does not cover the following expenses:

  • Any illness that was contracted in the initial 30 days of purchasing the policy
  • Any pre-existing diseases/illnesses/injury that was diagnosed before purchasing the policy
  • Pregnancy-related claims
  • Dental surgery or treatment unless it requires hospitalization 
  • Cost of spectacles/contact lenses and hearing aids
  • Certain diseases like cataract, hernia, piles, sinusitis, etc. are not covered in the first of the policy
  • Expenses incurred on Naturopathy, Ayurveda, Homoeopathy, or any other form of local treatment
  • Alcoholism, and drug abuse
  • HIV and AIDS

For details please refer to the policy terms and conditions

Royal Sundaram Health Insurance Claim Procedure

Royal Sundaram follows a simple claim process to make it convenient for their customers. The claim procedure that the insured employees need to follow is listed below:

  • Claim Intimation: The insurer needs to be informed at least 48 before the hospitalization (in case of planned hospitalization), and within 48 hours if it is an emergency hospitalization.
  • Claim Submission: The insured needs to submit the duly signed and filled claim form along with the supporting claim documents. Moreover, the policyholder also needs to furnish the name of the patient, details of the hospital including name, location, contact number, and also the date of hospitalization, and expected discharge, as a part of the claim intimation procedure.

Once all the claim documents are submitted, Royal Sundaram will make the payment for the permissible amount as per the policy terms and conditions.

To check more details, please refer to the Royal Sundaram Group health insurance policy wordings.

Written By: PolicyBazaar - Updated: 09 January 2020
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Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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