Medical Insurance

{"medical_insurance":{"title":"Medical Insurance","description":"

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Medical Insurance for the year 2025 - 2026 : Policy Period : 20th June 2025 to 19th June 2026 - Insurance Co : ICICI Lombard General Insurance Company Limited<\/strong><\/p>\r\n\r\n

ALPA India strives for the betterment of Indian pilots regardless of their country of employment. ALPA India offers its pilots and their family a medical insurance plan as part of its commitment to securing their future.<\/strong><\/p>\r\n\r\n

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\r\n\t\r\n\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t
           SNO   <\/strong><\/td>\r\n\t\t\t       Scope of coverage<\/strong><\/td>\r\n\t\t\t                                                                                       Terms                                     <\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
   1<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Family Definition<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

1+5 Self + Spouse + 2 children + Either 1 set of dependent parents\/parent-in-laws (*cross combination is allowed). Cross-combination Eligibility - Coverage can be extended to members with different gender combinations of parents or in-laws. (Applicable Only If One Parent Is Deceased). Age Band - Adult - 18 to 90 years & Child – Day 1 to 30 years.<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
   2<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

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Type of Cover<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Floater<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
   3<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Sum Insured<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

Graded as INR 3 Lakh, 5 Lakh, 10 Lakh, 25 Lakh, 30 Lakh per family<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
   4<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Pre-Existing Disease Exclusion<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Waived off<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
   5<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

First 30 days waiting period<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Waived off<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
   6<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

1 year exclusion<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                   Waived off<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
   7<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Maternity Benefit<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

Maternity limit Rs.1,50,000\/- for normal delivery & Rs.1,50,000\/- for C-Section.<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
   8<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Waiting period for Maternity benefit<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Waived off<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
   9<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

A waiting period of 6 months will be applicable for maternity benefits, calculated from the date of joining the policy. This condition applies only to new members.<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Applicable<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  10<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Waiting period for Members joining the mid-term of policy period<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

A waiting period of 3 months will apply before lodging any hospitalization or OPD claims<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  11<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Pre & Post Natal coverage<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

Covered upto 5% of Maternity Limit, within maternity Limit<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  12<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

New Born Baby Cover<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

Covered from Day 1 within family floater SI<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  13<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Pre & Post Hospitalisation Expenses 
\r\n\t\t\t(60-90 Days respectively)<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Covered<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  14<\/strong><\/td>\r\n\t\t\tRoom Rent Restriction<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

Room rent per day restricted for Normal, <\/strong><\/p>\r\n\r\n\t\t\t


\r\n\t\t\ta) Room Rent for 3 Lakhs SI Rs.3000\/- 
\r\n\t\t\tb) Room Rent for 5 Lakhs SI - Rs.6000\/- 
\r\n\t\t\tc) Room Rent for 10 Lakhs SI - Rs.8,000\/- 
\r\n\t\t\td) Room Rent for Rs.20 Lakhs SI - Rs.12,500\/- 
\r\n\t\t\te) Room Rent for Rs.25 Lakhs SI - Rs.15,000\/- 
\r\n\t\t\tf) Room Rent for Rs.30 Lakhs SI - Rs.15,000\/- <\/strong><\/p>\r\n\r\n\t\t\t


\r\n\t\t\tICU at Actuals or Rs 50K whichever is lower<\/strong><\/p>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t\t

  15<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Internal Congenital Ailments cover<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Covered<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  16<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Congenital External Disease or Defects or Anomalies<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Not Covered<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  17<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Emergency Ambulance Charges<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

Road ambulance charges are covered upto Rs. 2,000\/- per incident in case of emergency<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  18<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Cataract limit<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Rs 70,000\/- per Eye<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  19<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Corporate Buffer<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

Corporate buffer is covered with an overall limit of INR 60 Lac, restricted to family floater sum insured covered only for Critical Illness. Corporate Buffer shall not be applicable for maternity and other related claims where disease wise capping is applicable<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  20<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Lasik surgery<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

Covered if correction index is beyond +\/- 7.5D<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  21<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Sub Limit for various Ailments \/ Treatments<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  No limits on ailments<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  22<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Ayurvedic Treatment<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

Covered up to Rs.25000 in the policy in a government registered hospital<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  23<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Co-Payment<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

20% Co-pay for Parental Claims<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  24<\/strong><\/td>\r\n\t\t\tOPD<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

OPD Expenses @ Rs.10,000\/- per family for Health Check up Rs.4000\/-Dental, Vision consult, Cost of lens , Rs.3500\/- Medicine with Doctor prescription Rs.3000\/-. Exclusion in OPD 
\r\n\t\t\t(a)In case of vision OPD only cost of lens will cover frame will not be covered. 
\r\n\t\t\t(b)In case of dental OPD Crown Braces and cosmetic are not covered. 
\r\n\t\t\t(c)Any type of cosmetic treatment will not covered under OPD cover 
\r\n\t\t\t(d)Any expenses for the investigations\/ treatment taken without existence of any disease\/illness, sign\/symptoms. 
\r\n\t\t\t(e) Alternation treatment other that Allopathic treatment are not covered 
\r\n\t\t\t(f) vaccinations are not covered<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t\t

  25<\/strong><\/td>\r\n\t\t\tSpecial conditions<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

LGBTQ Cover\/Life in Partner - Covered.                                                                                                    <\/strong><\/p>\r\n\r\n\t\t\t

BEREAVEMENT COVER: Only in respect of Employee's death during hospitalisation, no copay  and other admissible  expenses are deducted. However this is not applicable to non-admissible amounts. This is not waived in respect of other dependents claims. Also this is permitted within the availability of FSI.  <\/strong><\/p>\r\n\r\n\t\t\t

Widow-idower Cover:If an employee passes away during the course of the policy, the benefits  can be extended to the dependents for the remaining policy period.Covered provided the dependents are not  deleted from the scope of the policy.  <\/strong><\/p>\r\n\r\n\t\t\t

Psychiatric \/ Psychosomatic disorder - Up-to INR 30,000 per family. Modern Treatment Methods and Advancement in Technologies is covered as per the Insurer GMC policy Terms.<\/strong><\/p>\r\n\r\n\t\t\t

Air Ambulance is covered for 1 Lakh per incident.                                                                                       <\/strong><\/p>\r\n\r\n\t\t\t

Genetic disorder -25% of sum insured or 4 Lakh, whichever is lower, will be applicable for genetic disorder admissions, applicable for all members of the family.<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t\t

26<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Cancer-Related Claims<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

Coverage is restricted to 50% of the sum insured or a maximum payable amount of \u20b9750,000, whichever is lower<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  27<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

A 5% discount on the premium will be applicable for members who have not made any claims under the current policy<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                   Not Covered<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  28<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Members who opt for the policy this year will be committed to the group medical insurance policy for a duration of three years.<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Not Applicable<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  29<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Members cannot reduce the sum insured selected under the expiring policy; however, they do have the option to enhance their coverage.<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                 Not Applicable<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  30<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Day Care Procedures<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Covered<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  31<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Dental Treatment<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

Covered if due to an accident and requiring 
\r\n\t\t\tHospitalisation<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  32<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Cashless Facility<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Yes<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  33<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Addition-Deletion on a pro-rata basis from Date of Joining and Date of Leaving, respectively, subject to CD Balance with the Insurance company<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Yes<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  34<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Claim Intimation<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  Waived off<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  35<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Claim Submission<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

Within 15 Days from Date of Discharge<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t\t
  36<\/strong><\/td>\r\n\t\t\t\r\n\t\t\t

 <\/p>\r\n\r\n\t\t\t

Third Party Administrator<\/strong><\/p>\r\n\r\n\t\t\t

 <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

                                                  In house<\/strong><\/td>\r\n\t\t<\/tr>\r\n\t<\/tbody>\r\n<\/table>\r\n\r\n

 <\/p>\r\n\r\n

\r\n\t\r\n\t\t\r\n\t\t\t
\r\n\t\t\t

                                                         PREMIUM FOR THE YEAR 2025 - 2026 (Policy period 20th June 2025 to 19th June 2026)<\/strong><\/h3>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t<\/tbody>\r\n<\/table>\r\n\r\n

 <\/p>\r\n\r\n

\r\n\t\r\n\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t
\r\n\t\t\t

                                            Sum Insured <\/strong><\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

\r\n\t\t\t

                             Premium incl. GST<\/strong><\/p>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t\t

\r\n\t\t\t

                                             3 Lakhs           <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

\r\n\t\t\t

                                      \u20b933,906<\/p>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t\t

\r\n\t\t\t

                                             5 Lakhs   <\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

\r\n\t\t\t

                                      \u20b91,09,628<\/p>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t\t

\r\n\t\t\t

                                            10 Lakhs<\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

\r\n\t\t\t

                                       \u20b91,22,400<\/p>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t\t

\r\n\t\t\t

                                            25 Lakhs<\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

\r\n\t\t\t

                                       \u20b91,42,405<\/p>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t\t

\r\n\t\t\t

                                             30 Lakhs<\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

\r\n\t\t\t

                                       \u20b91,46,926<\/p>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t\t

\r\n\t\t\t

                                           30 Lakhs<\/p>\r\n\t\t\t<\/td>\r\n\t\t\t

\r\n\t\t\t

                                       \u20b9 2,03,435<\/p>\r\n\r\n\t\t\t

                                       (8-member family<\/p>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t<\/tbody>\r\n<\/table>\r\n\r\n

\r\n\t\r\n\t\t\r\n\t\t\t
\r\n\t\t\t

                                                                                             Plus Rs. 2,500\/- as Admin Charges<\/strong><\/h3>\r\n\t\t\t<\/td>\r\n\t\t<\/tr>\r\n\t<\/tbody>\r\n<\/table>\r\n\r\n

 <\/p>\r\n\r\n

 <\/p>\r\n\r\n

 <\/p>\r\n\r\n

 <\/p>"}}