About Us

Group Health Insurance

We all work hard to make sure that we enjoy a financially secure life, but a sudden medical emergency can severely impact our financial planning and wellbeing.

Keeping this in mind Suryoday Small Finance Bank brings you an exclusive and comprehensive Group Health Insurance cover in partnership with ICICI Lombard General Insurance Co Ltd. This cover is designed to take care of your and your family’s health needs at a very affordable price.

Key Features

  1. Sum Insured Options –Rs. 3lacs |Rs. 5lacs |Rs.10 lacs.

  2. Option to select Individual or Floater cover (2 Adults, 2 Adults & 1 Child, 2 Adults & 2 Children).

  3. Group Personal Accident cover equivalent to the SI covering the Primary Proposer attached.

  4. Higher entry age up to 70 years, starting from 91 days. Minimum age of primary member should be 21 years.

  5. Single pricing slab for age band 21-60 years.

  6. Pre-existing disease (PED) covered after 24 months waiting period.

  7. Lifelong renewability subject to the policy holder continues to be a customer of the bank and the Bank continues to be the Corporate Agent and Master Policy Holder of ICICI Lombard General Insurance Co Ltd.

  8. No underwriting till 45 years of age, tele underwriting from 45- 60 years age.

  9. Convenient paperless digital onboarding via bitly link- Microsite.

  10. Tax benefits on premium paid u/s 80D of the IT Act.


Policy Conditions-Group Health Insurance
Age Band 91 day - 70 Years
Family Definition Self, Spouse, 2 dependent children up to 20 yrs. of Age
Sum Insured SI 3L / 5L / 10L
Room Rent Room rent charges capped at 1% for normal hospitalization and 2% for ICU on Sum Insured. All all the other related charges such as Doctor Visiting Charges, Consulting Charges, Medical Tests etc which are a function of the Room Rent as per Hospital Rate Card – Will also get reduced Pro Rata as per Room Rent Capping – as part of Overall Claim Settlement
Maternity Benefit Excluded
Pre-Existing Diseases Pre-Existing Diseases that have been declared at the time of proposal and accepted by Us will be covered after 24 months of continuous cover
Pre - Post Hospitalization Pre-hospitalization and Post hospitalization for 30 days & 60 days respectively are covered
Day Care Procedures Day Care Procedures are Covered as per the standard list
Donor Expense Covered upto Sum insured as per definition, provided organ used is for Insured person
Domiciliary Hospitalization Covered up to Sum insured for Medical expenses for treatment taken when confined within one's home subject to completion of minimum 3 continuous days of such hospitalization
Alternate Treatment Inpatient treatment for Alternate methods including Ayurveda, Unani, Siddha & Homeopathy treatment will be covered up to of Sum insured when taken in a Government recognized Hospital, on the prescription of a registered medical practitioner
Ambulance Service Covers road ambulance expenses, incurred to transfer the Insured following an emergency to the nearest hospital per event of emergency hospitalization, provided we have accepted the in-patient claim up to a maximum limit of Rs. 1500
Pre-Policy Medicals Tele UW above age of 45 years; Medicals above 60 years of age and in-case there is more than one PED
2 Years waiting period
  • Cataract
  • Benign Prostatic Hypertrophy
  • Myomectomy, Hysterectomy unless because of malignancy
  • All types of Hernia, Hydrocele
  • Fissures &/or Fistula in anus, hemorrhoids/piles
  • Arthritis, gout, rheumatism and spinal disorders
  • Joint replacements unless due to accident
  • Sinusitis and related disorders
  • Stones in the urinary and biliary systems
  • Dilatation and curettage, Endometriosis
  • All types of Skin and internal tumors/ cysts/ nodules/ polyps of any kind including breast lumps unless malignant
  • Dialysis required for chronic renal failure
  • Surgery on tonsils, adenoids and sinuses
  • Gastric and Duodenal erosions & ulcers
  • Deviated Nasal Septum
  • Varicose Veins/ Varicose Ulcers
  • All types of internal congenital anomalies/illness/defects
Exclusion
  • Lasik Surgery, Septoplasty, Infertility & Related Ailments incl.Male sterilityTreatment on trial/experimental basis; Admin/Registration/Service/Misc. Charges; Expenses on fitting of Prosthesis; Any device/instrument/machine contributing/replacing the function of an organ; Holter Monitoring are outside the scope of the policy
  • Any physical, medical or mental condition or treatment or service that is specifically excluded in the Policy Schedule under Special Conditions
  • Cost of routine medical, eye and ear examinations, preventive health check-up, cost of spectacles, laser surgery for correction of refractory errors, contact lenses or hearing aids, dentures and artificial teeth
  • Any expenses incurred on prosthesis, corrective devices, external durable medical equipment of any kind, like wheelchairs, crutches, instruments used in treatment of sleep apnea syndrome or continuous ambulatory peritoneal dialysis (C.A.P.D.) and oxygen concentrator for bronchial asthmatic condition, cost of cochlear implant(s) unless necessitated by an Accident or required intra-operatively
  • Expenses incurred on all dental treatment unless necessitated due to an Accident
  • Personal comfort, cosmetics, convenience and hygiene related items and services
  • Naturopathy treatment, acupressure, acupuncture, magnetic and such other therapies
  • Circumcision unless necessary for treatment of an Illness or necessitated due to an Accident
  • Vaccination or inoculation of any kind, unless it is post animal bite
  • Sterility, venereal disease or any sexually transmitted disease
  • Intentional self-injury (whether arising from an attempt to commit suicide or otherwise) and Injury or Illness due to use, misuse or abuse of intoxicating drugs or alcohol
  • Aesthetic treatment, cosmetic surgery and plastic surgery including any complications arising out of or attributable to these, unless necessitated due to Accident or as a part of any Illness
  • Any treatment/ surgery for change of sex or treatment/ surgery/ complications/ Illness arising therefore thereof
  • Any expense incurred on treatment arising from or traceable to pregnancy such as miscarriage, abortion or complications related to pregnancy and any fertility, infertility, sub fertility or assisted conception treatment or sterilization or procedure, birth control procedures and hormone replacement therapy. However, this exclusion does not apply to ectopic pregnancy proved by diagnostic means and is certified to be life threatening by the Medical Practitioner
  • Treatment relating to birth defects and external congenital Illnesses or defects or anomalies
  • All expenses arising out of any condition directly or indirectly caused to or associated with Acquired Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV, Human T-Cell Lymphotropic Virus Type III (HTLV-III or IITLB-III) or Lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or Variations Deficiency Syndrome or any Syndrome or condition of a similar kind
  • Charges incurred at Hospital primarily for evaluative or diagnostic or observation purposes for which no active treatment is given, X-Ray or laboratory examinations or other diagnostic studies, not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any Illness or Injury, whether or not requiring hospitalization
  • Expenses on supplements, vitamins and tonics unless forming part of treatment for Injury or Illness as certified by the attending Medical Practitioner
  • Weight management services and treatment, vitamins and tonics related to weight reduction programs including treatment of obesity (including morbid obesity), any treatment related to sleep disorder or sleep apnea syndrome, general debility, convalescence, run-down condition and rest cure
  • Cost incurred for any health check-up or for the purpose of issuance of medical certificates and examinations required for employment or travel or any other such purpose
  • Experimental, unproven or non-standard treatment which is not consistent with or incidental to the usual diagnosis and treatment of any Illness or Injury
  • Any case directly or indirectly related to criminal acts
  • Treatment taken outside the country
  • Treatment taken from anyone not falling within the scope of definition of Medical Practitioner. Any treatment charges or fees charged by any Medical Practitioner acting outside the scope of license or registration granted to him by any medical council
  • Any Illness or Injury resulting or arising from or occurring during the commission of continuing perpetration of a violation of law by You with criminal intent
  • Any consequential or indirect loss or expenses arising out of or related to Hospitalization
  • Any Injury or Illness directly or indirectly caused by or arising from or attributable to war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalization or requisition of or damage by or under the order of any government or public local authority
  • Any Illness or Injury directly or indirectly caused by or contributed to by nuclear weapons/ materials or contributed to by or arising from ionizing radiation or contamination by radioactivity by any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel
Co-Payment Nil
Claim submission clause Claim must be filed within 30 days from the date of completion of treatment. However, the Company may at its absolute discretion consider waiver, of this Condition in extreme cases of hardship where it is proved to the satisfaction of the Company that under the circumstances in which the insured was placed it was not possible for him or any other person to give such notice or file claim within the prescribed time-limit. The claim would invite additional 10% co-payment over and above payable amount as per policy terms and conditions
Mid-Term Inclusion Premium to be charged as per fixed grid for addition endorsement
Reasonable and Customary Charges Reasonable and Customary Charges will be applied on re-imbursement claims from non-network hospitals where medical treatment taken by the Insured Person during the Policy Period following an Illness or Injury that occurs during the Policy Period, subject to availability of the Sum Insured and any specific limits specified in the Schedule of Benefits and the terms, conditions and exclusions specified in the Policy document
Claim Intimation & Network clause All Reimbursement Claims must be intimated to ILHC within 24 hrs of Admission, in case of non-intimation/Delayed intimation 10% Co-pay would be applicable except for Accidental claims. If the member is getting admitted in any network hospital and filing for reimbursement claims such claims will be settled to members with 15% co-pay
Add-Del of Lives Premium to be charged as per fixed grid for addition endorsement. Premium to be refunded as per refund grid. No Refund for deletion if claim is under process or paid
Last year claim details NA
Special Condition 1 Policy also covers hospitalization arising out of Psychiatric ailments within a limit of Rs. 30,000 when inpatient treatment has been availed in a Hospital
Special Condition 2 Cataract procedure is capped at Rs. 30,000
Special Condition 3 50% Co-Pay for cyberknife treatment/Stem Cell TransplantationCochlear Implant treatment shall be restricted to 50% of the SI
Portability Portability is available on this product as per IRDA directive and product features
Termination Policy will cease to be in effect from the date of termination of relationship with the organization
Disclaimer Each policy issued under the Master Policy is valid for 1 year only

Policy Conditions-Group Personal Accident
Age of Entry: 21 – 65 years
Policy Tenure: 1 Year
Accidental Death:
on the occurrence of death of the Insured Person, provided such death results solely and directly from an Injury, within twelve months from the date of Accident resulting in such Injury, provided that the date of occurrence of the Accident falls within the Policy Period/Policy Year.
Permanent Total Disablement (PTD) resulting from Accident:

1) Loss of Sight of both eyes, or Physical Separation of two entire hands or two entire feet, or one entire hand and one entire foot, or of such Loss of sight of one eye and such Physical Separation/ Loss of one entire hand or one entire foot, then the Sum Insured as stated in the Schedule to this Policy hereto as applicable to such Insured Person.

2) Loss of Use of two hands or two feet, or of one hand and one foot, or of Loss of sight of one eye and Loss of Use of one hand or one foot, then the Sum Insured as stated in the Schedule to this Policy hereto as applicable to such Insured Person.

Exclusions

  • Suicide, attempt to Suicide
  • Being under influence of drugs other intoxicants
  • Participation in actual or attempted felony, riot, civil commotion
  • Committing any breach of law of land with criminal intent
  • Death or disablement resulting from Pregnancy or childbirth
  • Professional sports team in respect of specific benefit for inability to perform
  • Participation in any kind of motor speed contest
  • Underground mining & contractor specializing in tunneling
  • Naval, military or air force personnel
  • Radioactivity, nuclear risks, ionizing

GRIEVANCES
For resolution of any query or grievance, Insured may contact the respective branch office of the company or may call the toll free no. 1800-2666 or may approach us at the sub-section “Grievance Redressal” on the website www.icicilombard.com (Customer Support Section). However, if the resolution provided by us is not satisfactory you may approach Insurance & Regulatory Development Authority (IRDA) through the integrated Grievance Management System (IGMS) or IRDA Grievance Call Centre (IGCC) at their toll free no. 155255.

Disclaimer

Suryoday Small Finance Bank is a Corporate Agent of ICICI Lombard General Insurance Company Limited Bearing License Number CA0491 and its Registered Office is at 1101, Sharda Terrace, Plot 65, Sector 11, CBD Belapur, Navi Mumbai- 400614. The insurance products are offered and underwritten by ICICI Lombard General Insurance Company Limited (IRDA registration no. 115)having its registered office at House 414, Veer Savarkar Marg, Prabhadevi Mumbai- 400 025 Servicing of the policy and adjudication of claims is sole responsibility of ICICI Lombard General Insurance Company Limited and Suryoday Bank cannot be held liable for the same.

To know more about the Product, please refer to Policy Wordings

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Suryoday Small Finance Bank Ltd. CIN No: U65923MH2008PLC261472
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