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United India Group Health Policy

United India Group Health Insurance is a dedicated medical insurance policy that offers coverage to a group of people, usually those who work in the same organization. The benefit of the plan for employees is that it safeguards them from unanticipated accidents and hospital bills. The employer bears partial or whole premium expenses. The major highlight of the policy is that it is expandable to cover employees’ families under floater policies.

The Policy provides cover on an Individual or Family Floater basis, with an entry age of 18 years (min) and 26 years (max) for adults and 91 days (min) and 18 years (max) for children. In contrast to a Family Floater basis, which shares the Sum Insured limit with the group member’s entire family, an Individual basis provides a separate Sum Insured for each Insured Person.

Coverage Details

Here are the coverage details for the UNI Group Health Insurance Plan.

ParametersDetails
Mother Care CoverCoverage for less than 3 years of age
Grace Period30 Days
Cancelation Grid Period for which risk is retained Refund
Up to 1 month75%
> 1 Month – Less than 3 months50%
> 3 Month – Less than 6 months25%
> 6 Month – Less than 9 months15%
> 9 MonthsNil

Key Features and Benefits of Choosing the Group Health Policy By United India

The following are the salient features and benefits of considering the UNI Group Health Insurance Policy.

  • Pre and post-natal Medical Expenses

If specifically chosen, prenatal and postnatal medical expenses incurred on an outpatient basis will be covered up to the sub-limit stated in the policy schedule or certificate of insurance under the Maternity Expenses Coverage limit. These costs (including those for prenatal checkups, doctor consultations for tracking the pregnancy, and any complications that may result from it), from the date of conception up to six weeks after delivery, shall be covered.

  • Maternity Expenses Cover

The policy will pay for medical expenses incurred regarding a female insured person over the age of 18 for the delivery of a child in a hospital during the policy period, including but not limited to caesarian sections, vacuum births, water births, hypnobirthing, and midwife births, as well as for the medically necessary and legal termination of pregnancy.

  • Mother Care Cover

The policy will pay room rent and other boarding costs incurred up to limits as specified in the Policy Schedule for the Insured Person’s mother to stay with the Insured Person in the same Hospital if the Insured Person is less than 3 years of age and is hospitalised in an ICU, a Neo-natal ICU, or a Cardiac Care Unit of a Hospital.

  • Voluntary Co-Payment for In-patient Hospitalization

Over and above the sum detailed in the Policy Schedule, the Insured Person will make the Voluntary Co-Payment that is specified in the Policy Schedule/Certificate of Insurance. About the claim submitted by an insured person under the policy, the company will pay the remaining portion of the admissible amount.

  • Hospital Daily Cash Benefit (HDCB) Cover

For every completed day that the insured person is hospitalised or admitted to an ICU during the policy period, the policy will pay the Daily Cash Amount that is listed in the policy schedule or certificate of insurance under this benefit.

  • Wellness Cover

According to the WHO’s recommendations for routine immunisation of newborn babies, the insurance policy will cover reasonable and customary charges incurred during the policy period for vaccination expenses.

  • Sub Limit on Treatment/ Illness Surgery/Medical Condition

Up to the amount of the Sub Limit applicable per claim during the Policy period as specified in the Policy Schedule/Certificate of Insurance, the policy will pay the Medical Expenses incurred towards a claim for a specified Treatment(s) of an Illness/procedure(s).

  • Annual Aggregate Deductible

The Deductible amount specified in the Policy Schedule/ Certificate of Insurance shall be applicable on the aggregate of all claims made by an Insured Person if covered under the Policy on an Individual basis or by the family if covered under the Policy on a Family Floater basis during the Policy period.

  • Critical Illness Benefit Cover

The policy will pay a Critical Illness Sum Insured specified in the Policy Schedule/Certificate of Insurance if an Insured Person is determined to be suffering from any of the Critical Illnesses of the nature specified below during the Policy period.

  • ‘Loss of Pay’ Cover

A fixed benefit amount per week as stated in the Policy Schedule or Certificate of Insurance for the period will be paid by the policy if an Insured Person is hospitalised while the Policy is in effect due to any illness, disease, or injury sustained as a result of an accident, up to a maximum of 50 weeks per Policy Period. The benefit will start on the day “Loss of Pay” begins following the use of all employee leaves.

  • Dental Expenses Cover

If the insured person sustains injuries to his or her gums or natural teeth as a result of an accident, the policy will cover all related medical costs, including any emergency dental care.

  • OPD Physiotherapy Charges Cover

Up to the sub-limit stated in the Policy Schedule/Certificate of Insurance and would fall under the Base Sum Insured, the policy will pay the Insured Person’s Reasonable and Customary Charges incurred during the Policy period for a prescribed physiotherapy Treatment that is a Medically Necessary Treatment performed as an Out-Patient in a Hospital or at home by a qualified physiotherapist.

What Are The Exclusions Under the UNI Group Health Policy?

Though there are multiple exclusions under the Group Health Insurance policy by UNI, listed below are some of them.

  • Any admission-related costs that are primarily for diagnostic and evaluative purposes only are not included;
  • Any diagnostic costs that are not incidental to the current diagnosis and treatment or that are unrelated to it are excluded.
  • Costs associated with cosmetic or plastic surgery, as well as any other procedure intended to alter the appearance, unless necessary for reconstruction following an accident, burn, cancer, or as part of a medically necessary procedure to eliminate a direct or immediate threat to the insured’s health.
  • Expenses associated with any form of treatment, including surgical intervention, to change a person’s physical characteristics to those of the other sex.
  • Treatment costs that are directly related to or result from any insured person breaking the law with criminal intent or attempting to do so.
  • Treatments received in health hydros, nature cure clinics, spas, or comparable facilities, or private beds attached to such facilities that are registered as nursing homes, or admission that is arranged entirely or partially for domestic purposes.
  • Expenses for any treatment that hasn’t been proven effective, as well as services and supplies used in conjunction with treatments. Unproven treatments are those that do not have a substantial body of medical evidence to support their efficacy.
  • All illnesses and costs resulting from exposure to ionising radiation or contamination by radioactivity from any nuclear fuel (in explosive or dangerous form) or any nuclear waste produced during the burning of nuclear fuel during a nuclear, chemical, or biological attack.
  • Any alopecia treatment and related costs for products, wigs, or toupees, as well as treatments for hair loss.
  • The price of any health examinations, medical certificates, and exams that are necessary for employment, travel, or other similar purposes.
  • From the time the treating physician confirms the patient is in a vegetative state, artificial life maintenance, including the use of life support machines, is permitted.

How to Get the United India Group Health Insurance Policy?

However, the United India General Insurance website does not offer the policy for sale. There is no reason to worry, though. Probus Insurance is here to assist you;

To meet the exploding demand of the populace, Probus Insurance Broker Private Limited is a specialised insurance broker that operates throughout India and offers a wide range of insurance plans (including life and non-life).

Below is a list of the steps you should consider taking to purchase the UNI Group Health Insurance Policy through Probus Insurance.

  • The top of this page is where you’ll find the “Product” section. Moving your mouse over it brings up the term “Health Insurance”. Just press it.
  • The subsequent step includes choosing the gender you are and entering your “pin code” in the space provided on the right side of the page. From the menu, opt for “Continue”.
  • Figure out which person you want to insure next. The following procedure calls for you to choose your “deductible amount” and enter your age. (Select whether you have experienced ailments by selecting yes or no). After that, click “Get Plan”.
  • As quickly as you proceed to the next step, a list of plans and the required premium amount will appear on the screen. After that, locate your “UNI Group Health Insurance Policy” and buy it as soon as possible.

If you still experience difficulties purchasing the UNI Group Health Insurance Policy right away, just get in touch with a Probus Insurance customer service agent. The details for getting in touch are given below.

  • Via Call: +91 7304332968
  • Via WhatsApp: Say “Hi” to 7304332968
  • Via Mail: care@probusinsurance.com

Claim Process Of UNI Group Health Insurance Policy

One of the key characteristics of group health insurance policies is their hassle-free claims process, so employers must comprehend how the UNI group health insurance policy handles claims. A request for reimbursement for hospitalisation costs incurred by the insured employee during the policy period is known as a “Group Health Insurance Claim” under the terms of the group health insurance policy.

There are two types of claims in group health insurance. They are cashless claims and reimbursement claims.

Cashless Claim Process:

Depending on your insurer, the claim procedure might differ. The typical cashless claims procedure is outlined below.

  • In the network hospital, the policyholder presents the ID card provided by the insurer along with the specifics of the insurance policy they have purchased.
  • The hospital will send the TPA the information regarding the procedure and insurance.
  • The pre-authorization letter is checked by the TPA before being sent to the hospital.
  • The insurer pays the bills when the patient is released from the hospital. Only if any minor expenses are not covered by the policy will the policyholder be responsible for paying.
  • Both planned hospitalisation and emergency hospitalisation follow the same procedure. However, the claim intimation needs to be submitted within the previously mentioned window of time.

Reimbursement Claim Process:

You can start the reimbursement claims at the hospital of your choice. The standard procedure entails;

  • The insured or policyholder is responsible for covering all hospitalization-related expenses, including medical bills. Make sure to safely store all the receipts for the claim.
  • Send the insurer the original invoices along with a properly completed claim form. The majority of the time, the insurer’s website or offices will have the claim forms.
  • Following this, the claim request is examined and handled by the policy’s terms and conditions.
  • The insurer settles the payment to the policyholder’s account once the claim has been validated and the bills have been determined to be reliable.

Required Documents

Listed below are the documents required to file a claim for the Group Health Policy by UNI.

  • Duly filled claim form. Available on the website or the offices of the insurer as well.
  • The health insurance ID card is provided by the insurer.
  • After this, the claim request is verified and processed according to the terms and conditions of the policy.
  • A valid unique identity card like Aadhar, Voter ID, etc.
  • All the original medical bills and pharmacy bills.
  • Doctor consultation and prescription papers.
  • Investigation report
  • Discharge summary from the hospital.
  • A medical certificate signed by the doctor in charge.
  • For accidents, FIR or MLC (Medico-Legal Certificate) copy
  • Other relevant documents.

Frequently Asked Questions

By providing 15 days’ written notice, the policyholder may request cancellation of the policy at any time. In this situation, the plan will provide a short-term refund of the percentage of premium paid for the remaining Policy Period.

If a medical condition arises during the policy period, the plan will enable the insured to obtain a remote second opinion at the frequency specified in the policy schedule or certificate of insurance.

Yes, in regards to an Injury sustained while the Insured Person is participating in an adventure sport carried out by the rules, the plan will pay the Reasonable and Customary Charges incurred during the Policy period, up to the sub-limit specified in the Policy Schedule/Certificate of Insurance and which would be a part of the Base Sum Insured.

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