Employee Wellness Program

Features of Group Mediclaim OPD and Wellness Plan

Following are the unique features of OPD and Wellness cover for Group Mediclaim policy:

• Available for people with group health insurance

• Covers outpatient department (OPD) fee and wellness charges

• Purchased as an add-on cover only

• Provides cashless payment option

• Covers physical consultation, teleconsultation & e-consultation

Types of Plans under Group Mediclaim OPD and Wellness

Three types of coverage plans are available under the Group mediclaim OPD and wellness cover. They are:

1. Good Health+ - Good Health+ is a customized group OPD plan that provides coverage against medical expenses arising out of outpatient consultations, dental treatments, diagnostic tests, pharmacy expenses and vaccinations.

2. Care Well - Care Well is a non-selective group OPD plan that provides coverage against health expenses incurred on outpatient consultations, health check-ups, pharmacy expenses and teleconsultations. It also provides the group members with saving options in the form of ‘Discount Connect’ to reduce their healthcare expenditure.

3. E-Consultation - E-Consultation is a group health plan that provides coverage for online consultation fees charged by medical practitioners, such as a general physician, orthopaedic, gynaecologist, paediatrician, cardiologist, dermatologist and diabetologist among others. It allows the insured to avail online consultations through phone chat, voice call and video call.

Group Mediclaim OPD and Wellness Plans at a Glance

Good Health+

Good Health+ covers the daily or routine healthcare needs of a person insured under group health insurance up to the limit of the wallet. It offers sum insured of a minimum of Rs 7,500 to a maximum of Rs 2 lakh.

Coverage Under Good Health+ Plan

Good Health+ provides coverage for the following health expenses:

• OPD Consultation - It covers the expenses incurred on taking physical outpatient consultation with a medical practitioner, which does not require the insured to get hospitalized. It includes consultations taken by a general physician or a medical specialist. It does not cover consultations taken through homeopathic doctors.
• Diagnostic Tests - It covers the cost of diagnostic tests that have been prescribed by a doctor. For example, X-rays, ultrasound, blood test, etc. It does not include tests conducted for the purpose of preventive health check-ups.
• Pharmacy Expenses - It covers the cost of medicines that have been prescribed to the insured by a doctor. Under some plans, pharmacy vouchers may be given to the insured.
• Dental Procedures - It covers the medical expenses incurred on dental procedures, such as root canal treatment, root amputation, extractions, tooth X-rays, etc. It does not cover the cost of any cosmetic procedure undertaken by the insured member.
• Vaccination - It covers the cost of all vaccinations prescribed by a doctor or recommended by the World Health Organisation (WHO). This benefit is only available for insured children up to the age of 10 years.

Care Well

Care Well covers regular healthcare needs of an individual insured under a group health insurance policy up to the limit mentioned for each coverage benefit. Care Well is available under two sub-plans - Care Well Basic and Care Well Advance. Each sub-plan offers three coverage options for the insured employee/ group member to choose from.

Coverage Under Care Well Plan:

Care Well provides coverage for the following healthcare expenses:

• OPD Consultation - It provides coverage for OPD charges incurred on taking outpatient consultation with a medical practitioner, including general physician and medical specialists. It does not cover the cost of OPD consultation taken by a homeopathic doctor. While the Care Well Basic plan covers consultation fees up to Rs 2000, the Care Well Advance plan comes with a coverage limit of Rs 3000.
• Pharmacy Expenses - It covers the cost of medicines prescribed by a medical practitioner. The medicines cost will be covered on the sum insured or voucher basis. The Care Well Basic plan covers pharmacy expenses up to Rs 500, while the Care Well Advance plan covers medicines up to Rs 750.
• Health Check-Ups - It covers the medical expenses incurred by the insured on getting regular health check-ups. Every member is eligible to undergo health check-up under this cover. Moreover, Care Well also offers the facility of home sample collections for tests at over 40 cities across the country. The Care Well Basic plan covers 30 parameters, comprising of lipid profile, liver profile, kidney profile, iron deficiency and thyroid profile. In addition to these parameters under the Basic plan, the Care Well Advance plan covers 63 parameters that also includes complete hemogram, diabetic screen including Hba1c, vitamin profile D & B12 and testosterone.
• Teleconsultation - It offers medical consultation with a general physician over the telephone and covers the charges involved. The insured member can take unlimited teleconsultations during a policy year.
• Discount Connect - It provides the group members with saving options to lower the expenses incurred at network providers of the insurance company. The saving options can be used on OPD consultations, OPD procedures, diagnostic tests, radiology services, pharmacy expenses, health check-ups, etc. Discount Connect comes with a subscription of one year.
• Consultation

E-Consultation comes with both selection and non-selection option. It is available for a policy tenure of one year but has lifelong renewability. For every e-consultation, an online prescription will be provided to the insured. Besides, an insured member can take an unlimited number of e-consultations during the policy year.

E-Consultation offers six types of subscription plans that are illustrated in the table below:

Eligibility for Group Mediclaim OPD and Wellness Plan

Take a look at the eligibility criteria of OPD and Wellness plan for Group Mediclaim policy:

• Adults between 18 years to 60 years can purchase this plan. Senior citizens, such as parents and parents-in-law, can be covered up to 80 years.
• Children from 91 days to up to 18 years can be covered
• A maximum of six family members comprising of self, spouse, daughter, son, father, mother, father-in-law and mother-in-law can be covered.

Who Cannot Buy Good Health+ and Care Well Plan?

The following people cannot buy Good Health+ and Care Well plan:

• Contractors
• Temporary/ Seasonal/ Substitute/ Uncompensated employees
• Volunteers
• Silent Partners
• Shareholders/ Investors
• Non-active, temporary, freelance officers or managing members of the group/ company

Health Insurance Companies Offering Group OPD and Wellness Cover

The following table shows the health insurance companies that offer OPD and wellness covers under their group health insurance plans: