Employee Benefits

1. GROUP TERM LIFE

i. LIFE (Death due to – Accident & Sickness)


In the event of the insured employee’s death due to any cause – accident or sickness occurring anywhere in the world, except for death resulting from active participation in war or war like operations, and suicide in the first year of coverage, the benefit amount shall be paid in a lump-sum to his/her beneficiary.

 

ii. PERMANENT TOTAL DISABILITY RIDER (Due to Accident & Sickness)

 

If any insured employee becomes totally and permanently disabled from bodily injury due to accident or sickness and is wholly prevented from performing any occupation for remuneration or profit while less than 60 years of age, the benefit under this is payable in sixty monthly installments following a one-year disability waiting period. Extension of Death Benefit with no additional cost:If an insured employee becomes totally disabled due to an accident or sickness after he has been insured for twelve consecutive months and prior to his sixtieth birthday and dies within the next twelve months, the insured amount shall be paid in a lump-sum to his/her beneficiary.

 

iii. PERMANENT PARTIAL DISABILITY RIDER (Due to Accident & Sickness)

 

This benefit becomes payable if an insured employee becomes partially disabled on a permanent basis, as a result of a bodily injury due to an accident or sickness, while less than 60 years of age and at least six months after he becomes insured under this plan. The lump sum payment shall be made to the insured for that disability in accordance with the Schedule of Payments below.

Loss of arm between shoulder and wrist

50%

Loss of whole middle finger

6%

Loss of all toes

15%

Loss of hand below wrist

50%

Loss of whole ring finger

5%

Loss of one eye

50%

Loss of four fingers and thumb

40%

Loss of whole little finger

4%

Deafness in both ears

50%

Loss of four fingers

35%

Loss of leg at hip

50%

Deafness in one ear

15%

Loss of whole thumb

25%

Loss of leg between knee and hip 

50%

Loss of great toe

5%

Loss of whole index finger

10%

Loss of leg below knee

35%

Loss of other than great, if more than one toe, each

1%

                                                                                                                                                                                                                                                      

2. GROUP PERSONAL ACCIDENT & HEALTH

i.   Accidental Death

If an accidental injury results in the death of an insured employee, the insured amount shall be paid to his/her beneficiary.

ii.  Dismemberment, Loss of Sight, Hearing, and Speech Indemnity

If an accidental injury results in any of the following losses to an insured employee, the payment shall be made in one lump sum to the insured employee in accordance with the applicable percentage indicated here below to be applied to the insured amount.

Loss of Both Hands or Both Feet

100%

Loss of either Hand or Foot and Sight in one eye

100%

Loss of either Hand or Foot

50%

Loss of Sight in Both Eyes

100%

Loss of Speech

100%

Loss of Sight in one Eye

50%

Loss of one Hand and one Foot

100%

Loss of Hearing in Both Ears

100%

Loss of Thumb & Index Finger

25

 iii. Total and Permanent Disability

If, as the result of an accidental injury an insured employee becomes Totally Disabled, which disability has continued for a period of twelve (12) consecutive months and is unable to engage in any gainful occupation or employment for the remainder of the Insured employee’s life, the benefit amount shall be paid in a lump-sum to such Insured employee.

iv. Accidental Medical Expenses Reimbursement (AMR)

If, as a result of an accidental injury, an insured employee shall require treatment by a physician, use of hospital facilities, or the employment of a licensed or graduate nurse while at the hospital, the Reasonable, Customary and Necessary medical expenses incurred within fifty two (52) weeks from the date of the accident for such physician treatment, hospital charges and nurses fees, which are in excess of the deductible (if any) and up to insured amount limit stated in the Policy shall be paid.

v. Accidental Weekly Disability Indemnity (AWI)

If, as the result of an accidental injury, an insured employee is Totally Disabled and remains so continuously for a period in excess of the Elimination Period i.e. 1 week (7 days), the Weekly Accidental Disability Indemnity applicable to such Insured employee shall be paid periodically beginning with the first day following such Elimination Period, for the continuous duration of Total Disability, but not to exceed the maximum period of fifty two (52) weeks.

vii. In-Hospital Weekly Income – Accident & Sickness (IH- A&S)

When, as the result of accidental Injury or commencement of sickness, an insured employee shall be necessarily confined within a hospital as an In-patient for at least 24 hours under the continuous attendance of a physician, the Weekly Benefit stated in the Policy shall be paid, for each week that the Insured person shall be confined therein, up to fifty-two (52) weeks, commencing immediately following the Elimination (if any) stated in the Policy.

3. GROUP CRITICAL ILLNESS

Critical Illness provides a lump sum payment to an insured employee when the insured employee is diagnosed to be suffering from a critical illness as listed and defined in the Policy. Employees and their dependants can be covered under one of the following 3 plans.

Plan 1: Major Cancer Only; or

Plan 2: Major Cancers, Stroke, First Heart Attack, Serious Coronary Artery Disease, Heart Valve Surgery, Primary Pulmonary Hypertension;

Plan 3:  Major Cancers, Stroke, First Heart Attack, Serious Coronary Artery Disease, Heart Valve Surgery, Primary Pulmonary Hypertension, End Stage Lung Disease, End Stage Liver Failure, Fulminant Hepatitis, Kidney Failure, Coma, Aplastic Anaemia, Major Organ/Bone Marrow Transplantation.
First policy issue date: 02/05/2004

4. COMPREHENSIVE GROUP MEDICAL

Comprehensive Group Medical Insurance Policy provides flexible & customizable benefits that can be tailored to fit the needs of organizations for the welfare of their employees, employees’ spouse and dependent children. Medical treatment expenses against injury or sickness are reimbursed to the insured for reasonable & customary charges actually made by the insured up to a pre-determined maximum limit provided by the plan under the following benefits;

 

i.        In- Hospitalization / In-Patient (IP)

In-hospitalization benefits are payable for covered actual expenses incurred by an insured person during insured’s confinement in a hospital due to injury or sickness up to applicable plan limits for room & board, ICU / intensive care, surgeries, anesthesia, prescribed medicine, consultation, general nursing care, registered ambulance services to and from hospital, surgical benefits, diagnostic & laboratory expenses, physiotherapy, pre and post hospitalization expenses etc.


ii.      Maternity (MAT)

Maternity benefits are payable for covered actual expenses incurred by an insured person due to pregnancy confinement up to plan limits. Normal delivery or cesarean section or legal abortion or miscarriage include charges for routine delivery / admission, pre and post natal cares, all check-ups and other costs of pregnancy. Reimbursement shall be made for maternity / obstetrical confinement expenses only incurred after the insured has been enrolled in the appropriate category for at least 280 consecutive days.

 

iii.   Out-Patient (OP)

Out-patient benefits are payable in excess of applicable co-insurance or co-payment for covered actual out-patient expenses incurred by an insured up to applicable plan limits under the doctor consultation, investigation and medicine benefits. Minimum 25 eligible employees are required to avail this benefit.

 

iv.    Dental (DEN)

Dental benefits are payable in excess of applicable co-insurance or co-payment for covered actual routine dental treatment expenses incurred by an insured up to applicable plan limits under consultation, medication, scaling, filing, routine extraction, imaging/x-ray, root canal treatment (RCT), capping for RCT benefits. Aesthetics and Dentures are not covered. Minimum 50 eligible employees are required to avail this benefit.

 

v.      Optical (OPT)

Optical benefits are payable in excess of applicable co-insurance or co-payment for covered actual routine optical treatment expenses incurred by an insured up to applicable plan limits under consultation / tests for errors of refraction, prescribed medicine, prescribed frames & glass lenses for refraction benefits. Cost of contact lenses is not covered. Minimum 50 eligible employees are required to avail this benefit.


 
The required forms can be downloaded by clicking the links below:
  1.     Request For Proposal  (RFP) form ------------------------------------- Click here to download
  2.     Corporate Customer Profile form --------------------------------------- Click here to download
  3.     Census (Employee Detail) form ----------------------------------------  Click here to download
  4.     Enrollment form -------------------------------------------------------------- Click here to download
  5.     Health Declaration (G-42) form ------------------------------------------ Click here to download


First policy issue date: 02/04/2015

MetLife Group Insurance Policies contain certain exclusions, deductibles, limitations and terms. Contact MetLife representative or call us for more information.