i. In-Hospitalisation / In-Patient (IP)
In-hospitalisation 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 and laboratory expenses, physiotherapy, pre and post hospitalisation 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 caesarean 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. Outpatient (OP)
Outpatient benefits are payable in excess of applicable co-insurance or co-payment for covered actual outpatient 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 and glass lenses for refraction benefits. Cost of contact lenses is not covered. Minimum 50 eligible employees are required to avail this benefit.
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.
NIA Product Code: NIA/LI005/2071/072/GP/0008
Group Medical Policy Wording
