Hospitalization/Inpatient

Hospitalization/Inpatient expense reimbursement is limited to INR 500,000 per family per year (Base cover). The period for which an insured person is admitted in the hospital as inpatient and stays there for the sole purpose of receiving the necessary and reasonable treatment for the disease/ailment contracted/injuries sustained during the period of policy. (A). The minimum period of stay shall be 24 hours other than cases mentioned below (B). All expenses shall be reimbursed provided they are incurred in India. (C) All expenses to be incurred within the policy period.

Co-Payment under the Base Cover

A Co-payment of 20% on parental (or parents-In-law) claims and 10% on employee, spouse and children is applicable on the approved hospital bill. Example: For INR 10,000 as claimed amount for hospitalization of a parent (or In-laws), Insurance company will pay INR 8000, and employee must pay INR 2000 in such a scenario.

Note: Co-pay is not applicable on the top-Up cover chosen by employee i.e. Co-pay will be applicable only on Base cover of 5 Lakhs but not on the top-up insurance.​

Day Care

As a standard rule, expenses of hospitalization for minimum period of 24 hours are admissible. Certain treatments may be covered if they do not meet the 24-hour hospitalization as long as the treatments were provided on an inpatient basis and discharged the same day. However, this time limit is not applied to specific procedures/treatments i.e. Dialysis, Chemotherapy & Radiotherapy (for cancer), Cataract, Lithotripsy (Kidney Stone removal), D & C (Dilation & Curettage), Tonsillectomy, Coronary Angiography etc. This is not an exhaustive list of day care procedures/treatments, please also refer to exclusions mentioned under “General Exclusions” section.

For a complete list of covered day care treatments/procedures as well as exclusions, please write to vmware@fhpl.net with a cc to insurancehelpdesk@vmware.com 

Cataract Cover

Cataract Surgeries are covered up to conventional method procedures only and lens associated with the surgery up to multi-focal lens. Trifocal lens and laser treatment towards cataract are not covered under the policy.

Hospitalization Expenses

If the Insured is diagnosed with an Illness or suffers Accidental Bodily Injury which necessitates his Hospitalization for a minimum of 24 hours with an active line of treatment, the Insurer will reimburse the Insured Person’s consequent Hospitalization Expenses for:

• Room Rent (inclusive of nursing charges) – Restricted to Single Standard A/C room, no restriction on ICU
• Doctor’s fees (Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists fees)
• Intensive Care Unit
• Nursing expenses
• Surgical fees, operating theater, anesthesia, blood and oxygen
• Physiotherapy
• Drugs and medicines consumed on the premises
• Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)
• Costs of prosthetic devices if implanted during a surgical procedure (Copy of Original tax invoice of the hospital vendor mandatory)
• Organ transplantation including the treatment costs of the donor but, excluding the costs of the organ.
• Instrument charges payable up to INR 25,000/-

Pre-Hospitalization Expenses

If the Insured Person is diagnosed with an Illness which results in Hospitalization and for which the Insurer accepts a claim under a) above, the Insurer will reimburse  Insured Person’s Pre-Hospitalization expenses for up to 60 days prior to  Hospitalization.

Post-Hospitalization Expenses

If the Insurer accepts a claim under the above and, immediately following the Insured Person’s discharge, s/he requires further medical treatment directly related to the same condition for which the Insured Person was Hospitalized, the Insurer will reimburse the insured person’s post-hospitalization expenses for up to 90 days following his discharge.

Local Emergency Ambulance Services

The Insurer will also pay for Emergency ambulance road transportation by a licensed ambulance service to the nearest Hospital where Emergency Health Services can be rendered. Coverage is only provided in the event of an Emergency. These expenses are payable up to INR 3,000 per person per occurrence.

Maternity Health Cover

Treatment taken in Hospital arising from or traceable to Pregnancy, Childbirth including normal delivery/caesarian section.

Special Conditions Applicable to Maternity Health Cover Extension:

• These benefits are admissible only if the expenses are incurred in Hospital as in-patients in India.
• Claim in respect of delivery for only first two children and/or operations associated therewith will be considered in respect of any one Insured person covered under the Policy or any renewal thereof. Insured Persons with two or more children will not be eligible for this benefit.
• Expenses incurred in connection with voluntary termination of pregnancy (except where carried out under medical advice) during first 12 weeks from the date of conception are not covered.
• Any hospitalization with an active line of treatment that occurs during the pre and post-natal period will be covered only up to the maternity limit.

Maternity limit: Up to INR 75,000 per pregnancy /policy year (Applicable only towards the first two living children).

The above includes up to INR 2,500 per pregnancy /policy year towards Pre-natal and Postnatal expenses.

Part Maternity claims, where the Sum Insured towards the maternity benefit is exhausted under some other policy, are payable up to the maternity limit.

General Exclusions

• Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations or directly or indirectly caused by nuclear weapons.
• Circumcision unless necessitated due to an accident or necessary for treatment of a disease not excluded here under or as may be necessitated due to any accident), vaccination, inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or part of an illness.
• Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, cost of spectacles, contact lenses, hearing aids, non-medical pharmacy items, dressing charges, taxes, etc.
• Convalescence, general debility, “run down” condition or rest cure, sterility, intentional self-injury / suicide, all psychiatric and psychosomatic disorders and disease / accident due to and or use, misuse or abuse of drugs / alcohol or use of intoxicating substances or such abuse or additions etc.
• Domiciliary Hospitalization Benefit.
• HIV and AIDS & Venereal diseases.
• Infertility treatment: Expenses related to sterility and infertility which includes: i Any type of sterilization ii. Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI iii. Gestational Surrogacy iv. Reversal of sterilization
• Naturopathy, unproven procedure or treatment, experimental or alternative medicine and related treatment including acupressure, acupuncture, magnetic and such other therapies etc.
• Vitamins and tonics unless used for treatment of injury or disease.
• Voluntary termination of pregnancy during first 12 weeks (MTP).
• Ayurvedic treatment unless taken at registered Government hospital/ Government medical colleges.
• Expenses incurred at Hospital or nursing home primarily for evaluation/ diagnostic purposes which is not followed by active treatment for the ailment during the hospitalized period.
• Expenses incurred for investigation or treatment irrelevant to the diseases diagnosed during the hospitalization or primary reasons for admission.
• Genetic disorders and stem cell implantation/Surgery.
• External and or durable medical/non-medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Infusion pump, battery replacement etc., Ambulatory devices i.e. walker, crutches, belts, collars, caps, splints, slings, braces, stockings etc. of any kind, diabetic foot wear, glucometer/thermometer and similar related items and also any medical equipment which is subsequently used at home etc.
• Doctor’s home visit charges, attendant /nursing charges during pre and post hospitalization period.
• Treatment which is continued before hospitalization and continued even after discharge for an ailment/disease/injury different from the one for which the hospitalization was necessary.
• Outpatient diagnostic, medical or surgical procedures or treatments, non-prescribed drugs and medical supplies, hormone replacement therapy, sex change or treatment which results from or is in any way related to sex change.
• Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, Root canal including wear and tear etc. unless arising from disease or injury and which requires hospitalization for treatment.
• Expenses incurred during hospitalization or during the pre-post period that are not medically justified.
• All expenses arising out of any condition directly or indirectly cause by, or associated with Human T-Lymphotropic Virus Type III (HTLD-III) or Lymohadinopathy Associated Virus(LAV) or the mutants derivatives or Variations Deficiency Syndrome or any syndrome or condition of similar kind commonly referred to as AIDS , HIV and its complications including sexually transmitted diseases.
• Any treatment arising out of the Insured’s participation in hazardous activity including but not limited to scuba diving, motor racing, parachuting, hand gliding. Rock or mountain climbing etc.
• Treatment of obesity or ailment arising there from (including morbid obesity) and any other weight control program, services or supplies etc.
• If the Insured opts for a higher Hospitalization Class than the terms of the authorization obtained, then the amount payable (all medically payable charges) by or on behalf of the Insurer shall be reduced in direct proportion and shall be borne by the Policyholder or Primary Insured.

Note: This is not an exhaustive list of exclusions. For a complete list of  exclusions, please write to vmware@fhpl.net with a cc to insurancehelpdesk@vmware.com 

Voluntary Top-Up Cover

A top up health insurance is an extra safety net that provides additional health insurance over and above any existing insurance coverage available. The benefits of the policy are the same as existing policy. The top up available to employees is an additional INR 200,000 or INR 300,000 or INR 500,000 or INR 1,000,000 or INR 1,500,000 over and above the existing INR 500,000 base cover, however, the premium for top up needs to be borne by the employees.

How it works: The Company’s cover is for max of INR 500,000, in case you or your declared dependents need to undergo a treatment which costs beyond INR 500,000 then the top up can be utilized as an additional cover. All other terms and conditions of the policy remain unchanged.

Top-Up Premium Amount: Please click on the link below for Top-Up premium amount which has been negotiated for VMware employees.

Review the Policies and Procedures to view the Top-Up premium.

Note:

• Policy conditions remains as per the main policy. However, co-pay and maternity coverage is not applicable on Top-up
• In case employee leaves VMware India before policy expiry date (31st July 2023), premium paid towards Top-up will not be refunded and the benefit would not be continued.
• For new hires, premium will be calculated on pro-rata basis and deduction will happen in the subsequent month payroll. New hires need to re-select top-up cover for the new policy year during annual enrollment as it will not be automatically carried forward from the current year
• For existing employees, the amount towards annual premium will be deducted from your salary – One-time deduction
• Tax exemption under 80D on top-up policy premium (**Subject to change in Income Tax Law)
• Note: All employees need to select top-up cover for the new policy year during annual enrollment as it will not be automatically carried forward from the current year

Enrollment of Dependents

If you wish to enroll dependents in the Healthcare Plan, you must do so within 30 days of your date of joining. Coverage is effective on your date of hire. If you choose not to enroll dependents within 30 days of your date of hire, you will not be permitted to do so till the next annual enrollment window is open. If you experience a qualifying life changing event, you may enroll the new dependent within 30 days of the change or during the annual Open Enrollment period effective August 1st every year. Cohabitation partners need to fill Committed relationship form and complete the enrollment on MyLife [VMware network access required] portal upon qualifying the eligibility period.

Contributions

VMware pays 100% of the premium costs (Base Cover only) for you and your eligible dependents.

When Coverage Begins

Coverage for you will begin on the first day of your employment with VMware India and coverage for your dependents commence upon your declaring them on MyLife [VMware network access required].

When Coverage Ends

Coverage for you and your dependents under the VMware Healthcare plan(including top-up insurance) will end on the last day of your employment with VMware India. Please note that access to MyLife and FHPL portal will be deactivated upon your last date of work. We encourage submission of new & pending claim documents (original/hardcopy) to insurance helpdesk before your last date.

Note : There is an option for employees to opt for portability of insurance into a retail plan. This is solely at the discretion of the insurer based on underwriting terms and conditions. Please reach out to our Broker Marsh India (charan.v@marsh.com) 30 days in advance of your last date of work for further details. Please note that employees may opt for this at their own discretion as portability is not managed by VMware India. Insurer may extend the continuity of benefits like waiver of waiting period and pre-existing coverage etc. based on Insurance claim history and tenure.

Example: If market policy has a waiting period of four years, and if the insured is covered under group policy for four or more years, the waiting period exclusion may be waived.

You have to avail market policy before last day of employment with VMware India in order to avail continuity benefits as stated above.

Claims Process:

• Pre-Authorization Form is required to be filled and submitted at hospital insurance desk for availing cashless hospitalization. The form needs to be sent 3 days in advance for all planned hospitalizations.
• A Reimbursement​ Claim Form is to be submitted as per the Claim Submission Checklist. The claim needs to be submitted within 30 days from date of discharge.
• Pre and post-hospitalization expenses up to 60 days before and 90 days after can be reimbursed as per the Claim Submission Checklist​. The claims need to be submitted within 15 days, upon completion of 90 days from date of discharge.