Benefits (As per cover plan)
a. In-Patient Hospitalization Services
Including the following while the member is hospitalized:
- Surgical operations and procedures
- Professional fees
- Theatre fees
- Anaesthetics for surgery
- Assistants at operations
- Ward accommodation
- Intensive care and high care units
- Visits and consultation by a GP and / or Specialist (while hospitalized)
- X-ray and pathology (while hospitalized)
- Physiotherapy
- Ultrasound scans (while hospitalized)
- MRI and CT scan (while hospitalized)
- Blood transfusion
- Internal prostheses
- Medicine dispensed and used in hospital
Medicine dispensed on discharge from hospital 100% of cost (maximum of 14 days’ supply)
b. Annual Well Person Benefits
Annual Well person check up that includes the following:
- Comprehensive History & physical exam
- Random blood sugar
- Urea, Electrolytes *creatinine (kidney functions)
- Liver function test
- Stool for occult
- ECG
- Nutritional consultation: One consultation per year
- Lipid profile: One test per year
- Pap smear : One test per year for women aged 18 and above
- Mammogram: Women aged 40 and above once every two years
- Prostate Cancer Screening : One test per year for men aged 50 and above
c. Other
Qualification for Corporate Plans is a minimum of Ten (10) employees
- For Fortune Plan proof of association is mandatory with a minimum of 5 members
- Personal Accident cover is for accidental death, permanent total disability (PTD) and critical illness. Child guard is a Personal Accident cover for children. These vary as per plan selected.
- The Personal Accident claim on Death, PTD and Critical Illness, is payable only on one of the benefits given and is limited to once in a lifetime.
- Rehabilitation benefit includes aiding a member, following an admission due to illness or accident that lasts more than 3 days, using medically necessary practices to manage their current medical status. A consultant has to confirm in writing that rehabilitation is required.
- Services offered are Physiotherapy services; Occupational Therapy and Post Admission Consultation Reviews.
- Rehabilitation is subject to a specific number of days, or a sublimit whichever occurs earlier.
- Access to Annual Well person checkups is at selected Medical Service Centres only. The service has to be pre-authorised by Resolution Health.
- New Born Baby Illness Cover is a benefit under the mother’s congenital cover and includes babies born prematurely. This cover is for illness after birth and before discharge.
- All members of a family will be required to take up the same product line
- Corporate groups who subscribe to a limited panel of Medical Service Provider List get a discount on premium.
- Lodger fee for parent accompanying child below 6 years
- Home care services: This includes home based health and nursing services provided by visiting professionals such as a nurse, physiotherapist or home health agency. This benefit is provided post discharge where medically necessary, subject to approval and is coordinated by a Resolution Health Care Manager up to a maximum of 90 days per membership year.
- Third part recovery:- Where Cost incurred are recoverable from a third party, the Member shall facilitate Resolution Health’s involvement to ensure it recovers such costs from and through all relevant parties.
