Question 1

Which account will my premium payment be transferred to?

Accepted Answer

This will be transferred to the account of the Oriental Insurance Company

Question 2

Are payments to Alumni Association eligible for 80G or we get income tax rebate for insurance?

Accepted Answer

No, this amount will not be eligible for tax deductions.

Question 3

Once this plan comes into force, hope any alumni should be allowed to join the plan at any point of time based on allowable age limit?"

Accepted Answer

One entry window is planned in the first year of the plan. All alumni are eligible to join the plan. Hence it is in the best interest of the group that we don’t defer the  joining.

Question 4

Females may have their maiden name in the alma mater database but my health card needs to be in my current name. What should I do?

Accepted Answer

Please register with the name that you want on your health card and which also reflects in an official identity proof.

Question 5

When will the policy start? When will we receive our health cards?

Accepted Answer

The policy will start on May 14, 2021; claims will get honoured from this date The purchasing members are likely to receive their health cards around June 1st week

Question 6

Who will determine the alumni status?

Accepted Answer

The Alumni association would determine this – the definition would be made liberal to include alumni from across programs

Question 7

Will this plan work in conjunction with an individual health insurance plan that I have already purchased?

Accepted Answer

Yes. Absolutely. But please note that the waiting periods of the top-up policies would be waived off only if they are already waived off in your individual insurance policy.

Question 8

If two alumni are married does it make sense to have the younger spouse buy this for the family

Accepted Answer

No. The age of the oldest member in the family unit is considered to arrive at the slab rate

Question 9

Can someone buy base for parent and top-up for parent-in law or vice versa?

Accepted Answer

Yes

Question 10

Will this plan work in conjunction with my group health insurance scheme provided by my employee?

Accepted Answer

Yes. Absolutely.

Question 11

Why is it restricted to 2 dependent children? Is there no scope for the unit to include more children that are dependent?

Accepted Answer

The current offering is a standard plan and unfortunately covers maximum of 2 children.

Question 12

If I am covered by my spouse's policy, can I go ahead and enrol in the top up plan without having a base policy in my name?"

Accepted Answer

Yes

Question 13

Who will administer this plan? Who is the insurance company?

Accepted Answer

A) ELSA will administer the plan. Oriental Insurance Company is the insurer. B)Master policy would be issued to ELSA. Purchasers would be the members of the master policy

Question 14

Exit situation in case this group policy is not able to sustain for 4 years.

Accepted Answer

The waiting period credits is for the duration the members they stay with this group and plan - it’s highly unlikely that the group will dissolve and that too in a short time . Recommendation is to purchase additional insurance today for the following reasons :
1. Claims experience would be much smoother as part of this group
2. If you are covered by a corporate , it’s preferable to have ones own protection independent of employment 
3. If covered by your existing individual plan , it’s a good strategy to maintain the cumulative bonus on the same

Question 15

If I get married in the future, will I be able to add my spouse at no extra cost? Also, children in future?"

Accepted Answer

Yes. One can add both children / spouse on a  future date

Question 16

If the alumnus passes away does the policy continue for family

Accepted Answer

No, but the family will remain to be covered for the particular policy year. To continue to cover the family members from the next year, the family members can renew on individual policy ( port into individual plan) along with benefits of time spent on the group plan.

Question 17

Both of us, husband and wife are alumni. If policy holder passes away can the cover pass on to the remaining alumnus spouse?"

Accepted Answer

Yes. That is possible because for the next year the survivor can join the plan on the basis of his/her status as an alum

Question 18

Can one exit the plan and join back again?

Accepted Answer

No, once you exit the plan, you may not be allowed to join back the scheme. This is to prevent any kind of anti-selection. Members can’t insure themselves only when they expect some medical issue to come through.

Question 19

What if the policy goes for renewal and there aren’t enough members buying? How is sustainability of policy ensured?

Accepted Answer

The policy has been negotiated in multiple rounds to keep the minimum subscriber numbers to be as low as 1000 members which is a small proportion of the total alumni base.  Our overall member count increases by 1000 every year. Considering the exclusive benefits and considerable savings in premium, subscriber base is going to increase with passing time. So likelihood of such occurrence is low.

Question 20

If due to an unfortunate health event, I use my sum insured in a given year, will I be eligible for next year? Or is it one-off amount?"

Accepted Answer

Yes, you will be eligible next year as well. This is an annual cover for the family

Question 21

If premium is increased in 2nd year, can I pull back if I do not like the price? What if the base year price is low but then the second year is increased significantly?"

Accepted Answer

The option to pull out is available but once you opt out, you may not be able to re-enter the program on a future date. One needs to remember the ‘group construct’. A premium increase would mean that there have been claims in the group. In other words we have helped one of our alumnus / alumni to tide over their medical bills.

Question 22

Would it require health check-up/tests before enrolment?

Accepted Answer

No, since this is a group health insurance plan, there are no requirements of a health check-up This is a big benefit, as many individual plans require a medical test, which are often a hassle

Question 23

Isn't it easier to enhance the sum insured with the existing insurance provider

Accepted Answer

The group top up plan has a few key advantages over an open market policy – waiver of waiting periods (only 1 month for family policy and 3 months for parents) (in case already covered by the base plan), high room and ICU capping, high entry age of 80 years and lower premiums.  Also if you increase your sum insured, you may be subject to underwriting guidelines for the increased sum insured

Question 24

Will premium increase be same for everyone or will it increase basis individual's past claims?

Accepted Answer

This is a group plan and hence the price decrease or increase will be for the entire group.

Question 25

Is entry into the policy possible at the time of renewal, if not opted now?"

Accepted Answer

Yes

Question 26

Who issues the receipt for the payment made by an individual - the insurance company or the alumni association?

Accepted Answer

Receipt against funds transferred would be issued by the Alyve Health platform on behalf of the Alumni association

Question 27

The premium is annual or monthly

Accepted Answer

Annual

Question 28

What is the expected rise of premium from year two?

Accepted Answer

It is tough to say but dramatic changes are unlikely. Price depends on factors like claim ratio and demographics etc. – it could increase/decrease.  If the alumni association negotiates for a higher cover / deductible which may have an impact on prices. The number of members in the group is a significant criterion. To mitigate any rise in premium due to this factor, we must ensure that there is maximum participation from our alumni group.

Question 29

Will it cover OPD claims ? Please also tell us about full body check-up coverage, if any in the policy? Will this policy cover the cost of ongoing medication in the case of chronic disease treatment? (e.g. Insulin)"

Accepted Answer

No. OPD claims are not covered. Also, this does not have any annual health check-up benefits. Cost of ongoing or special medication used for the treatment of chronic conditions is not covered in this policy

Question 30

Will the top-up work even if there is no base plan?

Accepted Answer

Yes. In case you are paying the deductible out of  pocket, the standard waiting period of 4 years would apply on the PEDs.

Question 31

Is there co-pay for reimbursement claims?

Accepted Answer

No

Question 32

I have a base policy from employer where there is no waiting period. If I take the top up plan this year but leave my job over the course of next year, what happens to the waiting period?"

Accepted Answer

Most corporate plans have waiting periods waived off. In the rare case of hospitalizations in between jobs, the waiting periods would apply on the top-up plan. In case one is self-employed, it is advisable to also purchase the base insurance policy

Question 33

Can both parents and parents in law be separately covered in base and top-up plan?

Accepted Answer

Yes – this is possible. You may buy 1) Base for Parents and Top-up for Parents-in-law or 2) Base for Parents-in-law and Top-up for Parents

Question 34

Will Covid-19 treatment be covered?

Accepted Answer

Yes

Question 35

Are Ayush treatments covered?

Accepted Answer

Expenses incurred for Ayurvedic / Homeopathic / Unani Treatment are admissible up to 25% of the sum insured provided the treatment for Illness and accidental injuries, is taken in AYUSH Hospital.

Question 36

Why aspects like maternity are not part of it?

Accepted Answer

Maternity claims are limited to a certain section of the population. In such a voluntary program, insurers do not provide covers which have high probability of a claim. Furthermore, most corporate policies cover maternity

Question 37

Does the base policy have to be exhausted to claim under the top-up policy?

Accepted Answer

Yes

Question 38

Can both parents and parents in law be covered if I purchase the same plan twice?

Accepted Answer

No. Each alumnus can cover either parent(s) or parent(s) in law in each plan

Question 39

If I have another top up where the waiting period is waived off, will I get the waiting period waiver"

Accepted Answer

Waiver on waiting periods are only applicable in case it is waived off on the base policy

Question 40

I already have a base policy that I have purchased individually. Why should I switch to the LSR Alumni base policy

Accepted Answer

Any of the following reasons apply! Switching to the LSR Alumni base policy makes sense if you have a base policy which has a low cover (less than Rs 5 lacs) Switching also makes sense if you have purchased your base policy recently (less than 4 years back – in which case waiting periods would still apply on such a policy while the waiting periods are very low in the LSR Alumni base policy) (3 month for family and 6 months for parents) When you claim on the LSR  Alumni policy, you do not lose the No Claim Bonus of your individual policy – making it logical to maintain both individual plan and the LSR Alumni base plan Purchasing both the base and top-up plans from the LSR  Alumni program will enable a full cashless claim process

Question 41

I already have a base policy from my employer. Why should I purchase the base policy from the  LSR Alumni program?

Accepted Answer

The LSR alumni program is independent of your employment – this will ensure continued coverage when you are in between jobs or if you are considering self-employment Purchasing both the base and top-up plans from the LSR program will enable a full cashless claim process

Question 42

Should my existing base policy be exhausted before the top-up triggers? If my existing base policy is 7 lacs and I purchase the top up of 15 lacs and my claim is 10 lacs - how does it work?

Accepted Answer

Yes - the base policy needs to be exhausted before the top-up can trigger. In the scenario described, 7 lacs will be exhausted from the base policy first before triggering the top-up policy under which 3 lacs would be considered for claims

Question 43

What if we choose a room which has a higher room rent than the capping?

Accepted Answer

The insurer will apply a proportionate deduction on the claim reimbursement. For example, if the chosen room has a room rent 20% more than the permissible capping, then there would be a corresponding deduction in the overall claim reimbursement as well.

Question 44

Can you be reimbursed from both base and top up plans?

Accepted Answer

Yes

Question 45

What if we choose a hospital which is not in the GIPSA PPN network

Accepted Answer

Most urban hospitals are part of the GIPSA PPN network. If for any reason, one chooses a hospital which is not in the network, the insurance company will still honor the claim (as long as the chosen hospital is not in the blacklist of the insurance company) at rates which are similar to a comparable hospital in the GIPSA PPN network (e.g. hospitals in the same / similar PINCODE)

Question 46

I have a base policy from which we have made claims for cancer treatment. Will this be honoured in the top-up plan?

Accepted Answer

If your claims are getting honoured on the base policy then it will be accepted on the top up

Question 47

In case of a single claim of say, Rs 6 lacs, the hard copy documents are generally sent to the base plan. Then we are left only with photocopies. Will photocopies be accepted at Oriental Insurance Company?"

Accepted Answer

Yes, typically the insurer with the base policy will attest that all originals have been submitted to them

Question 48

What happens in case of more than 1 claim in a single financial year? Will the deductible limit be applied for both claims or only for the first claim?

Accepted Answer

Deductible of Rs 5 lacs applies for multiple events in the same year (it is an aggregate deductible)

Question 49

Cashless network and GIPSA??

Accepted Answer

The scheme is cashless for 8,000+ Oriental Insurance Company/Paramount network hospitals. Also, we get benefit of special negotiated GIPSA rates with network hospitals.
The Public Sector Insurers viz. National Insurance Co. Ltd; New India Assurance Co. Ltd.; Oriental Insurance Co. Ltd; and United India Insurance Co. Ltd. have negotiated special Package Rates with many hospitals across the Country (12 Cities) for a number of medical procedures. The negotiated tariff is offered under General Insurers Public Sector Association (GIPSA) wherein the 4 PSU insurers have created an Association and empanelled hospitals for fixed closed packages. The list of hospitals and the procedures are dynamic and exhaustive. The cities are Ahemdabad, Chandigarh, Chennai, Delhi, Hyderabad, Mumbai, Indore, Coimbatore, Kolkata, Bangalore, Jaipur and Pune.
The purpose of GIPSA is to have standardized packages & rates in respect of certain procedures to safeguard customers from being charged more by hospitals which in turn will ensure better utilization of Sum Assured in the Health Insurance. Procedures like Kidney Transplant, Total Knee Replacement, Liver Transplant, CABG, Dialysis, etc. are generally covered under GIPSA Rates. Nationwide more than 550 hospitals have enrolled for GIPSA

Question 50

If base policy has room/ICU capping, will the top up policy pay on actuals?"

Accepted Answer

The top up policy will consider claims beyond the Rs 5 lacs deductible.

Question 51

If I have employer insurance and IIT (BHU) Varanasi Alumni insurance as well, which base plan should I claim on?"

Accepted Answer

You may claim on either of the base plans.

Question 52

What role will Alyve Health play in the claims process? I am not in India and cant seem to download the Alyve Health app - what do I do?

Accepted Answer

Alyve Health would assist the alumni in the claim process by working with the TPA/insurance company and making the process easier for the alumni The Alyve Health mobile app is available in India at the moment. Members living outside of India can access the Alyve Health web interface using https://app.alyve.health/

Question 53

What will be the time lag for claim processing on the top-up plan considering base insurance policy isn't from Oriental Insurance Company? Would cashless claim be at all possible with two different insurers?

Accepted Answer

Claim processing would be done within 30-45 days depending on location, documents, type of illness etc.  Cashless is only possible in case your base policy has the same TPA as the top-up policy

Question 54

Do the insured need to have Indian id or the purchaser ?

Accepted Answer

The insured need to have an Indian Id Proof

Question 55

Does a US insurance plan count as a base plan to waive off the waiting periods on the top-up plan?

Accepted Answer

The waiting periods would apply on PED in this case as base plan of US will not be considered for waiving off the waiting periods on this policy

Question 56

I am an NRI. Should I purchase any of the plans?

Accepted Answer

This plan is suggested for those who (or their family members) would be spending at least some time each year in India.

Question 57

Does the proposed plan apply or be useful to those who are NRI- permanently based abroad but do spend sizable time in India off and on?

Accepted Answer

Yes – since this policy permits claim which arise in India and for hospitalizations within the borders of India

Question 58

I am not in India and cant seem to download the Alyve Health app - what do I do?

Accepted Answer

Alyve Health would assist the alumni in the claim process by working with the TPA/insurance company and making the process easier for the alumni The Alyve Health mobile app is available in India at the moment. Members living outside of India can access the Alyve Health web interface using https://programs.alyve.health/programs

Question 59

Does one have to be Indian citizen resident to buy? Can one buy just for parents ?

Accepted Answer

One can purchase as long as the  insured have an Indian ID proof ( Aadhar , DL , Voter card, PAN , Passport). Also - this is only for hospitalisation in India .

Question 60

Is hospitalization ( more than 24 hours ) for diagnostic purposes - eg before a transplant - covered ?

Accepted Answer

Only diagnostic purpose is not covered but covered in case of an active line of treatment

Question 61

Sub limits are different in the standard terms of the base and the top up policies - how will the insurer process the claims if one has bought both the base and top up (e.g. Cataract sub limit is 24,000 in base and 50,000 in top-up; ambulance is 2000 per hospitalization in base and 5000 per hospitalization in top-up)"

Accepted Answer

Cataract operation for each eye will be restricted to Rs 24,000 as per the terms of the policy. While it indeed is mentioned as Rs 50,000 in the top-up document, this top-up policy clause is common to retail and group business. So while for retail policy, it will allow up to Rs 50,000 per eye, for group policy it will be restricted to Rs 24,000/- only. Similar rules will apply for ambulance charges)

ELSA Group Medical Insurance

4 TYPES OF POLICIES

In 1 transaction you can buy one policy. To buy more policies perform more transactions

CHECK & PAY PREMIUM

BENEFITS OF GROUP POLICY

FEATURE ADVANTAGE

CLAIMS ADVANTAGE

PRICE ADVANTAGE

*PED: Pre Existing Diseases. Waiting Period for PED and planned procedures is 3 months for family policy and 6 months for parents/in-laws policy

IMPORTANT LINKS & DATES

The Process...

Transparent, seamless & hassle-free journey - during purchase & in use !

Some messages...

FAMILY PLANS

Employer covers are just not sufficient, you need more !

Note : In this policy you can insure Self, Spouse and max 2 children (less than 25 yrs age). Top Policy has entry age restriction of 80yrs.

Premium amount mentioned here do not include GST, Platform and Payment Charges

PARENTS & PARENTS-IN-LAW

The cover they need - now made affordable.

Note : You cannot have a parent and a parent-in-law in the same policy
No age restriction in Base Policy. Top Policy has entry age restriction of 80yrs.

Premium amount mentioned here do not include GST, Platform and Payment Charges

Subscribe for News, Promotions and More!

ELSA Group Medical Insurance

4 TYPES OF POLICIES

In 1 transaction you can buy one policy. To buy more policies perform more transactions

CHECK & PAY PREMIUM

BENEFITS OF GROUP POLICY

FEATURE ADVANTAGE

CLAIMS ADVANTAGE

PRICE ADVANTAGE

*PED: Pre Existing Diseases. Waiting Period for PED and planned procedures is 3 months for family policy and 6 months for parents/in-laws policy

IMPORTANT LINKS & DATES

The Process...

Transparent, seamless & hassle-free journey - during purchase & in use !

Some messages...

FAMILY PLANS

Employer covers are just not sufficient, you need more !

Note : In this policy you can insure Self, Spouse and max 2 children (less than 25 yrs age). Top Policy has entry age restriction of 80yrs.

Premium amount mentioned here do not include GST, Platform and Payment Charges

PARENTS & PARENTS-IN-LAW

The cover they need - now made affordable.

Note : You cannot have a parent and a parent-in-law in the same policy No age restriction in Base Policy. Top Policy has entry age restriction of 80yrs.

Premium amount mentioned here do not include GST, Platform and Payment Charges

Subscribe for News, Promotions and More!

Note : You cannot have a parent and a parent-in-law in the same policy
No age restriction in Base Policy. Top Policy has entry age restriction of 80yrs.