Health Insurance for Employees

Wellsurance Executive Policy

UIN: IRDA/NL-HLT/TAGI/P-H/V.I/69/13-14
Today's environment demands more of anyone looking to make a mark in this competitive world. Somewhere between the pressure to meet demands and the burning desire to excel, one’s health is often the first of the compromises.

Wellsurance Executive Policy goes beyond what health insurance policies do, and is designed to take care of the busy executive and his well being.
 
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  • We offer life-long renewal subject to application for renewal and the renewal premium in full has been received by the due dates and realisation of premium, unless the Insured Person or any one acting on behalf of an Insured Person has acted in an improper, dishonest or fraudulent manner or any misrepresentation or non cooperation under or in relation to this policy or the policy poses a moral hazard.
  • Fixed lump sum benefit is paid for -
  • Hospitalization:Cover hospitalization, ICU admission and specific major/minor surgeries.

    Post Hospitalization: Convalescence benefit, Covered outpatient expenses.

    Critical Illnesses: Diagnosis of any of the 9 covered critical illnesses.

  • Avail of unique Wellness Benefits. Get the Wellsurance Advantage.
  • Free Look Period –You have a period of 15 days from the date of receipt of the Policy document to review the terms and conditions of this Policy. If You have any objections to any of the terms and conditions, You have the option of cancelling the Policy stating the reasons for cancellation and You will be refunded the premium paid by You after adjusting the amounts spent on stamp duty charges and proportionate risk premium. You can cancel Your Policy only if You have not made any claims under the Policy. All Your rights under this Policy will immediately stand extinguished on the free look cancellation of the Policy. Free look provision is not applicable and available at the time of renewal of the Policy.
  • Grace Period of 30 days for renewing the Policy is provided under this Policy. However, coverage would not be available for the period for which no premium has been received.
  • Sum Insured Enhancement:The Insured may seek enhancement of Sum Insured in writing at the time of renewal, before the payment of premium. However, notwithstanding enhancement, for claims arising in respect of accident, injury or illness contracted or suffered during a preceding Policy period, liability of the Company shall be only to the extent of the Sum Insured under the Policy in force at the time when it was contracted or suffered. The Enhanced Sum Insured will have a fresh proposal status where the waiting period, deductibles and exclusions shall apply afresh. However the quantum of increase shall be as per underwriting guidelines of the company.
  • Changes will be notified to the policyholders 3 months in advance in case of revision /modification in approved product.
  • Likelihood of withdrawal of the product will be notified to the policy holders 3 months prior to the expiry of the policy and option would be given to migrate to similar Health Insurance policy
  • Tax Benefits - Get tax benefits for premium paid on policies as per section 80D of the Income Tax Act. Tax benefits are subject to income tax laws.
Wellsurance Executive Policy Benefits (in )
  Benefits Classic Supreme Elite
1 Diagnosed Critical Illness ( waiting period 90 days, survival period 30 days)      
i> Cancer of specified severity 300000 500000 750000
ii> First Heart Attack of specified severity 300000 500000 750000
iii> Stroke resulting in permanent symptoms 300000 500000 750000
iv> Kidney Failure requiring regular Dialysis 300000 500000 750000
v> Coma of specified severity 300000 500000 750000
vi> Total Blindness 300000 500000 750000
vii> Permanent Paralysis Of Limbs 300000 500000 750000
viii> Multiple Sclerosis with persisting symptoms 300000 500000 750000
ix> Major Burns 300000 500000 750000
2 Hospitalisation:      
a Hospitalisation Benefits      
  Hospital Cash (up to 90 days) 2000 per day 3000 per day 4000 per day
  ICU Benefit (up to 15 days) 3000 per day 4500 per day 6000 per day
  Nursing Expense ( max upto 90 days) 750 per day 1000 per day 1250 per day
  Physicians Visit ( max upto 90 days) 750 per day 1000 per day 1250 per day
  Investigation – MRI 2500 3500 3500
  Investigation – CT Scan or Doppler study 1250 1750 1750
  Investigation – Lab Test and/or X-ray and/or ECG 350 500 750
  Anesthetist's fees - for surgeries 2500 5000 7500
  Physiotherapy (while hospital confined & up to 30 days) 750 per day 1000 per day 1250 per day
  Ambulance charges (While admitting and while discharging from hospital) 2000 2000 2000
  Convalescence benefit 1500 2500 4000
b Major surgeries      
1 CABG- coronary artery bypass grafting 100000 150000 200000
2 Angioplasty -PTCA( percutaniuos transluminal coronery angioplasty) 100000 150000 200000
3 Brain surgery including Craniotomy, tumor removal and intercranial drainage 100000 150000 200000
4 Post traumatic surgery ( skull fracture, pelvis fracture, complicated fracture
Skull fracture
Traumatic amputation of upper and /or lower limb
Pelvis / Hip Fracture
Compound communicated fracture of any part where ORIF is required )
50000 75000 100000
5 Bone marrow transplant 100000 150000 200000
6 Major organ transplant(Excluding Kidney Transplant)- Heart, Lung, Liver, Pancreas 100000 150000 200000
7 Knee replacement
Traumatic / septic arthritis
Severe irreparable knee injury
75000 125000 150000
8 Hip replacement
Traumatic hip injury- both partial and total
75000 100000 150000
9 Spinal surgeries
Traumatic spinal injuries
40000 75000 100000
10 Enucleation
Malignant tumor of eye ball
Severe trauma to eye ball
Odentogenic cyst
40000 60000 75000
  Malignant tumor of eye ball      
  Severe trauma to eye ball      
  Odentogenic cyst      
11 Heart valve replacement 100000 150000 200000
12 Pacemaker implant 75000 100000 125000
13 Knee ligament surgery - trauma related 75000 125000 150000
c Minor Surgeries      
1 Appendectomy 10000 10000 15000
2 Cholecystectomy/ Removal of Gall Stone 15000 20000 20000
2 Removal of Gall Stone 15000 20000 20000
3 Removal of kidney stones 10000 10000 15000
4 Hernia repair 15000 20000 20000
5 Haemorrhoids 10000 10000 15000
6 Biopsy of growth 15000 20000 20000
7 Removal of skin lesion 15000 20000 20000
3 Post Hospitalisation benefits      
  Post operative Physiotherapy eligibility Min 2 visits 3500 5000 7000
  Chemotheraphy and/or radiation eligibility Min 3 visits 150000 250000 300000
  Kidney Dialysis 150000 200000 250000
1 2

    General Exclusions:


  1. Any Pre-existing Condition, any complication arising from it, or
  2. Intentionally self-inflicted Injury or illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS), Human Immune-deficiency Virus (HIV) infection; attempted suicide, or
  3. Professional Sports, Hazardous Activities ;or
  4. Organ transplants that are considered experimental in nature; expenses incurred for hospitalization or surgery for donation of organs ; or
  5. Pregnancy and all related conditions, including services and supplies related to the diagnosis or treatment of infertility or other problems related to inability to conceive a child; birth control, including surgical procedures and devices; This however does not include ectopic pregnancy proved by diagnostic means and is certified to be life threatening by the Physician.

    Note:


  1. For all sickness hospitalisation & minor surgeries & Critical illness waiting period of 90 days is applicable.
  2. Waiting period of 120 days applicable for major surgeries.
  3. No waiting period for Accident related hospitalization
  4. Hospitalization Benefits are payable while in hospital only.
  5. Hospital Cash: 1 day deductible for Sickness Hospital Cash benefit. Not applicable for hospitalization due to any accident.
  6. Critical Illness: The benefit for each critical illness will be paid once during the entire life time of the policyholder. On Renewal this benefit will be available for all Illnesses except for the one paid in the previous term(s).
  7. Kidney dialysis, Chemotherapy and/or radiation : Benefit paid once in lifetime of the policy holder.
  8. If an Insured Person suffers a covered Illness or Sickness or Disease for which benefits, are payable under more than one such Similar Policy issued by Us, then the Insured Person shall have the right to require a settlement of his claim in terms of any of his policies and contribution as defined in the policy will not apply.
  9. This policy covers hospitalization in India only.
  • Free Health Helpline - Reach our expert physicians to avail help on health & wellness related information. Get instant phone access. Call our Toll Free no 1800 103 5252. Timings: 9:00am to 7:00pm (From Monday to Saturday).. Get instant phone access. Call our Toll Free no 1800 103 5252. Timings: 9:00am to 7:00pm (From Monday to Saturday).
  • Health Portal – You will be given access to the Health Portal, exclusively developed for TATA-AIG General Insurance Co., which has a ‘Knowledge Centre” which will host ‘Health Articles’ on relevant topics like diabetes, Cholesterol, Weight management, Yoga, heart diseases, Fitness. The purpose of this service is to educate you on Health & Wellness topics so that you can start practicing Preventive Care.
    The Health portal will also host the list of network hospitals for Cashless settlement, provided by the appointed Third Party Administrator (TPA).
  • Health Query –You will be able to write queries on routine health problems like acidity, sinus, cough-colds, infections, diabetes etc on – “Post Your Health Query"
    The Queries will be answered by a Physician, and will be e-mailed to your e-mail address.
  • Discounted Services for Health & Wellness: You will be offered discounts at health related services like Gyms, Weight management Centers, beauty parlors, diagnostic centers by personally visiting / calling the respective centers in their respective cities and paying directly to the centre.
    We will provide the list of discounted tie-ups, along with Centre address/ contact numbers available on the health portal which will be updated on regular intervals.
  • e-News letter-You will receive regular updates on various health Topics, latest trends in Health & Wellness, via an ‘e-News Letter’ which will be mailed to your e-mail id (if available & provided). The purpose of this e-news letter is to educate you on Health & Wellness topics so that you can start practicing Preventive Care.

For all claims, contact E-Meditek (TPA) Services Ltd. (address below), our appointed service provider for your Health Policy. All admissible claims will be cashless, subject to admission in network hospitals authorized by E-Meditek (TPA) Services Ltd. If admitted to a non-network hospital, submit your bills to E-Meditek (TPA) Services Ltd. for reimbursements up to the specified limits.

E-Meditek (TPA) Services Ltd. has a network of 3000+ hospitals on all India basis.

Address: Plot 577, Udyog Vihar, Phase V, Gurgaon - 122016

Contact details: 24x7 Toll Free Claims Helpline 1800 103 5252 / 1800 22 9966 (Only for Senior Citizens) 

Read more about cashless process

Click here to know more about our claims Service.

Who should buy Wellsurance Executive Policy?

Individuals from age of 18 yrs up to 65 years

What is not covered under Wellsurance Executive Policy?

This entire Policy does not provide benefits for any loss resulting in whole or in part from, or expenses incurred, directly or indirectly in respect of:

  1. Any Pre-existing Condition, any complication arising from it. Except  if the insured  has taken a similar  Wellsurance Policy  from Us  and is covered  without a break, for a period of 4 consecutive years  since  inception  of the first policy with Us.Please refer Section ‘Part B1’ for detailed information
  2. Intentionally self-inflicted Injury or illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS), Human Immune-deficiency Virus (HIV) infection; attempted suicide, or
  3. War, civil war, invasion, insurrection, revolution, act of foreign enemy, hostilities (whether War be declared or not), rebellion, mutiny, use of military power or usurpation of government or military power; or
  4. serving in any branch of the Military or Armed Forces of any country, whether in peace or War, and in such an event We, upon written notification by You, shall return the pro rata premium for any such period of service; or
  5. Ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from burning nuclear fuel; or
  6. The radioactive, toxic, explosive or other dangerous properties of any explosive nuclear equipment or any part of that equipment; or
  7. Congenital anomalies or any complications or conditions arising therefrom; or
  8. Professional Sports, Hazardous Activities; or
  9. Cosmetic or plastic surgery or any elective surgery or cosmetic procedure, circumcision,  (except as a result of an Injury caused by a Covered Accident while Our Policy is in force ) that  improve physical appearance, surgical and non-surgical treatment of obesity (including morbid obesity) and weight control programs, or treatment of an optional nature; Routine health checks or convalescence, Custodial Care, general debility, lethargy,  rest cure;  expenses on vitamins, tonics and any other health supplement; vaccination, inoculation of any kind.
  10.  Any investigation(s) or treatments not directly related to a Covered Illness or Covered Injury or the conditions or diagnosis necessitating hospital admission; or Any surgery done on the organ(s), if they are not infected or affected;
  11. services, supplies, or treatment, including any period of Hospital confinement, which were not recommended, approved, and certified as Medically Necessary by a Physician; or
  12. organ transplants that are considered experimental in nature; expenses incurred for hospitalization or surgery for donation of organs ; or
  13. pregnancy and all related conditions, including services and supplies related to the diagnosis or treatment of infertility or other problems related to inability to conceive a child;  birth control, including surgical procedures and devices; This however does not include ectopic pregnancy proved by diagnostic means and is certified to be life threatening by the Physician; or
  14. Medical expenses incurred as the result of alcohol and/or drug abuse, addiction or overdose.
  15. Any surgery for donation of organs
  16. treatment of Spondylosis/ Spondilitis
  17. Cost of Spectacles and contact lens, hearing aids, walkers, crutches, wheel chairs and such other aids
  18. Any Ayurvedic, Homeopath or naturopathy treatments

Waiting period of 90 days for all sickness hospitalization and minor surgeries and Critical illnesses and 120 days for major surgeries is applicable. There is no waiting period for accident related hospitalization.

This policy covers hospitalization within India only.

If I am diagnosed with a critical illness for the first time in my life and get hospitalized for a surgery, what are the benefits payables?

Critical illness benefit is payable on diagnosis of a critical illness post survival period of 30 days. Hospitalization and surgical benefits are payable as per the plan and policy terms conditions.

Up to when is my pre-existing condition not covered?

Pre-existing Conditions will not be covered until 4 years of continuous renewals, since inception of the firstWellsurance policy with us.Please refer Section ‘Part B 1’ for detailed information.

Can the insured receive benefits from multiple insurance policies?

As Wellsurance is a fixed benefit policy, the insured can receive benefits from Wellsurance over and above any other existing health insurance policies he may have, subject to policy terms conditions.

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