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MEDICAL
AND SURGICAL SCHEMES
The behaviour, attitude, outlook, disposition of employees
reflects the image of a company.
As an employer, you are concerned about the multiple hazards
in terms of accidents and sickness that might affect the physical
and emotional well being of your employees.
Through its Medical and Surgical Schemes, SICOM offers you tailor-made
solutions to help you maximise the effectiveness of your risk
management program by protecting your employees as well as
their dependents.
What are Medical
and Surgical Schemes? These Schemes cater for the refund
of medical as well as surgical claims incurred by employees
and their dependents, and this, against a very competitive
contribution.
Who can join the scheme?
Every employee and his/her dependents shall be eligible
to join the Scheme provided that the employee is aged not
less than 18 years and not more than 60 years.
Dependents include spouse and unmarried children aged not
less than 6 months and not more than 18 years.
Your benefits at a glance
The amount refundable will be equal to a percentage (usually
in the range of 80% - 90%) of the expenses incurred, subject
to the limits per item in the Table of Standard Benefits.
In the case of surgical interventions, the refund will consist
of 100% of expenses incurred, subject to the limits per item
as specified in the Table of Standard Benefits.
Table of Standard Benefits
| |
Annual Limit
(Rs) |
| |
Plan A |
Plan B |
Plan C |
| Surgical Intervention |
10,000 |
20,000 |
30,000 |
| Inpatient Treatment |
8,000 |
15,000 |
25,000 |
| Outpatient Treatment |
3,000 |
6,000 |
6,000 |
| Dental Treatment |
3,000 |
6,000 |
6,000 |
| Hearing Aid |
3,000 |
3,000 |
3,000 |
| Optical Expenses |
2,000 |
4,000 |
4,000 |
| Normal Delivery |
3,000 |
6,000 |
9,000 |
Discounts
Discounts are offered to companies with a high membership.
Tax-Relief
Contributions towards the Schemes are deductible upon approval
of the scheme by the Income Tax Authority.
Main Conditions
- Each member shall be eligible for
full benefits immediately in respect of accidents and sickness
two months after joining the Scheme.
- For Normal Delivery, no refund shall be made during the
first 10 months of the Scheme.
- Entry to the Scheme is irrevocable
during the policy year of the Scheme.
- Each claim must be supported by appropriate
original documents (e.g, pharmacy's bill, doctor's official
receipt and prescription, clinic's bill) setting full details
of treatment undergone and expenses incurred.
- Refund of expenses incurred for medicines
and drugs will be considered only if prescribed by registered
medical practitioners.
- Claims in respect of spectacle frames
and/or lenses shall be refunded for first-time users only.
Replacement of frames and/or lenses of identical power shall
be considered after a period of 3 years.
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