Medical Policy

                                                    Medical Policy

This policy aims to define the medical benefits that Clustox offers to its employees and their family members

 SCOPE

This policy is applicable to all permanent employees of Clustox

POLICY

Clustox values the health and well-being of its employees and their families and, therefore, extends medical coverage to all its employees. The medical policy covers a range of services, including illness treatment, hospitalization, maternity-related cases, outpatient care, and specialized investigations, as prescribed by registered doctors

 The medical calendar for Clustox runs from January to December. Yearly limits for the medical policy will be prorated based on the date of joining, and the policy is applicable after the completion of the internship or probation period. However, the medical policy is not applicable during the probation, resignation, or termination period

Clustox offers four types of medical policies, which include hospital-related benefits, maternity-related benefits, accidental expenses, and outpatient department (OPD) coverage. These policies provide comprehensive coverage for various medical expenses incurred by employees and their dependents

Clustox medical policies also cover employees' spouses and children, providing them with the same level of healthcare benefits and coverage. This ensures that the entire family receives adequate healthcare support and benefits

 Benefits of Policy

 ● Higher Medical Limits

● Spouse covered

● Kids Covered

● Maximum Accidental Coverage

● Special Discounts of 20% on Lab Tests for all Clustox family members and also for their family members

 

 

 

 

 

 

                               ● Hospital Related Benefits

 

Sr No	Grades	Designations	Hospitalization*
1	G1	C Level	225,000
2	G2	SVP
3	G3	VP
4	G5	Sr. Director	200,000
5	G6	Director
6	G8	Sr. Architect/ Sr. Manager	175,000
7	G9	Architect/ Manager
8	G10	PSE, Associate Manager	150,000
9	G11	SSE, Assistant Manager
10	G12	SE, Executives	125,000
11	G13	Custodian Staff & Trainees	100,000

 

 

 

All types of hospitalization are covered, which encompass emergencies and subsequent treatments, as well as accident injuries

1. CABG (By-Pass)

2. Multiple Fractures

3. Cancer

4. Kidney Failure

5. And any special case approved by higher management

 

 

                                      ● Maternity Cover

 

Sr No	Grades	Designations	Maternity
			Normal	C- Section	Pre-Post Exp
1	G1	C Level	100,000	200,000	55,000
2	G2	SVP
3	G3	VP
4	G5	Sr. Director	90,000	180,000	45,000
5	G6	Director
6	G8	Sr. Architect/ Sr. Manager	60,000	120,000	30,000
7	G9	Architect/ Manager
8	G10	PSE, Associate Manager	50,000	100,000	25,000
9	G11	SSE, Assistant Manager
10	G12	SE, Executives	45,000	90,000	22,500
11	G13	Custodian Staff & Trainees	40,000	80,000	20,000

 

 Clustox's medical policy covers medical expenses related to pre-and postnatal care for a period of 30 days, including laboratory charges, medication costs, consultation fees, and hospital charges.

                                      ● Outdoor Patient Department

Sr No	Grades	Designations	Proposed Slabs
1	G1	C Level	90,000
2	G2	SVP
3	G3	VP
4	G5	Sr. Director	70,000
5	G6	Director
6	G8	Sr. Architect/ Sr. Manager	55,000
7	G9	Architect/ Manager
8	G10	PSE, Associate Manager	40,000
9	G11	SSE, Assistant Manager
10	G12	SE, Executives	25,000
11	G13	Custodian Staff & Trainees	20,000

 List of Exclusions

 Please find below a list of the most common exclusions for your reference. The policy documents contain a comprehensive list of exclusions for each benefit:

 

● WAR risk (Whether declared or not)

● AIDS and or “AIDS” related diseases

● Self-inflicted injuries

● Psychiatric benefits

● Alcoholism and addiction

● Cosmetic and plastic surgeries

● Dental and Vision Related medical issues

● all expenses which are not reasonable, customary, and necessary for the treatment of injury or illness

 

 

How to Claim Medical Reimbursement.

Here's a simple guide on how to claim medical reimbursement:

·      Collect all original medical bills, prescriptions, and reports

·  Fill out the medical reimbursement form, which can be obtained from the HR department or downloaded from the company portal

·       Attach all original documents and receipts to the reimbursement form

·       Submit the form along with the documents to the HR department within the specified time frame.

The HR department will review the claim and process the reimbursement if it meets the policy criteria.

Reimbursement will be credited to the employee's bank account or paid via cheaque

Note: Always check the policy documents for specific details on the claims process and required documents

● Request for Advance:

To request advance payment for medical expenses, the employees must submit a written or email request along with a prescription and expense estimate to the Clustox HR team. Upon verification, Clustox will directly pay the hospital. Please refer to the policy documents for specific details on the claims process and required documents

● Documents Submitting

All required documents for reimbursement claims must be submitted within 30 days of the date of treatment. Expenses without supporting documents will not be eligible for reimbursement. For more information on the required documents and reimbursement process

1- Fill Medical Reimbursement Form

2- Submit all original bills

3- Discharge Card/ Clinical Summary

4- Original Medical Reports

5- Doctor’s Prescriptions

6- Pharmacy Vouchers in Original

7- Original Payment Receipts

8- Copy of birth certificate

9- Any other relevant documents       Medical Policy