Diese Präsentation wurde erfolgreich gemeldet.
Die SlideShare-Präsentation wird heruntergeladen. ×

Maceton Ltd-Presentation.pptx

Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Anzeige
Wird geladen in …3
×

Hier ansehen

1 von 18 Anzeige
Anzeige

Weitere Verwandte Inhalte

Aktuellste (20)

Anzeige

Maceton Ltd-Presentation.pptx

  1. 1. Presentation of Group Insurance Scheme for Maceton Ltd.
  2. 2. About Guardian Life Mission: Our highest priority is to maximize financial benefits to our valued policy holders through proper risk management and sustained long term relationships. Vision: To help our valued policy holders in building a better and safer future and enjoy peace of mind through providing world-class life insurance products and customer service experiences.
  3. 3. Group Benefits for Maceton Ltd: 1. Natural Death (Group Term Life with ADB, PTD & PPD-1st Schedule of labor law), 2. Hospitalization (In-Patient Treatment), 3. Critical Illness(CIB-18) 4.OPD 5.OPD Dental 6.OPD Optical.
  4. 4. Natural Death (Group Term-GT) Group Life Insurance coverage provides settlement of Death (due to any reason; sickness) claim up to the sum assured against the Insured Employee or Group Member. The payment will be paid in the event of death of an employee from any cause whatsoever anywhere in the world, except- • Attempted suicide or intentionally self inflicted injury, while sane or insane. • “AIDS” or “AIDS” related Diseases or Complications. Accidental Death (ADB) If an insured employee meets with death due to an Accident, Guardian Life subject to the provision stated in the Respective Policy, will pay a Benefit Amount to the entitled person(s) or the employer. The Accidental Death Benefit is payable in addition to Group Term-GT Life Insurance Amount within the policy Maximum Limit to the beneficiary of the employee. Group Benefits for Maceton Ltd:
  5. 5. Group Benefits for Maceton Ltd : • Permanent Total Disability (PTD) • Permanent Partial Disability (PPD) In case of a Permanent Partial & Total Disablement caused directly by an accident only, indemnity according to the terms and conditions as per agreement shall be made by the GLIL to the Maceton Ltd as specified in the First Schedule of the Labor Law of Bangladesh and where applicable, only one sum namely the larger sum will be paid for multiple injuries resulting from one accident.
  6. 6. Group Benefits for Maceton Ltd: Critical Illness(CI-18) Coverage Critical illness insurance provides additional coverage for few illnesses or emergencies. At least 3 (three) months waiting period shall be applicable . 1.Cancer 10.Heart Valve Replacement 2.Heart Attack (Myocardial Infraction) 11.Surgery of Aorta 3.Stroke 12.Aplastic Anemia 4.Coronary Artery (Bypass) Surgery 13.Benign Brain Tumor 5.Kidney Failure (End Stage Renal Disease) 14.Chronic Lung Disease/End Stage Lung Disease 6.Major Organ Transplantation 15.Deafness/Loss of Hearing 7.Paralysis 16.Major Head Trauma 8.Multiple Sclerosis 17.Loss of Limbs 9.Blindness/Loss of Sight 18.Loss of speech
  7. 7. Hospitalization (In Patient Treatment): Group Benefits for Maceton Ltd: IPD Benefit Schedule Coverage in BDT. – Plan A Coverage Per Person Per Disability 200,000 Daily Hospital Room Rent (Actual or Max.) 5,000 Total Hospital Room Rent 80,000 ICU/CCU Limit per confinement 14 days All other In-Patient treatment expenses inclusive of surgical charges, consultation fees, medicines and relevant Medical investigations related to the ailment and other ancillary services (excluding Room & ICU/CCU charges) maximum Per Disability. 120,000
  8. 8. Out Patient Treatment(OPD): General OPD Benefit/Year Coverage Max. Coverage Maximum Limit per Member per year 30,000 Max. Consultation Charges Limit per Member per year including Dental & Optical 9,000 Specialist visit (at actual but not more than per visit) General Practitioner Office or Home visit (Actual or Max.) 1,500 500 Investigation Charges Limit per Member per year including Dental & Optical 12,000 Medicine Cost Limit per Member per year including Dental & Optical 9,000
  9. 9. Out-Patient Treatment Plan Dental: Out-Patient Treatment Plan-Dental Coverage Dental Treatment (Except Aesthetics & Denture) Maximum limit per Member per Year Dental coverage is limited to: 1) Amalgam, Resin Plastic & Temporary/Permanent Fillings 2) Root Canal Treatment 3) Doctor's Fee 4) X-rays / Investigations 5) Root Canal Treatment including bridging and capping 6) Extraction 7) Scaling & Polishing (Once in a year for each member) BDT 5,000
  10. 10. Out-Patient Treatment Plan Optical: Out-Patient Treatment Plan-Optical Coverage Optical Treatment Maximum per Member per Year Optical coverage is limited to: 1) Doctors Fee 2) Medication 3) Vision tests for errors of refraction Lenses and spectacles (BDT. 2,000/-once in a year) BDT 5,000
  11. 11. Claim Procedure In Patient Treatment • The Member must send ‘Claim Intimation Form’ to the company Within 48 Hours Of Any Hospitalization. ***Prior Intimation Shall Be Waived for Medical Emergency.
  12. 12. Excess Of The Benefit Limit Should Be Borne By The Member And Settled With The Hospital At The Time of Discharge. Benefit Limit Directly To The Hospital/Clinic Via Gop (Guarantee Of Payment) GLIL Preferred Hospital/Clinic MEMBE R
  13. 13. Reimburse Actual Expense Incurred For Hospital Treatment Up To The Benefit Limit Upon Receipt Of Complete Claim Form Along With Supporting Documents Within 10 Working Days Submit Claim Through ‘Claim Form’ Or ACPS To GLIL Within 30 Days From Discharge. Not Covered under GLIL Network MEMBE R **For All Medical Claim (IPD) Claim Submission Shall Be done in 60 Days. **https://myguardianbd.com/Home/GlilPreferedHospital
  14. 14. Supporting documents (duly attested by competent authority) include the followings: 1. Consultant’s Recommendation on prescription for hospitalization, 2. Copy of Discharge Certificate, 3. Copy of Investigations Reports while taking treatments, 4. A copy of the Patient's File while taking treatments (if possible), 5. Original Money Receipts or Bill of Consultants (Physician/Surgeon) fee, 6. Original Bill relating to Room Charges, Investigations and Other Services where applicable, 7. Original Bill of Medicine/Drugs related to treatment. 8. Original Bill relating to Surgical Operation charges (operation theatre, surgical team, delivery charge, anesthesia & other charges), 9. Original Bill relating to Ancillary Charges (e. g. Ambulance Service, Oxygen Therapy, Blood Transfusions etc.) as per the agreement. **Photocopy of any money receipt is unacceptable. ***Writing or Any Modification in any claim documents is strongly prohibited. It will be considered as Unfair Means (Subject to proper inquiry and proof) and will be treated as Invalid. Claim Procedure for Maceton Ltd(Cont’d):
  15. 15. • 10 days Pre & Post Hospitalization treatment expenses arising out of consultation, medicine costs & investigations are covered, provided that such expenses are related to the disease for which Hospitalization was required. • If any Insured is also covered for similar benefits under any other insurance Contract, then payment of the claim shall be made on pro-rata basis after taking into account the coverage under all contracts. • Any charge for food or food supplements (Horlicks, Viva, Vitamin, Calcium, Bournvita etc.) except vitamins as active treatment, antiseptics (Savlon, Dettol, Boroline, Povidone iodine etc), tissue/toilet papers, cosmetic creams or oils of any nature, any medicated items that’s are Pharmacologically not accepted as medicine even advised by physician, mineral water purifiers etc. are excluded. Telephone charges, Rental car services, VAT or any other etc . are not included. However, antiseptic or/and any of above mentioned items may be included subject to the consideration on the merits of sickness or disability and relevancy of the treatment. • The period for each Confinement shall be limited to a maximum of 30 (Thirty) days. Notwithstanding anything contained herein this Contract, the sum of total benefit shall in no event whatsoever exceed the maximum limit set forth in the Table of Benefits of Annexure – B (1) Changed as per your requirement. • Can’t be changed • Changed as per your requirement. Service charge is payable. Limitation
  16. 16. No benefit shall be paid under this Contract for expenses or losses resulting from or incurred in connection with or in consequence of the followings: • any Congenital Infirmity; • mental, emotional or psychiatric disorders, alcoholism or any other narcotic addiction; • circumcision, prophylactic, vaccination and immunization procedures; • Obesity i.e., treatment for, or required as a result of obesity, any condition under evaluation; • any procedures which is experimental or not generally accepted by the medical profession viz. acupuncture, Alternative Medical Care (Homeopathic, Herbal, Ayurvedic) etc; • any cosmetic skin treatment or plastic treatment/surgery, unless required as reconstructive surgery as a consequence of an injury due to Accidents, burns; • rest, convalescence or rejuvenation cures, thermal baths, physiotherapy, any confinement or treatment for the purposes of slimming or beautification; • treatment of family planning purposes including wilful termination of pregnancy, sterility or treatment related to infertility or Assisted Reproduction Technology (ART); Exclusions
  17. 17. • attempted suicide, violation or attempted violation of the law, injuries wilfully or intentionally self- inflicted or due to insanity or under the influence of a drug; • routine examination of eye and ear, fitting or replacement of eyeglasses (including Intra-ocular lens or contact lenses) or hearing aids; • health screening including Routine Examinations (health check-ups, investigations done by self), radiotherapy-X-ray radium or radioactive isotopes treatment (except Hospitalization), chemotherapy or hospitalization due to complication of chemotherapy (except Hospitalization) or any form of treatment when not incidental or necessary to the treatment of the injury/Illness which caused the Hospitalization; • any dental treatment not stated in the Table of Benefits of Annexure – B (1) unless required as a result of Hospitalization for re-constructive surgery as a consequence of an Accident; • injury arising due to Accident while participating in any unlawful activities (e.g. driving a car without a license); • non-surgical care for tuberculosis, Sexually Transmitted Disease (STD); • injury or disease directly or indirectly attributed to or caused by war, declared or undeclared, or war like operations or as a result of direct involvement in civil commotion; • Sleep disorders i.e., treatment for insomnia, sleep apnea, snoring, or any other sleep related breathing problem; • injury, destruction or damage caused by nuclear fission, nuclear fusion or irradiation; • costs of prostheses, corrective devices and medical appliances, unless such corrective devices and/or medical appliances are required as a part of surgical operations Exclusions
  18. 18. Thank You

×