Adobe – PY 2022-23 - GMC Policy Terms and Conditions

Policy Details
Policy Holder Adobe Systems India Pvt. Ltd.
Policy start and end date 01 April 2022 to 31 March 2023
Insurance Company United India Insurance Co Ltd
Third Party Administrator (TPA) Medvantage Insurance TPA Pvt Ltd

Policy Features

The GMC Family Sum Insured coverage is INR 7 lakhs per family. Thereis
no room- rent capping on 1+ 6 basis (Spouse / partner, 3 Children
Sum Insured
(Dependent children up to 25 Yrs), Parents/Parents In Law); however, the
parental sum insured is limited to INR 5 lakhs.
The Maternity benefit limit is for INR 1 Lakh each for maximum of 2
children. The benefit can be availed without waiting period. Pre / post-
natal and well-baby care expense can be availed up to INR 5,000 each
Maternity Benefit
within the maternity limit. New-born baby covered from day 1.
“Life threatening maternity complications to be covered upto full Sum
Insured”
Pre and Post Hospitalization are covered for 30 days prior to the date of
admission of the hospitalization and 60 days post discharge respectively.
Pre and Post Hospitalization
Only in the case of critical illness, pre and post hospitalization expensesare
enhanced to 60 and 90 days respectively.

OPD coverage of INR 15,000 per family. This would include Doctor
Consultations, Prescribed Diagnostics and Medicine, COVID Vaccines &
OPD Cover tests, Dental and Vision etc. (Dental and Vision Coverages as per the UIIC
wordings available on the last page of this document) on reimbursement
basis.

External Congenital diseases External Congenital diseases are covered up to INR 20,000 to the
maximum
On all parental claims, there is a Co-pay of 20% on admissible claim
Co-pay Amount, Infertility related procedures have 20% of Co-pay & Stem Cell
Implantation procedure also has 30% co-pay.
Ambulance Charges
Ambulance charges are INR. 3000 per hospitalization. (Home to hospital
/ hospital to hospital)

Intra Biological Targeted Therapy Biological Targeted Therapy is covered with a maximum limit of INR 5
Lakhs per life (including top-up sum insured if opted)

Intra-vitreal Covered for Avastin, Lucentis injection etc. AOA: 15K

Infertility Infertility is Covered up to a maximum limit of INR 100,000 with 20%

Co- pay
Up to 20% of Sum Insured subject to a maximum of INR2 Lacs per policy
Oral Chemotherapy period for claims involving Oral Chemotherapy, Crizotinib (targeted therapy)
2.50 lacs per family & INR 10 lacs policy limit & Rituximab Infusion as a
stand-alone 2.50 lacs/ family

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 Adobe – PY 2022-23 - GMC Policy Terms and Conditions

No additional sub-limit (as per new advanced treatment table), Co pay

Stem Cell applicable as per Policy terms.

Pre-Existing Disease Pre-existing disease is covered for all

Death During hospitalization No deduction in case of death during hospitalization

In case of life-threatening situations, if there is no active line of

Life Threatening situations
Treatment; however, is restricted to per incidence limit of INR25,000

Additional day care procedures /Non-list case which can be life-

Other ailments with the Annual threatening and/ or related to critical diseases like Kidney /Liver/Cancerand
Limit of 10 Lakh not so critical cases but lifestyle impacting situation including Lasik cases
where medically required

Bariatric Surgery Bariatric Surgery is covered subject to policy terms and conditions

If because of sickness, an employee is unable to perform the material and

substantial duties of his employment and is not engaged in any other
occupation for which employee is deemed reasonably qualified by
education, training or experience during this period. 10 cases weekly
compensation of INR 10,000 for a maximum 52 weeks. The disability
arising due to any of the following health conditions are covered: -
1)Neurological Disorders, Cerebro-Vascular Accidents, Polio/Post-polio
Sickness Disability syndrome, Myasthenia Gravis, Multiple Sclerosis, Parkinson's, Epilepsy,
Alzheimer’s 2)Certain infections like meningitis or any form of
encephalitis 3)Potts, TB, paraplegia 4)Diabetes Mellitus and its
complications. 5) Rheumatoid arthritis, Osteoarthritis (Rare),6) Coma.

Sickness should result in total disability to trigger its benefit and is

available only when employee has completely utilized the
sick/Casual/Privileged/Paid Leave.

Hormonal/ Adjuvant / Immune Covered up to INR 5 lakhs per family

modulators in Cancer Treatments
Autism with Base Policy there is a limit of INR 50,000/- (sub limit of INR
Autism
5,000 per therapy/consultation)
Reimbursement is applicable post consultation, only for therapies.
Cashless cannot be availed (including IPD as well as OPD treatment) -
Consultation (detailed report to be submitted) ONLY IF followed by
Psychiatric Treatment
therapy or medication to be reimbursed. Employee (including members
covered under health insurance) can claim up to INR 50,000 annually
(this is floater limit and not per member limit). NO CASHLESS CLAIM
Coverage of Medically advanced treatments restrictedup to 50% of the
sum insured (base cover) and for parents/parents in law 20% co-pay would
be applicable.
Robotic surgeries:
Advanced Treatment • Up to 75% of Sum Insured per policy period for claims involving Robotic
Surgeries for (i) the treatment of any disease involving Central Nervous
System irrespective of etiology; (ii) Malignancies
• Up to 50% of Sum Insured per policy period for claims involving Robotic
Surgeries for other diseases

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 Adobe – PY 2022-23 - GMC Policy Terms and Conditions

Ayurvedic Treatment For Ayurvedic Treatment, hospitalization expenses are admissible only
when the treatment has been undergone in a Government Hospital or in
any Institute recognized by the Government and/or accredited by Quality
Council of India/National Accreditation Board on Health. Only followed by
an active line of treatment warranting inpatient hospitalizations are
admissible.

Company's Liability for all claims admitted in respect of any/all insured

Person(s) during the period of insurance shall not exceed the Sum Insured
stated in the schedule.
Same Sex Partner 1. Coverage for the SAME SEX PARTNER self is as normal "self".
2. Cover for same sex partner subject to the following conditions: (a) Such
relationship not being in any contravention to any law of the land. (b) The
Insured confirms such relationship through the data provided for cover. (c)
The partner shall be covered prior to commencement of the policy. No mid-
term inclusion or change of partner is permitted. Change of partner can be
considered once in a block of 2 years with valid reasons and clear
recommendations from the Insured.
(d) The employee can cover either spouse or the partner and not both.
3. Adoption: Cover available only for legally adopted children within the
family definition of the policy. 4. Surrogacy: Cover available only for
maternity and pre-post-natal and up to the maternity sublimit. Surrogate
claim to be informed to the insurer immediately afterconception. Post event
inclusions will not be permitted. 5. Gender Reassignment Surgery: Covered
up to a sub limit of INR 5 Lakh per employee. Cover not available for partners

Day Care Procedure

Expenses on hospitalization for minimum period of 24 hours are admissible. However, this time limit is not
applied to specific treatments as per list for Day care procedure. You can find the list at Medvantage TPA
portal.

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This condition will also not apply in case of stay in hospital of less than 24 hours provided -

a. The treatment is undertaken under General or Local Anesthesia in a hospital/day care center in less than
24 hours because of technological advancement and
b. Which would have otherwise required a hospitalization of more than 24 hours

Day care pre approval:

a. Day care can be opted through cashless facility in the network hospital by obtaining prior approval.
b. If in case the day care is under the non-network hospital, pre-approval from TPA is required.

Procedures/treatments usually done in outpatient department are not payable under the policy even if
converted as an in-patient in the hospital for more than 24 hours or carried out in Day Care Center.

Exclusions

The company shall not be liable to make any payment under the GMC policy in respect of any expenses
whatsoever incurred by any Insured Person in connection with or in respect of:

PERMANENT EXCLUSIONS & WAITING PERIODS

All the Waiting Periods shall be applicable individually for each Insured Person and claims shall be assessed accordingly.
A. Permanent Exclusions
We shall not be liable to make any payment under this Policy caused by, based on, arising out of, relating to or howsoever
attributable to any of the following:
1. All expenses, caused by or arising from or attributable to foreign invasion, act of foreign enemies, hostilities, warlike
operations (whether war be declared or not or while performing duties in the armed forces of any country), civil war, public
defense, rebellion, revolution, insurrection, military or usurped power.
2. All Illness/expenses caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or
hazardous form) or from any nuclear waste from the combustion of nuclear fuel nuclear, chemical or biological attack.
3. a) Stem cell implantation/Surgery, harvesting, storage or any kind of Treatment using stem cells except as provided for in
clause II.8 (12) above; b) growth hormone therapy.
4. External Congenital Anomaly or defects.
5. Sterility and Infertility (Code-Excl17): Expenses related to Sterility and Infertility. This includes:
i. Any type of contraception, sterilization
ii. Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT,
GIFT, ICSI
iii. Gestational Surrogacy
iv. Reversal of sterilization
6. Circumcision unless necessary for Treatment of an Illness or Injury not excluded hereunder or due to an Accident.
7. Conditions for which treatment could have been done on an out-patient basis without any Hospitalization.
8. Investigation & Evaluation (Code-Excl04):
i. Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded;
ii. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
9. Any treatment or part of a treatment that is not of a reasonable charge, is not a Medically Necessary Treatment; drugs or
treatments which are not supported by a prescription.
10. Costs of donor screening or costs incurred in an organ transplant Surgery involving organs not harvested from a human
body.
11. Unproven Treatments (Code- Excl16): Expenses related to any unproven treatment, services and supplies for or in
connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical
documentation to support their effectiveness.
12. Any form of Alternative Treatment:
i. AYUSH Treatment;
ii. Hydrotherapy, Acupuncture, Reflexology, Chiropractic Treatment or any other form of indigenous system of medicine.
13. Dental Treatment, dentures or Surgery of any kind unless necessitated due to an Accident and requiring minimum 24 hours
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Hospitalisation. Treatment related to gum disease or tooth disease or damage unless related to irreversible bone disease
involving the jaw which cannot be treated in any other way.
14. Routine eye examinations, cost of spectacles, multifocal lens, contact lenses.
15. Refractive Error (Code-Excl15): Expenses related to the treatment for correction of eyesight due to refractive error less than
7.5 dioptres.
16. a) Cost of hearing aids; including optometric therapy; b) cochlear implants unless necessitated by an Accident or required
intra-operatively.
17. Vaccinations including inoculation and immunizations except in case of post-bite treatment.
18. Any Treatment and associated expenses for alopecia, baldness, wigs, or toupees and hair fall Treatment and products,
19. Cost incurred for any health check-up or for the purpose of issuance of medical certificates and examinations required for
employment or travel or any other such purpose.
20. Any stay in Hospital without undertaking any Treatment or any other purpose other than for receiving eligible Treatment of
a type that normally requires a stay in the Hospital.
21. Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins,
minerals and organic substances unless prescribed by a medical practitioner as part of hospitalisation claim or day care
procedure. (Code-Excl14)
22. Artificial life maintenance including life support machine use, from the date of confirmation by the treating doctor that the
patient is in a vegetative state.
23. Rest Cure, Rehabilitation and Respite Care (Code-Excl05): Expenses related to any admission primarily for enforced bed rest
and not for receiving treatment. This also includes:
i. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as
bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
ii. Any services for people who are terminally ill to address physical, social, emotional, and spiritual needs.
24. Treatments received in health hydros, nature cure clinics, spas or similar establishments or private beds registered as a
nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons. (Code-
Excl13)
25. Breach of law (Code-Excl10): Expenses for treatment directly arising from or consequent upon any Insured Person
committing or attempting to commit a breach of law with criminal intent.
26. Certification / diagnosis / Treatment by a family member, or a person who stays with the Insured Person, save for the
proven material costs which are eligible for reimbursement as per the applicable cover, or from persons not registered as
Medical Practitioners under the respective Medical Councils, or from a Medical Practitioner who is practicing outside the
discipline that he is licensed for.
27. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code-Excl12)
28. Prostheses, corrective devices and and/or Medical Appliances, which are not required intra-operatively for the Illness/
Injury for which the Insured Person was Hospitalized.
29. Cosmetic or Plastic Surgery (Code-Excl08): Expenses for cosmetic or plastic surgery or any treatment to change appearance
unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a
direct and immediate health risk to the Insured. For this to be considered a medical necessity, it must be certified by the
attending Medical Practitioner.
30. Change-of-Gender treatments (Code-Excl07): Expenses related to any treatment, including surgical management, to change
characteristics of the body to those of the opposite sex.
31. Obesity/ Weight Control (Code-Excl06): Expenses related to the surgical treatment of obesity that does not fulfil all the
below
i. Surgery to be conducted is upon the advice of the Doctor
ii. The surgery/Procedure conducted should be supported by clinical protocols
iii. The member has to be 18 years of age or older and
iv. Body Mass Index (BMI)
A. greater than or equal to 40 or
B. greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive
methods of weight loss:
a. Obesity-related cardiomyopathy
b. Coronary heart disease
c. Severe Sleep Apnoea
d. Uncontrolled Type2 Diabetes
32. Treatment received outside India.
33. a) Instrument used in Treatment of Sleep Apnea Syndrome (C.P.A.P.); b) Oxygen Concentrator for Bronchial Asthmatic
condition; c) Infusion pump or any other external devices used during or after Treatment.

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34. Hazardous or Adventure sports (Code- Excl09): Expenses related to any treatment necessitated due to participation as a
professional in hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering,
rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.
35. Injury caused whilst flying or taking part in aerial activities (including cabin) except as a fare-paying passenger in a regular
scheduled airline or air charter company.
36. Maternity (Code-Excl18):
i. Medical treatment expenses traceable to child birth (Including complicated deliveries and caesarean sections incurred during
hospitalization) except ectopic pregnancy;
ii. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy
period.
37. All non-medical expenses including but not limited to convenience items for personal comfort not consistent with or
incidental to the diagnosis and Treatment of the Illness/Injury for which the Insured Person was Hospitalised, such as,
ambulatory devices, walker, crutches, belts, collars, splints, slings, braces, stockings of any kind, diabetic footwear,
glucometer/thermometer and any medical equipment that is subsequently used at home except when they form part of room
expenses. For complete list of non-medical expenses, please refer to the Annexure I 'Non-Medical Expenses' and also on Our
website.
38. Any opted Deductible (Per claim/ Aggregate/ Corporate) amount or percentage of admissible claim under Co-Payment, Sub
Limit if applicable and as specified in the Policy Schedule/ Certificate of Insurance to this Policy.
39. Charges related to a Hospital stay not expressly mentioned as being covered, including but not limited to charges for
admission, discharge, administration, registration, documentation and filing, including MRD charges (medical records
department charges).
40. Any physical, medical or mental condition or Treatment or service that is specifically excluded in the Policy Schedule/
Certificate of Insurance under Special Conditions.

EXCLUSIONS WHEREVER WAIVED OFF SPECIFICALLY WILL NOT BE APPLICABLE.

Procedures as per the conventional method

Sl. No. Procedureres Remarks

Femto-Second Laser Cataract

1 Liability to be restricted for MICS Procedure
Surgery
Liability to be restricted for Conventional Laser Procedure &as
2 Lasik Surgery per the other policy terms and conditions

3 Coblation Related Tonsillectomy Liability to be restricted for Conventional Tonsillectomy

4 Bariatric Surgery Covered subjected to other policy terms and conditions.

Cyber Knife Gamma Knife

5 Liability to be restricted for Conventional Radiotherapy
Procedures

6 Ozone/ Hyperbaric Oxygen Therapy Not admissible because it is not proven procedure
Up to 20% of Sum Insured subject to a maximum of INR2 Lacs
7 Oral Chemotherapy
per policy period for claims involving Oral Chemotherapy
Hormonal/ Adjuvant / Immune
8 modulators in Cancer Liability to be restricted for 5lac
Treatments
9 Multifocal Lens Liability to be restricted for monofocal Lens
10 Avastin/ Lucentis Inj. Liability to be restricted to 15k per incident
Liability to be restricted to 5k within maternity sub limit (If
11 Newborn Well baby care expense well baby care expense included in GIPSA Package then the
same not admissible)
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12 Pre and Post Natal Expense Liability to be restricted for 5k within the maternity sub limit
(Pre 30 Days prior to DOA and 60 Days after DOD)

Coverage of Medically advanced treatments restricted up to

Note: All advance procedure 50% of the sum insured (basecover) and for parents/parents
in law 20% co-pay would be applicable
Robotic surgeries:
• Up to 75% of Sum Insured per policy period for claims
involving Robotic Surgeries for (i) the treatment of any
disease involving Central Nervous System irrespective of
etiology; (ii) Malignancies
• Up to 50% of Sum Insured per policy period for claims
involving Robotic Surgeries for other diseases

Reimbursement Claims in PPN Network Hospitals

Any Reimbursement claim for a Listed GIPSA Package procedure in a PPN (Preferred Provider Network)
Hospital would be restricted to the PPN applicable rates irrespective of the billed amount

Information on GIPSA

What does GIPSA stand for?

General Insurers' Public Sector Association. It is an association of 4 PSU’s general insurance companies namely
National Insurance Co Ltd., New India Assurance Company Ltd, Oriental Insurance Co Ltd & United India Insurance
Co Ltd.

What is GIPSA PPN?

Preferred provider network (PPN) of hospitals empaneled by GIPSA companies for their insured member.
Hospitals enter into an agreement with GIPSA companies for extending cashless hospitalization benefit for GIPSA
member companies’ health insurance beneficiaries. Currently approximately 2200 hospitals have empaneled
across 12 Major cities. Bangalore, Chennai, Coimbatore, Hyderabad, in south. Pune, Mumbai, Ahmadabad and
Jaipur in West. Delhi, Chandigarh, Kolkata and Indore.

What is GIPSA package?

In PPN Hospitals, GIPSA companies have negotiated special package rates for a good number of procedures
commonly undergone.

Medical Insurance Scheme for employees-

Benefits of using GIPSA Hospital Packages vs. Network Hospital vs. Non-Network Hospital and also availing
reimbursement route:

*GIPSA Network hospitals provide treatment based on rate schedule separately contracted with all the PSU
insurance companies in 12 major cities.

Process to find GIPSA network hospitals.

1 – Employee has to login through OKTA and once they login; they need to click on Medvantage SSO link shared in the
communication.

2 – Once the employee gets the next page, employee can click on Network hospitalization, located on top right-

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hand corner of the screen.

3 – Post that the employee would have option to view the Network as well as GIPSA Network hospitals.

Refer the terms and conditions for Non-Medical Expenditure related to ‘Covid-19’ and ‘Non Covid-19’ Treatments,
Diagnostic Tests incidental to these treatments and Home Care Treatment.

These guidelines given below are liable to be reviewed periodically:

1. Non-Medical Expenditure (NME):

A. For Covid-19 Patients:

i. The major component of NMEs is the Personal Protective Equipment (PPE). PPEs may be allowed up to the

following limits for treatment of Covid-19 Patients:

a. Treatment in ‘Isolation Room / Single Room’: INR 1,000 per day

b. Treatment in ‘ICU’: INR 1500 per day

B. For Non-Covid-19 Patients:

a. Expenditure towards PPEs if used may be subsumed under the room rent / ICU charges limit.

2. RT-PCR or any other approved test for ‘Covid-19’ may also be allowed to Non-Covid-19 admissionsas per the

rates approved by the State / UT Administration / Appropriate Government Authority up to a maximum of INR

1,000 provided the test is done as per medical protocol while availing hospitalization treatment for a Non-

Covid-19 ailment / disease / injury. The expenses shall become admissible only if the primary claim is

admissible under the policy. The above expenses as mentioned in this clause shall be admissible only once for

chronic/ repetitive treatments like dialysis and chemotherapy.

3. Where, the policy already has ‘Non-medical Expenses’ as an Add-on cover, the Insured may be given a choice

to prefer a claim under the said Add-on cover of the policy or as per the above provision.

4. Hospitalization: Treatment for COVID-19 is regulated by various government agencies / authorities. The

policy shall cover treatments availed by insured members from hospitals / Isolation centres / community halls /

schools / colleges / stadiums / railway coaches/ any other facility / make-shift or temporary hospital notified by

the competent government authority to treat COVID-19. Treatments availed at these places shall be

considered as hospitalization treatments.

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5. Home Care Treatment: Many of our Retail and Group Health (excluding Government Schemes) cover Home

Care Treatment. However, even for our other health products also the ‘Home Care Treatment’ shall be

covered. The coverage, terms, and conditions for ‘Home Care Treatment’ is given below. No specific

endorsement needs to be passed on the policy to give effect to this cover.

a. Home Care Treatment means Treatment availed by the Insured Person at home for Covid19 on positive

diagnosis of Covid-19 in a Government authorized diagnostic Centre, which in normal course would require

care and treatment at a hospital but is actually taken at home maximum up to 14 days per incident provided

that:

i )The Medical Practitioner advises the Insured Person to undergo treatment at home

ii There is a continuous active line of treatment with monitoring of the health status by a medical practitioner

for each day through the duration of the home care treatment

iii Daily monitoring chart including records of treatment administered duly signed by the treating doctor is

maintained.

iv Insured shall be permitted to avail the services as prescribed by the Medical Practitioner. Cashless facility

shall be offered under home care expenses if the treatment is through a network provider.

v In case the insured intends to avail the services of non-network provider claim shall be subject to

reimbursement, a prior approval from the Insurer / TPA needs to be taken before availing such services.

b. In this benefit, the following shall be covered if prescribed by the treating Medical Practitioner and is related

to treatment of COVID:

i )Diagnostic tests undergone at home or at diagnostics center

ii Medicines prescribed in writing

iii Consultation charges of the medical practitioner

iv Nursing charges related to medical staff

v Medical procedures limited to parenteral administration of medicines vi Cost of Pulse Oximeter, Oxygen

cylinder and Nebulizer

c. The benefit under this clause is limited to INR 15,000 per incident.

d. Where, the policy already has ‘Domiciliary Hospitalization’ cover, the Insured may be given a choice to prefer
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a claim under the said Domiciliary Hospitalization cover of the policy or as per the above provision.

e. In case of policies with in-built Home Care Treatment cover, the terms & conditions of that particular policy

shall have to be followed.

f. The claim intimation clause should be adhered to. Government Schemes shall continue to be governed by

the Scheme as it is without any change.

6. Quarantine: Quarantine is a restriction on the movement of those who may have been exposed to a

communicable disease but do not have a confirmed medical diagnosis. Quarantine can be an ‘Institutional

Quarantine’ generally maintained by the public authorities. People with travel history are normally lodged in

such facilities. It can be a private facility like hotels, etc. People who do not wish to stay in Institutional

Quarantine facilities may opt for private facilities. It can also be a home quarantine. As Quarantine is done only

to restrict movement of persons who do not have a confirmed medical diagnosis, the expenses in case of

Quarantine are not covered.

In case of an admissible claim, expenses incurred on the following procedures (wherever medically indicated) either as in-
patient or as part of day care treatment in a hospital, shall be covered. The claim shall be subject to additional sub-limits
indicated against them in the table below:

Modern Treatment Methods &

S.No. Limits Per Surgery
Advancement in Technology

Up to 20% of Sum Insured subject to a maximum of INR2 Lacs per

Uterine Artery Embolization & High
1 policy period for claims involving Uterine Artery Embolization &
Intensity Focused Ultrasound (HIFU
HIFU

Up to 10% of Sum Insured subject to a maximum of INR1 Lac per

2 Balloon Sinuplasty
policy period for claims involving Balloon Sinuplasty

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Up to 70% of Sum Insured per policy period for claims involving

3 Deep Brain Stimulation
Deep Brain Stimulation
Up to 20% of Sum Insured subject to a maximum of INR2 Lacs per
4 Oral Chemotherapy
policy period for claims involving Oral Chemotherapy
Immunotherapy-Monoclonal Antibody Up to 20% of Sum Insured subject to a maximum of INR2 Lacs per
5
to be given as injection policy period
Up to 10% of Sum Insured subject to a maximum of INR 1 Lac per
6 Intra vitreal Injections
policy period

Up to 75% of Sum Insured per policy period for claims involving

Robotic Surgeries for (i) the treatment of any disease involving
Robotic Surgeries (Including Robotic Central Nervous System irrespective of etiology; (ii) Malignancies
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Assisted Surgeries)
Up to 50% of Sum Insured per policy period for claims involving
Robotic Surgeries for other diseases

Up to 50% of Sum Insured per policy period for claims involving

8 Stereotactic Radio Surgeries
Stereotactic Radio Surgeries
Up to 30% of Sum insured subject to a maximum of INR3 Lacs per
9 Bronchial Thermoplasty
policy period for claims involving Bronchial Thermoplasty
Vaporization of the Prostate (Green
Up to 30% of Sum Insured subject to a maximum of INR2 Lacs per
10 laser treatment for holmium laser
policy period.
treatment)
Up to 15% of Sum Insured per policy period for claims involving
Intra Operative Neuro Monitoring
11 Intra Operative Neuro Monitoring subject to a maximum of INR 1
(IONM)
Lac per policy period

Stem Cell Therapy: Hematopoietic Stem

Cells for bone marrow transplant for No additional sub-limit however co pay as per policy terms is
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hematological applicable
conditions to be covered only

Note: If, for a given admissible claim, limits as listed in the Table above AND Ailment Capping Limits as in policy are applicable
simultaneously, then the lower of the two limits shall apply.

PS: For detailed terms and conditions, expiring policy should be referred andshall hold good for detailed interpretation.

Note: Annual sub limits for all the coverages have not been mentioned. For further details please reach to the below

Call Center: 1800-210-0404

Email ID: adobe.nda@marsh.com / adobe.blr@marsh.com

Dental Expenses Cover under OPD

We will pay the medical expenses incurred towards dental treatment including any emergency
treatment by a Dentist following an accident where the Insured Person suffers injuries or damage to his natural teeth and/or
gums. The payment under this benefit is within the Basic Sum Insured, subject to limits specified in the schedule.

This benefit also provides cover for:

a. The fees for a dental practitioner and associated costs for carrying out routine dental
procedures like clinical oral examinations, tooth scaling, normal fillings, minor procedures
and non-surgical extractions.

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 Adobe – PY 2022-23 - GMC Policy Terms and Conditions

b. Root canal treatment and surgical extraction of tooth.

This Benefit will exclude

i. Any instructions for plaque control, oral hygiene and diet

ii. Any treatment which is cosmetic in nature.

Permanent Exclusion 13 under Section IV of the Policy Wordings stands deleted for this cover.
All claims under this Benefit can be made as per the process defined under Section V. 5 under the Base Cover Terms and
Conditions and Section III under Optional Cover Terms and Conditions, as applicable.

Vision Expenses Cover under OPD

We will pay the Reasonable and Customary Charges incurred during the Policy period by the
Insured Person up to the limit specified in the Policy Schedule/ Certificate of Insurance and will
be within the Base Sum Insured in relation to the following:

i. Eye examination by an optometrist or ophthalmologist

ii. Cost of lenses to correct refractory errors

We will not be liable to make any payment in respect of the following:

i. Cost of frames for the prescribed lenses.
ii. Sunglasses, unless medically prescribed by a Medical Practitioner.
iii. Medical or surgical Treatment of the eye.
iv. Lenses which are not medically necessary and are not prescribed by an optometrist or
Ophthalmologist.

If this Option is in force in respect of the Insured Person, then the relevant part of Exclusion
IV.A.14 will be deemed to be inoperative for the purpose of this Option in respect of that Insured Person up to the Sum Insured
specified for this Benefit.

All claims under this Benefit can be made as per the process defined under Section V 5 under the Base Cover Terms and
Conditions and Section III under the Optional Cover Terms and Conditions, as applicable.

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