DIGIT HEALTH PLUS POLICY
POLICY SCHEDULE
UIN: GODHLGP21487V032021
Hi,
Enjoy the extra protection and say bye-bye to
regrets !
Your Policy Number is : D151760647
Policy Start Date 08-Jun-2024
Policy Valid Upto Date 07-Jun-2025
GMC Policy Document Generation Date: 18-Jun-2024
Policy Number: D151760647 Endorsement Version Number / Option Number: Base Option
Details of the Insured
Name of Group
Organizer/Manager/ ALTURA CONSULTING PRIVATE LIMITED
Policy Holder
Address of Group
Organizer/Manager/ 7TH FLOOR, RAMKY GRANDIOSE, GACHIBOWLI, HYDERABAD ,500032
Policy Holder
Policy Type Digit Renewal Group Type Employer - Employee
Master Policy Number D151760647 Policy Tenure 1 Year
Policy inception date 08-Jun-2024 Policy expiration date 07-Jun-2025
GST State Code 36 GSTIN 36AAGCA6278B1ZR
TPA Name Digit in-House
Policy Description Base
Partner Details
ARKA INSURANCE
Partner name Partner Code 1121502
BROKING PRIVATE LTD
Office Name RM Name
Demographic Summary
Relationship Lives Count
Self 30
Spouse/Partner 16
Child 19
Total 65
Premium Summary
Values shown in the below table are per member premium rates excluding taxes.
Packa Sum
ge Insure 0-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81-85 from-86
Name d
Package1 200000 3,344.69 3,680.79 4,464.00 5,908.44 7,616.79 9,697.05 12,495.85 16,355.33 21,476.86 28,304.52 37,160.34 48,124.38 59,443.61 72,194.53
Premium Details
Net Premium 2,84,498.12
GST 51,209.66
Gross Premium 3,35,707.78
Special Conditions
Coverage Details Annexure
Below Coverages will be applicable to all packages
All Packages
No
Sum insured As Per Package
Family Composition
Employee + Spouse + Dependent Children
Sum Insured Basis: Floater
Baby Day 1 Cover: Covered up to Sum Insured
6 Max no. of Members Allowed Per
non- Relationship to Employee Max Allowable Age at Entry
1 Family
1 Self 1 75
0 Spouse/Partner 1 75
Yes Child 6 30
Total Dependents 7
Sum Insured and Room Rent Restriction
Per day Limit for Normal
Per day Limit for ICU Room Type Restriction
Room
No Restriction for Normal
Metro 2.00 % of SI 4.00 % of SI Room & No Restriction for
ICU
50 No Restriction for Normal
Non-Metro 2.00 % of SI 4.00 % of SI Room & No Restriction for
ICU
No
Proportionate Deduction clause applicable where Insured member has opted for room
Proportionate Deduction
rent higher than eligible room rent category. Proportionate deduction clause will not be
Clause
applicable for ICU Hospitalization.
[Link] Rent : Room rent includes bed charges, duty doctor, nursing charges and service
Room Rent Restriction charges or amenities (if any)
Special Condition [Link] Rent : ICU charges includes ICU bed, general medical support, medical devices
expenses, critical care nursing and intensivist charges.
Co-Payments, SI Restrictions and Deductibles
100 Following Co-payment will be applicable on each claim on admissible claim
amount
2.0 Self : No Co-pay
No Co-payment Spouse: No Co-pay
No Child: No Co-pay
No Parent: No Co-pay
No
Siblings: No Co-pay
No
No Network Hospital Reimbursement Co-
No Not Applicable
No pay
App
No
Non-network Co-pay Not Applicable
Waiting Periods
300 PED Waiting Period Not Applicable Initial Waiting Period Not Applicable
200
350
250
Specific Illness Waiting
Not Applicable
Period
Maternity
Maternity Limit Normal
Metro City 30000 Non-Metro 20000
Delivery
Maternity Limit
Metro City 35000 Non-Metro 25000
Caesarian Delivery
Maternity Waiting
Not Applicable
Period
Maternity benefit is available only for Self + Spouse Maternity Benefit will be applicable
Maternity Eligibility
for first 2 children only.
Pre and Post Natal Pre and Post-Natal expenses covered up to INR 5000 on IPD Basis Only. Pre and Post-
Expenses Natal limit is Within Maternity Limit
Well Baby Expenses Not Covered
Well Mother Expenses Not Covered
Maternity Limit for
Life-threatening maternity complications will be covered Covered up to Maternity Limit
Complications
Maternity Limit for twin-
Limit for twin-delivery will be 100% of Maternity Limit
delivery
Infertility Treatment Not Covered
Corporate Buffer
Corporate Buffer Not applicable
Frequent Coverages
Ambulance charges covered upto 1 % of Sum Insured upto a maximum of
INR 2000 per case in case of emergency only. Ambulance charges will be
Emergency Ambulance applicable for transferring patient to Hospital or between Hospitals in the
Hospitals ambulance or in an ambulance provided by any ambulance service
provider only
Day Care Procedures Day Care procedures are covered up to 100 % of SI
Pre and Post Hospitalization
Covered up to 30/60 days respectively max up to 100% of Sum Insured.
Expenses
Lasik Surgery Not Covered
Aayush Treatment Not Covered
Domiciliary Hospitalization Not Covered
Psychiatric ailments Not Covered
Organ Donor Expenses Not Covered
Congenital Conditions Internal congenital diseases are covered up to 100% of SI, external is Not Covered.
Terrorism Covered
Reasonable and Customary Charges will be applied on re-imbursement
claims from non network hospitals where medical treatment is taken during
the Policy Period following an Illness or Injury that occurs during the Policy
Reasonable And Customary Clause
Period, subject to availability of the Sum Insured and any specific limits
specified in the Schedule of Benefits and the terms, conditions and exclusions
specified in the Policy document.
All reimbursement claims have to be intimated to Digit within 7 days from date of
Claim intimation clause admission.
All reimbursement claims have to be intimated to Digit within 30 days from date of
Document Submission clause discharge.
Dental Treatment (Due to accident
Covered upto SI in case of accidental Hospitalization only.
only)
Advanced and Modern Treatments
Uterine Artery Embolization and HIFU Covered up to 50 % of SI.
Balloon Sinuplasty Covered up to 50 % of SI.
Deep Brain stimulation Covered up to 50 % of SI.
Oral chemotherapy Covered up to 50 % of SI.
Immunotherapy Covered up to 50 % of SI.
Intra vitreal injections Covered up to 50 % of SI.
Robotic Surgery Covered up to 50 % of SI.
Stereotactic radio surgeries Covered up to 50% of SI.
Bronchical Thermoplasty Covered up to 50 % of SI.
Vaporisation of the prostrate Covered up to 50 % of SI.
IONM - (Intra Operative Neuro Monitoring) Covered up to 50 % of SI.
Stem cell therapy Covered up to 50 % of SI.
Cyber Knife Treatment Covered up to 50 % of SI.
Gamma Knife Treatment Covered up to 50 % of SI.
Cochlear Implant treatment Covered up to 50 % of SI.
OPD
OPD Sum Insured OPD Treatment is Not Covered.
Digit Advantage Covers
Additional Sickness Benefit Covered
Automatic Sum Insured Reinstatement Covered
Wellness Benefits Wide range of wellness benefits available on the Digit app
Other Terms and Conditions(Applicable to all Packages)
Additional premium will be charged for each additional member as per the rater given
Premium Rating
above.
Midterm additions allowed only for natural additions subject to intimation received within
45 days. Any additions for new employee/spouse / children would be allowed within 45
Addition Endorsements days of joining/ marriage / birth respectively. Any endorsements will be from the date of
addition and not from the inception of the policy. Prorated premium will be charged for
each member added during the policy term.
In case of refund endorsements on account of deletion, pro-rata refund for entire family
will be done subject to nil claims. Deletion to be intimated immediately on finalization of
last working day of employee and within 45 days after the last working day of the
employee. In case employee avails the claim after his Last Working Day for which
Deletion Endorsements
deletion intimation is received after DOA, insurer would recover paid amount from
available float balance. Pro-rata refund will be calculated as from last working day if
intimation is within 45 days, else intimation date will be consider for calculation subject to
nil claim.
Premium Payment
Yearly
Frequency
All insurable members in the group to be insured under policy and there shall be no
Non-Selection Clause selection of members unless specifically declared to and agreed by the underwriting team
of Digit.
Any Doctors/ Surgeons fees charged/paid over and above the Hospital Standard
Tariff/Package stand excluded from the scope of the policy. In case of Chamber cases or
Other Condition 1 outside visiting consultant has conducted the surgery or is being consulted, Insurance
company would be liable to pay up to the agreed tariff/ package rates with the hospital.
The over & above limit will have to be borne by the customer.
Cheque dishonor / Non-receipt of payment: The policy is void ab-initio in case of non-
Other Condition 2
receipt of premium or dishonor of Cheque issued towards premium payment
This policy is subject to the standard policy wordings, warranties, exclusions and
Other Condition 3 conditions as per “Digit Health plus policy (Revision)” Wordings. In case of dispute, the
terms and conditions detailed in the policy document and policy schedule shall prevail.
The coverage has been provided basis information provided by you/proposer to us and
we reserve the right to cancel the policy since inception without refund of premium as per
policy terms and conditions and shall not be liable for any claims if it is found that any of
Other Condition 4
your statements or particulars or declarations in the proposal form or other documents
are incorrect /misleading /Fraudulent in any respect on any matter to the grant of a cover
or submission of claim in future.
The Policy Wording attached herewith includes all the standard coverage offered by Go
Digit General Insurance Ltd. to its customers. Your entitlement for coverage/benefits shall
Other Condition 5
be restricted to the Coverage/Benefits as mentioned in this Policy Schedule. For any
clarification please call our Call Center Number 1800 258 4242
Mumbai, Delhi, Kolkata, Chennai, Bangalore, Hyderabad, Ahmedabad, Pune, and Surat
Other Condition 6
will be considered as Metro Cities. All other region will be considered as non-metro
Additional Sickness Benefit:
Digit will pay 50% of monthly take home salary for up to 2 months in case following
conditions are fulfilled:
1. Insured undergoes hospitalization as an inpatient for a period of 7 continuous and
completed days.
2. Post hospitalization, the insured is unable to perform each and every duty
pertaining to their employment leading to absence from work, provided such inability to
work is certified by the treating doctor during hospitalization.
3. The insured has exhausted all paid leave and the absence from work is resulting in
leave without pay.
The Benefit shall start applicable after all the leaves are exhausted or after 15 days post
discharge of hospital, whichever is maximum.
1. The monthly benefit amount payable will be lower of:
a. 50% of net take home salary calculated as the average of net take home salary of
preceding 3 months. OR
b. INR 50,000
2. This cover is applicable only for ESC and ESCP policies. The cover is not applicable
Other Condition 7 for Employee only or Parents only policies.
3. This cover is applicable only for individuals employed in a full-time, salary-paying
job.
4. The cover is not applicable for contractual employee.
5. This benefit will be payable only once in a policy period.
6. The Benefit shall stop after cease of the master policy or if the employee retirees or
leave the employment or his/her employment has been terminated by the employer.
Exclusions under Additional Sickness Benefit:
No benefit will be payable in the following cases:
1. In case the hospitalization is for maternity treatments.
2. IN case of any cosmetic surgeries or cataract/eye related surgeries to correct eye
power.
3. If the absence from work is due to any kind of quarantine.
4. In case hospitalization is in absence of an active line of treatment.
5. If the hospitalization claim is not admissible as per the other terms of this policy.
6. Net take home salary shall excludes one time incentives, variable pays, Bonus,
performance based incentives, reimbursements.
Automatic Sum Insured reinstatement:
Up to 50% of Base SI will be reinstated provided that the 100% of the base SI is
exhausted and subsequently insured needs additional cover for unrelated illness /
condition within the policy period. The second hospitalization must happen after the
original Sum Insured has already been exhausted and there is a minimum gap of 45 days
Other Condition 8
since the Sum Insured was exhausted and Insured person was discharged from the
hospital for the reinstatement to trigger. Sum Insured reinstatement will also be
applicable in family floater policies, where other family members may reinstate the Sum
Insured in case the Sum Insured has been fully exhausted. 45 days clause shall not be
applicable for different insured person within the family.
Claim Administrator Details
Contact Details 1800 258 4242
Email ID healthclaims@[Link]
For Senior Citizens seniors@[Link]
Consolidated Stamp Duty has been paid as per Letter of
To view Policy Wordings Click Here Authorization No.67-B/04/2017-18 Date: 30th May 2017
issued by Department of Stamps and Registration ,
For & On Behalf of Go Digit General Insurance Ltd.
Bengaluru- 560009 - KARNATAKA.
Authorized Signatory
Go Digit General Insurance Limited, Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th
Block,Bengaluru, Karnataka-560095, IRDAI Reg. No.-158, CIN: U66010PN2016PLC167410, Website: [Link],
Toll-free Number: 1800-258-5956.
