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THE ORIENTAL INSURANCE COMPANY
Medical Insurance

ALPA Group Medical Coverage (GMC) Details for the year 2022 - 2023 (from 20th June 2022 to 19th June 2023)

ALPA India strives for the betterment of Indian pilots regardless of their country of employment. ALPA India offers its pilots and their family a medical insurance plan as part of its commitment to securing their future.

  • Siblings & Children upto 30 yrs
  • Permanent disabled child, covered without any age limit
  • Normal Room Rent For 5 lacs - 6k, 10 lacs - 8k, 25 lacs -12.5k & 30 lacs - 15k
  • All other charges in accordance with the Room Rent restriction
Sl.No.COVERAGEDEFENITIONNEW TERMSADDITIONAL BENEFITS
1Family DefinitionA family floater policy is a health insurance plan which covers the entire family on the payment of a single annual premium. The sum assured covers the entire family and can be used in case of multiple hospitalizations in the family
  • 1+ 5 Self + Spouse + 4 children OR Parents or Parents in-law (cross selection allowed) & Siblings upto 30 years (size of the family should not be more than 1+5)
  • Only dependent and unmarried children & Siblings upto 30 years covered. Rest - 99 years.
2Sum Insured family floater basisThe sum insured is the maximum value for a particular year that the insurance company can pay if hospitalized. Any amount exceeding the sum insured will have to be borne by (the) GMC member (“The” agreed )amount on the sum insured will be the maximum amount (that will be) received in case of medical treatment or hospitalization.5 lacs , 10 lacs , 25 lacs & 30 LacsYou can select the coverage as per your family's requirment
3Room Rent RestrictionsSub-limit on room rent would mean that the insurer defines the maximum amount it will pay towards the room rent.
430 days , 1st, 2nd 3rd & 4th Year waiting1. Coverage of Pre-existing Conditions without any waiting period.
2. Waiver of the exclusions relating to the first 30 days of the Policy period.
Waived
5Maternity Day 1No waiting period for MaternityNormal & Csection Rs. 1.5 lacs
6Pre & Post Natal expensesPre- and post-natal expenses would mean costs pertaining to ultrasound, regular checkups, doctor's consultation fee, medicines and so on. These are similar to pre- and post-hospitalisation expenses that are admissible under a standard health insurance policy.Pre - Within Maternity limits , Post within full Sum insured
7New born Baby CoverCover Medical Expenses towards the medical treatment of the Insured Person's New Born Baby while the Insured Person is Hospitalised for Inpatient Care for delivery.Covered within Family Floater SI from Day 1No additional premium required for new born bay
8Pre-existing Disease Covered - day 1Any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and/or were diagnosed, and/or received medical advice/treatment within 48 months prior to the first policy issued by the insurer.Covered for all Members
9Pre & Post Hospitalization periodThe Policy pays the Medical Expenses incurred as defined for an ailment/disease Injury not different from the one for which hospitalization was necessary during the Pre and Post Hospitalization period.60 & 90 days
10Domiciliary hospitalisationDomiciliary hospitalization means medical treatment for a period exceeding three days for such an illness/disease/injury which in the normal course would require care and treatment at a hospital but is actually taken while confined at home under any of the following circumstances: the condition of the patient is such that he/she is not in a condition to be removed to a hospital, or the patient takes treatment at home on account of the non-availability of a room in a hospital.10% of SI
11Emergency Ambulance charges / Air fareExpenses for utilizing an ambulance service for transporting an insured person to a hospital in case of an emergency or from one hospital to another if medical services required are not available.Emergency ambulance charges - air fare - Max of Rs 10 k - emergency. Air ambulance charges - Max Rs 2 lacs. Incl/ Commercial Airlines
12External congenitalThe Policy is extended to provide coverage for surgical treatment on in-patient basis for External congenital disease/s in life threatening situation upto the limit specified in the Policy Schedule towards this benefit.Covered Under Life threatening conditions
13Copay clauseHowever, capped ailments like cataracts will not attract any Co-pay20% copay on Parental Claims, No copay on othersNo copay for member, spouse, children and sibilings
14CataractA cataract is a cloudiness or opacity in the normally transparent crystalline lens of the eye. Cataract surgery is a procedure to remove the lens of your eye and, in most cases, replace it with an artificial lens.Cataract INR 70,000 per eye
15Cochlear Implant treatmentA cochlear implant is a small electronic device that electrically stimulates the cochlear nerve (nerve for hearing)Restricted to 40% of Sum Insured
16Cyber Knife treatment and stem cell tplt.The CyberKnife —one of the most advanced forms of radiosurgery — is a painless, non-invasive treatment that delivers high doses of precisely targeted radiation to destroy tumors or lesions within the body. It uses a robotic arm to deliver highly focused beams of radiation.Covered with 40% copay
17Corporate BufferA corporate buffer limit to take care of any defined emergencies which exceed the individual/ Family limit of the Sum Insured specified under the Policy. This additional limit is available basis Per person/ family limit subject to the overall corporate buffer limit specified in the Policy Schedule selected for the full policy period. The Corporate Buffer will not be available for diseases /procedures / treatments where specific sub-limit/s is /are applicable in the Policy.Rs. 50 Lacs - Equivalent to family SI - For Critical illness
18Day Care proceduresWe will pay the Medical expenses incurred for the Day care procedures which do not require 24 hours Hospitalization due to technological advancement .This excludes all procedures or treatment taken in Out-patient departments.Covered as per Insurer standard coverage list (List attached)
19Terrorism Related HospitalizationCovered
20LGBTQ Cover/ Live In partnerMedical insurance to same-sex partners/ 1 live in partnerCovered
21Oral chemotherapyOral chemotherapy is a cancer-fighting drug given by mouth in tablet, capsule, or liquid form. It is prescribed by your doctor, nurse practitioner, or physician's assistant, and has the same benefits and risks as chemotherapy given by infusion. Today, many cancer patients receive oral chemotherapy as a treatmentCovered for all members
22OPD Expenses @ 10k Per FamilyThe Policy is extended to include consultations, pharmacy, diagnostics, medical and surgical procedures taken on an Out-Patient basis upto the amount as stated in the PolicyCovered
23Lasik SurgeryThis extension covers charges incurred towards correction of refractive errors by using lasik surgery in case of compound myopic astigmatism in both eyes to the level of (- )7.5D and above.If power of eye is above +/- 7.5, is payable
24In case of Death of MemberValidity of the policy, after the demise of the Main Policy Holder (ALPA member)Continued cover of dependants, No copay or deductions on claims
25Psychiatric AilmentsAlso called mental health disorders, refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behaviour. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behavioursIn such case only on doctor prescription and admission an amount of INR 30,000 can be claimed per family (in-patient / out-patient)New Benefit
26Balloon SinuplastyThis minimally invasive technique is used to treat chronic or recurrent sinusitis or sinus infections when medical therapy has not provided adequate reliefCovered and restricted to 50% of the sum insured
Covered without any age limits
New Benefit
27Permanent disabled childCovered without any age limitsNew Benefit

Premium Details for Policy Period 20th June 2022 to 19th June 2023

SUM INSURED5 LACS10 LACS SI25 LACS SI₹ 92,300
SUM INSURED5 LACS10 LACS SI25 LACS SI₹ 92,300

Premium plus Admin charges - Rs. 2500/-

Insurance CompanyThe Oriental Insurance Co.Total amount to be paidSum Insured
TPA…..................Vidal Health₹69,951for 5 Lacs
₹78,288for 10 Lacs
Policy stated wef 20th June 2022 & now the premium will be on PRORATA basis₹88,443for 25 Lacs
₹94,800for 30 Lacs