Medicare

Co-op Medicare

Having a pre-existing condition should not prevent you from getting a medical cover!

The Co-op MediCare plan is designed to suit your health needs.

It takes care of the expensive medical treatments incurred for both inpatient and outpatient.

Your health is precious to you. It enables you to live a happier life.

With MediCare, you do not have to worry about not having enough money for treatment in case you fall sick.

Co-op MediCare is suitable for individuals, families, groups and organizations.

  • Waiting periods

    • 120 days for non-accidental surgery, gynecological and ENT surgery.
    • 6 months for disclosed pre-existing, chronic, congenital and HIV/AIDS & related conditions.
    • 12 months waiting period for cancer.
    • Newly diagnosed chronic ailments are not subject to the waiting period but the amount payable is limited to the sublimit for pre-existing & chronic ailments.
    • 12 months for maternity and 1st Ever Emergency claims.
    • All illnesses (inpatient and outpatient) are subject to 30 days waiting period.

  • In and out patient bundles

    COVER TYPE IN PATIENT OUT PATIENT
    LILAC 200,000/= 20,000/=
    BLOSSOM 400,000/= 25,000/=
    JASMINE 600,000/= 30,000/=
    ORCHID 800,000/= 40,000/=
    DAISY 1,000,000/= 50,000/=
    LILY 2,000,000/= 70,000/=
    TULIP 3,000,000/= 80,000/=
    JACARANDA 5,000,000/= 120,000/=

  • Exclusions

    • Self referred or self prescribed treatment
    • Family planning, infertility & impotence
    • Intentional self- injury, chronic drunkenness, suicide or attempted suicide, drug and substance abuse, hazardous pursuits(sports and hobbies)
    • Cosmetic and beauty treatment (unless necessitated by accidental injury)
    • Outpatient ambulance services
    • Experimental treatment or treatment subject to medical research
    • Weight management treatment and drugs
    • Diagnostic equipment(glucometers, BP Machines etc and hearing aids
    • General medical checkups not incidental to diagnosis of an illness or Injury
    • External surgical appliances(crutches and wheelchairs and prosthesis
    • Dental prosthesis, crowns, dentures, bridges and braces
    • Alternative medicine ( acupuncture, chiropractor, herbal medicine).
    • Treatment outside the appointed panel of service providers
    • Nutritional supplements unless prescribed as part of medical treatment of specified conditions
    • Adult vaccinations and private vaccines for children.
    • Costs of donor and related cost transplant for organ transplant
    • Optical services including eg eye glasses/lenses/frames, eye testing, transplants/grafts and laser surgery

  • Conditions

    • The waiting period is not applicable for accidental cases or persons transferring from another Medical Insurance Policy.
    • Outpatient treatment can only be purchased at the inception/renewal of the policy and not during the term of the policy.
    • Members are not subjected to medicals tests on joining.
    • No cash deposit is required and no contribution to the bill by the customer.
    • Extensive service provider/hospital network.

  • Outpatient procedures

    • Present your membership smart card at the service provider’s (doctor, clinic or hospital) facility’s desk for identification.
    • Your membership will be checked and confirmed using your smartcard and fingerprints.
    • Complete and sign the claim form which will be made available at the service provider’s facility. The attending physician/specialist must also complete and sign the claim form. A claim form must be completed for each episode of treatment and for each person.
    • All bills will be sent by the service provider directly.

  • Benefits

    • Pays for hospitalization medical expenses.
    • Provides supplementary benefits within the main covers which include pre-existing conditions, chronic conditions, HIV/AIDS, maternity, inpatient dental & ophthalmology (eye disease).
    • Funeral expenses cover.
    • Enables valid members to obtain quality healthcare from private providers.
    • Available to customers/employees and their immediate dependents.
    • Access to 24-hour medical treatment.
    • No cash deposit.
    • No contribution to the bill by the customers.
    • Various options are available.
    • Wide scope of cover.
    • Dependent children can be covered on their own, provided the parent proves that they are covered elsewhere e.g. by an employer and the children are not included.
    • Mixing of both inpatient and outpatient options.

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