Domain Registration ID: D414400000002908407-IN Editor - vinayak Ashok Jain (Luniya) 8109913008

Sachcha Dost News Entertainment OPC Pvt. Ltd.

Customized scheme exclusively designed for Registered of Customers of Sachcha Dost News Entertainment OPC Pvt. Ltd offering the Group Health Indemnity benefit from Religare Health Insurance.

Plan 1 Details:-

Particulars Description
SumInsured (SI) inRs. 60K
Covertype Individual
Eligible Relationship Self
Entry Age –Min Asan Adult 18 Years,
Entry Age –Max Asan Adult 70 Years,
Exit Age LifeLong*
Membership Registered Customers of Sachcha dost News Entertainment OPC Pvt.Ltd
Heath Check-up NO,Good health declaration basis
Policy Tenure 1 Year
Claims Pay-out Re-imbursement
Claims Servicing In–house
Benefits  
Hospitalization expenses  
In- patientcare UP toSI
WaitPeriods  
Initial WaitPeriod 30Days (exceptforInjuries/Accident)
Name dailments 12months
Pre-existingDiseases 12months
Sub Limit:-  
DailyCash :- 2000/- per day for suminsured 60k after 1 day deductible

Plan 2 Details:-

Particulars Description
SumInsured (SI) inRs. 60K
Covertype Individual
Eligible Relationship Self
Entry Age –Min Asan Adult 70 Years,
Exit Age LifeLong*
Membership Registered Customers of Sachcha dost News Entertainment OPC Pvt.Ltd
Heath Check-up NO,Good health declaration basis
Policy Tenure 1 Year
Claims Pay-out Re-imbursement
Claims Servicing In–house
Benefits  
Hospitalization expenses  
In- patientcare UP toSI
WaitPeriods  
Initial WaitPeriod 30Days (exceptforInjuries/Accident)
Name dailments 12months
Pre-existingDiseases 12months
Sub Limit:-  
Daily Cash :- 2000/- per day for suminsured 60k after 1 day deductible

Final Premium Rates in INR (Including GST):

Individual
Age Band / SumInsured 60000
18Yearsto 70Years 800
Above70Years* 1040

*Subject to Master Policy renewal. 

Section 1: Sales & Issuance Process

The sales will be done in the following way:

Process (Excel Booking)

  • RHICL health insurance product Group Care will be pitched to the customer by Sachcha Dost News Entertainment OPC Pvt Ltd.
  • Once the customer’s consent is taken from the customer, enrollment form is filled up by the customer and retained by Sachcha Dost News Entertainment OPC Pvt Ltd
  •  Enrollment form will be shared with the partner which is required to be completely filled and stamped with all the necessary declarations. Enrollment form attached for reference.
  • The data from application form is taken in the attached excel sheet format:

Section 2: Cancellation and Endorsement:

Cancellation- Customer may give request to Sachcha Dost News Entertainment OPC Pvt Ltd.in writing or customer will share the same request with RHICL within 24 hours of receiving the request. Customer may give 15 days’ notice in writing, to Sachcha Dost News Entertainment OPC Pvt Ltd/RHICL for the cancellation of the Policy, in which case the Company shall from the date of receipt of the notice, cancel the Policy and refund the premium for the unexpired period of this Policy at the short period scales as mentioned below, provided no Claim has been made and full premium has been received under the Policy.

Cancellation period upto (x months) from Policy Period Start Date Refund %
1 month 75
3 months 50
Beyond 6 months 0
  1. Any deviations to the above process in refund amount calculation will be post approval of RHICL Vertical Head
  1. Free Look Cancellation – Customer may give cancellation request to Sachcha Dost News Entertainment OPC Pvt Ltd., within 15 days from the receipt of the Certificate of Insurance return the Certificate stating reasons, if the terms and conditions are not acceptable to the Insured Person. Sachcha Dost News Entertainment OPC Pvt Ltd. will share the same within 24 hours with RHICL. If no Claim has been made under the Certificate, the Company will refund the premium received after deducting proportionate risk premium for the period on cover.
  • Endorsement- There are 2 types of endorsements that the customer may do viz.:
    • Premium bearing endorsement- As we are providing only one sum insured with one premium in that case no premium bearing endorsement allow in this.
    • Non- Premium bearing endorsement- Those endorsements having no impact on the premium for eg: Rectification in name, address, mobile no.
  • In case of any customer request like endorsement, cancellation or Claim related query, customer to contact RHICL at 1800-102-4488 or write to customerfirst@religarehealthinsurance.com
  • The premium would be refunded to the Sachcha Dost News Entertainment OPC Pvt Ltd

Claims Process – Group Care

  1. Claims will be intimated through the call Centre or through a fax/letter and the claim will be intimated once you/Insured Member inform Religare Health and a registration of the claim in the books will be done by Us.
  2. The customer service team at the call Centre will provide required assistance and explain claims procedure to the insured/representative along with all the mandatory documents required.
  3. The following information has to be provided during intimation of claims
  1. Name of the Policyholder
  2. Name of Claimant with customer ID
  3. Type of Claim
  4. Date of Accident/Loss
  5. Approximate claim amount in case of Accidental Medical expenses claim
  6. Date of Admission in case of hospitalization

An SMS/ or communication through any media will be sent to the requestor on intimation with a unique ID against which all the documents/information can be submitted or any query can be resolved.

  1. There will a checklist of documents defined which will be updated as and when needed and the same documents will have to be received depending on the claim/benefit claims. Once the documents have been received the claims will be entered in the Core system where the following details will be entered and quality check done.
  2. Checklist of all documents to be received
  3. Date of loss being within the policy period
  4. Benefits availed
  5. Restriction on policy if any
  6. Sum Insured Balance
  7. Length of stay in case of Accidental hospitalization
  8.  Line of treatment
  9. Detailed Bill Entry ( In case of Accidental hospitalization)
    1. Room Rents
    1. Doctor Charges
    1. Consumables
    1. Nursing Charges
    1. Surgery Charges
    1. OT and Anesthetic Charges
    1. Pharmacy
    1. Investigations

i. Date of Accident

j. Description of Accident

k. Nature of Injury

l. Extent of disablement

m. Legal details for egs: FIR Details etc.

  • Post the data entry is completed and the policy benefits have been validated, the claim will be sent to a medical assessing team to check medical admissibility in case of Accidental hospitalization claim.
  • In the event of the claim being deficient where all mandatory documents have not been submitted or further information is required, a communication seeking such information will be sent to You /Insured Members.
  • 3 reminders after every 7 days will be sent in case the customer has not provided such information. Post the 3 reminders, if the claim is still pending, no further follow-up will be done In case information is received post that, the claim will be processed with due approvals.
  • During the claim processing if the assessing team decides that the case is not payable, then the same will be sent for approval for such rejection as per the matrix defined post which the customer will be informed of the same. If You /Insured Members feels or has further documents to enhance his claim to the queries received, You /Insured Members can send a response on the same. Upon receipt of the response the claim will be independently reviewed on merit and the claim can be reopened after the due approvals as per matrix defined. In case post the receipt of further information, the claim cannot be approved, the same will be communicated to You /Insured Members.
  • All claims where no deficiency is involved will be processed in 30 days from the receipt of last necessary and complete document.
  • You /Insured Members will be notified at every stage of the claim process through an SMS or any other medium of the status of claim i.e. during intimation, approval/rejection, deficiency and payment.
  1. Claims-
Level Email ID
Level 1 claims@religare.com


  • Indicative list of documents Required for processing of Claim under Policy
Sr. # Document Name
1 Age Proof of The Insured Member’s child
2 Boarding Pass (in case of Air travel)
3 Certificate from Bank for outstanding amount of loan
4 Certificate from treating doctor
5 Certificate of settlement of Claim from Insurer, if claimed under other Policy.
6 Claim form duly filled & signed by Insured Member/ Legal heir / Nominee
7 Death certificate or Attested Copy is sufficient
8 Description of the case for need of house/ Vehicle modification
9 Diatomic test atoms of water in stomach and water of reservoir, if applicable
10 Disability certificate – Medical Officer/Civil Surgeon of Civil hospital /Govt. Hospital of the District / Units concerned, (certificate) stating extent disablement
11 Discharged Summary, if applicable ( Certified Copy)
12 Discharged Summary (Original Copy)
13 Doctor’s Certificate  confirming the injury and advising confinement to bed/ unfit to work for specified number of days
14 In RTA cases-Driving license, if applicable
15 Dying Declaration in case of death due to burns injury, wherever applicable
16 Electrocution case – SEB (State Electricity Board) Panchnama, whenever applicable
17 Employer certificate mentioning the cause and nature of accident resulting in Death
18 Employer certificate mentioning the cause and nature of accident resulting in the disablement and period of leave granted to the employees
19 F.I.R. and Panchnama wherever applicable (original or certified copies)
20 F.I.R. or accident Death report or Inquest Panchnama (in original or certified copies)
21 Factory inspector report if accident occurred in the organization
22 Fitness certificate
23 Forensic report , whenever applicable
24 FSL report ,  whenever applicable
25 Hospital indoor Treatment Papers including Discharge Summary & medical bills
26 Indemnity Bond
27 Investigation /test reports & Payment Receipts there of
28 Investigation Reports like Laboratory test, X-rays and reports essential of confirmation of the type and percentage of disability
29 Invoice and payment Receipts of Equipments used for mobility
30 Invoice/ estimate of expenses incurred and Receipts for house/ vehicle modification
31 Leave certificate from the employer
32 Letter from the employer stating the reason for loss of Job
33 Mechanical report of the vehicle which met with an accident, if applicable
34 Medical bills with prescriptions ( Original copy)
35 Medical Practitioner’s certificate confirming the Injury and advising rest/ unfit to work for specified number of days
36 Original receipts of expenses incurred for funeral expenses
37 Original receipts of expenses incurred for repatriation of remains
38 Original Ticket
39 Photo ID from school/college/institute
40 Photo of injured showing the disability
41 Police Final Report
42 Post Mortem Report (certified copies), if conducted
Sr. # Document Name
43 Proof of Admission in school/ college 
44 RACT, MACT documents as applicable
45 Receipt of Education fees paid
46 Receipt of Payment of ambulance service
47 Salary Certificate/Slips/ Form 16, if applicable
48 Spot Panchnama (certified copies) if applicable
49 Treating doctor’s certificate confirming degree of burns
50 Any other document as required by Us

Note:

Only in the event that original bills, receipts, prescriptions, reports or other documents have already been given to any other insurance company or to a reimbursement provider the Company will accept properly verified photocopies of such documents attested by such other insurance company/reimbursement provider along with an original certificate of the extent of payment received from such insurance company/reimbursement provider. In case You/Insured Member shall require Original copies submitted to Us, we shall return the same after adjudication of the Claim.