1. Eligibility of Medications
Coverage under this program is strictly limited to generic medications. Any non-generic (branded) medications shall not qualify for reimbursement or claims.
2. Excluded Categories
The following medications, treatments, and conditions are expressly excluded from coverage:
o Oncology (cancer-related) treatments
o Genetic or hereditary disease-related medications
o Medications prescribed for diabetes o Medications prescribed for hypertension (high blood pressure)
o Any other medication or treatment not expressly categorized as a covered generic medication
3. Coverage for Accidental Emergencies
o Expenses incurred for medications arising out of accidental emergencies may be considered for coverage, subject to approval by the insurance company and compliance with applicable policy terms and conditions.
o Such coverage shall be limited strictly to generic medications prescribed as part of emergency treatment following an accident.
o The claimant must submit complete supporting documentation, including but not limited to emergency medical records, prescriptions, invoices, and proof establishing the occurrence and nature of the accident.
o All claims under accidental emergencies shall be subject to verification, assessment, and final approval by the insurance company, whose decision shall be final and binding.
o Any hospitalization expenses, procedures, or non-medication costs related to accidental emergencies shall not be covered unless expressly approved by the insurance company.
4. Claims Submission and Documentation
o All claims must be submitted within 15 days post-treatment.
o Claims must be supported by valid prescriptions, tax-compliant invoices, and complete medical documentation.
o Incomplete or inconsistent submissions may result in rejection or delay.
5. Verification and Transaction Conditions
o All claims and transactions are subject to verification.
o Reimbursement will only be processed for genuine, verifiable transactions supported by proof of purchase and payment.
o The provider reserves the right to request additional documentation and to reject claims in case of discrepancies or suspected misuse.
6. Approval and Discretion
o Claims are subject to eligibility criteria and internal policies of the company and/or the insurance company, as applicable.
o The Company/insurance company reserves the right to approve, partially approve, or deny any claim based on verification outcomes and policy terms.
7. Fraud and Misrepresentation
o Any false, misleading, or fraudulent information may result in immediate disqualification. o the provider reserves the right to recover any disbursed amounts and take appropriate legal action.
8. Amendments
The provider reserves the right to modify these Terms & Conditions at any time. Continued participation constitutes acceptance of such changes.