KASA FAMILY HEALTH MEMBERSHIP

Terms & Conditions

Membership Fee: ₹4,999
Membership Period: 12 months from activation
Members Covered: Up to 4 registered individuals
Service Provider: KASA Hospitals, a unit of Kasa Healthcare Private Limited, Nellore

1. About the Membership

KASA Family Health Membership (“Membership”) is an annual healthcare membership program providing registered members access to specified outpatient doctor consultations and eligible diagnostic services at KASA Hospitals, subject to these Terms & Conditions.

The Membership is not a health insurance policy and does not provide insurance coverage, cashless hospitalization, reimbursement, or payment for healthcare services obtained outside KASA Hospitals.

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2. Membership Registration

One Membership may cover a maximum of four (4) registered individuals.

All members must be registered by providing the information and identification required by KASA Hospitals.

Membership benefits:

– Are available only to registered members.
– Are personal and non-transferable.
– Cannot be shared with another individual.
– Cannot be exchanged for cash or monetary credit.

KASA Hospitals may verify the identity of a member before providing Membership benefits.

Once the permitted registration period is completed, registered members ordinarily cannot be substituted or replaced during the Membership period except for correction of genuine registration errors or other exceptional circumstances approved under hospital policy.

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3. Validity

Membership is valid for twelve (12) months from the date of activation.

Benefits expire at the end of the Membership period and cannot be carried forward, transferred or converted into cash.

Renewal will be subject to the pricing, benefits and Terms & Conditions applicable at the time of renewal.

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4. Doctor Consultations

Registered members are eligible for outpatient consultations with participating KASA Hospitals doctors and specialties covered under the Membership.

Consultations are subject to:

– Doctor availability;
– Appointment availability;
– Hospital operating schedules;
– Clinical appropriateness;
– Participating doctors and specialties.

The Membership does not guarantee consultation with a particular doctor or at a particular time.

Medical emergencies and clinically urgent patients may be given priority irrespective of Membership status.

Inpatient consultations, bedside consultations, procedures and other services not classified as eligible outpatient consultations are not included unless specifically stated.

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5. Diagnostic Services Included

Eligible diagnostic services available under the Membership include:

– Eligible blood/laboratory investigations;
– X-ray;
– CT scan;
– Ultrasound;
– ECG;
– TMT;
– 2D Echo.

Diagnostic services are covered only when they are:

1. Medically necessary based on the patient’s clinical condition;
2. Prescribed by an authorized KASA Hospitals doctor; and
3. Included within the applicable Membership covered-services list.

Holding a Membership does not automatically entitle a member to request or undergo any diagnostic investigation.

The treating doctor will determine the type and frequency of investigations required based on the patient’s medical condition, clinical necessity, accepted medical practice and patient safety.

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6. Medical Necessity

All diagnostic investigations under the Membership must have a genuine clinical indication.

A member cannot demand a blood test, X-ray, CT scan, ultrasound, ECG, TMT, 2D Echo or any other investigation solely because the service is listed as a Membership benefit.

Doctors retain complete and independent clinical judgment regarding whether an investigation is required.

KASA Hospitals will not require or encourage doctors to prescribe medically unnecessary investigations for the purpose of utilizing Membership benefits.

Repeated or high-cost investigations may be subject to appropriate clinical review to confirm medical necessity and patient safety.

Such review shall not unreasonably restrict genuinely medically necessary care.

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7. Prescription Requirement

For a diagnostic service to qualify as an included Membership benefit, it must ordinarily be prescribed by an authorized KASA Hospitals doctor following appropriate clinical evaluation.

A prescription or recommendation from an outside doctor does not automatically qualify an investigation for Membership coverage.

The member may consult an appropriate KASA Hospitals doctor, who will independently evaluate the patient’s condition and determine whether the requested investigation is clinically necessary.

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8. Laboratory and Blood Investigations

Eligible laboratory investigations performed at KASA Hospitals are included when medically necessary and prescribed by an authorized KASA Hospitals doctor.

Certain investigations may be excluded, including:

– Specialized high-cost investigations;
– Outsourced tests;
– Genetic or molecular testing;
– Certain histopathology/cytology investigations;
– Specialized immunology or other investigations not included in the Membership covered-services list.

Any excluded or separately chargeable investigation will be communicated to the patient before testing wherever practicable.

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9. X-Ray Services

Eligible X-ray examinations prescribed by an authorized KASA Hospitals doctor are included under the Membership.

Printed X-ray films are not included or routinely provided under the Membership.

X-ray images are maintained digitally through KASA Hospitals’ applicable imaging and medical-record systems and made available for clinical review.

Where a formal radiology report forms part of the applicable X-ray service, it will be handled according to the hospital’s normal reporting process.

If a patient specifically requests printed films or other physical media and KASA Hospitals is able to provide them, applicable printing or material charges may be separately payable.

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10. CT Scan Services

Eligible CT scans are included when medically necessary and prescribed by an authorized KASA Hospitals doctor.

CT examinations are subject to clinical appropriateness and applicable radiation-safety requirements.

Printed CT films are not included or routinely provided under the Membership.

CT images are maintained digitally through KASA Hospitals’ applicable imaging and medical-record systems and made available for clinical review.

A CT diagnostic report will be provided or made available to the patient according to KASA Hospitals’ normal reporting process.

Unless expressly included in the covered-services list, additional charges may apply for:

– Contrast media;
– Specialized medicines or injections;
– Specialized consumables;
– CT Angiography;
– Cardiac/coronary CT studies;
– Specialized CT protocols;
– Sedation or anesthesia;
– Interventional procedures;
– Other specifically excluded components.

The hospital/radiology team may decline or modify a requested CT examination when it is considered medically inappropriate or unsafe.

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11. Ultrasound, ECG, TMT and 2D Echo

Eligible ultrasound, ECG, TMT and 2D Echo investigations are included when clinically indicated and prescribed/advised by an authorized KASA Hospitals doctor in accordance with applicable Membership and clinical requirements.

The appropriate investigation will be determined based on the patient’s clinical condition.

Specialized procedures, consumables, medicines or services outside the standard included investigation may be separately chargeable.

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12. Services Not Included

Unless specifically stated as an included Membership benefit, the following are not covered:

– Medicines and pharmacy purchases;
– Contrast media and excluded consumables;
– Hospital admission and inpatient charges;
– Room/bed charges;
– ICU/NICU charges;
– Surgeries;
– Operation theatre charges;
– Medical or surgical procedures;
– Cath Lab procedures;
– Implants, prostheses and medical devices;
– Blood and blood products;
– Injections, vaccines and immunizations;
– Dialysis;
– Ambulance services;
– Dental procedures and dental materials;
– Physiotherapy unless specifically included;
– Home healthcare;
– Tests or services obtained outside KASA Hospitals;
– Outsourced or specifically excluded investigations;
– Specialized investigations not included in the covered-services list;
– Medico-legal examinations/reports;
– Employment, insurance, visa or certification-related examinations;
– Physical X-ray or CT films;
– Any service not expressly included under the Membership.

Non-covered services will be charged separately according to applicable hospital rates.

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13. Emergency Services

Membership does not mean that all emergency treatment is free.

Where applicable, eligible consultations and diagnostic investigations may be covered according to the Membership Terms.

Emergency procedures, medicines, consumables, admission, ICU care, surgery and other non-covered services will be separately chargeable.

Emergency treatment will always be determined according to the patient’s immediate clinical requirements.

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14. Fair Usage and Prevention of Misuse

The Membership is intended for genuine healthcare needs.

The following may constitute misuse:

– Sharing Membership benefits with an unregistered person;
– Impersonation or identity fraud;
– Providing false registration information;
– Altering or falsifying prescriptions;
– Misrepresenting symptoms for the purpose of obtaining unnecessary investigations;
– Attempting to obtain diagnostic services without genuine clinical need;
– Collusion intended to obtain medically unnecessary services;
– Reselling or commercially exploiting Membership benefits;
– Pressuring, threatening or inducing healthcare professionals to prescribe unnecessary investigations.

KASA Hospitals may investigate suspected fraud or misuse.

Where intentional misuse or fraud is reasonably established, KASA Hospitals may suspend or terminate Membership benefits after appropriate review, subject to applicable law.

Frequent genuine use of healthcare services due to illness will not, by itself, be considered misuse.

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15. Clinical Independence

All doctors and healthcare professionals retain independent clinical judgment.

Membership does not require a doctor to prescribe any investigation, medicine, procedure or treatment merely because the patient is a member.

All clinical decisions will be based on medical necessity, professional judgment, accepted medical practice and patient safety.

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16. Appointment and Service Availability

Consultations and diagnostic services are subject to:

– Doctor availability;
– Appointment availability;
– Equipment availability;
– Technical or maintenance downtime;
– Hospital operating schedules;
– Clinical emergencies;
– Operational capacity.

Membership does not guarantee immediate appointments or zero waiting time.

If an included diagnostic service is temporarily unavailable, KASA Hospitals will make reasonable efforts to schedule the service when available.

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17. Pre-Existing Medical Conditions

Having a pre-existing medical condition does not automatically prevent an individual from becoming a member.

Eligible consultations and medically necessary diagnostic services may be utilized according to Membership Terms.

However, Membership does not mean that every investigation, treatment, medicine, procedure or hospitalization required for a pre-existing condition is automatically included.

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18. No Cash or Reimbursement Value

Membership benefits:

– Cannot be exchanged for cash;
– Cannot be transferred;
– Cannot be accumulated as monetary credit;
– Cannot be claimed as reimbursement;
– Cannot be used to claim payment for services obtained elsewhere;
– Have no cash value if unused.

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19. Cancellation and Refund

Membership fees are ordinarily non-refundable after Membership activation or utilization of any Membership benefit, subject to applicable law and the hospital’s published cancellation/refund policy.

Where a refund or other remedy is required under applicable law, the applicable statutory rights of the consumer will not be restricted by these Terms.

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20. Suspension or Termination

KASA Hospitals may suspend or terminate Membership in cases of reasonably established:

– Fraud;
– Identity misuse;
– Deliberate misrepresentation;
– Membership sharing;
– Falsification of records or prescriptions;
– Abuse of healthcare professionals or staff;
– Intentional misuse of Membership benefits.

A member will not be terminated merely because they develop a serious illness, require frequent legitimate consultations, or require medically necessary investigations.

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21. Medical Outcomes

Membership provides access to specified healthcare services but does not guarantee:

– Prevention of disease;
– Diagnosis of every medical condition;
– Cure of any disease;
– A specific medical outcome;
– Availability of a particular doctor at all times.

All medical investigations and treatments have inherent limitations and must be interpreted and managed by qualified healthcare professionals.

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22. Medical Records and Digital Images

KASA Hospitals may maintain medical records, reports and diagnostic images electronically.

Digital diagnostic images may be made available to treating healthcare professionals through the hospital’s applicable systems.

Patients may request access to available medical records, reports or diagnostic images in accordance with hospital policy and applicable requirements.

Physical X-ray and CT films are not included as a Membership benefit.

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23. Privacy and Personal Information

KASA Hospitals may collect and process personal, identification and health information as reasonably necessary for:

– Membership registration;
– Identity verification;
– Healthcare delivery;
– Maintaining medical records;
– Membership administration;
– Billing;
– Fraud prevention;
– Patient communication.

Information will be handled according to applicable privacy, confidentiality and data-protection requirements.

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24. Changes to the Membership

KASA Hospitals may make reasonable changes to administrative processes, appointment systems, participating doctors and service-delivery procedures.

Material changes affecting core benefits already promised to an active member will be handled fairly and in accordance with applicable law.

Pricing, benefits and Terms applicable to future renewals may be revised.

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25. Governing Terms and Grievances

The Membership and these Terms & Conditions are governed by applicable laws of India.

Any Membership-related grievance may first be raised with the designated KASA Hospitals Patient Relations/Membership Help Desk for resolution.

Nothing in these Terms limits any statutory rights or remedies available to consumers under applicable law.

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26. Acceptance of Terms

By purchasing, activating or using the KASA Family Health Membership, the primary member confirms that they understand and accept that:

– The Membership covers up to four registered members for 12 months.
– Membership is not health insurance.
– Only specified consultations and eligible diagnostic services are included.
– Diagnostic investigations must be medically necessary and prescribed by an authorized KASA Hospitals doctor.
– Membership does not give a right to demand unnecessary investigations.
– Not every test available at KASA Hospitals is automatically included.
– Medicines, hospitalization, procedures, surgeries, consumables and other excluded services are separately chargeable.
– Printed X-ray and CT films are not included.
– CT reports will be provided/made available according to hospital reporting procedures.
– Membership benefits are personal and non-transferable.
– The full covered-services list, exclusions and Terms & Conditions apply.

By completing registration, the primary member accepts these Terms for themselves and, where legally permitted, on behalf of the other registered members.