Membership Terms and Conditions

Last updated on 9th Sep 2023

Terms and Conditions for Clinikk Smart Health Plans

These Terms and Conditions ("Terms"), together with any specific declarations or information provided by You (”You/Your”), sets out the basis on which You may avail the healthcare and wellness features under Your "Clinikk Membership", a service that is provided to You by Ohealer Healthcare Services Private Limited ("Company/We/Us/Our") having its registered address at Radha Krishna Towers, 2nd Floor Bannerghatta Main Road, Opposite IIM Bangalore Bangalore, Karnataka India.

Introduction

Welcome to Clinikk! We are thrilled to have you become a member. Clinikk is a healthcare company on a mission to make high quality healthcare available to as many people as possible. Our goal is to make sure you and your family can access high quality healthcare without suffering from financial burden. We do this by offering you all-in-one Clinikk memberships which include not only health insurance for emergencies but OPD benefits for day to day health needs.

Clinikk is designed to be convenient and the first place you can go to for any of your health concerns or goals. Once you join us as a member, you can see Clinikk doctors as many times as you want completely free, whether in-person at our Clinikk Health Hubs or via tele-consultation through the Clinikk app. Each Clinikk Health Hub also has a Care Team which includes a nurse and a patient care coordinator to help you follow-up or answer questions about your health or your membership. You can choose a membership that comes with OPD benefits like paying for medicines and tests your Clinikk doctor prescribes, including specialist doctor fees, tests, and treatments. Your health history at Clinikk is stored in one place so you do not have to bring your health records and worry if the doctor knows your past history. Over time, you will begin to appreciate the Care at Clinikk that’s personal and familiar.

At Clinikk, our business does well if our members stay healthy. We practise care that keeps our members out of the hospital. Our doctors are trained to catch problems early and manage problems with only the necessary medicines and tests. Our Care Team is able to remind you of any pending visits and help you follow a personal Care Plan.

We're proud to be a technology-driven healthcare company that prioritises customer service values of empathy, integrity, and ownership. With Clinikk, you can rest assured that we are here to help you and your family live healthy lives.

  1. Terms & Definitions
  2. Membership: This refers to the membership offered by Clinikk which includes a range of benefits from health insurance for sudden and expensive medical bills to benefits for day to day healthcare needs.

    Clinikk Health Hubs: These are primary care centers that are staffed by a Care Team comprising family-medicine trained doctors, nurses, and patient care coordinators.

    Member: This refers to individuals listed under any Clinikk Health Plans who are entitled to the benefits of the membership and agree to be bound by the Terms and Conditions.

    Membership fees: This refers to the total Membership fee for Your Clinikk membership. It consists of two components: fees paid to Clinikk for managed care services and OPD benefits, and the insurance premium paid to the Insurance Provider, if the membership includes group insurance cover.

    Managed Care services: Managed care refers to help offered to access various healthcare and wellness services to improve Members health and well-being and prevent the onset of serious health problems. These services include unlimited Clinikk doctor consultations both in-person and over Tele-consultation, Care Team and Care Plans.

    Primary care services refer to the range of basic health care services that are provided by Clinikk Health Hubs, including general check-ups, basic diagnostic tests, procedures and consultations with primary care physicians.

    Care Team: This refers to the team of doctors, nurses, and patient care coordinators who staff the Clinikk Health Hubs and provide tele-consultation and care guidance.

    Tele-consultation: This refers to the provision of healthcare services, including diagnosis, consultation, and prescription, using telecommunication technologies.

    Group Health Insurance: This refers to the hospital insurance coverage provided by Our Insurance Provider that covers the cost of hospitalizations and day care services as per their terms and conditions.

    Outpatient Department (OPD) Benefits: This refers to the benefits provided by Clinikk memberships for tests and medicine prescribed by the Clinikk Doctor or a doctor referred by the Clinikk Doctor.

    Activation Date: This refers to the date of Group Insurance cover activation for Clinikk Smart Silver, and Smart Diamond memberships and onboarding completion for Clinikk Smart Senior and Clinikk Silver Senior.

    Healthcare Partners: These refer to any third-party healthcare providers including laboratories, diagnostic centres, clinics and hospitals.

    Day Care services: These are medical procedures that require hospitalisation for less than 24 hours.

    Outpatient Department (OPD) services: These are doctor consultations, tests, medicines or procedures taken without hospitalization.

  3. Clinikk Health Hubs
  4. Clinikk Health Hubs are primary care centres staffed by a team (”Care Team”) of family-medicine trained doctors, nurses, and patient care coordinators.

    Details about our Clinikk Health Hubs are provided in the link https://www.clinikk.com/visit/visit-us with their respective timings

    Clinikk Health Hubs do not function as pharmacies or a laboratory and, therefore, cannot provide tests or medicines prescribed by external doctors. Members can only access tests or medicines recommended by a Clinikk Doctor.

  5. Tele-consultation & Care Team Support
  6. Members can consult Clinikk Doctors in-person by visiting the Clinikk Health Hubs or over tele-consultation through visiting the Clinikk app or Care Team Chat. Tele-consultation is available 24/7 with an on-call doctor with a maximum wait time of 30 minutes. For tele-consultation with a specific doctor, members need to book an appropriate time slot as per the doctors’ availability.

    Members are entitled to unlimited and complimentary access to the Care Team chat service. This service allows members to ask follow-up questions about their condition, schedule visits, or seek assistance related to their membership. To connect with the Care Team support at any time, use the chat feature within the app or send a WhatsApp message to the number link provided.

  7. Memberships
  8. Clinikk offers memberships for adults and children and senior:

    i: Clinikk Smart Silverii: Clinikk Smart Diamondiii: Clinikk Smart Senior

    The Smart Silver and Smart Diamond memberships come with health insurance that can be opted as part of the memberships. The health insurance is provided by our Insurance Provider as a group health insurance exclusively for the customers of Clinkk and covers the cost of hospitalizations and day care procedures.

    The terms and conditions for the health insurance provided by the partner insurer can be found at the provided link. If you have opted for a super-top, see the following terms and conditions at the provided link.

    The Smart Silver and Smart Diamond memberships come with personal accident insurance that can be opted as part of the membership. The personal accident insurance is provided by our Insurance Provider and it covers the cost of hospitalizations and day care procedures. (The terms and conditions for the personal accident insurance can be found at the provided link.)

    The Smart Diamond and Smart Senior membership come with annual Outpatient Department (OPD) Benefits, which covers tests and medicine prescribed by a Clinikk doctor (limited to details in section on OPD Benefits and Cover), and tests and medicine prescribed by referred specialists, and referred specialist consultation fee. For terms and conditions of these OPD benefits, please see the section OPD Benefits and Cover.

    The Smart Silver membership has discounts on medicines and tests available in Clinikk Health Hub as prescribed by the doctor.

    All active members get free unlimited doctor consultations in-person and over tele-consultation.

    While we facilitate access to the insurance coverage as a group administrator, we do not underwrite nor assume any risks associated with the policy. In the event of any claims made under the group insurance policy, it may be communicated to us for coordination purposes, however, it is imperative to note that the Insurance Provider shall be solely responsible for all claim processing and decision-making.

  9. OPD Discounts and Benefit:
  10. The Smart Silver membership offers discounts on medicines and tests available at the Clinikk Health Hub when prescribed by a Clinikk doctor. Discounts do not apply to medicines or tests prescribed by external doctors or taken outside Clinikk.

    The Smart Diamond, and Smart Senior membership include an annual outpatient department (OPD) Benefits for tests and medicines, subject to the following conditions:

    i: The membership is activeii: The tests and medicines must be prescribed by a Clinikk doctor and taken at Clinikk.

    For Smart Diamond and Smart Senior members, the (OPD) Benefits also pays for specialist fees, tests, and medicines prescribed by the specialist, provided the specialist was referred by a Clinikk doctor.

    (OPD) Benefits will cover expenses for the above tests, fees and medicines up to an annual limit. Tests and medicines at Clinikk will be charged at MRP. The OPD Benefit annual limit for each membership can be found on clinikk.com or by asking on the Care Team Chat.

    Once the (OPD) Benefits are exhausted, members are eligible for the same discounts on medicines and tests as those available under the Smart Silver membership. Any unused (OPD) Benefits in an annual period will not carry forward to the next year.

  11. Exclusions and limitations on the OPD Discounts and Benefit:
  12. The (OPD) discounts and benefits does not cover any cosmetic procedures, dental procedures or treatments, therapeutic procedures, or daycare procedures. Certain treatments and services, available at Clinikk or outside, are not eligible for OPD Benefits, including but not limited to: wellness products, supplements, medical equipment, vaccinations, fertility-related treatments/tests, maternity (except as specified below), mental health, physiotherapy, speech therapy, and other non-allopathic therapies.

    i: Maternity-related costs are covered under the Smart Diamond membership after a waiting period of 9 months. Only diagnostic and consultation costs (with a referred specialist) are covered; medical procedures or medicines related to maternity are not included.

    The Company reserves the right to limit coverage for specific tests or tests based on medical necessity or membership limitations.

    If a reimbursement is requested without having consulted a Clinikk doctor first, the reimbursement request may be denied.

    For Smart Diamond and Smart Senior members, specialist fees are only covered if they are referred by Clinikk doctors for the treatment of the original problem. Fresh referral has to be taken for treatments lasting more than 60 days. If multiple specialists are seen for the same issue, these fees may not be covered if they are deemed medically unnecessary by the Clinikk medical team.

  13. To use your OPD Benefit:
  14. Smart Diamond and Smart Senior members can reimburse medicines or tests taken outside Clinikk in the following cases:

    Consult a Clinikk doctor in-person or via tele-consultation

    Get the prescribed test or medicine from Clinikk and use the (OPD) Benefits to cover the cost. If the prescribed test or medicine is not available at Clinikk, or if your nearby Clinikk Health Hub is shut, purchase it elsewhere and apply for reimbursement.

    If you are referred to a specialist by Clinikk and you are a Smart Diamond or Smart Senior member, apply for reimbursement of specialist fees, medicines and tests prescribed by the specialist.

  15. How to reimburse with OPD Benefit:
  16. Smart Diamond and Smart Senior members can reimburse medicines or tests taken outside Clinikk in the following cases:

    i: In case the medicine is not available in the inventory of the Clinikk, the prescribed medicine can be bought from outside and the cost will be reimbursed subject to the OPD benefit limit.ii: The Clinikk Health Hub is shut and the member is availing medicine or tests prescribed by a Clinikk doctor at a Clinikk Health Hub or via tele-consult.iii: In cases of an emergency, Clinikk will reimburse the member the doctor fees, medicines and tests related to the emergency. Emergency generally means a serious medical condition or symptom resulting from injury or sickness which arises suddenly and requires immediate care and treatment to avoid jeopardy to the life or serious damage to the health of a Person. Clinikk Medical Team’s clinical judgement with regards to an emergency will be final.

    Members shall initially pay out-of-pocket for eligible doctor fees, medicines and tests and then raise a request for reimbursement from their (OPD) Benefits.

    Members must make the reimbursement request within a stipulated period of 30 days from the date mentioned in the Clinikk’s prescription in order to be eligible for any reimbursement, if any. Reimbursement requests submitted after 30 days may be denied. The reimbursement request needs to be accompanied by documents including but not limited to: the Clinikk prescription, the bill and receipt of test or medicines and any referred doctor prescription.

    The Company will review and process your reimbursement request within 14 days from the date of submission of the last required document. Each reimbursement request will be reviewed for eligibility, and the Company reserves the right to approve or reject reimbursement requests based on these terms and conditions.

    All reimbursements are subject to the approval of Clinikk and membership coverage.

  17. Membership fee payments and renewals:
  18. All memberships are valid for a year from the Purchase Date. Members can opt for flexible payment options including monthly, quarterly, semi-annually, and annually. Membership purchases less than Rs 15,000 may require auto-pay setup.

    Members must pay the applicable membership fee in a timely manner, within 7 days of their due date.You will have the option to pay your membership fee as early as 7 days in advance or.

    Failure to pay the membership fee may result in the termination of the Member’s membership and loss of benefits coverage.

    The Company reserves the right to revise the annual membership fee on annual renewal.

  19. Cancellation and Refunds
  20. You can get a full refund for your Clinikk membership within the first 15 days (the "Free Look Period") of your membership activation if you find the terms and conditions not acceptable. To be eligible for a refund, you must provide a reason for cancellation in writing or by calling our support line. This refund is only applicable to customers who made an annual payment for their Clinikk membership. If you use any OPD Care services or claim insurance benefits during this period, there will be no refund of the respective component of your Membership Fees.

    After the free look period, You can cancel your Clinikk membership at any time by informing us in writing or by calling our support line. If you pay non-annually, you will not get a refund and your OPD and IPD benefits will continue till the end of the payment period. If you paid annually and did not use any OPD services or insurance benefits, you will get a partial refund based on a pro-rata basis according to how long you were a member. The pro-rata basis of refund shall be as such:

    Within 1 month of membership
    More than 1 and less than 3 months
    More than 3 and less than 6 months
    More than 6 months
    75%
    50%
    25%
    0%

    Clinikk reserves the right to cancel your Clinikk membership without a refund if it is discovered that you have provided false or incomplete information at the time of buying or activating the Clinikk membership. You shall extend all reasonable cooperation with Clinikk or Our associates (including any third-parties involved in the investigation) in this regard. If you refuse to disclose information in Your possession or to cooperate with an investigation we will reserve the right to terminate your Membership without refund.

    In order to ascertain your eligibility Clinikk reserves the right to ask you to undergo medical evaluation before your membership is purchased. The expense of these evaluations will have to be borne by You.

    After purchasing a Clinikk membership, but prior to its activation, a medical evaluation may be necessary. In such cases, for Smart Diamond members, Clinikk will cover the cost of the medical evaluation at the Clinikk Health Hub. For Smart Silver members, Clinikk will provide a discount on the evaluation cost. If the member is deemed eligible, the costs of these evaluations will be adjusted against the annual limit of the out-patient benefit. In the event of membership rejection, the cost of the evaluation or the provided discount will be deducted from the membership fee before issuing a refund

    We reserve the right to cancel your Clinikk membership without refund under the circumstances mentioned below. Your group insurance cover(s) with Our Insurance Provider may continue to be active for the remainder of its term provided the terms and conditions of the insurance cover(s) have not been breached. The following are conditions for cancellation without refund:

    i: If You are convicted under the Indian Penal Code as the perpetrator of a crime, during the tenure of Your Clinikk membership.ii: In case of verbal or physical abuse, harassment and/or threats towards any member of the Clinikk staff, or any Clinikk collaborators (including Our Healthcare, Insurance, and investigation Partners).iii: Improper, incomplete, or false disclosures with regards to your medical condition or any other information sought by the company

    If you do not pay your instalment on time, your Clinikk membership will be cancelled after a 7-day grace period. If you do not pay within this grace period, your membership will lapse and your benefits will cease. If you previously cancelled a membership with non-annual payment mode, you will be required to pay in annual mode.

  21. Amedments
  22. The Company reserves the right to amend these Terms at any time. Members will be notified of any changes, and continued use of the membership after such notification constitutes acceptance of the revised Terms.

    The Company shall ensure that you are informed and kept up-to-date in the event of any changes to your membership, our operations, or any other changes that may be relevant to your membership. You can access the latest information about our services on the application and our website.

  23. Confidentiality
  24. We agree to keep all Your information confidential, subject to the terms of this Agreement. We shall not, without obtaining Your written consent, disclose such information, including any medical information, to any third parties except Healthcare Partners and Our Insurance Provider and for any purposes other than for Clinikk’s internal research and scientific assessment and those contemplated under this Agreement. This obligation shall not extend to any information that is already in the public domain or which We are under an obligation to disclose pursuant to the applicable law or orders of any court or governmental or regulatory body.

    Our Insurance Provider may use Your information, including Your medical information, for their clinical and claim review purposes, subject always to applicable law in force.

  25. General Terms and Conditions
  26. Dispute Resolution: This Agreement is subject to Indian law. The courts in Bengaluru shall have the exclusive jurisdiction over any disputes or differences arising under or in relation to this Agreement.

    Assignment: You shall not assign any of its rights and obligations under this Agreement, except with Our prior written consent.

    Notices: Any notice, request, demand, approval, consent, or other communication under this Agreement shall be delivered in writing.

    Force Majeure: Notwithstanding anything to the contrary in this Agreement, We or Our Healthcare Partners shall not be liable by reason of any failure or delay in the performance of any duties and obligations under this Agreement if such failure or delay is caused by natural disasters, strikes, lock-outs, embargoes, war, riots, civil commotion, virus outbreaks any orders of governmental, quasi-governmental or local authorities, or any other similar cause beyond Our control and without any fault or negligence of Our own.

    We shall inform You and keep You updated in the event of any changes to Your Clinikk membership, Our operations, or any other changes relevant to Your membership of the Clinikk membership. All up to date information about Our services can be accessed on the Clinikk App and Our website at Clinikk.com.

  27. Declarations
  28. I hereby understand and agree that by consenting to purchase this Clinikk Plan, I have read and understood the contents of this Terms and Condition, and freely provide the declarations below:

    i: All the information and declarations provided to Clinikk are true, accurate and complete to the best of my knowledge and information, and that I have read the terms of this Agreement and agree to be bound by them.ii: By opting for the Clinikk Plan membership, I freely consent to OHealer Healthcare Services Private Limited seeking and the relevant hospital or such similar provider, establishment, or clinic (who at anytime has attended to me in the past or present concerning anything which affects my physical and mental health) providing Clinikk with my medical information and records for the purpose of reviewing my eligibility to the Clinikk Plan and the provision of any services thereunder.iii: I authorise Clinikk to process, use, store, disclose and transfer any information, including medical information, as is made available by me or the relevant hospital or such similar provider, establishment, or clinic, for the sole purpose of providing and improving its services, fulfilling its contractual obligations to me, billing, conducting background screening, investigations, and carrying out any other activity related or incidental thereto, subject always to the requirements under the Information Technology Act 2000 or any other applicable law in force.

Contact Information

For any questions or concerns related to these Terms or the Plans, please contact the Company's customer support at ops@clinikk.com or 847-7878-847.

© 2023 Ohealer Healthcare Services Pvt. Ltd.