This document ("Agreement"), together with any specific declarations or information
provided
by You
("You/Your"), sets out the basis on which You may avail the dental care and wellness
features
under Your
"OroGlee Plan", a service that is provided to You by OroGlee Solutions Private Limited
("Company/We/Us/Our"),
having its office at 2nd floor, Plot No 32, Telecom Nagar, Gachibowli, Hyderabad
500032,
Telangana, India.
INTRODUCTION:
We help You access various dental care and wellness services to improve Your dental health and
well-being
and
prevent situations leading up to any unplanned dental treatments. Our dentists and in-house
specialists, as
approved or empanelled with Us ("OroGlee Dentists"), will provide best-in-class
service.
You have subscribed to the OroGlee Plan and its services are available to You on Our website if You
have paid
the applicable yearly subscription ("Membership/ Plan Fees").
Depending upon Your OroGlee Plan, You can:
-
avail various Preventive Care services. Such Preventive Care Services vary across the
different plans
available – OroGlee Smile, OroGlee Joy and OroGlee
Delight;
-
avail dental outpatient services ("OPD") under the group dental insurance
policy
obtained by Us for You
from an Indian insurance company ("Insurance Partner"), by becoming an
"OroGlee
Joy" or "OroGlee Delight"
member;
Under Your OroGlee Plan (for OroGlee Smile, OroGlee Joy and OroGlee Delight members), We provide
You with a
wide network of dental clinics ("Dental Care Partners"), empanelled with us and
Our
Insurance Partner. The
Dental Care Partners will provide You best-in-class facilities, and come highly recommended.
In consideration of the above, the Company and You (collectively referred to as
"Parties"
) agree as follows:
PROCESS AND PROCEDURES
-
-
For availing the Preventive Care services and/ or Dental OPD benefits under Your OroGlee
Plan, You
are required to share your Plan ID with the Dental Care Partner.
- Preventive Care services and/ or Dental OPD benefits under Your OroGlee Plan
are
only available at Dental Care Partners.
- Normally, wherever mentioned the services covered under Your OroGlee Plan will
be available in a cashless
manner at
the concerned facility. However, certain treatments may require You to visit the Dental Care
Partner multiple times
over a period of time to complete the treatment. As the Dental Care Partner can submit a
claim to the OroGlee Insurance
Partner only after completing the treatment - depending on the situation and the requirement
You may be
expected to
pay a security deposit to the Dental Care Partner before start of treatment to cover the
treatment
related expenses. Once the claim request is approved then any treatment related
expenses over
and above the claim amount shall be deducted from the security deposit and the balance shall
be returned
to You by the Dental Care partner
-
Normally, wherever mentioned the services covered under Your OroGlee Plan will be available
in a cashless
manner at
the concerned facility. However depending on the situation and the requirement You may be
expected to
pay a security deposit to the Dental Care Partner before start of treatment to cover the
treatment
related expenses in events such as
- (a) A medical emergency faced by You, which may be included under Your
OroGlee Plan
once the Insurance Partner has been able to assess the request for such treatment;
- (b) Us/Insurance Partner needing to further assess Your request;
- (c) Technical reasons faced by Us, Insurance Partner, or the TPA.
Please note that if you initiate a treatment with a Dental Care Partner without
having
first sought
pre-approval, through OroGlee, by OroGlee’s Insurance Partner, and not for one of the
reasons above, the
claim request may be denied. If the claim request is approved then any treatment related
expenses over
and above the claim amount shall be deducted from the security deposit and the balance shall
be returned
to You by the Dental Care partner
- The broad procedure for availing any features under Your OroGlee Plan is as
follows:
Step 1:
You are required to book an appointment with the Dental Care
Partner for
the necessary service You wish to utilize.
Step 2:
Once you are at the Dental Care Partner’s facility, please share
your Plan ID
along with the service
you wish to avail. The Dental Care partner will quickly check your eligibility to avail the
service you want/ need.
For availing Dental OPD service at the Dental Care Partner’s facility you will be expected to
provide a Government Approved Photo ID mentioning your
date of birth. You will also be expected to provide certain
details in the
Pre-authorization form for cashless treatments and then sign the form.
Step 3:
For non-insurance-based services you can then avail the service
and leave the
facility. OroGlee will
make the payment for the service directly to the Dental Care Partner. For Dental OPD based
services the Dental
Care Partner will obtain necessary approval from Our Insurance Partner. Once approval is
obtained the service
will be provided to you. Post the treatment, claim settlement will be initiated by the Dental
Care Partner on
its own. Once the claim is approved by Our Insurance Partner you can leave the Dental care
Partner’s facility.
You will be informed beforehand if there would be any payment necessary from your end for the
service availed.