OroGlee - Membership terms for plans

Terms of Your OroGlee Plan

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 registered 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:

OUR SERVICES :

1. Your OroGlee Plan will commence on the date on which the OroGlee Plan is shown as “ACTIVE” on the OroGlee website ("Effective Date") and will be valid for a period of ONE year, or as mentioned while buying the OroGlee Plan, or until cancelled.
2. Preventive Care: The Preventive Care features of Your OroGlee Plan will provide You access to OroGlee empaneled dental clinics to improve Your oral health and well-being and prevent situations leading up to any unexpected dental treatment. The Preventive Care facility is available to all the OroGlee Plan members with different levels of use i.e. OroGlee Smile, OroGlee Joy and OroGlee Delight plan holders.
3. Dental OPD: If You are an OroGlee Joy or OroGlee Delight plan holder then along with the Preventive Care services, You will also receive cover for dental treatments from Our Insurance Partner. The dental treatment related services provided to You under Your OroGlee Joy or OroGlee Delight will include cashless treatment facility from a wide network of dental clinics.

INSURANCE COVER :

1. The sum insured for the insurance is available only to You. It is issued to You exclusively on a per individual basis.
2. In the event that any document or information is required from You in processing any claim under the group dental insurance policy by the Dental Care Partner or the Insurance Partner, You shall co-operate and provide the same to Us.
3. While we provide You access to the insurance cover, by acting as a group administrator, We do not underwrite the same or assume any risk thereunder. Claims under the group dental insurance policy may be intimated to Us for coordination, but all claim processing and decision will be by the Insurance Partner directly.
4. The premium amount payable towards such insurance cover is determined by the Insurance Partner, and is included in the cost of Your OroGlee Joy/ OroGlee Delight plan price. You may view the premium amount paid by You, and passed on to the Insurance Partner by Us, on the OroGlee website.
5. Any dispute or query related to any claim or terms of the insurance policy will be addressed by Us with Our Insurance Partner and We will not be liable to You in this regard. If the dispute is not resolved by Us, You may reach out directly to Our insurance partner.

PROCESS AND PROCEDURES

1. 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.
2. Preventive Care services and/ or Dental OPD benefits under Your OroGlee Plan are only available at Dental Care Partners.
3. 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
4. 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.
5. 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.

RIGHTS AND DUTIES OF THE PARTIES:

Please note that the Parties have the following rights and obligations under this Agreement:

1. For the purpose of determining Your eligibility for certain OroGlee Plan, We reserve the right to require You to undergo checkups, and You shall extend all reasonable cooperation with Us in this regard.
2. The final decision in relation to whether and where any specific Dental OPD service may be available to You through Your OroGlee Plan, shall be made by Our Insurance Partner, per its sole discretion.
3. We are not responsible for the outcome or result of any treatments, or the quality of care provided by any Dental Care Partner. Additionally, by way of this Agreement or otherwise, we do not assume or shall be deemed to assume any liability towards any loss or damage arising out of or in relation to any opinion, advice, prescription, procedure, actual or alleged errors, omissions and representations provided or made by any dentists or any other personnel at any Dental Care Partner.
4. We do not have a principal agent relationship, partnership, joint venture relationship or any similar arrangements with any of the Dental Care Partners or with Our Insurance Partner..
5. We reserve the right to revise the admission and renewal criteria and/or charges for the OroGlee Plan, as well as the choice of Insurance Partner, per Our sole discretion. We will provide You with an advance notice of 30 days before implementing such a change. In such an event, You may be required to undergo additional tests recommended by an OroGlee Dentist.
6. We reserve the right to update, modify or remove any specific service including Preventive and Dental OPD service or Dental Care Partner available to You, at Our discretion.
7. We cannot guarantee that Our services will be available in any language other than English. Support for other languages is provided on a best effort basis, as available from time to time.
8. All calls between You and OroGlee may be recorded for quality, training, and compliance purposes.

CANCELLATION OF PLAN:

1. We will provide You a no-questions-asked refund of Your OroGlee Plan in the first 15 days of your first subscription to Your OroGlee Plan. If any services are availed or insurance benefits claimed during this period there will be no refund.
2. Apart from the foregoing, You may, at any time, during the validity of the OroGlee Plan, choose to opt-out of the OroGlee Plan by intimating Us in writing or through email using your registered email ID with OroGlee. Consequently, We will cancel Your OroGlee Plan (and/or insurance policy) and provide a refund in the manner set out at https://oroglee.com/cancellation and in accordance with Our Insurance Partner's terms and conditions.
3. If it is discovered that any information provided by You at the time of subscribing OroGlee Plan or during the OroGlee Plan was untrue, inaccurate, incomplete, suppressed or not disclosed (wilfully or otherwise) or in the event of any dishonest or fraudulent activity being discovered by Us or Our Insurance Partner then Your OroGlee Plan and insurance cover may be cancelled, without refund. You shall extend all reasonable cooperation with Us 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 OroGlee Plan without refund.
4. We reserve the right to cancel Your subscription to the OroGlee Plan, and permanently suspend access to any services with no refund. However, Your group dental insurance cover(s) with Our Insurance Partner 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. Your OroGlee Plan may be terminated without refund in the following cases:
5. On cancellation of Your OroGlee Plan by either Party, the validity of any login or access credentials for the Website for accessing any services related to the OroGlee Plan also immediately stand cancelled.

CONFIDENTIALITY

1. 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 Dental Care Partners and Our Insurance Partner and for any purposes other than for OroGlee’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.
2. Our Insurance Partner and Healthcare Partners may use Your information, including Your medical information, for their clinical purposes, subject always to applicable law in force.

GENERAL TERMS & CONDITIONS

1. Dispute Resolution: This Agreement is subject to Indian law. The courts in Hyderabad shall have the exclusive jurisdiction over any disputes or differences arising under or in relation to this Agreement.
2. Assignment: You shall not assign any of its rights and obligations under this Agreement, except with Our prior written consent.
3. Notices: Any notice, request, demand, approval, consent, or other communication under this Agreement shall be delivered in writing and/ or through email.
4. Force Majeure: Notwithstanding anything to the contrary in this Agreement, We or Our Dental Care Partners or Our Insurance 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, 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.
5. We shall inform You and keep You updated in the event of any changes to Your OroGlee Plan, Our operations, or any other changes relevant to Your subscription of the OroGlee Plan. All up to date information about Our services can be accessed on Our website at https://oroglee.com

DECLARATIONS

You hereby understand and agree that by consenting to purchase this OroGlee Plan, You have read and understood the contents of this Agreement/ Terms of OroGlee Plan, and freely provide the declarations below:

1. All the information and declarations provided to Oroglee Solutions Private Limited are true, accurate and complete to the best of Your knowledge and information, and that You have read the terms of this Agreement/ Terms Of OroGlee Plan and agree to be bound by them.
2. By opting for the OroGlee Plan, You freely consent to Oroglee Solutions Private Limited seeking and the relevant dental clinic or such similar provider, or establishment, (who at any time has attended to You in the past or present concerning anything which affects Your dental health) providing OroGlee with Your dental health information and records for the purpose of reviewing Your eligibility to the OroGlee Plan and the provision of any services thereunder.
3. You authorise Oroglee Solutions Private Limited to process, use, store, disclose and transfer any information, including medical information, as is made available by You or the relevant dental clinic or such similar provider, or establishment, for the sole purpose of providing and improving its services, fulfilling its contractual obligations to You, billing, conducting background screening, investigations, claims assistance for Your insurance, 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.