Employee

Insurance
Benefit Manual
2022-23
What you need to know:
At ITC we ensure that benefits are effectively designed to help employees live a healthy lifestyle. This brochure has been developed to take into
account your busy life. The information falls under what you need to know (dates, processes, information on specific benefits) and frequently asked
questions.

Please take the time to review this information in detail.

Group Mediclaim Policy

Provides insurance coverage to employees & dependents for expenses related to hospitalization due to illness, disease or injury subject to a
minimum of 24 hours hospitalization followed by an active line of treatment .

Voluntary Parental Policy

Provides insurance coverage to Parents/Parents in law for expenses related to hospitalization due to illness, disease or injury subject to a
minimum of 24 hours hospitalization followed by an active line of treatment .
.
Voluntary Employee Top Up Policy
Provides additional insurance coverage to employee & dependents over & above the Base policy for expenses related to hospitalization due
to illness, disease or injury subject to a minimum of 24 hours hospitalization followed by an active line of treatment.
 Group Mediclaim Policy

Insurer: The New India Assurance Co. Ltd.

TPA: Medi Assist Insurance Pvt. Ltd.
Brokers: Marsh India Insurance Brokers Private Ltd
Policy Period: 1st Sept, 2022 to 31st Aug, 2023
Medical Benefits Coverage Details

Policy Benefits Employee Policy

Sum Insured Family Floater with INR 5 lakhs per family

Coverage Type Family Floater

Self + Spouse + 4 Dependent Children (up to the age of 25 years)

Dependent Coverage

Policy Benefits Parental Policy

Sum Insured INR 1 lakh, INR 2 Lakh, INR 3 Lakh, INR 4 Lakh & INR 5 Lakh – New Option Available

Coverage Type Family Floater

Parents/Parents in Laws
Dependent Coverage

Policy Benefits Top - Up Policy

Sum Insured INR 2.5 lakhs, INR 5 lakhs, INR 7.5 lakhs & INR 10 lakhs

Coverage Type Family Floater

Self + Spouse + 4 Dependent Children (up to the age of 25 years)

Dependent Coverage
Medical Benefits Coverage Details

Benefits / Extensions Coverage Benefits / Extensions Coverage

Standard hospitalization Yes

Maternity benefits Yes

TPA services Yes (Medi Assist)

Newborn Baby cover day 1 Yes

Preexisting diseases Yes

Pre-Post natal Expenses Yes

Day care procedures Yes

Waiver on 1st year exclusion Yes

10% for ESC, 20% for Parents
Waiver on 30 days exclusion Yes Co payment on Claims ((Not Applicable on Capped Ailments)

Room Rent Yes

Pre-Post hospitalization Expenses Yes Ailment Capping Yes

Medical Benefits Dependent Details

Benefits Coverage

Members Insured in a family 1+5

Employee and Spouse/Partner Yes

Children Yes (for the first 4 living Children can be

covered up to to the age of 25 years)

Parents, Parents-in-Law Yes (parents or parents – in law (Cross

combination not allowed)

Mid Term enrollment of existing Not allowed

Dependents
Mid Term enrollment of New Joinees Allowed provided the employee has enrolled
(New employees + their Dependents) self + dependents on the portal within the
enrollment window period.
Mid term enrollment of new
Allowed provided the employee has enrolled
dependents (Spouse/Children)
new dependent (Spouse/Child) on the portal
within 30 days from the date of event (marriage
/ birth of child)

Note: Employee + Spouse/Partner + 4 Dependent Children + 2 dependent Parents/Parents In law (Cross

combination not allowed) as per company policy conditions.
Medical Benefits Policy Period

Existing Employees + Dependents

Commencement Date 1st Sept 2022
Termination Date 31st Aug 2023

New Joinees + Dependents on intimation through HR

Commencement Date Date of Joining - provided the employee has enrolled self +
dependents within the enrollment window period.
Termination Date 31st Aug 2023

New Dependents (due to Marriage / Birth) on intimation through HR

Commencement Date Date of such event - provided the employee has enrolled
new dependent (Spouse/Child) on the TPA portal within 30
days from the date of event ( marriage / birth of child)
Termination Date 31st Aug 2023
Medical Benefits Coverage Levels

Room Rent Eligibility Applicable

Normal Room Rent : INR 5000 ( For both ESC and Parents/in-laws cover)
**Room rent including Nursing , resident
ICU : No capping ( For both ESC and Parents/in-laws cover)
doctor and related charges

These benefits are admissible in case of hospitalization in India.

In event of a member opting for a higher category/ room rent - escalation cost of all other expense due to the room upgrade would be born by the
member covered.
Room rent includes nursing charges and duty doctor charges.

Co-payment on claims Applicable

Parents/Parents In-Law 10% for ESC, 20% for Parents/ Parents in law (Not Applicable on Capped Ailments)
Medical Benefits Standard Coverage
Coverage
• Room and boarding
• Doctor fees
• Intensive Care Unit
• Nursing expenses
• Surgical fees, operating theatre, anesthesia and oxygen and their administration
• Physical therapy consumed on the premises.
• Drugs and medicines consumed on the premises
• Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)
• Dressing, ordinary splints and plaster casts
• Costs of prosthetic devices if implanted during a surgical procedure
• Radiotherapy and chemotherapy

Note: The expenses are payable provided they are incurred in India and within the policy period. Expenses will be
reimbursed to the covered member depending on the level of cover that he/she is entitled to.
Expenses on hospitalization for minimum period of 24 hours provided with active line of treatment are admissible.
Expenses that are of a diagnostic nature only or are incurred from a preventive perspective with no active line of
treatment and do not warrant a hospitalization admission are not covered under the plan.
A security deposit of a minimum of INR 10,000 or more may be collected from the empaneled hospitals which may be
reimbursed fully or partially post deduction of non admissible expenses and once cashless settlement is done by the
Third-Party Claims Administrator (TPA). Above mentioned list is indicative, it may vary based on the hospital and
hospitalization.
Medical Benefits Pre & Post Hospitalisation Expenses

Pre - hospitalisation Expenses

Definition If the Insured member is diagnosed with an Illness which results in his / her hospitalization and for which
the Insurer accepts a claim, the Insurer will also reimburse the Insured Member’s Pre-hospitalization
Expenses for up to 30 days prior to his / her hospitalization
Coverage Yes
Duration Within 30 days before hospitalization

Post - hospitalisation Expenses

Definition If the Insurer accepts a claim under hospitalization and immediately following the Insured Member’s
discharge, further medical treatment directly related to the same condition for which the Insured Member
was Hospitalized is required, the Insurer will reimburse the Insured member’s Post-hospitalization
Expenses for up to 60 day period
Coverage Yes
Duration Within 60 days post discharge

Please note that although you are covered for post hospitalization claims for 60 days after discharge, you are expected to file a reimbursement claim with the TPA within 30
days of incurring the expense.
Pre and post hospitalization expenses can be claimed under reimbursement and cashless facility
Medical Benefits Maternity Benefits
Benefit Details

For Normal Delivery INR 50,000 within the Floater Sum Insured

For C-section / Cesaerean Delivery INR 50,000 within the Floater Sum Insured

Restriction on number of children Maximum of 4 Children

9 Month waiting period Waived off

Pre-Post Natal Expenses Covered per delivery within the respective sub limits.

Infertility Treatment Covered within Maternity Limit upto INR 50,000

Newborn baby covered from day 1 Covered from day1. Baby addition intimation to be given within 30 days of
birth.

Surrogacy Covered up to maternity limit

• These benefits are admissible in case of hospitalization in India

• Covers only first four events during the entire lifetime (events includes maternity and related claims) Those who already had four or
more events (maternity/maternity related) will not be eligible for this benefit
• Expenses incurred in connection with voluntary medical termination of pregnancy during the first 12 weeks from the date of conception
are not covered
• Any complication arising related to pregnancy can be payable within the mentioned maternity sublimit and subject to the hospitalization
and treatment.
Medical Benefits Co-payment
Benefit Details
Employees
10% co pay on admissible claim amount
Spouse
Co-pay is not applicable for capped ailments
Children
Parents / Parent in 20% co pay on admissible claim amount
laws Co-pay is not applicable for capped ailments

Co pay is applicable on the admissible claim by the Insurer

(admissible claim = total cost of treatment - non payable expenses)

Illustration: How it works

FACTORS AMOUNT

Total Claim Amount INR 1,20,000

Non-payable Expenses INR 20,000

INR 1,20,000 – INR 20,000 = INR

Claim Admissibility under GMC Policy
1,00,000
ILLUSTRATION
20% Co-pay on admissible claim amount INR 1,00,000 * 20% = INR 20,000

INR 1,00,000 - INR 20,000 = INR

Total Claim Settlement Amount
80,000

Co-payment Liability for employee INR 20,000

Benefits Extensions Definitions
Benefits For ITC Definition

External Congenital Diseases covered for life threatening ailments only (Employee +Spouse +
Congenital Diseases Covered
Children)

Bereavement Cover Covered No deduction in claim amount in case of death of employee during hospitalization only for Employees.

Cataract Treatment Covered Standard cataract cover up to INR 50,000 for either one or both eyes per member.

Accidental Injury expenses

Accidental Injury related expenses above INR.1,000 and maximum capped at INR.10,000 incident
including under day care Covered
(OPD basis only for employees)
treatments

Ambulance Charges Covered Covered up to 1% of Sum Insured

Expenses incurred for Ayurvedic/Homeopathic/Unani Treatment are admissible up to 25% of the sum
insured provided the treatment for illness/disease and accidental injuries, is taken in a Government
Ayurvedic Cover Covered hospital or in any institute recognized by Government and /or accredited by Quality Council Of India /
National Accreditation Board on Health, excluding centers for spas, massage and health rejuvenation
procedures..

Home Care Treatment Cover Covered INR 10,000 per member in case of COVID 19 positive case only

Inpatient Hospitalization cover upto 25% of Sum insured

Mental disorder Covered

Genetic Disorder Covered Covered with a sub-limit of 25% of Sum Insured

Benefits Extensions Definitions

Benefits For ITC Definition

12 Advance treatment covered as per applicable Sub Limits.

• Uterine Artery Embolization & High Intensity Focused Ultrasound – Upto 20% of SI & Maximum
INR 2 Lakh.
• Balloon Sinuplasty - Upto 20% of SI & Maximum INR. 2 Lakh.
• Immunotherapy-Monoclonal Antibody - Upto 20% of SI & Maximum INR. 2 Lakh.
• Deep Brain Stimulation - Upto 50% of SI & Maximum INR. 5 Lakh.
• Robotic Surgeries - Upto 50% of SI & Maximum INR. 5 Lakh.
Advanced Treatments Covered Covered • Bronchial Thermoplasty - Upto 50% of SI & Maximum INR. 2.5 Lakh.
• Vaporisation of the Prostate (Green laser treatment for holmium laser treatment) - Upto 50% of SI
& Maximum INR. 2.5 Lakh.
• Intra vitreal Injections - Upto 10% of SI & Maximum INR.75,000.
• Stereotactic Radio Surgeries - Upto 50% of SI & Maximum INR. 3 Lakh.
• Intra Operative Neuro Monitoring (IONM) - Upto 10% of SI & Maximum INR 50,000.
• Stem Cell Therapy - Upto 50% of SI & Maximum INR 2.5 Lakh.
• Oral Chemotherapy - Upto 10% of SI & Maximum INR 1 Lakh.
Policy Comparison - Corporate Vs Retail Plan | Parent

Ease of operation in the Group Plan:

 Easy enrollment: no documents are required

 Easy portability on separation: Employee can

move to retail plan with existing insurer. Waiting
period stands waived to the extent of coverage
under group medical insurance plan of ITC
Infotech. Portability is Enabled through a letter
from ITC Infotech based on application from
employee, 30 days prior to separation.

 Refund of Premium: Pro-rated premium refund

available in case of nil claim

 Income Tax exemption: Auto-enrollment for

income tax exemption since premium deduction is
done through payroll
Group Medical Insurance Policy | Voluntary program
ESC (Employee, Spouse and Child) Top-up Policy
Cover Floater Sum Insured Premium (INR) Incl GST
Tax exemption
2,50,000 2,650
Employee, Spouse & 5,00,000 5,301  Tax exemption on voluntary premium under Sec
80 D (per annum)
Children 7,50,000 7,715  ESC top-up – exemption upto INR 25,000
10,00,000 10,129 pa
 Voluntary parents – exemption upto INR
25000 pa for parents <=60 years
Parental Policy  Voluntary parents – exemption upto INR
50000 pa for parents >60 years
 Auto-accounting of exemption in the income tax
Cover Floater Sum Insured Premium (INR) Incl GST on enrollment (separate advise is not required for
exemption).
1,00,000 11,602  Parent-in laws are not applicable for tax
exemption.
2,00,000 19,488
1 Parent/Parent-In-Law 3,00,000 26,346
Payment of premium for voluntary cover (ESC and
4,00,000 * 30,298 Parent policy - India Group Medical Insurance):
5,00,000 * 33,933
 Employees in other geos: In one installment –
1,00,000 17,486
credit to Company’s account directly by the
2,00,000 27,198 employees
2 Parents/Parents-In-Law 3,00,000 36,914
4,00,000 * 42,452
5,00,000 * 47,546

* Enhancements in 2022-23 policy

General Exclusions
• Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations
• Circumcision unless necessary for treatment of disease, Vaccination,
• Cosmetic Treatment, Plastic Surgery other than necessitated Due to accident,
• Dental Treatment or surgery unless necessitated by accident and requiring hospitalization
• Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol, Obesity Treatment,
• Psychosomatic disorders, Sterility, Venereal Disease
• Rotational Field Quantum Magnetic Resonance, Enhanced External Countercc Pulsation
• Injury or disease caused directly or indirectly by nuclear weapons
• Naturopathy, Acupressure, Acupuncture, Magnetic Therapy, Experimental and Unproven Therapy
• Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges,
• Personal comfort charges, baby food, diaper, toiletry items, tissue paper, ayah charges etc.
• Ambulatory devices like Walker, crutches, belts, collars, caps, splints, slings,braces, stockings, elastocrepe bandages, external ortho-
• Paedic pads, subcutaneous insulin pumps, diabetic footwear, Glucometer, Thermometer, Alpha/Water Bed and similar related items Or Any medical
equipment which is used at home
• Genetic Disorders
• Hospitalization for diagnostic tests only
• Vitamins and tonics unless used for treatment of injury or disease
• Voluntary termination of pregnancy during first 12 weeks (MTP)

Note: The above-mentioned exclusions are indicative & not exhaustive.

Enrollment Process – Medibuddy Portal
Enrollment Process- Medibuddy Portal

MediBuddy Portal Login Page

MediBuddy portal URL :

https://portal.medibuddy.in/l
ogin.aspx

For Username and Password

as received from Medi Assist
via email or

your default User ID will be

PSID@itcinfotech, e.g. Ps. Id
is 1234, User ID will be
1234@itcinfotech

& default password will be your

registered Date of Birth in
DDMMYYYY e.g. your date of
birth is 10th November 1990
your password will be
1011990

Note: Please use the link for enrolment: https://portal.medibuddy.in/Home.aspx

19
Getting Enrolled – Home Page

• Employee can change his/her marital

status by selecting drop down.

• If your status is married, please

select ‘Date of marriage’

• +Add button allows employee to add

his dependents, dependent details
Should be as per the Government ID
proof.

• Edit & Delete option allows employee

to edit or delete dependents only.
Employee can add dependent
parents / in-laws with additional
premium.

• Annual Payable Premium will reflect

in the premium box.

• Voluntary Top Up Cover, employee

can select from drop down.

• Voluntary Top Up premium will reflect

in the premium box.
Password Change & Profile Update

MediBuddy Portal Login> >

Password Change

1. System will prompt to

force change the
password, Update
alternate email id &
contact number on the
first login.

2. Once password is
changed employee will
be logged out and will
have to login with
updated credentials.

21
Getting Enrolled – Re-login Process

MediBuddy Portal Re-Login Process

• Re-login with changed password & link your e-

mail ID & Mobile number. This is one time
activity.

• Please enter the OTP sent to your keyed in

email ID & password and click verify to
continue.

• You will be prompted to update alternate email

& mobile no. which is optional, employee has
to tick “All looks good, continue.

22
Getting Enrolled – Employee, Spouse and Child (Base policy)

1. Employee can change his/her marital status by selecting drop down.

2. If your status is married please select ‘Date of marriage’
3. +Add button allows employee to add his dependents, dependent details Should be as per the Government ID proof.
4. Edit & Delete option allows employee to edit or delete dependents only.
Getting Enrolled – ESC Top up

• Employees have an option to enhance the cover (with no option to reduce the sum insured)
• Once employee completes dependent enrolment, employee must right tick on ‘I agree’ disclaimer & click on ‘Submit’ button to complete the enrolment process.
• Employee will get confirmation email with enrolled dependent details & opted Top Up details if any with payable premium details.

©2021 ITC Infotech. All Rights Reserved. 24

Enrollment Process – Parents Voluntary Cover

• Employees have an option to enhance the cover (with no option to reduce the sum insured)
• Once employee completes dependent enrolment, employee must right tick on ‘I agree’ disclaimer & click on ‘Submit’ button to complete the enrolment process.
• Employee will get confirmation email with enrolled dependent details & opted Top Up details if any with payable premium details.

©2021 ITC Infotech. All Rights Reserved. 25

Getting Enrolled – Process – Parents-in-law Voluntary cover

• Employees have an option to enhance the cover (with no option to reduce the sum insured)
• Once employee completes dependent enrolment, employee must right tick on ‘I agree’ disclaimer & click on ‘Submit’ button to complete the enrolment process.
• Employee will get confirmation email with enrolled dependent details & opted Top Up details if any with payable premium details.

26
Getting Enrolled

The Procedure : What Must You Remember ?

 Employees must provide all the details of dependents in the enrollment window. Dependents once declared cannot be added or
changed during the policy period.
 No midterm inclusion of dependents would be allowed except in case of spouse due to marriage of an employee and birth of child.
 Midterm enrollment of new dependents (Spouse / Children) is allowed for employees within 30 days from Date of Marriage/ Date of
Birth. The details need to be provided to HR within 30 days from date of event.
 Existing Employees are covered as on date of policy commencement (or date of joining for new employees joining after 1st September
2021) along with their eligible dependents as per data provided by HR to Insurance Company.
 Eligible Dependent covered under the policy for existing employees can be viewed on the TPA website.

©2021 ITC Infotech. All Rights Reserved. 27

Insurance Services – Medibuddy Mobile App
Insurance Services

View and Download E-card

Your MediBuddy App is a Access, view, and download your Medi Assist

doorway to a wide range e-Card for cashless hospitalization.

of insurance related
Cashless Healthcare
information such as -
Keep track of all your medical expenses & make cashless
network hospitals, hassle-
payments on the MediBuddy app.
free cashless
hospitalization, seamless Locate Network Hospitals
Find the right network hospital near you, filter by location and
claims reimbursement
specialties available.
process, claim status
tracking, online health Reimbursement Submission
records, view your policy If you’ve opted for reimbursement, submit your hospital

details and download e- expenses.

cards.
Claims Forms
Download all necessary forms for claims submissions and pre-
authorization.
One App Multiple Benefits

MediBuddy Gold Comprehensive and dedicated State of the art integrated Comprehensive Huge savings on
For your and your family Insurance Tab Health Tracker COVID Care Services Medicines
Seamless Claims Submission & Tracking

Easily submit your claims on the MediBuddy Mobile App and track the progress claim progress

Four Step Claim Submission Process

Easy and fast submission of hospitalization details

An option to upload all required claim documents in one go Your Name

Your Claim ID

Name of the Hospital

A feature to track the progress of your claims

An overview of your claim details

Easy support in case you face any difficulty while uploading

the claim
Access to Network Hospitals & Planned Hospitalization

Search for a network hospital near your location and intimate hospitalization

Filter based on Distance, Speciality and type of policy

Get information on Doctors available, OP packages available,

rooms and other information

Intimate Cashless Hospitalization 48 hours prior to

hospitalization

Easily add beneficiary and other details

3-Step cashless intimation process

Confirm your hospitalization through the mobile app by

submitting all required documents such as Doctor’s
prescription
Download the MediBuddy App

Open portal.medibuddy.in on your The popup that appears post login will give Click on the links and you will be Or give a missed call to
browser and enter your username and you links of app download on Microsoft redirected to the store page where you can the displayed number to receive an app
password Store, App store and play store download the MediBuddy App download link on your mobile phone
Claim Process
Claim Process – Cashless Hospitalization

Planned Emergency
Hospitalization Hospitalization

Approach hospital minimum 48 hrs. prior to admission , produces Admission in Hospital

TPA card with Govt ID and completes pre-authorization formalities

Pre-Authorization formalities to be completed

Faxes Pre-Authorization letter to TPA for Approval within 24 hrs and sent to TPA for Approval

If all the documents are in order, TPA will issue authorization letter If all the documents are in order, TPA will issue
to hospital within 3 hours authorization letter to hospital within 3 hours

If the case is Declined, Denial Letter will be

If the case is Declined, Denial Letter will be issued to hospital issued
(denial of cashless does not mean denial of treatment or claim) (denial of cashless does not mean denial of
treatment or claim)

Incase additional information is required, TPA will inform the Incase additional information is required, TPA will
Hospital / Employee inform the Hospital / Employee

35
Claim Process – Reimbursement

Submits all original

Collects all original
Insured visits non Hospital documents
Takes discharge, pays for documents, receipts and
network hospital for along with filled claim
treatment investigation reports from
treatment form within 21 days from
Hospital
date of discharge to TPA

Incase additional
information is required,
TPA acknowledges
TPA will inform the
receipt of claim If claim is payable, If claim is declined, denial
employee via email with
documents via email and payment will be made to
reminders, If documents mail will be sent.
commences claim employee via NEFT
are not submitted within 30
process
days, claim may be closed/
declined

36
Claims Document Check List & Attachments
No. Document Required (All in ORIGINAL)
Signed Claim form Part A & Part B (Part A Need to be filled by the employee and Part B needs to get it filled by the hospital
1
(KYC form is mandatory for claims above INR 100,000)
Main Hospital bills in original (Original Hospital Payment Receipt with serial number, with bill no; signed and stamped by the
2
hospital) & itemized bills.
3 Discharge Card/Summary (original).
4 Attending doctors’ bills and receipts and certificate regarding diagnosis (if separate from hospital bill)
Original investigation reports or attested copies of Bills & Receipts for Medicines, Investigations along with Doctors
5
prescription in Original & Laboratory
6 Follow-up advice or letter for line of treatment after discharge from hospital, from Doctor.
7 Break up with details of Pharmacy items, Materials, Investigations even though it is there in the main bill
In case the hospital is not registered, please get a letter on the Hospital letterhead mentioning the number of beds &
8
availability of doctors & nurses round the clock.
In non- network hospitalization, please get the hospital and doctor’s registration number in Hospital letterhead and get the
9
same signed and stamped by the hospital.
In case of accidents, please note FIR or MLC (medico legal certificate) is mandatory. Original Death Summary: In case of
10
Death Claims
11 One Cancelled Cheque with Employee Name printed to settle the claim to Employee Bank account.
Reimbursement form Non-medical expenses list
Pre-Authorization form
Portal Login https://www.medibuddy.in/ass https://www.medibuddy.in/ass
https://www.medibuddy.in/assets/c
https://portal.medibuddy.in/ ets/claimForms/reimbursemen ets/claimForms/non-
laimForms/cashless-claim-form.pdf
t-claim-form.pdf admissible-expenses.pdf

37
Deductions / Non Payable Expenses
Administrative Expenses
• Admission charges • Relative stay charges • Booking charges • Surcharge/Service charges
• Registration charges • Additional stay • Overhead charges • Incidental charges
• Medico-legal charges • Gate pass/Attendant pass • Establishment charges • Waste disposal charges
• Attendant stay charges • Conveyance charges • Tax/Luxury charges

Documentation Expenses
• Documentation charges • Medical records charges • Death certificate • TPA charges
• Discharge summary • Birth certificate • Medical certificate

Consumable
• Antiseptic/ disinfectant solutions • Toiletries & stationeries & • Housekeeping charges • Referral charges
• Soap & Powder (talc) cosmetic expenses • Preparation charges • HIV Charges
• Oil & Cream • Oxygen cylinder • DONOR organ charges • RMO/ duty doctor charges
• Sanitary pads/Diapers • ECG electrode charges • Vaccination charges • Assistant charges for minor cases
• Cassette/CD/Film charges • Mortuary/coffin charges • Outstation consultants / surgeons • Expenses towards sterilization

Services
• Private nuINRe charges • Food/beverages • Water charges • A/C charges
• Telephone charges • Diet & dietician charges • T.V / Internet charges • Stationary charges
• Fax charges • Electricity charges • Newspaper/magazine • Lines/Laundry charges

Note: The list is indicative, actual deduction would vary.

Judicious Utilization of Benefits
Health Insurance is a benefit for the employee and their dependents. One has to utilize the benefit with utmost caution and prudence.

The ever increasing cost for the benefits require a proactive involvement from all of us.

The following steps are recommended, ensuring the benefits is prudently utilized by the employee and dependents covered:

• Maximize your value for money - “Act with prudence on your choice of hospital/service provider” while availing cashless

• Please ensure to crosscheck the final bill sent to the TPA for the following:

o You are Billed only for the services utilized for e.g. category of room, diagnostics undergone , medicines consumed

o Total of the bill

• In case of any planned hospitalization, approach the hospital in advance (48 hrs) and request pre-authorization- this enables TPA to further negotiate the rates

• To approach hospitals with caution – most expensive is not necessarily the best

• Try to negotiate

• Ask WHY & WHAT is billed to you (as a consumer, we have the right to know)
GMC FAQ
• What is a Family Floater plan?

• In a Family Floater plan all insured members are covered on floater sum insured basis. The sum insured for a family floater is the maximum liability for any and all claims made by all the
insured members. One single policy takes care of the hospitalization expenses of your entire family. Family Floater Health Plan takes care of all the medical expenses during sudden
illness, surgeries and accidents.

• What is a Health Card / E card?

• A health card comes along with the Health Policy. It is similar to an Identity card. This card would entitle you to avail cashless hospitalization facility at any of the network hospitals. A health
card mentions the contact details and the contact numbers of the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of
assistance. Moreover, you need to display your health card at the time of admission into the hospital.

• What do you mean by Network /Non-network Hospitalization?

• A Hospital, which has an agreement for providing Cashless treatment, is referred to as a 'Network Hospital'. Cashless facility is provided only at the network hospitals. Non-network
hospitals are those with whom there is no agreement and any policyholder seeking treatment in these hospitals will have to pay for the treatment and later claim as per reimbursement
procedure.

• What do you mean by Pre and Post hospitalization?

• Pre and Post hospitalization expenses cover all medical expenses incurred within 30 days prior to hospitalization and expenses incurred within 60 days post hospitalization provided the
expenses were incurred for the same condition for which the Insured Person’s hospitalization was required.

• What do you mean by pre-existing disease or conditions?

• Pre-existing Condition means that any condition, ailment or injury or related conditions for which you had signs or symptoms, and were diagnosed/treated, in the past prior to the first policy
issued by the insurer.

• What is Co-Payment?

• Co-payment means a cost-sharing requirement under a health insurance policy that provides that the insured will bear a specified percentage of the admissible costs. Copayment does not
reduce the sum insured, it is a sharing of expenses incurred.

• What is a waiting period?

• A waiting period is the length of time the insured needs to wait before being eligible for Health Policy benefits.

• How will the payment of claim be made?

• All claims will be payable to policyholder in INR by Cheque /DD or through bank transfer.
 Contact Details

TPA SPOC Contact Person Contact Details E-mail ID

SPOC 1 Help Line 08067714681 [email protected]

1st Level Mr. Lalith Kumar S 8792926297 [email protected]

2nd Level Ms. William Rohini 7619538455 [email protected]

3rd Level Ms. Achanta Tulasi 9620856349 [email protected]

MARSH SPOC Contact Person Contact Details E-mail ID

1st Level Ms. Usha 8655853165 [email protected]

2nd Level Mr John Kenneth NA [email protected]

3rd Level Ms. Latha S NA [email protected]

THANK YOU
Thank You
Disclaimer: The Mercer Marsh Benefits (MMB) is the service value proposition which Marsh brings for its clients. MMB is not an insurance product. In India an
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