Académique Documents
Professionnel Documents
Culture Documents
Version 1.0
Oct 1, 2014
Wipro For Internal circulation only
Employee Compensation & Benefits Team
Contents
OBJECTIVE .......................................................................................................................................... 3
COVERAGE.......................................................................................................................................... 3
POLICY OVERVIEW ............................................................................................................................. 3
POLICY BENEFITS ................................................................................................................................ 4
POLICY TERMS & CONDITIONS........................................................................................................... 5
Co-payment ................................................................................................................................................. 5
Day Care Procedures ................................................................................................................................... 7
Health Insurance Portability ........................................................................................................................ 7
Definition of hospital and nursing home ..................................................................................................... 8
Illness ........................................................................................................................................................... 8
CONTRIBUTION .................................................................................................................................. 8
EXCLUSIONS UNDER MEDICLAIM ...................................................................................................... 9
PROCESS FOR CLAIM SUBMISSION .................................................................................................... 9
Claim Documents....................................................................................................................................... 10
Procedure .................................................................................................................................................. 10
E-medical card ........................................................................................................................................... 11
TOP COVER ....................................................................................................................................... 12
Summary table of Applicable Annual Premium based on employees age & Scope of Cover .................. 13
Top-Up Policy period ................................................................................................................................. 13
Accessing Top-Up Application ................................................................................................................... 13
CONTACTS ........................................................................................................................................ 14
AMENDMENT HISTORY .................................................................................................................... 14
OBJECTIVE
Group Mediclaim policy provides for reimbursement of hospitalization expenses for illness, disease or
injury sustained by employee, spouse and children.
Expenses for hospitalization are payable only if a 24 hour hospitalization has been taken. (Except for
select day care procedures, which do not require a 24 hour hospitalization). Under the scheme, the
typical expense heads covered are the following: room/boarding expenses as provided by the hospital
or nursing home; nursing expenses; surgeon, anesthetist, medical practitioner, consultant, specialist
fees; anesthesia, blood, oxygen, operation theater charges, surgical appliance, medicines and drugs.
diagnostic material and X-Ray; dialysis, chemotherapy, radiotherapy, cost of pace maker, artificial limbs
and cost of organs and similar expenses.
COVERAGE
All India based employees of WT, WI, WC and Eco Energy, are covered under the policy.
POLICY OVERVIEW
Policy Details
Policy Holder
Wipro Limited
Covered Members
Total Members Covered per
Family (Including Employee)
Employee
Spouse
Child
Covered
POLICY BENEFITS
Policy Benefits
Standard Hospitalization
Pre & Post Hospitalization Expenses
Covered
Relevant expenses Covered (30 days & 60 days respectively) Refer
maternity benefit for maternity related pre and post limits
Covered
Maternity
Dental
Invitro fertilization
Covered for a maximum of first 10 cases throughout the year with a limit
of INR 100,000 per case in absence of multi-specialty hospital in a radius
of 50 KM for named ailments only. (subject to approval of insurer)
Mobility Extension
Lasik Treatment
Morbid obesity
Ayurveda
Mental ailment
Waived off
Covered (INR 1000 per claim for Emergencies only)
For Class A cities Normal Delivery: INR 40,000, Caesarian Delivery:
INR 40,000. Other cities - Normal Delivery: INR 30,000, Caesarian
Delivery: INR 40,000. Pre & Post Natal OPD expenses upto INR 5000
within the Maternity Limit is covered. Maternity benefit is applicable
for first two live births only. Any complication rising from pregnancy
will not be covered.
Within the maternity limit for the normal expenses. Complications
which require an admission can be processed under floater.
Covered (Only list of select procedures like Dialysis, chemotherapy,
radiotherapy and other such specified treatments taken in the hospital/
nursing home where the insured is discharged on the same day. Refer
Policy Terms & Conditions for details). Carries 5 percent copay for all
day care treatments
Covered (INR 10,000 for surgical treatment per family). Out of this, the
sub limit for Root canal treatment is INR 3,000 per tooth inclusive of
cost of the crown.
(Cosmetic treatment like filling, capping, scaling, polishing, dentures,
cleaning & treatment of similar nature are not payable. Detailed
prescription, nature of treatment, procedures done, pre-numbered
receipts are a must for dental treatment claims. In addition, X-ray
reports may be asked for if required for justification of admissibility of
claim.)
Covered upto INR 40,000
HIV
HIV covered upto sum insured for self, spouse and children
Stem cell therapies and Cyber Knife treatment are covered upto 50% of
the sum assured.
A Standard Co-pay of 10% will apply where the room rent is up to the Lower Room Rent cap.
A co-pay of 15% will apply where the room rent is between lower room rent cap and the Upper room
rent cap
A co-pay of 20% will apply where the room rent exceeds the upper room rent cap
A class cities includes Metros, Bangalore, Hyderabad, Pune and NCR. Rest of the cities are classified as B
class cities
Sub-limits for Robotics Assisted Surgery
The following ailments are capped with the below mentioned sub-limits (specific to A-type & B-type city).
All procedures other than the ones mentioned below are excluded from the policy if performed using
robotics.
AILMENTS
Table 1.1
Surgery Type
General
Surgery
Description
A
Class B
Class
cities
cities
Clouding of vision, common in elderly
25000
22000
people
Inflammation
and
infection
of
24000
17000
tonsils/adenoids, glands between mouth,
nose and throat
Abnormal connection between two
35000
30000
organs, generally between the rectum and
vagina/rectum and urinary bladder,
General
Surgery
General
Surgery
Fissurectomy
Haemorrhoidectomy
(Excluding staples &
tackers)
Thyroidectomy
HEMI
Thyroidectomy
TOTAL
Arthroscopy
General
Surgery
Arthroscopic Surgery
Orthopaedics
Hydroceletomy
unilateral
Urology
Hydroceletomy
bilateral
Urology
General
Surgery
General
Surgery
Orthopaedics
General
Surgery
Appendicectomy
open
Appendicectomy
laparoscopic
General
Surgery
General
Surgery
Cholecystectomy
open
General
Surgery
Cholecystectomy
laparoscopic
General
Surgery
Hysterectomy open
Hysterectomy
Gynecology
Gynecology
Same as above
Repair of a fissure(a crack or a tear in the
lining of an organ),sphincterectomy is the
correction of a tear on a sphincter( muscle
that helps in contraction of an organ)
Surgical removal of a haemorrhoid(
protrusion of the mucous lining of rectum
due to constipation)
Partial surgical removal of a thyroid gland(
usually done when suffering from cancer)
Total surgical removal of thyroid gland
A procedure done by inserting a fiberoptic
tube into the joints to study the nature of
condition causing inflammation
Done to treat cartilage tears( cartilage is
the tissue lining the joints)
Removal of hydrocele (collection of fluid
around testes), one side. Related to male
reproductory organ
Removal of hydrocele( collection of fluid
around testes), both sides.Related to male
reproductory organ
An x-ray test done to find out the flow of
blood into and out of one's heart( basically
to study the nature of blood vessels)
Correction of hernia( protrusion of
internal organs through weak abdominal
muscles)
Correction of hernia( protrusion of
internal organs through weak abdominal
muscles)
Removal of appendix by cutting open the
abdomen
Removal of appendix by laparoscopy(
insertion of a laparoscope and removal of
appendix by bit by bit, requires just a small
incision on the abdomen)
Removal of gall bladder upon finding
stone formation( by cutting open the
abdomen)
Removal of gall bladder upon finding
stone formation( by minimal invasion using laparoscope)
Removal of uterus due to any
complications( by cutting open the
abdomen)
Removal of uterus due to any
30000
25000
25000
20000
32000
25000
40000
35000
50000
45000
35000
30000
75000
50000
25000
20000
35000
30000
20000
15000
40000
35000
60000
50000
35000
30000
50000
45000
45000
40000
50000
45000
50000
45000
60000
55000
laparoscopic
complications( by laparoscopy)
Portability to be offered to an employee only if s/he has spent minimum 2 years in the organization to
be eligible for portability.
Example:
Say Ram joined the Company on 1st Oct 2012. He has completed 2 years in the Group Policy. He has quit as
of Nov 2014. Ram can therefore continue with the same policy, however he will not get pre-existing
benefits for next 2 years (so that he completes 4 years of waiting period). Oct 2016 onwards, he can avail
to avail pre-existing coverage.
Say, Krishna joined the Company on 1st Jan 2011. He has completed 4 years in the organization. Krishna
decided to separate from the organization as of April 2015. Since he has already completed 4 years in the
policy (hence waiting period of 4 years is completed), if he chooses to he will get pre-existing benefits April
2015 onwards.
Portable policy will be given at the retail rates approved by the Insurer. Employee opting for retail policy
will have to undergo pre-policy medical tests. 50% of medical test expenses subject to a maximum of
INR375 would be borne by the insurer when the proposal accepted by the insurance company.
Portability cannot be given if employee is suffering from any chronic illness at the time of enrollment in
portable policy. Chronic illnesses are conditions or illnesses which are prolonged or recurrent,
progressive and may be irreversible i.e. cancer, organ transplant, renal failure, cardiac disease, brain,
neurological conditions and etc.
Definition of hospital and nursing home
Hospital & nursing home where treatment is availed means any institution in India established for indoor
care and treatment of sickness and injury which is registered with the local authority having 15 inpatient
beds , full equipped operation theatre , fully qualified nursing staff and doctor round the clock.(In class 'C'
towns No of beds be reduced to 10). This condition can be waived in case of very small towns.
The list of network hospitals is dynamic (subject to addition and deletion). It is strongly advisable to check
with Medi Assist customer care number or Mediclaim Helpdesk to check the hospital status.
Illness
Any one illness will be deemed to mean continuous period of illness and it includes relapse within 45 days
from the date of last consultation. Occurrence of same illness after the lapse of 45 days will be considered
as fresh illness.
CONTRIBUTION
WIPRO pays the annual premium on behalf of the employees; the contribution from the employees
towards this premium is accumulated on a monthly basis by way of deduction through salary.
The contribution would be based on Marital Status of the employee, as given below:
Employee Category
Monthly Premium
Individual (Single)
INR 230
Married (Family)
INR 480
A nominal amount is collected every month in excess of the medical insurance premium component. The excess will
be utilized towards wellness programs and preventive healthcare interventions. Regular communication will be sent
out on the available programs and we urge you to make the most out of them.
Diseases, illness, accident or injuries directly or indirectly caused by or arising from or attributable to
war, invasion, act of foreign enemy, war like operations (whether war be declared or not).
Circumcision whether or not necessitated by vaccination or inoculation or change of life or cosmetic or
aesthetic treatment of any description, plastic surgery unless necessary for treatment of a disease not
excluded by the terms of the policy or as may be necessitated due to treatment of an accident.
The cost of spectacles and contact lenses, hearing aids.
Convalescence, general debility, run-down condition or rest cure, sterility/family planning surgeries
both vasectomy and tubectomy/ infertility, venereal disease, intentional self-injury (whether arising
from an attempt to suicide or otherwise) and use of intoxicating drugs and/or alcohol.
Virus Type III (HTLV III) or Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or
Variations Deficiency Syndrome or any Syndrome or condition of a similar kind.
Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-Ray or laboratory
examinations or other diagnostic studies not consistent with or incidental to the diagnosis and
treatment of the positive existence or presence of any diseases, illness or injury whether or not
requiring Hospitalisation/ Domiciliary Hospitalisation.
Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by
the attending Medical Practitioner.
Diseases, illness, accident or injuries directly or indirectly caused by or contributed to by nuclear
weapons/materials or contributed to by or arising from ionising radiation or contamination by
radioactivity by any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel.
Termination of pregnancy within 12 weeks of the gestational period.
Naturopathy treatment, pranic healing, holistic healing, unani, yogic healing etc.
Treatment related like hysterolaparoscopy, ovarian drilling , endometriosis, chocolate cyst, diagnostic d
and C are not covered
IVF Pre and Post or any other infertility related treatment is not covered.
Family planning surgeries are not covered.
Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of
any of these including caesarean section, except abdominal operation for extra uterine pregnancy
(Ectopic pregnancy), which is proved by submission of Ultra Sonographic report and Certification by
Gynaecologist that it is life threatening one if left untreated
Claim Documents
In the event of a claim, you would be required to furnish the following for or in support of a claim:
a) Duly completed claim form
b) Bills, receipts and discharge certificate/card from the Hospital
c) Bills from Chemists supported by proper prescription.
d) Test reports and payment receipts.
For any claims effective 1st Oct 2013, please use the claim form available in myWipro My Information Source
People Practice India Policies My Financial Mediclaim Medical Insurance Claim form. You will need to
fill the form and drop the supporting documents in Wividus Drop box, please write to
mediclaim.helpdesk@wipro.com for claims processing or for any clarification.
Please refer the portal for the detailed checklist ailment wise: www.mediassistindia.com
Procedure
Depending on the need and condition of hospitalization, employee can go for 3 forms of hospitalization:
(i). Planned Hospitalization: In the case of a planned admission, doctor must have been consulted first and
would in turn have advised on the probable date of hospitalization. In such a case, employee must apply for an
approval of the estimated hospital expenses directly with the TPA at least 4-5 days prior to the date of
hospitalization. Employee needs to fill Pre-Authorization form for Cashless Claim(Available in Section 10, Forms).
This would help you get the best services, room and rate with help of TPA. Below process can be followed for
registering claim incase of a planned hospitalization (Cashless if approved by TPA):
track basis with your TPA and is likely to receive approvals within 4 hours during any working day.
For cashless treatment it is mandatory for the hospital to have an approval from your TPA. Incase of delay in
receiving the approval or when you cannot wait for receiving the approval owing to medical urgency you can
undertake
the
treatment
by
paying
the
necessary
cash
deposit.
If you receive approval from your TPA after paying the cash deposit, you are entitled for refund of the cash
deposit (as per reimbursement process mentioned in point (iii)). Below process can be followed for
registering claim incase of an emergency hospitalization:
Yes
Preauthoriza
tion given
No
Employee
will
be
him/herself to the hospital
and claim reimbursement
from Insurer through TPA.
Stop
(iii). Reimbursement: Incase any hospital does not accept cashless facility, employee can register the claim as
reimbursement. Below mentioned documents for or in support of a claim need to be submitted within 30
days of hospitalizatio:
a) Duly completed claim form
b) Bills, receipts and discharge certificate/card from the Hospital
c) Bills from Chemists supported by proper prescription.
d) Test reports and payment receipts.
Please refer the portal for the complete document checklist on ailment wise: www.mediassistindia.com
a) You would need to log the claim in myWipro under My Financials MAS, Health Check, Medi-cards
& Insurance claim (WISH)
b) All relevant documents along with the claim form need to be dropped in the nearest Wividus drop
box.
c) Documents must be submitted within 30 days of completion of hospitalization treatment. Any
late submission shall not be considered.
d) Medi-Assist will process and settle the claim within 14 working days of receipt of complete
documents.
E-medical card
You can print yours & your familys e-card yourself on the link provided below:
myWiproMy FinancialsMAS, Health Check, Medi-cards & Insurance claim (WISH) Medicard.
Do remember to print the card(s) and share with family right away as medical contingency hits unplanned
most of the time.
TOP COVER
Top up Cover Policy Features
Top Up Cover offers you an option to increase your Mediclaim Insurance for furthering your financial
protection benefit under this plan.
Employee can increase sum insured upto INR 100,000, INR 200,000, INR 300,000, INR 500,000, INR 700,000 OR
INR 1,000,000 over and above the existing sum insured. A one-time premium would be deducted from payroll
in the month this additional coverage is opted for.
Please note that it is important to top-up your cover in case you have a chronic pre-existing ailment, failing
which CMAP benefit may not be released by the Company.
Employees will have option of buying a top-up cover over and above the floater cover at their own expense.
Top up is a limited period offer and available from 1st Oct to 15th Nov in 2014.
Critical Illness Cover (Please note it is important to top-up your cover in order to be eligible for this
benefit):
Amount of cover INR 2 lacs (over and above sum insured and top up)
This benefit is for the employee only
The critical illnesses covered are as below:
Cancer of specified severity
First Heart Attack
Coronary artery surgery open chest (CABG)
Heart valve replacement
Coma of specified severity
Kidney Failure
Stroke resulting in permanent symptoms
Major organ/Bone marrow transplant
Multiple Sclerosis
Motor Neuron disease with permanent symptoms
Permanent paralysis of limbs
Loss of Pay Cover (Please note it is important to top-up your cover in order to be eligible for this benefit):
This benefit is for employees only
Amount INR 5000 per week
This benefit will commence immediately on the day Loss of Pay (due to medical exigencies) begins
and will be paid till employee returns to work or for 52 weeks, whichever is earlier
New Employees have to opt for top-up cover within 45 days from the date of joining or on returning from
abroad. The premium payable calculated will be proportionate to the number of months the policy will be
effective.
The top-up cover can be utilized only after exhausting the main cover.
The Top up policy is applicable from 1st October 2014 to 30th September 2015 if applied during the window
mentioned above.
For new joinees/Long Term assignee return cases, top up is applicable from 1st of the following month in
which you choose Top up Cover in myWipro.
myWipro Top up Coverage application will be accessible from the 1st to the 20th of every month (only for a
new joinee / returnee from Long term onsite assignment).
To choose Top up Cover, please log onto myWipro My Financials Top Up Cover.
Top up option, once selected on myWipro cannot be cancelled.
The Top up Cover lapses in the event of Separation due to resignation / Termination from the company as in
the case of default coverage. There will be no refund of Top up premium paid in such event.
Summary table of Applicable Annual Premium based on employees age & Scope of Cover
Unmarried
Amount
INR 100,000
INR 200,000
INR 300,000
INR 500,000
INR 700,000
INR 1000,000
Below 35
Years
36 - 45 Years
450
850
1110
1399
1678
2014
490
930
1200
1512
1814
2177
Married
Above 45
Years
700
1320
1710
2155
2586
3103
Below 35
Years
36 - 45 Years
950
1790
2320
2923
3508
4209
1030
1940
2520
3175
3810
4572
Above 45
Years
1260
2400
3590
4523
5428
6514
To choose Top up Cover, please log onto myWipro My Financials MoreTop up Cover. Please refer to the
Editorial section for further information on how to raise a request on myWipro.
CONTACTS
For any further information with regards to the Policy,
E-mail Id's
Contact No.
Timings
080 32413698
+91 9341625893
24 / 7
wipro@mediassistindia.com
First level of
escalation:
escalation.mediclaim@wipro.com
24 / 7
Final level of
escalation:
padmat@mediassistindia.com
+91 9739519191
Visit myWipro My Information Sources People Practices India Other Benefits Healthcare
services to know about the existing offers across the network of hospitals/ clinics.
Visit Channel W Fit for Life to take proactive care of your health!
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AMENDMENT HISTORY
Amendment Date Policy Version
Author
Approved By
Oct 1, 2014
C&B Team
Head C&B
1.0
Nature of Changes
Renewed Policy for year 2014-15
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