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Group Mediclaim & Personal Accident Policy

(with effect from May 18, 2011 to May 17, 2012) Private & Confidential

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COVERAGES Family Definition PreExisting Ailment Covered 30 Days Waiting Period 1stYr. Exclusion Pre & Post Hospitalization Maternity Cover 9 Months Waiting Period Baby Cover Day One Room Rent Limits Corporate Buffer Terrorism EXPIRING & PROPOSED FEATURES Self + Spouse + 3 Dependent Children + 2 Dependent Parents Covered For All Waived Off Waived Off 30 & 60 Days Respectively Rs. 30,000/for Normal & 50,000/for Cesarean Waived Off Covered from Day 1 Up to 1% of Sum Insured for normal & 1.5% for ICU Rs. 1,000,000/ Covered For All

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Policy Terms Insurance Company Brokers Third Party Administrator (TPA) Sum Insured Family Scope Family Members Covered Cashless Facility Pre &Post Hospitalization Pre Existing Aliments Maternity Cover Baby day one Cover Particulars The National Insurance Co. Ltd. Futurisk Insurance Broking Co. Pvt. Ltd. E-Meditek (TPA) Services Ltd. As per Grade 1+6 Employee+Spouse+3 Dependent Children + Dependent Parents Yes 30 & 60 days respectively Covered Covered without 9 months waiting period Yes

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Eligibility
Category I II III IV Salary PM >/= 1 Lac More than 50,000 less than 1Lac More than 25,000 upto 50,000 </= 25,000 Sum Insured (INR) 500000 300000 200000 100000 Coverage Employee +Spouse+ 3 Dependent Children (up to age of 25 years) +Parents Employee +Spouse+ 3 Dependent Children (up to age of 25 years) +Parents Employee +Spouse+ 3 Dependent Children (up to age of 25 years) +Parents Employee +Spouse+ 3 Dependent Children (up to age of 25 years) +Parents Employee Contribution* (PM) 1079 581 421 195

* Employee Contribution will be deducted every Month from the Salary / Remuneration Private & Confidential

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POLICY FEATURES : CASHLESS SERVICE
The policy will be having cashless facility offered by E-Meditek (TPA) Services Ltd. The Third party Administrator (TPA) Every employee and their family members, covered under this policy will be issued an e-card by EMeditek which will entitle them to avail cashless facility with any of the empanelled hospitals subject to their getting pre - approval from E-Meditek. There are more than 1500 hospitals on the panel across India. The service will ensure that members covered under the policy gets treatment at the hospital empanelled in the Network without having any money to pay, if approved by E-Meditek (Except for non-medical expenses). In the event if member choosing to avail treatment at a hospital not empanelled with the E-Meditek the claim shall be settled on reimbursement basis. All papers related to such claims will be routed through the Respective HR Representative to CORP-HR for ensuring timely payment of reimbursement claim.

Note: As per the Insurance policy Any Hospitalization please intimate E-Meditek (TPA) / Futurisk (Broker) 48 hours in advance or mail to intimation.mumbai@emeditek.com. Private & Confidential

Hospitalization Procedure

Emergency Admission
Network Hospital

Planned Admission
Non-Network Hospital
Contact Futurisk Insurance Broking at paragsarode@futurisk.in & intimation.mumbai@emeditek.com to intimate the hospitalization

Contact E-Meditek (TPA) & Inform about the nature of emergency & your ID No Get the Admission Request Note from Filled And signed by the treating doctor / hospital And signed by you, done in advance Network hospital will fax the request to E-Meditek (TPA) E-Meditek doctors will examine the Pre-Authorization Request form & decide on cashless Availability, as per the policy guideline All additional requirement letter, denial letter, Issued depending upon plan, benefit & balance sum insured available to the hospital

Once discharged then please submit the Following documents to HR For further processing Please submit the ORIGINAL papers within a week after discharge. 1.Dully filled & signed Claim Form. 2. Hospital bill & Payment receipt 3. Discharge Card 4. Prescriptions 5. Bills of medicines, surgical items 6. Details of Pre-Hospitalization expenses if any 7. IPD Papers, if required Papers will be sent to Futurisk & Settlement can be expected within 4 weeks from the receipt of all ORIGINAL Documents, without any deficiency.

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CASHLESS SERVICE NETWORK HOSPITAL DETAILS
Network Hospital for Cashless facility - An exhaustive list of Network Hospitals is available at the website of E-Meditek : www.emeditek.com

Note: The Hospital list gets updated regularly. All employees are requested to check the updated list on website

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Admission Request Note?

This is a request for cashless hospitalization. The same has to be duly filled up, signed and stamped by treating doctor. Thereafter the hospital will fax it to E-Meditek . The contact details of E-Meditek are available in the website.

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CASHLESS SERVICE: FAQ
How to fill the Admission Request Note? Part A: To be filled in by treating doctor. Information required are: The ID No as appearing on the e-card, signs and symptoms of the present ailments, duration of the ailment, diagnosis, pre existing conditions if any, proposed line of treatment, tentative date of admission, approximate days of stay and approximate cost of hospitalization. Part B: To be filled in by claimant authorizing E-Meditek to obtain details of treatment and collect documents from the hospital and pay the hospital bill while accepting the terms and conditions of E-Meditek authorization.
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CASHLESS SERVICE: FAQ
What is an Authorization Letter? An Authorization letter is the communication Ascertaining the admissibility or acceptance of the cashless service. The same is issued by E-Meditek subject to admissibility of the claim and availability of balance Sum Insured for the member. Whether claim has been admitted for cashless reimbursement or not? Please note that authorization letter or Denial letter shall be faxed directly to the hospital with intimation to the insured by E-Meditek

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NON - CASHLESS CLAIM SETTLEMENT
Non Cashless Claim settlement will be facilitated by Futurisk Insurance Brokers India Pvt. Ltd.

NORMS FOR NON CASHLESS CLAIM SETTLEMENT

If cash less facility is not availed, pre-authorization is denied or treatment is availed at a nonnetwork hospital, the insured will have to settle the bills directly with the hospital and subsequently claim reimbursement by submitting the following documents within 30 days from the date of discharge from the hospital : 1. 2. 3. 4. 5. 6. 7. Claim form duly signed by you Original discharge card/ Discharge Summary Original Hospital Bills/ Original Payment receipts Original report of all investigations Prescriptions, Pre hospitalization bills, and bills of medicines and Surgical appliances if purchased by you, along with duly stamped receipt In- Patient Department (IPD) papers, if required.

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POLICY FEATURES : PRE-EXISTING DISEASE BENEFIT :
The pre-existing disease benefit helps the members get a complete coverage for all medical emergencies, including ailments that may have been there before the start of this policy. Pre-existing disease benefits will be extended to all members enrolled under the policy.

WAIVER OF 1 YEAR EXCLUSION FOR ALL INSURED MEMBERS :

First year exclusion for Cataract, Gall Stones, Arthritis & related ailments, Benign Prostatic Hypertrophy, Hysterectomy, for Menorrhagia or Fibromyoma Hernia, Hyderocele, Congenital Internal Disease, Fistula in anus, Piles, Sinusitis and related disorders is deleted from our Policy means all claims for above diseases are payable.

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MATERNITY : The maternity benefit ensures that female members of the group are covered for medical expenses relating to delivery. This benefit will ensures that delivery related expenses up to amount of Rs, 50,000/- will be borne by the insurance company. Pre & Post hospitalization expenses not covered in maternity claim. Nine months waiting period for maternity claim is not applicable under this section. NEW BORN BABY COVER : New Born baby will be covered from Day 1 from the date of birth. However, birth certificate needs to be subitted to Regional HR/HO HR, with the mediclaim form for the coverage of the New born baby immediately after birth. PRE AND POST HOSPITALISATION EXPENSES COVER BENEFIT : Relevant medical expenses incurred during a period up to 30 days prior and 60 days after hospitalization will be considered as part of claim and therefore settled. 24 HOURS HOSPITALISATION : Only Expenses on Hospitalization for minimum period of 24 hours are admissible However this time limit will not apply for specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye surgery, Dental Surgery, Lithotripsy (Kidney Stone removal), Tonsillectomy taken in the hospital/Nursing home and the insured is discharged on the same day of the treatment will be considered to be taken under hospitalization benefit.

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PRE & POST HOSPITALIZATION : FAQS 1. What expenditures will generally be covered under the Pre Hospitalization Clause? Medical expenses incurred for Laboratory Test, Pathological Test and such similar overheads are usually incurred prior to hospitalization and will be covered under the pre Hospitalization Clause. 2. What expenditures will generally be covered under the Post Hospitalization Clause? Medical expenses incurred for recommendation health check up subsequent to release from hospitalization and other such similar overheads usually incurred post hospitalization will be covered under the Post hospitalization Clause.

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GENERAL DEFINITION
1. Medical Practitioner
Medical Practitioner means a person who holds a degree/ diploma of a recognized institution & is registered by Medical Council or respective state of India. The term Medical Practitioner would include Physician, Specialist & Surgeon (e.g..MBBS, MD, MS). 2. Hospital / Nursing Home Means any institution in India established for indoor care & treatment of sickness & injuries which either has been registered as a hospital or nursing home with the local authorities & is under the supervision of a registered & qualified medical practitioner or should have atleast 15 inpatient beds. Note: If the hospitalization claim doesnt meet the above mentioned criteria then the claim will not be payable.

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GENERAL POLICY EXCLUSIONS
Injury or disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, Warlike operation (whether war be declared or not). Cost of Spectacles, Contact Lenses, Hearing Aids. Dental Treatment or surgery of any kind unless requiring hospitalization on account of accidental cases. Circumcision unless necessary for treatment of the disease, cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated to an accident or as a part of any illness. Convalescence, general debility Run Down condition or rest cure, congenital external disease or defects or anomalies, Sterility (Infertility), venereal disease, intentional self injury and use of intoxicating drugs / alcohol. Voluntary medical termination of pregnancy during first 12 weeks from the sate of conception.
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GENERAL POLICY EXCLUSIONS
Acquired Immune Deficiency Syndrome (AIDS) Injury or disease directly or indirectly caused by or contributed to by nuclear weapon / material Naturopathy Treatment Medical Expenses for a Organ Donor Expenses incurred for disease declared as an Epidemic by Health Authorities. Charges incurred at Hospital or Nursing Home primarily for diagnostic, X ray or Laboratory examinations not consistent with or incidental to the diagnosis & treatment of the positive existence or presence of any ailment, sickness or injury, for which confinement is required at a hospital / nursing home.

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GUIDELINES

Payment of Claim :All medical /surgical treatments under this policy shall have to be taken in India and admissible claims thereof shall be payable in Indian Rupees.

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Condition of Membership This cover will be extended to all Prime Focus employees as per the policy and guidelines presented above and any other guideline to be issued in due course of time. The moment an employee leaves the organization he/she will be out side the scope of this cover.

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Group Personal Accident Policy

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Coverage : This cover will be extended to all Prime Focus employees only as per the policy and guidelines presented herein and any other guideline to be issued in due course of time. TYPE OF COVER: Wider Cover Coverage as per the category

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SUM INSURED
Category I II III IV Salary P. M >/= 1 Lac More than 50,000 less than 1Lac More than 25,000 upto 50,000 </= 25,000 Sum Insured (INR) 500000 300000 200000 100000

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DESCRIPTION ON THE COVERS OFFERED WIDER COVER Accidental Death Cover : Wherein on death of the employee on account of an unfortunate event of an accident; entire sum insured is paid out to the nominee of the employee. Permanent Total Disablement : The Insured Person in case of permanent total disablement because of an accident will receive the total Sum Insured e.g. loss of sight on both eyes, loss of both hands etc.

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GENERAL POLICY EXCLUSIONS 1. Suicide, attempted suicide or self inflicted injury or illness. 2. Whilst under the influence of intoxicating liquor or drugs. 3. Any deliberate or intentional, unlawful or criminal act, error, or omission of the member 4. From war (whether declared or not), civil war, invasion, act of foreign enemies. 5. Whilst engaging in aviation or ballooning, whilst mounting into, dismounting from or traveling in any balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world. 6. Any loss suffered by the member on account of his participation as the driver, co-driver or passenger of a motor vehicle during motor racing or trail runs.

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GENERAL POLICY EXCLUSIONS 7. Any loss caused either directly or indirectly by nuclear energy, radiation. 8. Venereal or sexually transmitted disease. 9. HIV (Human Immunodeficiency Virus) and / or any HIV related illness including AIDS (Acquired Immune Deficiency Syndrome) and / or mutant derivatives or variations thereof however caused. 10. Pregnancy, resulting childbirth, miscarriage, abortion, or complication arising out of any o the foregoing. 11. The Insureds participation in any naval, military or air force operations whether in the form of military exercises or war games or actual engagement with the enemy, whether foreign or domestic.

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If you have any query or need any assistance, kindly get in touch with :
Futurisk Insurance Broking Co. Pvt. Ltd. (Ph: 022 40704000) Futurisks Relationship Manager for Prime Focus Mr. Parag Sarode paragsarode@futurisk.in & intimation.mumbai@emeditek.com Mob: +91 98339 20286

Prime Focus HR Representatives or Corporate HR

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THANK YOU

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