Mediclaim Policy for Employees & their Family

Benefits of the Policy

Benefits of having a Corporate Policy in compared to Individual Retail Policy are
as follows:
RETAIL POLICY

CORPORATE POLICY

Pre-existing disease is covered after 3 years Pre-existing disease is covered from Day 1
30 Days waiting period applicable

30 Days waiting period not applicable

Pre-policy medical tests are required above

45 years of age

Pre policy medical tests are not required

Congenital Internal Ailments are not covered

Congenital Internal / External Ailments are

covered

Maternity not covered

Maternity is covered

Capping on room rent is limited

No capping on room rent

PREMIUM AMOUNT
PREMIUM AMOUNT

PAID BY COMPANY PAID BY EMPLOYEE

SELF

100%

SPOUSE

100%

CHILD-1

100%

CHILD-2

100%

CHILD-3 (+)

50%

50%

100%

50%

50%

DEPENDENT PARENT
If Residing with employee
(JAJPUR,CHANDIKHOL,CUTT
ACK,BHUBANESWAR)
If not Residing with employee

COVERAGE
AMOUNT
NOPR
CASE

COVERAGE AMOUNT

OPD

Rs. 4000

HOSPITALISATION

Rs.2,00,000

COVERED

Per Insured Person

Family Floater

PREMIUM CHART

NOPR
AGE BAND

INCLUDING
SERVICE TAX

0-65

Rs. 3,576/-

66-70

Rs. 6,780/-

70+

Rs. 9,234/-

Features

Family Floater Sum insured for hospitalization Rs. 2,00,000.

Domiciliary (OPD) expenses Rs 4,000 per insured person
No premium recovery from employee for self, spouse and two dependent children (
Dependent children implies unemployed sons up to 25 years of age / unemployed
and unmarried daughters).
50% of applicable premium for third and more child to be borne by the employee.
If dependent parents are residing (Jajpur, Chandikhol,Cuttack & Bhubaneswar) with
the employee, no recovery of premium from the employee but if the dependent
parents are not residing with the employee, 50% premium to be recovered.
Maternity: Maternity Benefit covered subject to a maximum of Rs. 30,000/- Normal
and 50,000 Caesarean without 9 months waiting period.
New Born Dependant : Covered from day of birth within the overall family floater
limits and also subject to family not exceeding the stipulated size as above on
inclusion of the baby.

Features

Mid-term inclusion of existing employees newly acquired dependent (newly

married spouse/new born baby/newly adopted child ) is allowed subject to
declaration
Corporate Floater : Available to each family unit up to the limit of Sum
Insured opted by them and on expiry of their sum insured.
Type of Treatment shall include Allopath and or Homeopath and or
Ayurved and or any other recognized practices covered provided for a limit
up to 10% of sum insured for treatment taken in registered government
hospitals
Ambulance charges @ 1% of Sum Insured subject to a maximum of Rs.
2,000/- per person per event subject to overall admissibility of the claim.

List of Exclusions

SN
1

List of Exclusions
Intentional self injury / use of intoxicating drugs or liquor or Disease directly
due to one or more of them.

2 Vaccination / Inoculation / Circumcision other than medical grounds.

3 Congenial defects / anomalies / Venereal diseases.
4

Beauty treatment (Including plastic surgery unless necessitated by an

accident).

5 Cost of eye glasses / Lenses / Frames.

6

Cost of Diagnostic studies not related to medical treatment covered under

this policy.

7 Injury / Disease related to radio activity.

8 Injury / Disease due to war and war related operations.
9 Cost of special diet.

Claim Documents Submission process :

All Claim documents for reimbursement should be
submitted within 30 days from the date of discharge in
case of claim for Pre-hospitalization and Hospitalization
expenses. For Post Hospitalization expenses, all claim
documents should be submitted within 15 days of
completion
of post
hospitalization
treatment
/ period
Day
Care Procedures
are Covered
as per standard
list
stipulated ( 60 days from discharge) for post
Pre
Hospitalization Cover
Post Hospitalization
Coveras per policy ,
hospitalization
expenses
coverage
whichever is earlier .

Documents Required for OPD Claim Submission

Duly Filled & Signed Claim Form
All investigation & test reports- including ECG, X-Ray,
Ultra-Sound, CT Scan, MRI
All original pharmacy bills & prescriptions.
All original consultation papers/documents against
bill/receipt submitted along with Claim form .

Documents Required for Reimbursement Claim Submission

Duly Filled & Signed Claim Form

Original Discharge Summary
Original hospital bills/ receipts & supporting annexures. . (please make sure patient
name is mentioned on every bill/document submitted)

Final / Advance paid receipt with receipt no.

All investigation & test reports- including ECG, X-Ray, Ultra-Sound, CT Scan, MRI
All pharmacy bills & prescriptions.
All consultation papers/documents against bill/receipt submitted along with Claim
form .

Process of log-in & checking calim Status

https://www.mediassistindia.net/IWP

empcode@tatasteelkpo
DOB(DDMMYYYY)

FAQ
1) What is the validity period of the policy ?
The policy is valid for 1 year from the inception date i.e. 16-Sept-15.
2) Can I purchase this policy for self and family in any month?
You can enrol only in the month of September and October within the enrolment date.
There after, we will be accepting applications of new joiners only within 2 months
from their date of joining.
3) During renewal, will the premium remain the same ?
The premium may increase or decrease or remain same next year depending upon the
claim history of the policy.
4) I am having a mediclaim policy for my family which I purchased of my own. Can I
opt for this policy as well ?
Yes, you can opt for this policy. It is an additional benefit for you.
5) Can I opt out of the policy during the policy period ?
No, you cannot opt out of the policy during the policy period since it is a corporate
policy.

20

FAQ Continues..
6)What is the Maximum Entry Age in the policy?
There is no maximum entry age in this policy .
7) I am an unmarried employee. If I get married, will I be allowed to add my spouse as
a family member in later year?
Yes you are allowed to add your spouse as a family member during the policy.
8) What are the tax benefits which can be availed under this plan?
Deduction u/s 80 D of income tax act is available from taxable income for premium
paid towards health insurance.
A) For self, spouse and children - (Maximum Rs.15000/-)B) For parent (s) (Maximum
Rs.15000/-)* In case parent (s) are resident senior citizen (Maximum (Rs.20000/-)
9) I want to purchase this policy for my family. Is it mandatory that I enrol myself as
well ?
Yes, it is mandatory that as per the terms & conditions of the policy, an employee has
to enrol himself / herself as well.

21

FAQ Continues..
10) What do you mean by the Family floater?
In a family floater sum insured covers all the members in the family who has enrolled
in the policy. For eg: In the family if one of the member have utilized the amount of
Rs.1 lakh from the total coverage of Rs.2 Lakhs, the remaining amount can be utilize
by the other members of the family.
11) In case own parents have expired and the parents-in-law are dependent on the
employee (spouse being the only child) - can they be covered?
As per the mediclaim policy, only parents of the employee are covered
12) What is the amount of coverage for maternity benefits?
The maternity benefit covered upto Rs.30,000/- for normal and Rs.50,000/- for
caesarean.
The benefit is applicable for first 2 living children only.
13) I have joined Tata Steel on 01 January, 2016. Can I purchase this policy for self and
family?
Yes, you can purchase this policy for self and family within two months of joining .
The premium will be charged as per pro rata basis.

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Contact details for Mediclaim related Issues

BISWA PRAKASH DASH - 9040094930
HAMUEL PANI- 9861157264
PHONE : 06726-606045

THANK YOU
24 AUGUST 2013

MEDICLAIM FOR DETs