Medical Insurance Benefits Manual 2011-2012

The Group Mediclaim Program provides adequate, pre-defined insurance coverage to Collabera Solutions Pvt. Ltd. employees & their dependents for expenses related to hospitalization due to illness, disease or injury.

Insurer Third Party Administrator (TPA) Policy Start Date Policy End Date Coverage Type (Floater / Individual) Dependent Coverage Sum Insured

United India Insurance Company Ltd. Medi Assist India TPA Pvt. Ltd. 03rd July 2011 02nd July 2012 Floater Type 1+5 [Employee + Spouse + 2 Children + 2 Parents / Parents-In-Law] (Combination not permitted) INR 2,00,000/- per family

Benefits covered
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Standard Hospitalization with TPA Services Pre-existing diseases : Any ailment ruled out prior to the date of Inception is covered Pre-Post Hospitalization Expenses (Pre - 30 & Post - 60 days) Maternity benefits up to INR 50,000/- for C-Section and INR 35,000/- for Normal Delivery. There is no waiting period. A maximum of the first two children will be covered. (Incase of baby complications during delivery separate set of Discharge summary & IP bill & other supporting documents are required to claim)

Pre & Post Natal Expenses up to INR 5,000/- (applicable only in case of minor complications which warrants inpatient admission for Min 24hrs within the maternity limit as mentioned above)

Day Care means the course of medical treatment or a surgical procedure which is undertaken under general anesthesia in a Hospital, which is not less than 2 hours nor more than 24 hours. Ailments like Dialysis, Chemotherapy, Radiotherapy, Eye surgery, Hernia operation Lithotripsy (kidney stone removal), Tonsillectomy, etc. are covered. For any ailments not mentioned in the list above, please check with your TPA provider .

Cap on Room Rent INR 3000/- for normal hospitalization and INR 5000/- for ICU hospitalization. Any case if it exceeds employee should pay the room difference as well as subsequent charges

Reimbursements of expenses related to hospitalization, room and boarding :

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Doctors fees Intensive Care Unit Nursing expenses Surgical fees, operating theatre, anesthesia and oxygen and their administration Physiotherapy as a followed up of Hospitalization treatment.. Drugs and medicines consumed on the premises Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests) Dressing, ordinary splints and plaster casts (as a part of in patient admission) Costs of prosthetic devices if implanted during a surgical procedure, Organ transplantation (Except Donor charges)/Radiotherapy and Chemotherapy

Benefits not covered

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Diagnostics 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 of any ailment, sickness or injury for which confinement is required at a Hospital / Nursing Home

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Ambulatory Services Dental treatment of any kind unless accidental Injuries requiring min 24hrs hospitalization Cost of spectacles ,contact lenses and hearing aids Deductibles (First 3000/- INR of every hospitalization should be paid by the claimant/Employee) Domiciliary Hospitalization 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 Congenital external diseases or defects / anomalies HIV and / or AIDS Hospitalization for convalescence, general debility, rest cure, intentional self-injury, use of intoxicating drugs / alcohol Venereal diseases Injury or disease caused directly or indirectly by nuclear weapons Naturopathy/ Homeopathy/ Ayurveda treatments Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, any re-usable items (crutches/crepe bandages/Thermometer/bedpan/walker) etc.

Any cosmetic or plastic surgery except for correction of injury

Contd

Benefits not covered

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Vitamins and tonics unless used for treatment of injury or disease Infertility treatment Voluntary termination of pregnancy during first 12 weeks (MTP) All Psychiatric or Psychosomatic disorders Epilepsy

Expenses incurred for pre and post hospital treatment more than 30 & days respectively, and expenses incurred for the

treatment of any of the following diseases unless warrants for Inpatient admission with active line of treatment - Asthma

- Bronchitis - Chronic Nephritis and Nephritic Syndrome - Diarrhea and all types of dysenteries including Gastroenteritis - Diabetes Mellitus and Insipidus - Hypertension - Influenza, Cough, and Cold - Pyrexia of unknown origin for less than 10 days - Tonsillitis and upper respiratory tract infection including Laryngitis and Pharyngitis - Arthritis, Gout and Rheumatism

Excess-Employee Contribution
Excess
Definition
Excess is a special cost containment measure, wherein claims are not payable up to a certain amount as mentioned in the policy. For Example, if the policy says a deductible of INR 5,000, the claims below INR 5,000 are not payable. Rs.3,000/-

Excess Amount for Collabera policy Applicable for

Deductible of the first 3000/-of each & every claim or series of claims for the same ailment/same line of treatment or series of hospitalization or day care treatments including Pre-post hospitalization expenses.

Capped Ailments: Deductible is not Applicable for

Cataract Surgery for Rs.20,000/- per eye. Hip & Knee Replacement for Rs.1,25,000/- for each Leg/Knee/Hip.

1.1 Cashless Hospitalization

Cashless hospitalization means the Administrator may authorize upon a Policyholder s request for direct settlement of eligible services and it s according charges between a Network Hospital and the Administrator. In such case the Administrator will directly settle all eligible amounts with the Network Hospital and the Insured Person may not have to pay any deposits at the commencement of the treatment or bills after the end of treatment to the extent as these services are covered under the Policy.
List of hospitals in the TPAs network eligible for cashless hospitalization

Contact Customer Service Line

Click on below ICON for Network list https://www.mediassistindia.com/HealthCareProviders.html # Select - Medi Assist Network Hospitals

Toll Free No: 1800 4259 449 Toll Free Fax:1800 4259 559

Mediassist Network Hospitals

For Latest List kindly check in this URL https://www.mediassistindia.com

Emergency Hospitalization
Step 1 Get Admitted Step 2 Pre-Authorization by hospital Step 3 Treatment & Discharge

In cases of emergency, the member should get admitted in the nearest network hospital by showing their ID card.

Relatives/care takers of admitted member should get in touch with the Insurance desk/Billing authority in hospital & Seek pre authorization by sending cashless form to Medi Assist. The preauthorization approval/denial letter would be directly given to the hospital.

After your hospitalization has been pre-authorized the employee is not required to pay the hospitalization bill in case of a network hospital. The bill will be sent directly to, and settled by the TPA

Process

Emergency Hospitalization Process

Member gets admitted in the hospital in case of emergency by showing his ID Card Member/Hospital applies for pre-authorization to the TPA within 24 hrs of admission TPA verifies applicability of the claim to be registered and issue pre-authorization

Hospital sends complete set of claims documents for processing to the TPA

Member gets treated and discharged after paying all non entitled benefits like refreshments, etc.

Preauthorization given by the TPA

No Claims Processing by TPA & Insurer Release of payments to the hospital

Non cashless Hospitalization Process

1.2 Non-Cashless Hospitalization

Admission procedure In case you choose a non-network hospital you will have to liaise directly for admission. Discharge procedure In case of non network hospital, you will be required to clear the bill and submit a claim to Medi Assist for reimbursement from the insurer. Please ensure that you collect all necessary documents such as - discharge summary, investigation reports etc. for claim processing. Submission of hospitalization claim 1. After the hospitalization is complete and the patient has been discharged from the hospital, you must submit the final claim within 20 days from the date of discharge from the hospital.

Claims Process

Claim Docs

Claims Process
Insured admitted as per hospital norms. All payments made by member Insured sends relevant documents to Prudent office within 15 days of discharge Employee

Is claim liable (coverage/ applicabilit y) No

Yes

Yes

TPA performs medical scrutiny of the documents

Is document received within 15 days from discharge No

Insured will create the summary of Bills (2 copies) and attach it with the bills The envelope should contain clearly the Employee ID & Employee e-mail

Claim Rejected

TPA checks document sufficiency

Is documenta tion complete as required

Yes

Claims processing done within 21 working days

Payment to be made to HR. The discharge voucher and copy of payment receipt to be sent to HR.

No

Medi Assist will send mail about deficiency and document requirement

Employee

Procedure to access information and e-Cards (ID Cards)

To print cards please follow the below mentioned steps: Step 1: Go to https://www.mediassistindia.com via the Internet Step 2: `Click on to Login at the top left of main sheet Step 3 : Select corporate employee option Step 4: Log on with the help of username and password Step 5: You can now view the details of your dependents Step 6: To print cards click on the e-card status link Step 7: Click on the `Print ID card` for each member Step 8: Log off once the e-Card is printed User ID Password : : Employment Number@collabera.com (e.g. Coll1213) collabera (The password is case sensitive)

In addition to access your soft copy of e-card and policy details, the following is also available via the UHC Web site:     Claims check list - for submission of claims for reimbursement Claims document requirement - Ready reckoner Claims status - for claims related to yourself and covered family members for claims made starting Network hospital list - for the hospitals in the Medi Assist network (more than 4800+ Hospitals across PAN India)

Claims Document List

Signed Claim form Main Hospital bills in original (with bill no; signed and stamped by the hospital) with all charges itemized and the original receipts Discharge Summary (original) Attending doctors bills and receipts and certificate regarding diagnosis (if separate from hospital bill)

Claims Form

AT web https://www.mediass isndia.com

Click the below icon for claim form

Original reports, Bills and Receipts for Medicines, Investigations along with Doctors prescription in Original and Laboratory Follow-up advice or letter for line of treatment after discharge from hospital, from Doctor. 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 and availability of doctors and nurses round the clock. In non- network hospitalization, you may have to get the hospital and doctor s registration number in Hospital letterhead and get the same signed and stamped by the hospital, if required.

Reimbu sement cl im f m

Check list

*Documents mentioned are mandatory. Claim will not be processed without these

*Please retain photocopies of all documents submitted

Contact Details
Prudent Contact Details First Level Contact Mr. Arun Kumar G.E Support Manager Employee Benefits Practice E-mail id: arun.kumar@prudentbrokers.com Mob Number: 09611102770 Escalation : 1st Level Mr. Anil. K Assistant Vice President Employee Benefits Practice E-mail id: anil.k@prudentbrokers.com Mob Number: 097400 98660 Mr. Gurpal Singh Dhingra Vice President E-mail id: gurpal@prudentbrokers.com Mob Number: 099001 78500

Collabera Contact Details: HR Contact Person Name Contact No E-Mail ID : Waseem Pasha / Hema J : Ext.. 8522 / 8511 : waseem.pasha@collabera.com / hemavathij@collabera.com

In case of emergency you could also reach on: 9886911525 / 9880129477

Thank You