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1. Employee Insured Benefits Manual Start

2. Program Details Group Medical Insurance Provides insurance coverage to employees for expenses related to hospitalization due to illness, disease or injury Provides insurance coverage against the risk of death / injury during the policy period sustained due to an accident caused by violent, visible and external means Group Personal Accident Provides life (term) insurance protection in case of death Group Term Life Frequently Asked Questions & Common Definitions FAQs & Common Definitions Next

3. Medical Insurance Next

4. Medical Insurance Coverage Details Enrollment in the program Cashless Process Non-Cashless Claims Process Claims Document List Benefits Extensions – Definitions General Exclusions GMC Contact Details

5. Medical Benefit – Coverage Details

6. Medical Benefit – Dependant Coverage No Individual should be covered as dependent of more than one employee

7. Medical Benefit – Policy Period • Employee coverage is done by default as per the eligibility. • Dependents coverage is done on basis of declaration made to HR as per the start of the coverage from as mentioned above

8. Medical Benefit – Coverage Levels

9. Medical Benefit – Standard Coverage Covers expenses related to • Room and boarding • Doctors fees • Intensive Care Unit • Nursing expenses • Surgical fees, operating theatre, anesthesia and oxygen and their administration • Physical therapy • 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 A) 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. B) Expenses on Hospitalisation for minimum period of 24 hours are admissible. However this time limit will not apply for specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye & Dental Surgery (due to accident), Lithotripsy (kidney stone removal), Tonsillectomy, D & C and many more procedures (as listed in the attached file) 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 Hospitalisation Benefit. C) Bone fractures, dislocations and ligament tear, over and above ailments covered under standard hospitalization (OPD) are covered.

10. Pre & Post Hospitalization Expenses

11. Maternity Benefits • These benefits are admissible in case of hospitalisation in India. • Covers first two children only. Those who already have two or more living children 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.

12. Medical Benefit – Enrollment • Existing employees are covered under the policy from 1st January 2012. • All New joinees must enroll their dependents within 30 days of joining the company. • In case of change of status due to marriage or birth of child , enrolment must be done within 30 days of such event. • Workflow Provide required details of yourself and your dependents to the HR HR sends the data to the insurer for endorsements Insurer updates their data, endorses member and sends the detail to the TPA TPA updates the active member database and prints the cards ID card mailed to the HR within 10 working days Employee verifies details on the ID card Error in data printed on card Notify TPA with revised details and mailing address for corrections ID card received by employee Use card for cashless hospitalization ID Card Ok

13. Medical Benefit – Cashless Process Cashless 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. Planned Hospitalization Emergency Hospitalization Note :Patients seeking treatment under cashless hospitalization are eligible to make claims under pre and post hospitalization expenses. For all such expenses the bills and other required documents needs to submitted separately as part of the claims reimbursement.

14. Planned Hospitalization TPA authorizes cashless within 6 hours for planned hospitalization to the hospital Step 1 Pre-Authorization Member intimates TPA of the planned hospitalization in a specified pre-authorization format at-least 48 hours in advance Claim Registered by the TPA on same day Yes All non-emergency hospitalisation instances must be pre-authorized with the TPA, as per the procedure detailed below. This is done to ensure that the best healthcare possible, is obtained, and the patient/employee is not inconvenienced when taking admission into a Network Hospital. No Pre-Authorization Completed Follow non cashless process Step 2 Admission, Treatment & discharge Member produces ID card at the network hospital and gets admitted Member gets treated and discharged after paying all non entitled benefits like refreshments, etc. Hospital sends complete set of claims documents for processing to TPA After your hospitalisation has been pre-authorized, you need to secure admission to a hospital. A letter of credit will be issued by TPA to the hospital. Kindly present your ID card at the Hospital admission desk. The employee is not required to pay the hospitalisation bill in case of a network hospital. The bill will be sent directly to, and settled by TPA Claims Processing & Settlement by TPA & Insurer Next

15. Emergency Hospitalization & Process Step 1 Get Admitted In cases of emergency, the member should get admitted in the nearest network hospital by showing their ID card. P R O C E S S Pre-authorization given by the TPA Non cashless Hospitalization Process Member gets admitted in the hospital in case of emergency by showing his ID Card No Step 2 Pre-Authorization by hospital Yes Relatives of admitted member should inform the call centre within 24 hours about the hospitalization & Seek pre authorization. The preauthorization letter would be directly given to the hospital. In case of denial member would be informed directly Member gets treated and discharged after paying all non medical expenses like refreshments, etc. Member/Hospital applies for pre-authorization to the TPA within 24 hrs of admission Hospital sends complete set of claims documents for processing to the TPA TPA verifies applicability of the claim to be registered and issue pre-authorization Step 3 Treatment & Discharge After your hospitalisation has been pre-authorized the employee is not required to pay the hospitalisation bill in case of a network hospital. The bill will be sent directly to, and settled by TPA

16. Non-Cashless • Admission procedure • In case you choose a non-network hospital you will have to liaise directly with the hospital for admission. • However you are advised to follow the pre authorization procedure to ensure eligibility for reimbursement of hospitalisation expenses from the insurer. • Discharge procedure • In case of non network hospital, you will be required to clear the bills and submit the claim to TPA for reimbursement from the insurer. Please ensure that you collect all necessary documents such as – discharge summary, investigation reports etc. for submitting your claim. • Submission of hospitalisation claim • You must submit the final claim with all relevant documents within 30 days from the date of discharge from the hospital. • Under hospitalization claims, you are also permitted to claim for treatment expenses 30 days prior to hospitalisation and 60 days after the date of discharge. This is applicable for both network and non-network hospitalization. Claims Process Claim Docs

17. Non-Cashless Claims Process Member intimates TPA before or as soon as hospitalization occurs (within 24 hrs preferably) Claim registered by TPA after receipt of claim intimation Insured admitted as per hospital norms. All payments made by member Insured sends relevant documents to TPA office within 21 days of discharge A Is claim payable? Is document received within 30 days from discharge TPA performs medical scrutiny of the documents • 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 Yes Yes No No Claim Rejected Is documentation complete as required TPA checks document sufficiency Claims processing done within 15 working days Payment to be made to HR. The discharge voucher and copy of payment receipt to be sent to HR. Yes No Send mail about deficiency and document requirement A Next

18. Claims Document List *Please retain photocopies of all documents submitted

19. Benefit Extensions – Definitions Next

20. Benefit Extensions – Definitions Note: When treatment such as Dialysis, Chemotherapy, Radiotherapy is taken in the Hospital/Nursing Home/Clinic and the insured is discharged the same day the treatment will be considered to be taken under Hospitalisation Benefit section and thus covered. Next

21. Cost Sharing – Definitions

22. Medical Benefit – General Exclusions • Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations or caused directly or indirectly by nuclear weapons • Circumcision unless necessary for treatment of disease • Congenital external diseases or defects/anomalies • HIV and AIDS, Sexually Transmitted Diseases or Venereal diseases • Hospitalisation for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol. • Naturopathy, Homeopathy, Ayurvedic, Unani or any other form of alternative therapies • Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, etc • Any external prosthetic devises and durables like Cost of spectacles, contact lenses, hearing aids, artificial limbs , Crutches, wheel chair etc • Any cosmetic or plastic surgery except for correction of injury • Hospitalisation for diagnostic tests only or treatments where there is no active live of treatment or OPD treatments, psychological treatment • Health foods, Vitamins and tonics unless used for treatment of injury or disease • Infertility treatment, Sterilization or Voluntary termination of pregnancy during first 12 weeks (MTP) • Claims submitted without prescriptions/diagnosis or necessary documents in originals. • Vitamins and tonics unless used for treatment of injury or diseases • Costs incurred as a part of membership/subscription to a clinic or health centre • Hospitalization in less than 15bedded hospitals / unregistered hospitals. Next

23. TPA: I-Care Health Management and TPA Services Pvt. Ltd. www.icaretpa.com Contact Centre: 1860 425 3232 Insurer Reliance General Insurance Co Ltd www.reliancegeneral.co.in Allergan India 1st Level Contact Santosh Kumar Mob:+91 99000 18169 Email ID- santosh.kumar@icaretpa.com 2nd Level Contact Mr. Ali Raza Email ID- santosh.kumar@icaretpa.com 1st Level Contact Mr. Jeejo Thomas Mobile – +91 9342288493 Email ID – Jeejo.Thomas@relianceada.com 2nd Level Contact Mr.ArhanGotadke Email ID – Arhan.gotadke@relianceada.com 1st Level Contact2ndLevel Contact Ms Swapna MG Ms LopaSaikia Email ID – Mg_swapna@allergan.comEmail ID – saikia_lopa@allergan.com Medical Benefit – ContactDetails

24. GPA Benefits Next

25. Group Personal Accident Policy Benefit Details Enrollment in the program Claims Procedure Document Checklist Exit

26. GPA – Benefit Details This insurance provides compensation/payment up to a financial limit as assigned by the company, to the insured person or his legal personal representative, if the insured person suffers death or disablement due to an accident. The cover is worldwide but payment of claim can only be made in India and in Indian Rupees. General Exclusions

27. GPA – Details for PPD * Indicative list, Please refer to policy document

28. GPA – Enrollment • All existing employees are covered under the policy from 1st January 2012. The policy ends on 31st December 2012. • For new employees, enrollment data must reach the Insurer within 30 days of your joining Allergan. Please contact your HR and provide enrollment data (viz. name, date of birth, gender). • The policy ends on 31st December 2012 or Date of Leaving the Organization whichever is earlier

29. GPA – Claims Process Is claim approved within 10 days? Claimant / Assignee notifies HR, who in turn would intimate Marsh / Insurer and submit required claim documents within 30 days of the event On approval cheque is sent to Allergan HR within 3 working days, from where it is given to the employee / beneficiary. Yes On obtaining all relevant documents, Insurance Co. will begin processing the claims No On rejection of the claim, Insurer provides a valid reason for the rejection to Allergan HR / Employee / Beneficiary Claim Investigation and Review within 3 days of submission of all the required documents

30. GPA – Claims Document Checklist Weekly Benefit Claims Death Claims Dismemberment/ Disablement Claims • Completed Claim form • Doctor's Report • Disability Certificate from the Doctor, if any • Investigation/ Lab reports (x-ray etc.) • Original Admission/discharge card, if hospitalized • Employers Leave Certificate & Details of salary • Completed claim form • Attending Doctor's report • Death Certificate • Post Mortem/ Coroner's report • FIR ( First Information Report) • Police Inquest report, wherever applicable • Completed claim form • Doctor's Report • Disability Certificate from the Doctor • Investigation/ Lab reports (x-ray etc.) • Original Admission/ discharge card, if hospitalized. • Police Inquest report, wherever applicable

31. GPA – General Exclusions • Service on duty with any armed force • Intentional self injury, suicide or attempted suicide • Insanity • Influence of intoxicating drink or drugs • Aviation other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft any where in the world • Nuclear radiation or nuclear weapons material • Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, mutiny, military, or usurped power, seizure, capture, arrest,, restraint, detainment’s of all kings, princes, and people of whatever nation, conditions and qualities so ever • Childbirth, pregnancy or other physical causes peculiar to the female sex • While committing any breach of law with criminal intent

32. GPA – ContactDetails Providers Insurer: Reliance General Insurance Co. Ltd. Escalation Point Mr. Arhan Gotadke Email ID – Arhan.gotadke@relianceada.com Mr. Jeejo Thomas Email ID: Jeejo.Thomas@relianceada.com Allergan India Ms Swapna MG Email ID: Mg_swapna@allergan.com Ms LopaSaikia Email ID: Saikia_lopa@allergan.com

33. GTL Benefits Next

34. Group Term Life Policy Benefit Details Enrollment in the program Claims Process Document Checklist Exit

35. GTL – Benefit Details

36. GTL – Enrollment • All existing employees are covered under the policy from 1st January 2012. The policy ends on 31st December 2012. • The policy ends on 31st December 2012 or Date of Leaving the Organization whichever is earlier • Eligibility criteria: • Having Attained 18 years of age and being under 60 years of age. Coverage will expire upon insured’s 61st birthday or conclusion of the membership or employment. • All regular full-time permanent employees • Employees on probation, intended to become permanent employees upon satisfactory completion of their probationary period and not employed on a temporary basis . • Please note – Employees above free cover limit will be covered up to the full SA limit on completion of medical underwriting/questionnaire/declaration of good health. The Insured is expected to complete the underwriting on time (generally within 1 month of enrolment in the plan). The Scheme covers only the individual employees meeting the eligibility conditions and fulfilling Kotak India Insurance Company Limited Underwriting requirements

37. GTL – Exclusions • Service on duty with any armed force • Insanity • Venereal disease • AIDS • Influence of intoxicating drink or drugs • Aviation other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft any where in the world • Nuclear radiation or nuclear weapons material • Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, mutiny, military, or usurped power, seizure, capture, arrest,, restraint, detainment’s of all kings, princes, and people of whatever nation, conditions and qualities so ever • Childbirth, pregnancy or other physical causes peculiar to the female sex • While committing any breach of law with criminal intent

38. GTL – Claims Process Is claim approved within 7 days? Claimant / Assignee notifies HR, who in turn would intimate Marsh / Insurer and submit required claim documents within 30 days of the event On approval, the cheque is sent to Allergan HR within 3 working days, from where it is given to the Employee / Beneficiary Yes On obtaining all relevant documents, Insurance Co. will begin processing the claims No On rejection of the claim, Insurer would provide a valid reason for the rejection to Allergan HR / Employee / Beneficiary Claim Investigation and Review within 3 days of submission of all the required documents

39. GTL – Document Checklist • Claim form (completely filled) • Death Certificate (original or attested) • Attendance record & Salary Slips (last 2 months) • Identification of deceased (photo ID with DOB) • Member enrollment form • Beneficiary identification with relationship proof If death within 1 year of coverage • Death certificate by doctor • Post Mortem report (if performed) • Letter of employment for deceased • FIR report (in accident cases)

40. GTL – Contact Details Ms. AkankshaKonkar Email ID – akanksha.konkar@kotak.com Escalation Point Ms.Deepika Kahlon Email ID – Deepika.kahlon@kotak.com TOLL FREE No. 1800 209 8800 Ms MG Swapna Email ID – mg_swapna@allergan.com Ms.LopaSaikia Email ID – saikia_lopa@allergan.com

41. FAQ’s & Common Definitions