ICSL – FHPL Mediclaim Policy How to Access you Mediclaim Card.

1. ICSL – FHPLMediclaim Policy How to Access you Mediclaim Card.

2. Policy Details: Policy No. : 161000/48/11/41/00000458 Policy Period : 02/05/2012 To 01/05/2013 Insurance Company : United India Insurance Company Limited TPA : Family Health Plan (TPA) Limited Premium Rate for Employee : Rs.2371/- Premium Rate for Dependant : Rs.415/-(Rs.830/-) Add Service Tax : 10.30% Coverage of Rs.1 Lacs for Family Floater

3. Policy Details Maximum family size allowed : 4 (1+3) Definition of Family : Employee + Spouse + 2 Dependent Children (unmarried & non-earning only) OR 2 Dependent Parents (Father, Mother). Nomination Process: During policy period additions of newly married & new born baby are only allowed in case member has less than three dependents covered. Others are not allowed during policy period. Changes of nominations during policy period will not be allowed.

4. Coverage Details Basic Sum Insured / Limit Per family : Rs.1 Lacs per family on Floater Basis Claim Co Payment(employee) : 90%(Insurance):10%(Employee) Ratio Claim Copayment (Dependent) 85%(Insurance):15%(Employee) Ratio Pre-Existing Diseases : Covered from day 1 Pre & Post Hospitalization Expenses: Covered upto 30 days and 60 days respectively Maternity Benefit: Allowed Max. upto 2 children (2 deliveries) Normal Rs.20,000/- & Caesarian Rs.25,000/- No Cashless will be given for maternity. No pre-post expenses allowed. Dental Coverage : Not Covered

5. Coverage Details Ambulance Charges : Ambulance Charges Rs.1,500/- depending on case to case Room Rent : Room rent restricted to 1%, ICU 2% of sum insured Monthly addition of employees: Coverage for new joinees from the date of joining by paying Pro-rata Premium Monthly deletion of Employees : Coverage ceases from the date of leaving the organization/retirement with refund on Pro-rata basis Domiciliary Hospitalization not covered

6. How to access Mediclaim E-card?

7. Type www.fhpl.net

8. Click on login & Select E-card

10. Enter Corporate ID : 174, User Name as Emp__code and PASSWORD :First letter of your name in CAPITAL AND last three digits of your Emp_Code and click on Login

11. Click on Member Details to see your nominees details

12. To check claims status click on claims Click to get E-cards of your family members Your nomination details are displayed

13. Click on Open

14. Take Printout of E-cards

15. How to avail benefits under your policy Member approaches with Network Hospitals with ID Hospital sends Intimation to FHPL Eligibility Member approaches Any other Hospital Out of Pocket payment Not Covered Avails treatment, makes upfront payment Submits bills to FHPL for reimbursement Covered TAT : less than 2 hr for routine cases Emergency : No authorization required Regularization within 24 Hrs Authorization as per eligibility Cashless treatment at NWH

16. Do’s • Carry your ID card (IDEA)/ E Card (FHPL) at the time of admission at network hospitals • Incase of emergency admission kindly contact FHPL within 24 hrs of hospitalization • Incase of emergency kindly refer your companies name and your Emp No at the time of admission • Take a pre approval from FHPL for all the elective cases • Sign on the final bill at the time of discharge from the hospital • For any other assistance call the account manager

17. What are the documents essential for claiming for reimbursement? • Original detailed discharge summary • Original investigation reports along with bill • Original Hospital Bill-consolidated and with detail breakup of every component of the bill with the patients signature on it. • Incase of surgical packages – detail breakup of the package • Medicine bills with prescriptions. • Claim Form – ( available on FHPL website ) • MLC Certificate from the hospital in the case of Road traffic accident. Or a certificate from the treating doctor mentioning that the patient was not under the influence of alcohol at the tome of Accident. • Obstetric history (GPLA) in the case of maternity claims  • Payment receipt for the payment done to the hospital. • Original investigation reports along with bills & receipts • Consultation receipts. • Medicine bills with prescriptions.

18. Hospitalization Intimation Please send the intimation mail within 24 hours with following details on mail IDs info@fhpl.net or vimalkumar.sinha@fhpl.net with a cc to HR on manish.dabhi@idea.adityabirla.com Intimation Details:- Employee Name             : Employee Code             : Name of Patient             : Relationship with Employee : Name of Hospital/Doctor : Date of Admission          : Also remember to submit your claims within 7 days from date of discharge from the hospital.

19. All India FHPL Contact Numbers

20. Thank You Any Suggestions/Feedback!! Good Luck