Employee Health Insurance Program User Manual 2016-17

1. Employee Health Insurance ProgramUser Manual2016-17 1

2. Employee Insurance Program This presentation is a summary of the employee benefit insurance policies offered to the employees by 3i Infotech Consultancy Services Limited. It contains the necessary details related to your insurance policies like benefits available, claims procedures, enrollment process,. 2

3. Agenda • Coverage • Exclusions • Points to remember • Reimbursement claims • Cashless claims • Important IL Healthcare details • Contact details • Obtaining Health Cards • Tracking a claim (queried)

4. Employee Health Insurance Policy The Group Health Insurance Program provides pre-defined insurance coverage to all employees & their dependents for expenses related to hospitalization due to illness, disease or injury. In the event of a hospitalization claim (more than 24 hrs), the insurance company will pay the insured person the amount of such expenses as would fall under different heads mentioned below, and as are reasonably and necessarily incurred thereof by or on behalf of such insured person, but not exceeding the sum insured in aggregate mentioned in the policy: - Room Charges, - Nursing expenses, - Surgeon, Anesthetist, Medical Practitioner, Consultant, Specialists Fees, - Anesthesia, Blood, Oxygen, Operation Theatre Charges Surgical Appliances, Medicines & Drugs, & similar expenses. 4

5. Health Insurance Policy - Features 5

6. Health Insurance Policy - Features Maternity Benefits Restrictions 6

7. Health Insurance Policy - Features Existing Associates + Dependents New Joiners + Dependents New Dependents on account of Marriage / Birth 7

8. General Hospitalization Benefits Pre- existing Disease Pre-existing diseases refers to condition or ailments that may have been contracted before the start of the policy. There is usually a waiting period of 4 years for covering such ailments in standard individual policy. Covered from day 1 Any hospitalization expenses during the first 30 days from the commencement date of the Policy is not covered for the new joiners. This exclusion is however, not applicable to any emergency hospitalization occurring due to an accident. Waived off for all 30 Day Waiting Period for new joiners 1st/2nd/3rd/4th Year Waiting Period Medical insurance policies have waiting period of 1/2/3/4 years for reimbursement of medical expenses for treatment of certain specified ailments. The specified ailments mainly include Cataract, Benign Prostatic Hypertrophy, Hysterectomy or prolapsed of uterus, Hernia, Hydrocele, Fistula in anus, Piles, Sinusitis, Joint Replacement due to Degenerative condition, Age related osteoarthritis and Osteoporosis, among others. Waived off for all 8

9. General Hospitalization Benefits Domiciliary Hospitalization Domiciliary hospitalization means treatment done at home in India for a period exceeding three days for disease, illness or injury, which in the normal course, would require hospitalization. This could happen if either the condition of the patient is such that he/she cannot be moved to Hospital/ Nursing Home, or the patient cannot be admitted to Hospital/Nursing Home for lack of accommodation. Not Covered Day care procedures refers to such treatment which does not necessarily require 24 hospitalization due to medical technological advancement. Such list of ailments are available with insurance companies and are referred to as Day care ailments. Day Care treatment can be taken in network hospitals – on a cashless basis or in the form of reimbursement Covered Day Care Ambulance Charges Ambulance charges are provided for emergency hospitalization wherein the patient needs to be rushed to the hospital. Under this extension the policy will reimburse such expenses as per the pre decided limits. SUBJECT TO A MAXIMUM OF RS.1000/- 9

10. Sub Limits for Ailments/Treatments • Disease Wise Capping • Appendix - 20,000 • Eye related - 20,000 • Hernia - 20,000 • Hydrocele - 12,000 • Hysterectomy - 50,000 • Piles – 15,000 • Cholecystectomy - 35,000 • Kidney/Urinary Stones - 25,000 • FESS – 35000 • 50% Co-Pay for cyberknife treatment/Stem Cell Transplantation • Cochlear Implant treatment shall be restricted to 50% of the SI

11. Pre/Post Hospitalisation The expenses incurred in relation to the condition of hospitalization, generally 30 days prior to the date of hospitalization as well as 60 days post the discharge are reimbursed under the Pre & Post Hospitalisation Clause. These expenses include things like medication prescribed at the time of discharge, follow up treatment etc. Please Note: Pre & Post Hospitalization expenses is applicable in case of Maternity in this policy only in Inpatient basis. If the Insured member is diagnosed with an Illness which results in his / her Hospitalization and the claim is admissible, the Insurer will also reimburse the Insured Member’s Pre-hospitalization Expenses. Covered for 30 days prior to date of admission Pre Hospitalization Expenses Post Hospitalisation Expenses Relevant expenses for 60 days post discharge from hospital for an admissible hospitalization claim will be reimbursed in the policy. Covered for 60 days post the date of discharge 11

12. Maternity Benefits The Maternity expenses limit allowable is INR 35,000 per Normal delivery & INR 50,000 per Caesarean Delivery within the overall Sum Insured for the first two live births . There are special conditions applicable to the Maternity Expenses Benefits as below: Claim in respect of delivery for only first two live births and/or operations associated therewith will be considered. Expenses incurred in connection with voluntary medical termination of pregnancy during the first 12 weeks from the date of conception are not covered Maternity Expenses Maternity or pregnancy related expense of hospitalization other than those excluded (like voluntary termination of pregnancy in the first 12 weeks of delivery) will be payable. The maternity benefit is applicable for Normal / Cesarean delivery within the overall Sum Insured for the first two live births Covered up to a limit of INR 35,000 for Normal & INR 50,000 for Caesarean 9 Month Waiting Period The 9 month waiting period waived off for new joiners to claim Maternity Benefits under Group Health Policy. Waived off. Maternity benefit available to all employees from day 1. 12

13. Baby Coverage On Delivery of a child, the child is prone to many health disorders like jaundice or expenses incurred for incubator for pre-mature births or any other complication to the child. Usually there is a 90 days waiting period for covering baby in the policy. Covered from Day 1. The normal baby expenses like pediatrician visit, nursery charges, etc. prior to discharge from hospital post delivery is covered within the family SI. Vaccination charges are not payable. 13

14. Exclusions • Mid term addition of dependents except • Spouse (should be intimated within 1 month of marriage) • New born (should be intimated within 1 month of birth) • Hospitalization for investigation only not covered • Lasik surgery, Septoplasty, Infertility treatment are not covered • Administration, registration, miscellaneous and service charges are not covered • Treatment on experimental/trial basis is not covered • Dental treatment is not covered except in case of an accident

15. Exclusions cont • Holter Monitoring are outside the scope of the policy • Treatment on account of or related to psychiatrist ailment • Expenses related to Prosthesis is outside the scope of the policy • Expenses related to the external medical devices are out of the scope of the policy • Infertility & Related ailments including male sterility is out of the scope of the policy

16. Cashless claims • For planned hospitalization it is recommended that cashless approval is taken one day prior to hospitalization • Please ensure that pre authorization form has correct UHID along with the updated mobile no. • Please note that stand alone investigation/ diagnostic procedure for evaluation is not covered under the policy. • Once the fax is sent, it is advisable to confirm the receipt of the same from the call centre • If a revert is not received in 4-5 hours from the time of confirmation of fax receipt, please get in touch with HR team who in turn will ensure co-ordination with ICICI Lombard.

17. Cashless claims conti… • Please also note that initial approval from insurance company comes for a part of the estimated cost of treatment, which will be enhanced as per the progress in the treatment based on the progress report provided by the hospital to IL Healthcare. • At the time of discharge final bill should be sent to ILHealthcare 3-4 hours before the time of discharge so that last minute problems can be avoided.

18. Reimbursement claims • Main hospitalization claims documents should be submitted within 30 days from date of discharge. • Post hospitalization claim can be submitted within 60 days from date of discharge or 30 days from date of end of treatment whichever is earlier • Please ensure that claim form is filled properly and signed. Please also do not forget to mention the UHID on claim form along with your latest mobile no. Also, it is mandatory to mention NEFT as payment option. Account details need to be mentioned along with the cancelled cheque • In some cases indoor case papers might be required hence it is advisable that a copy of indoor case papers is collected at the time of discharge from the hospital.

19. Reimbursement claimscont… • Please ensure that following documents are submitted in original along with the claim form (additional documents may be required depending on the case): • Original Discharge card mentioning date of admission, date of discharge, investigations done, findings, detailed line of treatment • Original bills & paid receipt • Bills & paid receipt should be supported by: • Medicine bills, • Prescriptions for medicines • Original Investigation reports

20. IL Healthcare contacts • Toll Free Call Center No.: 1800 2666 • Fax: 040-66989160/61 Toll free Fax no: 1800-2666 • E mail: ihealthcare@icicilombard.com • Address for sending the reimbursement claims: ICICI Lombard General Insurance Company Ltd.ICICI Lombard Health Care, ICICI Bank Tower, Plot No. 12, Financial District, Nanakram Guda, Gachibowli, Hyderabad, Andhra Pradesh- 500032

21. Obtaining Health Cards • Follow the below mentioned path: www.icicilombard.com >claims corner >IL Healthcare • Click on Print I card, mentioned under the head claims, subhead services. • Enter your UHID no. in the box and click on search. • You can take a print out of the card displayed or save it as a PDF document for your future reference. You can also click on or copy the below mentioned URL to go directly to the print I card page: http://24x7.icicilombard.com/ghi/iHealthCare/iCare_Wfrm_SearchPrintICard.aspx?Login=N

22. Tracking a Claim (queried) • You can track the status of your claim by following the below mentioned path, in case the claim is queried: www.icicilombard.com >claims corner >IL Healthcare • Click on Track your claim, mentioned under the head claims, subhead services. • Enter the claim number provided to you at the time of the query & click on search. You can also click on or copy the below mentioned URL to go directly to the print I card page: http://24x7.icicilombard.com/ghi/iHealthCare/iCare_wfrm_ClaimStatus.aspx?Login=N

23. I Healthcare important links • I health care- https://www.icicilombard.com/IL-Health-Care/icare.html • Process for claims: https://www.icicilombard.com/health-insurance/floater-claims.cms • Claim Form- https://www.icicilombard.com/Content/ilom-en/Hospital_list/click2mail/sendDetails.asp?val=claims_form • Claim form(PDF): https://www.icicilombard.com/Content/ilom-en/Downloads/Health/Claim_Form_iHealthcare.pdf • Network hospital list : https://www.icicilombard.com/Content/ilom-en/Hospital_list/search.asp • Track your claim : http://24x7.icicilombard.com/ghi/iHealthCare/iCare_wfrm_ClaimStatus.aspx?Login=N • Print I card : http://24x7.icicilombard.com/ghi/iHealthCare/iCare_Wfrm_SearchPrintICard.aspx?Login=N

24. Thank You