FAQ ON GROUP MEDICLAIM POLICY

1. FAQ ON GROUP MEDICLAIM POLICY CAVINKARE PRIVATE LIMITED

2. What is Group Mediclaim Policy ? • GMC Policy is taken for mediclaim coverage for employees and their families in the event of hospitalisation. • Following points are essential for coverage : - • Minimum Coverage of 24 hours hospitalization. • Treatment should be availed only in registered hospital / nursing home under the supervision of a registered & qualified medical practitioner • Hospital should have the following: • - Minimum 20 in-patient beds (in metros) 15 in non-metros • - Fully equipped OT • - Fully qualified nursing staff round the clock • - Fully qualified & registered doctors round the clock

3. Who is our Insurer & TPA? • We have our policy with National Insurance Company Limited, Chennai • TTK Healthcare Services, Chennai is our TPA. • Contact Details of TTK in-charge – Ms. Anitha -anitha.rani@ttkhealthcareservices.com / 98840 94544             TPA stands for Third Party Agency

4. What is Policy period & Who are all covered under the policy? • CavinKare Group Mediclaim Policy period commences on 22nd August of every year, and closes by 21st August of next year. • Employees and their dependents are covered under the policy. • Dependents includes Self, Spouse, Parents & Children, subject to max. of 6 members in a family including employee. ( 1 + 5 coverage )

5. What are the features of CK Mediclaim policy ? • Pre-existing diseases covered • Waiver of 1st year exclusion • Waiver of 30 days waiting period • Coverage till 80 years • Inclusion of maternity benefit ( Pre & post maternity charges not covered ) • Baby coverage from Day 1 • Floater made policy • Coverage for 1 + 5 dependents • Cashless scheme - network with 3500 hospitals through out India

6. What is my claim eligibility ? We have a graded coverage for our employees – • MN3 & Above Rs.85,000 pa • MN4 & MN 5 Rs.50,000 pa • O1 & O2 Rs.40,000 pa • O3 & O4 Rs.30,000 pa Eligibility amount is per member in a family.

7. What is floater made policy ? • Under floater scheme the sum insured for the individual family members will be added and the total insured amount will be treated as sum insured for family members. • If an employee in MN4 grade has 4 members in his family, total SI for his family is Rs. 2.0 lacs • 50000/- * 4 = 200000 /- Sum Insured • Sum Insured amount can be used within the family, and there is no restriction on the same.

8. What is cashless facility ? • ID cards are provided to employees & their dependants. • With the use of id card, they may get admitted in any of the network hospitals through out India and need not pay any cash during hospitalisation.

9. Cashless access for Hospitalization How does Cashless access for Hospitalization works ? Hospital faxes Pre Authorisation to TTK on Toll Free Number Patient approaches Network hospital Based on recommendation of physician Request received at TTK Pre Auth dept thru Dedicated Fax Machines CYCLE TIME SAME DAY. Claims Dept checks for coverage and eligibility Authorisation faxed to Hospital Use Toll Free Nos. Medical Dept checks for Treatment & Applies Negotiated Tariffs Online HelpDesk at Select Hospitals :Authorisation & Billing

10. Will my claim be covered under reimbursement scheme ? • Yes. If the hospital is not covered under cashless scheme, employee may get admitted to any nearest hospital. The amount incurred by the member towards hospitalization shall be reimbursed.

11. What are the documents to be submitted for reimbursement claim ? • Original Discharge Summary • Medical investigation / diagnostic test Bills must be accompanied by photocopies of the Reports • Medical bills and prescriptions • Lab reports, x-ray / scan reports etc. • Claim to be submitted to HRD.

12. In case of reimbursement claim submitted by me, why full amount doesn’t get reimbursed from TPA ? • Following charges / expenses incurred by member is disallowed as per Mediclaim conditions : - • Admission fee • Registration Charges • Diet & Canteen charges • Telephone calls • Service charges • Miscellaneous Expenses • Purchase of diapers, napkins, child food like Nestum • This is applicable for both cashless & reimbursement claims.

13. Will maternity claim for 3rd child be covered ? • Only 2 live births are covered. i.e, if the claimant has 2 children, then the 3rd baby delivery charges are not payable even if he/she has not claimed for the 1st and 2nd children • Similarly, Medical/voluntary termination of pregnancy – unless necessitated by medical advice where fetal/maternal life is endangered is not covered under Mediclaim

14. What are the other coverage excluded from policy ? • Domiciliary Hospitalization • Treatment for sterility / infertility. • Family planning operations • Naturopathy treatment • Admissions for evaluation / purely for investigation • Congenital external disease or defects • AIDS

15. OTHER FREQUENTLY RAISED QUERIES

16. ADDITIONS & DELETIONS • Employees presume that by sending their wedding invitation to HR, their spouse shall be covered automatically. • Nomination form should be filled in by employee, giving details of their nominee, DOB and duly signed form should reach HR for adding their dependents. • Similarly, any deletion in the family to be informed by giving a nomination form to HR. Otherwise, Company will continue to pay the premium for that member unncessarily.

17. Where do I get mediclaim related forms ? • For your convenience, forms ( claim reimbursement & nomination form ) are made online available in http://my.cavinkare.com • All you need to do is, login with your emp id, click the DOWNLOAD FORMS link, and can take the print out of the forms.

18. Whom should I contact in HR for further information on Mediclaim ? • You may contact Mr. Kalaiselvan, kalaiselvan@cavinkare.com ( 044–24317749 ) or • Ms. Kayal, kayal@cavinkare.com ( 044 – 24317751 ) for further details on Mediclaim policy.

19. THANK YOU !