Medical Benefits

1. Medical Benefits Next

2. Medical Benefit Non-Cashless Coverage Details - Team Members Claims Document List Coverage Details – Parents Benefits Extensions – Definitions Limits & Eligibility- Team Member General Exclusions Limits & Eligibility- Parents Top-Up Plan Enrollment in the program-Team Members Claim Optimization Enrollment in the program Parents GMC Contact Details Retrieving e-Card FAQ’s Cashless Process

3. Medical Benefit- Team Member – Coverage Details Parents Coverage Next

4. Medical Benefit Parents– Coverage Details Please Note: Parental cover is optional and the 20% of the premium cost has to be borne by the Team Member. The cost as mentioned in the following slides would be deducted from the salary of the Team Member. Next

5. Medical Benefit – Dependent Coverage Team Member Policy Parents Policy Next

6. Medical Benefit – Policy Period *Dependent coverage for all new joiners would be subject to the declaration made in enrolment portal. In case the one has not been enrolled the cover would be extended in subsequent renewal post March 2016 only. Enrolment details ** Declarations for new additions in the family to be made in prescribed format within 30 days of the event . Failing which the cover would be extended in subsequent renewal post March 2016 only. Next

7. Medical Benefit – Coverage Levels Next

8. 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 • OPD / Domiciliary coverage of Cancer and Dialysis (CKD) • Oral 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 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. Next

9. Pre & Post Hospitalization Expenses Next

10. Maternity Benefits • These benefits are admissible in case of hospitalisation in India. • The baby is covered from Day 1 for any treatment within the family floater, subject to the intimation to the insurance company through the Insurance desk/HR within 30 days of the birth. • The expenses incurred on account of Vaccinations, baby check up and other well baby charges will not be covered in the Policy • Covers for 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. Next

11. Limits & Eligibility – Team Member Policy • Room Rent eligibility up to • 1% of sum insured - INR 3000 per day for normal non ICU admission • 2% of sum insured – INR 6000 per day for ICU & CCU. In event of a member opting for a higher category/ room rent – escalation cost of all other expense due to the room upgrade would be borne by the member covered. Explanation: The cost of treatment (consultation, procedure charges etc) are directly related to the category of room Example 1- Member opts for a room which is INR 6000 per day. This is two times the eligibility. The actual escalation in cost is not determined. Hence only 50% of the admissible claim would be paid. Example 2- Member opts for a room which is INR 7000 per day. This is more than two times the eligibility. The actual escalation in cost of treatment is determined and the difference is borne by the insured. Room rent to includes nursing charges • Maternity • INR 50,000 for normal delivery • INR 50,000 for C Section (Caesarean) delivery Any further expense have to borne by the insured / claimant. • Ailment capping – • No Ailment caps Next

12. Limits & Eligibility – Parents Policy • Room Rent eligibility up to • 1.5 % of sum insured – INR 3000 per day for normal Non ICU admission • 3% of sum insured- INR 6000 per day for ICU & CCU In event of a member opting for a higher category/ room rent – escalation cost of all other expense due to the room upgrade would be borne by the insured / member covered. Explanation: The cost of treatment (consultation, procedure charges etc) are directly related to the category of room Example 1- Member opts for a room which is INR 6000 per day. This is two times the eligibility. The actual escalation in cost is not determined. Hence only 50% of the admissible claim would be paid Example 2- Member opts for a room which is INR 6000 per day. This is two times the eligibility. The actual escalation in cost is determined and is the difference is borne by the insured Room rent to includes nursing charges • Ailment Capping • Cataract - INR 27,000 per eye Next

13. Medical Benefit – Enrollment of Parents Parental base coverage is optional. Team Member can choose to cover parents on agreement to share premium cost with Target India in proportion of 20:80 where Team Member pays 20% of the annual premium and Target India shares 80% of the premium. • For new joiners, only pro-rata premium i.e. premium for the remaining number of days in the policy would be charged. • There will be a refund of pro-rata premium for terminated team members provided there is no claim during the policy period. Next

14. Medical Benefit – E Cards • Log on to FHPL website https://www.fhpl.net • Click on the Logins -> E-Card Tag • Key in the Corporate ID – 840 • Key in the Login ID and the Password ** • Click on Login • Click on the Member Details • Click on E-Card option to view / print the card ** Unique User id and password for each team member will be been sent by e-mail. In case you have not received the same please write to insurance.helpdesk@target.com Next

15. 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. Next

16. Planned Hospitalization TPA authorizes cashless as per SLA 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/Team Member 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 Team Member 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 Please Note: At the time of discharge when the TPA receives the final bill, they try to renegotiate with the Hospital for a better price. Hence it may take some time for TPA to revert back with final approval. This exercise helps as a cross-check in case the hospital has overcharged you and ensures that your sum insured utilization is optimum and is saved for any future exigencies.. Please be patient Claims Processing & Settlement by TPA & Insurer Next

17. 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 Team Member 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 Next

18. 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. Post 30 days the reimbursement claims will not be considered. Claims Process Claim Docs Next

19. Non-Cashless Claims Process Member intimates TPA before or as soon as hospitalization occurs 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 30 days of discharge A Is claim payable? Is document received within 30 days from discharge TPA performs medical scrutiny of the documents • Members will create the summary of Bills (2 copies) and attach it with the bills • The envelope should contain clearly the Team Member ID & Team Member e-mail Yes Yes No No Claim Rejected Is documentation complete as required Payment to be made to Insurance Help Desk . The discharge voucher and copy of payment receipt to be sent to Insurance Help Desk . TPA checks document sufficiency Claims processing done as per SLA Yes No Send mail about deficiency and document requirement A Next

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

21. Benefit Extensions – Definitions Next

22. 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

23. Medical Benefit – General Exclusions (Indicative) • 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 AIDS , Venereal diseases • Hospitalisation for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol. • Injury or disease caused directly or indirectly by nuclear weapons • Naturopathy, Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, etc • Cost of spectacles, contact lenses, hearing aids and various other external prosthetic devices like cochlear implants, crutches, wheel chairs etc. • Any cosmetic or plastic surgery except for correction of injury due to accident • Hospitalisation for diagnostic tests only, well baby charges, no active line of treatment, no diagnosed ailment, less than 24 hrs of Hospitalization (except day care procedure listed in the policy) • Psychiatric treatment • Vitamins and tonics unless used for treatment of injury or disease • Infertility treatment , Sterility and related treatments. • Voluntary termination of pregnancy during first 12 weeks (MTP) • Immunization, Vaccinations, Inoculations. • OPD Claims, Health foods , Costs incurred as a part of membership/subscription to a clinic or health centre or stay at rehabilitation center for alcoholics, drug or narcotics Next

24. Voluntary Top Up Insurance A Voluntary, Affordable solution to enhance your Target Medical Insurance Where the Target-funded group medical cover stops, medical top-up begins! Advantages • Access. You have access to insurance coverage that may not be available in the market • Discount. The policy is eligible for group discount rates since it is bought in the name of Target • Voluntary. You can choose to/ not to participate based on your need • Personalized. You can opt for additional insurance of INR 100,000, INR 200,00 or INR 300,000 • Tax advantage. The premium you pay is eligible for a tax break subject to Income Tax rules • Easy. Single online-enrolment window where you can sign-up for everything at one go • Convenient. You don’t need to remember to pay any premium, we will deduct it from your paycheck Next

25. Why Top-Up? • No maximum age limit at the time of enrollment • Day 1 coverage for pre-existing illness • No health declaration • No medical testing for dependents above the age of 65 years • Access to FHPL’s cashless hospital network • Coverage across 3 sum insured options: INR 100,000, INR 200,000 or INR 300,000 • Better access and lower premium than an individual insurance plan Next

26. Top-Up Plan – Cover For Dependents • Cover for your family (self spouse and children) • 3 sum insured options of INR 100,000 , INR 200,000 & INR 300,000 on a family floater basis (excluding parents), as per declaration made under the base policy. • Coverage applicable for Self, Spouse and 2 children • Premium in 2 equal instalment • (Top up plan does not change / enhance the existing sub-limits like Maternity benefit, Cataract & room rent) • Cover for your parents or parents in law • 3 sum insured options of INR 100,000, INR 200,000 & INR 300,000 on a family floater basis for parents. • Coverage on 1+1 floater basis. Can cover parents and in laws in any combination restricted to 2 individuals (as per base family policy) • Premium in 2 equal instalment • (Top up plan does not change / enhance the existing sub-limits like Maternity benefit, cataract & room rent) Next

27. Premium Rates • Premium to increase your insurance cover for self, spouse and 2 children • Premium to increase your insurance cover for parents or parents in law * Inclusive of service tax -12.36% Next

28. Top-up Plans-Comparison with Individual Plans Next

29. Top-up Plans-Comparison with Individual Plans Next

30. Top-Up Plan-Terms and Conditions (T&C) • 3 sum insured options of INR 100,000 ,INR 200,000 & INR 300,000 on a family floater basis for Team Member policy and parental policy, as per declaration made under the master policy. • The same coverage conditions as under the base policy to apply, including caps, co-pay and room rent restrictions. • Lock-in period for 2 years with no increase in premium or top-up sum insured. • The claim experience and premium revision would be for the group as whole and would not be benefitting or penalizing individuals for claiming or not claiming under the policy. • The option for voluntary top up cover would be extended only at the renewal for existing Team Members and to new Team Members on 1st October every year. Existing Team Member can opt for Top-Up cover only in the subsequent renewal if they do not enrol during the enrolment period. • Premium would be deducted from payroll in 2 instalments; April and May • Team Members who join Target between April and September can enroll for medical top-up effective October 1 and premium would be recovered from October payroll. Next

31. Top-Up Plan - Terms and Conditions (T&C) • The Top-up option will be available with a minimum lock-in of 2 policy years irrespective of claims made. • Team Member can choose to upgrade to higher Sum Insured after the lock-in at renewal • Team Member can choose a lower coverage/Sum Insured at renewal only if in the previous year there were no claims after completion of the lock-in. • In case a Team Member leaves Target in between the year, there shall be prorated refund of premium in case of no-claim status under the Top-Up policy. • On separation, the coverage will cease as of the last worked day. • In case of payment of premium by instalment, the Team Member will be liable to pay the balance premium in case he/she leaves the organization prior to the payment of all instalments. The premium shall be deducted from his/her F&F settlement. (Applicable for resigning Team Members only) Next

32. Top-Up - Covers Offered & Exclusions • All the benefits covered under the Target base policy which include • Hospitalization Expenses including: • Hospital (Room & Boarding and Operation theatre) charges • Fees of Surgeon, Anesthetist, Nurses, Specialists • Cost of diagnostic tests, medicines, blood, oxygen • Cost of appliances like pacemaker, artificial limbs and organs • Pre Hospitalization Expenses • Post Hospitalization Expenses • Pre-existing Diseases • Ambulance Charges • Any other benefits offered by current health policy* • Exclusions • The policy terms and exclusions shall be as per the current medical insurance policy (base policy). Please refer the base plan details for the Sum Insured and Sum Insured options with respect to these benefits Next

33. Claim Optimization • Health Insurance is a benefit for the Team Member and the dependents. One has to utilize the benefit with utmost caution and respect the benefit extended from the organization. • The ever increasing cost for the benefits require a proactive involvement from the Team Members. • The following steps are recommended, ensuring the benefits extended are adequately utilized by the Team Member and dependents covered • Please ensure to crosscheck the final bill sent to the TPA for the following: • Billed only for the services utilized for e.g. category of room, diagnostics undergone • Total of the bill • In case of any planned hospitalization, approach the hospital in advance (48 hrs) and request pre authorization- this enables TPA to further negotiate the rates • To approach hospitals with caution – most expensive is not necessarily the best. One can explore Preferred Partner Hospitals for special discounts • Try to negotiate ( you as a consumer have the right to negotiate)-Ask WHAT and WHY Next

34. Medical Benefit – Contact Details Next

35. FAQs & Common Definitions Next