User Manual For M/s. AMW Motors Ltd.

1. User ManualFor M/s. AMW Motors Ltd. Employee Health Insurance Program For the Year 2014-2015 Alliance Insurance Brokers Pvt. Ltd.

2. Employee Insurance Program This presentation is a summary of the employee benefit insurance policies offered to the employees by M/S AMW Motors Ltd. It contains the necessary details related to your insurance policies like benefits available, claims procedures, enrollment process, as well as contact details of Alliance Representatives. If you have questions or need any additional information, Alliance team will be happy to assist in all matters concerning to your Insurance Benefits. Disclaimer: This document has been prepared exclusively for M/S AsiaMotorWorks Ltd.and is only for reference of benefits under the Employee Benefit Program. The contents herein should not be copied or distributed without the prior permission of Alliance Insurance Brokers Pvt. Ltd. Any breach of these conditions will be constituted as unlawful and may invite legal action. Alliance Insurance Brokers Pvt. Ltd.

3. 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. Know your Health Insurance Program M/S AMW Motors Ltd.offers the following Employee Benefit Insurance Policy. Click on the icon to know more details of the policy including Benefits , Claims Procedure, Exclusions of the following Insurance Policies: Alliance Insurance Brokers Pvt. Ltd.

4. Know your Health Insurance Program Providing you the ease of understanding your benefits in detail, you can choose to click on the icons below to know more: Your Policy at a Glance Benefits Offered How to Enroll Claims - Cashless Claims – Non – Cashless/ Re-imbursement Exclusions Exit Contact Alliance Alliance Insurance Brokers Pvt. Ltd.

5. Your Health Insurance policy at a Glance Sum Insured Details Members Covered General Hospitalization Benefits Cont… FAQ’s Exclusions Alliance Insurance Brokers Pvt. Ltd.

6. Your Health Insurance policy at a Glance Maternity Benefits Restrictions Cont… FAQ’s Exclusions Alliance Insurance Brokers Pvt. Ltd.

7. Your Health Insurance policy at a Glance Existing Associates + Dependents New Joiners + Dependents New Dependents on account of Marriage / Birth Insurance Partners FAQ’s Exclusions Alliance Insurance Brokers Pvt. Ltd.

8. Sum Insured Family Floater Under the family floater, the insurance cover will be available to all members of the family unit. The sum insured is available for utilization by any member of the family with or without any sub limit inter se. It is however subject to the overall family sum insured for all members put together. Applicable • The entire sum insured will be applicable to the entire family without any sublimit to any member in case of family floater. FAQ’s Exclusions Alliance Insurance Brokers Pvt. Ltd.

9. Members Covered * No Individual should be covered as dependent of more than one employee ** Dependent's coverage subject to them being enrolled in the policy within the given timelines *** Should be financially dependent on the employee FAQ’s Exclusions Alliance Insurance Brokers Pvt. Ltd.

10. General Hospitalisation 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. Covered for all enrolled members from day 1 30 Day Waiting Period for new joiners 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 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 FAQ’s Exclusions Cont… Alliance Insurance Brokers Pvt. Ltd.

11. General Hospitalisation Benefits Day Care 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 only – on a cashless basis. Please refer to the complete list by clicking on the attachment. Covered 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. MAXIMUM OF RS.2,500/- FAQ’s Exclusions Cont… Alliance Insurance Brokers Pvt. Ltd.

12. Pre & Post Hospitalisation Expenses 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 are not applicable in case of Maternity. Pre Hospitalisation Expenses 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 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 FAQ’s Exclusions Alliance Insurance Brokers Pvt. Ltd.

13. Maternity Benefits • The maximum benefit allowable is INR 30,000 for nomal delivery and INR 50,000 for C section 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. • Pre-natal and post natal expenses are covered . Covered up to a limit of INR 30,000 for Normal and INR 50,000 for C section. Maternity Expenses AnyMaternity or pregnancy related expense 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. 9 Month Waiting Period Waived off. Maternity benefit available to all employees from day 1. There is usually a 9 month waiting period for new joiners to claim Maternity Benefits under Group Health Policy. Cont… FAQ’s Exclusions Alliance Insurance Brokers Pvt. Ltd.

14. Maternity Benefits Pre & Post Natal Expenses This cover is similar to that of Pre & Post hospitalization expenses. While Pre & Post hospitalization expenses excludes expenses incurred prior to and after Delivery of child, the same is covered under Pre & Post Natal charges. Not Covered Baby Cover 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 maternity sub-limit. Vaccination charges are not payable. FAQ’s Exclusions Alliance Insurance Brokers Pvt. Ltd.

15. Restrictions Room Rent Capping Room rent is capped to a certain limit in the policy. Parents choosing to go for higher room category than what is specified in the policy will need to bear the incremental room rent amount. This would also apply to related expenses such as nursing charges, doctor’s fees, etc. which is associated with the room category. This limit may differ for ICU. 1% of the SI, in case of Normal room & 2% of the SI in case of ICU admission Illustration: There is a room rent restriction 8/15/2014 Alliance Insurance Brokers Pvt. Ltd. Cont…

16. Claims – Cashless administration Cashless service ensures that the employee and the covered family members get treatment at the hospital empanelled in the TPA Network without having to pay any money. This is however, subject to approval from the TPA based on the benefits covered under the policy. For Updated List of hospitals please visit http://www.healthindiatpa.com 24 X 7 Customer Care Center of Health India (TPA) Call Center Toll: 1800 220102 (Toll Free) Cashless counter : 02242471920/21/14/04 You may also contact Alliance representative on the following number: Mr. Nitesh Sharma- 9167980504 E mail ID – Mumbai : nitesh@allianceinsurance.in Click for Emergency Hospitalization Click for Planned Hospitalization FAQ’s Exclusions Alliance Insurance Brokers Pvt. Ltd.

17. Cashless - Planned Hospitalisation Member intimates TPA / Alliance of the planned hospitalization in a specified pre-authorization form 48 hours prior to hospitalization Claim Registered by the TPA TPA issues letter of Approval within 24 hours for planned hospitalization to the hospital Pre-Authorization Completed Yes No Member produces ID card at the network hospital and gets admitted Follow non cashless process Member gets treated and discharged after paying for all non-entitled expenses like the deductions based on the policy terms, the cost of non payable items etc. to the hospital. Alliance Insurance Brokers Pvt. Ltd.

18. Cashless - Emergency Hospitalisation Process In case of a sudden requirement of Hospitalization, the cashless process is as follows: Member get admitted in the hospital in case of emergency by showing his health card and ID Card . Treatment starts. Member / Hospital applies for pre-authorization to the TPA within 24 hrs of admission TPA verifies applicability of the claim to be registered and issue pre-authorization Pre-authorization given by the TPA Follow non cashless process No Yes Member gets treated and discharged after paying all non entitled benefits like refreshments, etc. Alliance Insurance Brokers Pvt. Ltd.

19. Claims - Reimbursement Benefit Admission procedure In case of a non-network hospital, the patient will need to be admitted to the hospital and take the treatment. Discharge procedure In case of non network hospital, employee will be required to clear the bills and submit the claim to TPA through Alliance helpdesk for reimbursement. Please ensure that all necessary documents such as discharge summary, investigation reports, payment receipts, reports etc. are collected in original for submitting your claim. • Submission of hospitalization claim • After the hospitalization is complete and the patient has been discharged from the hospital, the claim must be submitted within 15 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 hospitalization and 60 days after the date of discharge. This is applicable for both network and non-network hospitalization. Click for Process Click for Claim Docs FAQ’s Exclusions Alliance Insurance Brokers Pvt. Ltd.

20. Claims - Reimbursement Process Documents received by TPA within 7 days * from discharge Member intimates TPA before or as soon as hospitalization occurs (within 24hours of discharge) Claim registered by TPA after receipt of claim intimation Insured admitted as per hospital norms. All payments made by member No Claim Closed/ Rejected Yes TPA performs medical scrutiny of the documents for admissibility of the claim Sends mail about deficiency and document requirement for re-submission Documentation complete as required TPA checks document sufficiency Yes No No Yes Claims processing done within 21 working days Claims cheque is sent to the employee/ client * Note: If deficiency is not submitted within the given timelines, the same will be considered as closed. Alliance Insurance Brokers Pvt. Ltd.

21. Claims - Reimbursement Documents • Claim form duly filled and signed by the claimant • Original Discharge Summary • Main Hospital bills in original (with bill no; signed and • stamped by the hospital) with all charges itemized and the original receipts • Attending doctors’ bills and receipts (if separate from hospital bill) and certificate regarding diagnosis. • Original reports of Bills and Receipts for Medicines, Investigations along with Doctors prescription in Original and Laboratory • All original payment receipts must be taken from the hospital including invoices for implants and stickers in case of lenses • Follow-up advice or letter for line of treatment after discharge from hospital, from Doctor. • Break up details of Pharmacy items, Materials, Investigations even though it is there in the main bill • In case the hospital is not registered, please get a letter on the Hospital letterhead mentioning the number of beds and availability of doctors and nurses round the clock. • In non-network hospitalization, please get the hospital and doctor’s registration number in Hospital letterhead and get the same signed and stamped by the hospital. • Note: there may be additional documents other than the above mentioned list, required by the TPA, based on specific treatments. Alliance Insurance Brokers Pvt. Ltd.

22. How to Enroll Provide required details of your dependants to the HR. HR in turn send the details to Alliance on 7th of everymonth. Alliance 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 E-Cards uploaded on TPA’s website within 7 working days. E card received by employee Employee verifies details on the E card Notify HR/Alliance with revised details Error in data printed on card E Card Ok Uses card for cashless hospitalization You need to enroll in order to obtain coverage for yourself and eligible dependents. Please contact your HR and provide relevant enrollment data (viz. name, date of birth, gender). Your enrollment data must reach the Insurer within 30 days of your joining the company. Declare all new dependents i.e. when your family status changes because of marriage, birth or adoption of a child. New spouse must be declared within 30 days of the marriage. Similarly, information about new-born child has to be declared immediately after the child-birth. If you do not enroll within the defined timelines, the next enrollment can be done only at next renewal. Alliance Insurance Brokers Pvt. Ltd.

23. General Exclusions Injury or disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, Warlike operation or disease directly or indirectly caused by or contributed to by nuclear weapons/materials. Exclusions Circumcision unless necessary for treatment of the disease, cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness. Surgery for correction of eyesight, cost of spectacles, contact lenses, hearing aids. Convalescence, general debility ‘run-down' condition or test cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self injury, all psychiatric and psychosomatic diseases/disorders, accident due to misuse of drugs/alcohol or use of intoxicating substance. Acquired Immune Deficiency Syndrome (AIDS). Naturopathy, unproven procedure/treatment, experimental or alternative medicine/treatment including acupuncture, acupressure, magneto therapy etc. Out patient diagnostic/medical/surgical procedures/treatments, non-prescribed drugs/medical supplies/hormone replacement therapy, sex change or any treatment related to this. Any kind of service charges/surcharges, admission fees/registration charges etc. levied by the hospital. 9. Doctor’s home visit charges/attendant, nursing charges during pre and post hospitalization period except in case of domiciliary hospitalization. Alliance Insurance Brokers Pvt. Ltd.

24. General Exclusions • 10. Expenses on irrelevant investigations/treatment; private nursing charges, referral fee to family physician, outstation doctor/surgeon/consultant’s fees etc. • Genetic disorders/stem cell implantation/surgery. • External/durable medical/non medical equipments of any kind used for diagnosis/treatment including CPAD, CAPD, infusion pump etc., ambulatory devices like walker/ crutches/ belts/ collars/ caps/ splints/ slings/ braces/ stockings/ diabetic foot wear/ glucometer/ thermometer & similar related items & any medical equipment which could be used at home subsequently. • 14. Non medical expenses including personal comfort/ convenient items/ services such as telephone/ television/barber/ beauty services/ diet charges/ baby food/ cosmetics/ napkins/ toiletries/ guest services etc. • Treatment for obesity or condition arising there from (including morbid obesity) and any other weight control program services/supplies. • Injury arising from any hazardous activity including scuba diving, motor racing parachuting, hand gliding, rock or mountain climbing etc. • Treatment received in convalescent home/hospital, health hydro/nature care clinic and similar establishments. Payment: All medical/surgical treatments under this policy shall have to be taken in India and admissible claims thereof shall be payable in Indian currency. • Note: The above list is an illustrative list of exclusions and not an exhaustive list of all exclusions. Alliance Insurance Brokers Pvt. Ltd.

25. Claim Intimations All Claims must be Intimated With Health Insurance companies strictly adhering to Claim Intimation timelines now, we request you to ensure that you intimate all your claims within the stipulated period to avoid rejection. Claim Intimation Guidelines Claim Intimation Compulsory • The employee has the option to intimate claims to the TPA via FAX/PHONE/MAIL. • Planned Hospitalization should be intimated two days prior to admission. • Emergency Hospitalization should be intimated within 24 hours of admission. • For all claims, members can send an intimation mail to frd@healthindiatpa.com • along with a CC to nitesh@allianceinsurance.inwith the following details: • Name of the Employee • Name of the Corporate • Name of the Dependent Patient ( if applicable) • Employee ID/TPA ID • Name of the Hospital/Provider • Address of the Hospital for verification purpose • Date of Admission • Estimated Cost of Hospitalization • Probable Diagnosis • Kindly note: Violation of the above mentioned timelines may result in denial of claims by the Insurer/TPA & any exception will be at the sole discretion of the Insurer only. • For further assistance /clarification, you can contact: Health India Details Ms. Durga Tripathi Tel No: 022-66867522 Alliance Contact Details Mr.Nitesh Sharma Cell - +91 9167980504

26. Claim Submission Timelines All Reimbursement Claims must be submitted within 15 Days * All Reimbursement claims must be submitted to the TPA within 15 daysfrom the date of discharge. Pre-hospitalization bills can be submitted along with hospitalizations bills in case of re-imbursement and in case of cashless Claims, the pre-hospitalization bills can be submitted within 7 days from the date of discharge. * In case of post-hospitalization, the timeline would be 7 days from the completion of the treatment or 60 days from the completion of hospitalization, whichever is earlier. The following documents, in ORIGINAL,must be submitted at the time of Claims submission, • Duly-filled and signed Claims form. • Discharge card or Death Summary (in case the patient passed away during hospitalization). • Final hospital bill with appropriate payment receipts, including invoices for implants and stickers in case of lenses. • All Original Reports. • Prescriptions and medicine bills. • Consultation Bill along with supporting Consultation letters. • A letter from the doctor mentioning the obstetric history in GPLA format (in case of maternity claims). • FIR/MLC copy in case of Claims related to accidents. • Indoor Case Papers, if applicable. • Kindly retain photo-copies of all documents that are being submitted to the TPA. You might need them for later reference. • Kindly note: Violation of the above mentioned timelines during the Claims Submission process may result in denial of Claims by the Insurer/TPA & any exception will be at the sole discretion of the Insurer only. For further assistance /clarification, you can contact: Alliance Contact Details Mr.Nitesh Sharma Cell - +91 9167980504

27. Contact Alliance For any query related to Insurance, Associates are requested to follow the below mentioned Escalation Matrix: Alliance Insurance Brokers Pvt Ltd 7th floor, Gold Crest, 10th Road, Juhu, Vile Parle (West), Mumbai- 400 049. Alliance Insurance Brokers Pvt. Ltd.

28. THANK YOU HEALTH IS NOT VALUED TILL SICKNESS COMES