Presentation on Group Mediclaim Policy of Mahindra Rural Housing Finance Limited

1. Presentation on Group Mediclaim Policy of Mahindra Rural Housing Finance Limited Grade L10 A, B & C (2019-2020)

2. MEDICLAIM POLICY The Mediclaim Policy Reimburses Expenses incurred due to • Disease • Illness • or Accident. The Mediclaim Policy stipulates that a claim is admissible when the insured (beneficiary) is admitted in a hospital for a minimum of 24 hours and for an active line of treatment • Insurance reimburses Reasonable & Customary Expenses within the scope of the policy towards treatment in Hospital.

3. Continue………. • 24 hours hospitalization is not applicable for: • Dialysis, Chemotherapy, Radiotherapy • Eye Surgery • Tonsillectomy, Sinusitis • Lap Appendectomy, Hysterectomy, lithotripsy, Hernia Repair, Piles, Hydrocele • Coronary Angioplasty • Fracture or dislocation, Prostrate surgery • The above list is not exhaustive, hence the employees can check with Health India TPA in case of any treatment which is for less than 24 Hrs.

4. Definition of Hospital • An institution established in India for indoor care & treatment of sickness • Registered with local authorities • Under supervision of registered & qualified medical practitioner • Minimum of 15 inpatient beds( In Smaller cities/ towns the same is reduced to 10 beds) • Fully equipped operation theatre • Fully qualified nursing staff 24/7 • Fully qualified doctors 24/7

5. Family Coverage & Sum Insured • Coverage • Family Definition- Only Self • ESIC Employees – Rs.50,000/- • Non ESIC Employees – Rs.1,00,000/-

6. Policy Benefits • All Pre- existing ailments are covered. • Waiting Period of 30 days waived. • Waiver on 1st Two years exclusion • Pre & Post hospitalization expenses are covered for 30 & 60 days respectively.

7. Expenses Payable • Room, Boarding, Nursing Charges • ICU Charges • Surgeon, Anaesthetist, Consultants, Medical Practitioner, Specialist fees. • Anaesthesia, Blood, Oxygen, O. T. charges, Surgical Appliances, Medicines & drugs, Artificial Limbs, Cost of Prosthetic Devices like pacemaker, Implants, and Relevant Laboratory/Diagnostic test and Similar expenses • Pre Hospitalization Expenses: Expenses incurred 30 days prior to date of admission( Consultation / Test Charges ) • Post Hospitalization: Expenses incurred up to 60 days from the date of discharge.

8. Expenses Not Payable • Admission/Registration • Telephone charges • Attendant's charges • Home Visit/Nursing charges - at residence after discharge • Assistant fee/Follow up charges in advance • Sundry/Medico Legal Charges/Diabetic chart charges • Thermometer Charges • Container for Specimen/Disposable Bag charges • Admission Kit • External Surgical Aids: Lumbo-sacral/Collar belt /Knee cap/Knee brace/ walker/hot water bag/baby kit/urine pot / traction kit/ folding commode etc • Inhaler/ Nebulizer • Diet charges • Special/protein diet/health drinks unless prescribed by the doctor • Documentation/Folder/Stationery/In Patient chart charges

9. General Policy Exclusions • Injuries or diseases caused by war and war like operations • Circumcision, Vaccination, Inoculation, Cosmetic treatment, Plastic surgery • Surgery for correction of Sight, Spectacles, Contact lenses, Hearing Aids • Dental Treatment without hospitalization unless arising due to an accident • Convalescence, General weakness, Congenital external disease, Infertility & Related ailment,Sterility, Venereal disease, Alcohol use, Self injury • AIDS • Diagnostic expenses not followed by active treatment for the ailment. • Vitamins and Tonics unrelated to treatment • Injuries or diseases caused by nuclear weapons • Expenses related to pregnancy incl. Abortion during first three months of pregnancy. • Naturopathy treatment, Unproven procedures, experimental or alternative medicine.

10. TPA SERVICES • ENROLMENT • IDENTITY CARDS • TPA HELPDESK AT REGIONAL OFFICES OF MRHFL • CLAIMS ADMINISTRATION • CASHLESS HOSPITALISATION (THROUGH NETWORK HOSPITAL) • REIMBURSEMENT CLAIMS

11. Provider Network-Cashless 4200 + Hospitals across the country Covering 32+ states Average 20 Hospitals being added every month Complete hospital list available at www.healthindiatpa.com

12. Cashless Hospitalisation • This service enables the customer to avail treatment at the Network Hospital without being required to pay for the treatment. • All expenses incurred will be paid to the Hospital deducting the non medical expenses • Please produce your Identity Card & Adhaar Card copy at the hospital on network where you wish to avail treatment. • Kindly fill in the Health India TPA Card Number, Name of the Patient, Age & Contact Number in the Cashless Request Form • The treating doctor/ hospital will fill in the remaining part of the Request Form & Fax it to Health India TPA for approval. • For Emergency Request- TAT – 4 - 6 hours • Planned Admissions: Approval can be availed 3 days in advance.

13. Procedure for cashless Hospitalization Treatment & Discharge PA request Info Approval Admission In case any further info is required, the hospital is asked to submit the info and processing happens Approval or denial is issued as per the terms and conditions of your insurance policy Pre-auth request is submitted to Health India TPA by the hospital and is processed at Health India TPA You are advised admission by your doctor

14. Cashless Hospitalisation-Know Your Rights • Check & Sign the hospital bill. If possible ask for a copy of the bill. • Copy of your medical records. • Avoid informing the hospital your total coverage details- as hospitals have a tendency to inflate credit bills.

15. Claim documents required in case of Reimbursement Standard Check list for submission of claim Original Claim Form duly signed by you. (Fill the claim amt in Signed Claim Form) Original Main Hospital bill with Bill Number & break up, (With detailed break up of various heads like Room Rent/OT charges/Nursing etc). Original Discharge summary (Gives the summary of diagnosis and treatment in hospital) Original Death summary (Only in case of death of Patient during Hospital stay). Original Hospital Payment Receipt with receipt number (With seal & signature of hospital) (if main bill does not carry a bill number). Original Payment Receipt with receipt number (For consultation/surgeon charges if charged outside the main hospital bill). Hospital registration number (Registration No. & Number of beds, on hospital letterhead with signature) Doctor’s registration number (On doctor’s letterhead with signature). Original Pharmacy and Investigation bills (Along with prescriptions & Lab reports). Original prescriptions (On doctor’s letterhead mentioning duration and dosage for medicines and advice for diagnostic tests). investigation reports in original/attested from hospital (Reports for all tests done along with images) Police FIR / Medico Legal Certificate (MLC) (Mandatory for All Road traffic accidents-Duly attested by Police Note - The above list of documents is indicative. In case of any other document requirement as specified by the insurance company our Document recovery Team will contact you on receipt of your claim documents by us.

16. Important Points to remember - 1 • Please retain a copy of all documents submitted to us for further reference • Please retain POD copy of the courier for tracking your consignment in case of any delay etc. • For implants used in Cataract, Heart Valve Surgeries, CABG, Abdominal Surgeries, Knee replacement surgeries. Please submit the bill (in case purchased outside) from the vendors for the prosthetic devices used along with Sticker • Please arrange the enclosures as per checklist. E.G. of documents required in case of Cataract & Accidental Case • Cataract – • Discharge Card of the hospital or nursing home. • Detailed hospital Bill (Main Bill / Final Bill). • Invoice Of Lens ( With IOL sticker) • A-Scan Report • All medicine bills & investigation report with respective prescriptions.

17. Important Points to remember - 2 • Accidental Case – • Discharge Card of the hospital or nursing home. • Detailed hospital Bill (Main Bill / Final Bill). • Investigation report in support of diagnosis • MLC / FIR Copy • Certificate from treating doctor for influence of Alcohol • Detailed narration of the incidence from treating doctor * Please note Indoor case papers will be required for processing of claim if proper treatment details are not available on discharge card & if TPA or Insurance Company want s to review day to day condition of the patient

18. SUBMISSION OF CLAIMS & CLAIMS RELATED DOCUMENTS Claims needs to submitted within 30 days from date of discharge Keep a photocopy of submitted documents Please contact your Regional HR to submit the claim documents to TPA helpdesk being held at MRHFL regional offices Kindly drop a mail to below email ID while submitting documents to TPA helpdesk: TO – MRHFL_mediclaim@mahindra.com

19. Turn Around Time [TAT] • Identity Card • Web cards by the 30th of the following month from DOJ • Cashless Hospitalisation • Emergency cases: 3-4 hours • Planned: 48-72 hours • Reimbursement claims settlement • Maximum of 15 – 20 working days Subject to complete documentation & availability of all information required to settle a claim • In case of Shortfall the same will be intimated in 3 working days

20. Escalation Matrix of Health India TPA for all Mediclaim Related Queries

21. Escalation Matrix of MIBL for all Mediclaim Related Queries

22. Escalation Matrix of MRHFL for all Mediclaim Related Queries

23. Wish you a healthy and happy future ! Thank you