OSI Consulting Pvt Ltd

1. OSI Consulting Pvt Ltd Presentation on Group Mediclaim

2. Parties Involved…..

3. Group Mediclaim Policy….. • Scope of Cover: • Covers Medical Expenses of an employee arising out of an accident or disease. • Medical Expenses are reimbursed provided Hospitalization takes place

4. Coverage Details….. • Room Rent – is Restricted to Rs.1500/-in case of normal hospitalization and Rs.2500/- in case of ICU. • Nursing / Medical Practitioner Fees. • Consultation Fees. • Anesthesia / Anesthetist Fees. • Treatment fees including medicines, blood, oxygen, artificial limbs / organs, operation theatre charges, surgical appliances. • Diagnostic costs related to a hospitalization up to the limit of the Sum Insured.

5. Hospitalisation….. • Minimum period of 24 hrs. • Time Limit Not Applicable For Specific Treatments Like • Dialysis • Chemotherapy • Tonsillectomy • Eye surgery • Dental surgery • D & C and others

6. Minimum Criteria for Hospital….. • Min 15 In-Patient Beds. • Fully Equipped Functional Operation Theatre. • Round the Clock Availability of Nursing Staff/ Doctor.

7. Additional Covers opted by – OSI Consulting Pvt Ltd. 30 Days Exclusion Waiver : • Any disease/illness that occurs during first 30 days of commencement of insurance is not covered under an ordinary mediclaim policy. However, OSI has opted for the waiver of this exclusion. First TwoYears Exclusion Waiver : • A Standard Group Mediclaim Policy does not cover certain diseases (Eg: cataract, hernia, hysterectomy, hypertrophy etc.) in the first two years succeeding the inception of the policy. • Since this exclusion has been waived, the employees of OSI can avail these benefits in the first year itself.

8. Additional Covers opted by OSI Consulting Pvt Ltd. Maternity Expenses Benefit: • Treatment taken in hospital/Nursing Home arising from pregnancy. • The Maximum benefit that can be availed is Rs. 25,000/- for normal and Rs. 40,000/- for C - Section. • Pre Hospitalisation and Post Hospitalisation is not covered under Maternity Expenses. • Voluntary abortions excluded from the scope of policy

9. Additional Covers opted by OSI Consulting Pvt Ltd. Child Day One Cover: • With the inclusion of this cover a New born baby is covered from the day of birth ( Provided intimation has to be given for this to HR). Coverage of Pre-Existing Diseases: • Any injury/disease that was in existence prior to the inception of the current policy is a pre-existing disease. • OSI has opted for the coverage of these diseases for employees and their dependants.

10. Benefits of GMC for OSI Consulting Pvt Ltd • Maternity Coverage • 9 months waiting period waiver • Child Day one cover • Preexisting Diseases Cover • First two years exclusion waiver • 30 days waiting period waiver • All the above with no medicals • Employees covered from Date of Joining subject to availability of adequate CD balance with Insurance company

11. General Exclusions…..

12. General Exclusions…..

13. Claims Process….. • All claims are processed through the TPA • Treatment can be taken either at a Network Hospital or a Non Network Hospital • Cashless facility can be availed at Network Hospital • Treatment at Non Network Hospital is reimbursed

14. Claims Process – Cashless….. • Member approaches Network Hospital with ID Card. • Caution Deposit may be asked at some hospitals, which has to be paid by the member. Once the member gets an approval for cashless treatment, the deposit is reimbursed to the member. • Network hospital intimates TPA. • TPA issues authorization within 4 Hours.

15. Claim Process – Cashless….. • Network Hospital extends Cashless facility to member • Member is discharged • Network Hospital forwards claim documents to TPA for settlement

16. Claims Process – Reimbursement….. • Member avails treatment at any Non Network Hospital • In case of reimbursement claims, a prior intimation is to be sent to Hertigate TPA at heritagehyd@bajoria.in and HR at kkurra@osius.com. Intimation format is enclosed. • Makes the payment upfront to the Hospital • All reimbursement claims would be processed through Visista. • Hence the claim documents should be handed over to Visista by the respective member / HR. • The claim documents would be processed by Visista and sent to the TPA for finalizing the claim. • TPA verifies the documents submitted.

17. Claims Process – Reimbursement….. • Incase of further requirements the TPA intimates Visista/ client within 4 working days • Upon receipt of the complete documents with the claim form TPA settles the claim within 21 working days • Once the claim is finalized the cheque would be handed over to Visista which in turn would be passed to the respective member /HR • Reimbursement claims to be submitted to Visista within 14 working days from date of discharge from hospital

18. Checklist for Reimbursement Claims….. • Claim form duly filled • Original Discharge Summary • Medical Bills & Respective Prescriptions • Test Reports, Prescriptions & Respective Bills in Originals • Hospitalization Bills Originals • All Receipts in Original • Cash Receipt or Original Credit Card Charge Slip in case of credit card payment

19. Details of Network Hospitals….. • All India – 4000+ Hospitals • Soft copy of the Network Hospitals available at http://www.heritagehealthservice.com/corp • All other hospitals which do not feature in the list are Non Network Hospitals

20. E-Cards(Health cards) Download Procedure Please follow the below process to access the E-Cards(Health cards) . • Step 1 : log on to http://www.heritagehealthservice.com/corp • Step 2 : Click on the “Emp login/ ECard” Tag. • Step 3 : Select the Corporate Code : OSICONS • Step 4 : Please enter your employee id in both “Employee ID” and “Password” fields (Eg. Emp ID NS0477 Password is also NS0477) • Step 5 : Click submit  • Step 6 : Click on the card number (highlighted) • Step 7 : View the E card & print the same.

21. For any queries contact Visista ….. • Mr. K.S.Naveen Varma – 8008404859 naveen@visistarisk.com • Mr. Shramik Kumar – 9989037737 shramik@visistarisk.com