Learning the HR Express Way Mediclaim Policy Read on to know more….. HR Express Mediclaim Policy.

Learning the HR Express Way

Mediclaim PolicyRead on to know more…..

HR ExpressMediclaim Policy

Learning the HR Express Way

All you want to know about the Mediclaim Policy…

• About the Policy

• Coverage

• Status of Coverage (Viewing E-Cards)

• Addition/Deletion of Dependents

• Waiting Period

• Treatment Outside India

• In case of Separation from the organization

• Maternity Benefits

• Expenses Covered and Not Covered under the policy

• Coverage Limit

• Premium Amounts

• Third Party Service Provider

• Network & Non Network Hospitals

• Things to do before Hospitalization

• Cashless Procedure

• Claims in case of non-network hospitals

• Things to be kept in mind before leaving the hospital

• Important Contact Numbers

• Sample Forms

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What is the objective of Mediclaim Policy? • To provide financial support to the employees and their dependents for unforeseen

hospitalization (minimum of 24 hours) expenditure upto the coverage limit.• To ensure smooth interaction with the medical authorities during such emergency in terms of

quality, speed and payments.

What BENEFITS do we get under the policy?• Insurance coverage for hospitalization expenses. • The coverage extends to ‘pre-existing’ diseases as well.• Medical expenses for pre-hospitalization (upto 30 days) and post-hospitalization (upto 60

days) are also covered.• Maternity coverage upto Rs.50,000 within the coverage limit, for both normal and cesarean

cases.• For more details on the above benefits, please read further.

How do I TAKE COVERAGE under this policy?• All existing InterGlobe employees are covered, as it is a mandatory policy. All new employees

are covered from their date of joining the Organization.• Spouse and upto 2 children can also be included at no additional cost.

Can I cover my PARENTS and ADDITIONAL CHILDREN as well?

• Yes, financially dependent parents (not in-laws’) below 80 years, and more than 2 children can also be included, subject to the employee paying 100% of the additional premium for them.

• For existing employees, the premium is payable at the time of renewal of the policy in July every year. For new employees, at the time of joining the organization.

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How do I know STATUS of my COVERAGE?• Log on to www.emeditek.com to know your coverage status. Follow the below steps:-

– Go to => <E-Cards> Go to = <Member’s Login>– Enter => <User Name> Prefix your employee code with IGL (i.e. IGL1234). – Enter => <Password> Your DOB in DD-MMM-YY Format (i.e. 01-Jan-07).– Select => <Login> as “Card Holder” Go to <Membership Card> Print <E-Card>.

• Employees can upload their scanned photograph in the <Membership Card> section.• In case you find any discrepancy in your/your family members’ records, please immediately

intimate your BU-HR.

Is ADDITION/DELETION of DEPENDENTS permissible during the term of the policy?

• Spouse: Permissible (9 months’ waiting period for maternity benefits under the policy fornew joinees).

• Upto 2 Children: Permissible (1 month waiting period).• More than 2 Children: NOT permissible, once included in the policy by the employee.• Parents: NOT permissible, once included in the policy by the employee. • Death Certificate will be required to be submitted in case of deletion due to death.

Why this WAITING PERIOD?• To facilitate genuine cases and avoid misuse of benefits under the policy.• Every claim passed under the policy could increase the possibility of enhancement of

premium by the insurance company at the time of renewal of policy.• Parents: 1 month waiting period for ‘pre-existing’ diseases for parents of new joinees.• Maternity Coverage: 9 months’ waiting period for new joinees from the date of joining.• Any addition/deletion/correction of records takes approx. 1 month to reflect on the website.

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What is the BUFFER Policy?• A provision to take care of any hospitalization charge of employee and his/her family (Spouse and upto 2 children) that exceeds the basic coverage limit of Rs.1.00 Lacs upto a

maximum limit of Rs.2.00 Lacs per family.• For consideration under this buffer policy, the employee should have completed atleast 1

year of service with the Organization and the release of this additional amount is at the sole discretion of the management.

Does the policy cover treatment undertaken OUTSIDE INDIA?• No. The policy is applicable only in India.

What happens to my coverage in case of separation from the organization?

• In case of separation from the Organization, the coverage under this policy ceases after the date of relieving from the service. Premium paid by the employee will not be refunded.

What are the MATERNITY BENEFITS under the Policy? Is a NEW BORN CHILD also covered?

• Maternity expenses are covered up to a maximum limit of Rs.50,000/- for both normal and cesarean cases (9 months’ waiting period from date of joining of the employee), whether the employee is married or not, at the time of joining. Employee getting married after joining the organization would need to include wife to claim coverage under maternity extension. This will be within the overall coverage limit opted by the employee.

• New-born child will be covered (from day 1 upto the age of 3 months) under maternity extension, and expenses incurred for the treatment taken in the hospital as an in-patient, shall be payable subject to maximum limit of Rs.50000/- available for maternity benefit extension. Thereafter, child will have to be covered as employee’s dependent.

• Pre and post-maternity expenses are not covered under maternity extension.

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What are the expenses COVERED under the Policy?• Reimbursement of reasonable and necessary expenses for treatment of illness / disease / injury

contracted during the currency of the policy (e.g. room rent, nursing care, Doctor’s fee, investigations charges, medicine charges, operation theatre and like expenses), which fall within the available limit upto the maximum coverage limit in any one period of insurance stated in the policy schedule.

• When treatments such as Dialysis, Chemotherapy, Radiotherapy, Dental Surgery, Lithotripsy (Kidney Stone Removal), Tonsillectomy, Dilatation & Curettage, etc., taken in the Hospital/Nursing-home and the insured is discharged on the same day, the treatment would be considered to be taken under Hospitalization section of the policy and the claim would be admissible.

• Operation of the Eye by Laser Capulsotomy (Cataract Operation) is covered under Hospitalization benefits of Mediclaim Policy even when the treatment is taken in an Eye Clinic.

What are the expenses NOT COVERED under the Policy?• Out-Patient Treatment.• Expenses incurred at Hospitals/Nursing-homes primarily for Diagnostic, X-Rays or Laboratory

examination/tests, which are not consistent with or incidental to the diagnosis and treatment of the positive existence of any ailment.

• Vaccination/Dietician fees, expenses on vitamins/tonics, if not directly related with the treatment, expenses on luxury items unless within the room package, attendant charges including extra food/bed charges, if any.

• Registration/admission/file charges, telephone/Xerox/certifying charges, sanitary items, etc.• Expenses incurred on cost of external aids e.g. Spectacles, Contact Lenses, Hearing Aids,

Clutches, Dental Treatment unless requiring Hospitalization, Sterility, Intentional self-injury and other exclusion clauses mentioned in the policy.

• Any Cosmetic/Ayurvedic/Naturopathy/Homeopathy Treatments is not covered under the policy.• The benefits under this policy are subject to the approval by the Insurance Company.

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What is my COVERAGE LIMIT?• Sum Insured is the total limit of the employee/family for which the claim can be permissible. • The basic coverage limit is Rs.1.00 Lacs per year for the employee and his/her family (spouse

+ upto 2 children). This coverage limit will be applicable to financially dependent parents, in case employee has opted to include them under the policy, by paying 100% of the additional premium for parents.

Can I ENHANCE COVERAGE LIMIT?• Yes, an employees can opt to enhance limit over and above the basic coverage limit of Rs.1.00

Lac, by paying 100% of the additional premium for the enhanced coverage.• The maximum amount of coverage limit enhancement can be Rs.5.00 Lacs per year.• The extra Premium required to be paid by the employee for the additional sum insured limit

over and above Rs.1.00 Lac, would be initially paid by the company, and later-on be recovered from the employee’s salary, in one installment, the following month.

Will the ENHANCED coverage limit be applicable to my FAMILY & DEPENDENT parents as well?

• Yes, the enhanced coverage limit will be applicable to the employee’s family as well. The employee can opt to include dependent parents as well, by paying 100% of the additional premium for the enhanced limit.

• In case the dependent parents are covered, the additional coverage limit is NOT meant for the expenses under pre-existing diseases where expenses are recurring in naturee.g. Chemotherapy, dialysis or any other such expenses. Under such circumstances the coverage limit for them will remain the same i.e. Rs.1.00 Lac only.

• The option of enhancing the coverage limit can be exercised only at the time of the renewal of the policy by the existing employees. The new employees can exercise this option at the time of joining, by filling a specified form for the same.

• The enhancement of coverage limit is NOT permissible during the term of the policy. Once enhanced, coverage limit CAN NOT be decreased/reduced.

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What will be the PREMIUM and how much will it COST me?

Age Group 0-35 Yrs. 36-45 Yrs. 46-55 Yrs. 56-65 Yrs. 66-70 Yrs. 71-75 Yrs.

1.00 Lacs 1697 2023 2865 3311 3706 3900

2.00 Lacs 3350 3809 5550 6358 7146 7800

3.00 Lacs 4675 5314 7900 9110 10290 11300

4.00 Lacs 5750 6660 9986 11664 13239 14500

5.00 Lacs 6970 7948 12257 14218 16187 18000

For Employee (plus Spouse & upto 2 Children):• If your age is 0-35 yrs. and coverage limit opted by you is Rs.1.00 Lac then as per the

table your premium is Rs.1697/- only. There will be NO deduction upto Rs.1.00 Lac coverage limit, as it is part of your CTC Salary.

• Now, suppose you want to enhance the coverage to Rs.3.00 Lacs, then the additional premium you would need to pay will be => Rs 2978 (i.e. Rs.4675/- minus Rs.1697/-).

• Additional premium is recovered from your salary in one installment (for existing employees, in September. For New Joinees, in the next month’s salary from Date of Joining).

For more than 2 Children:• Additional 35% of the Premium payable by you for each child will be an additional of Rs

594/- ( i.e. 35% of Rs.1697/-) if your fall under age group of 0-35 years.

For Financially Dependent Parents:• Additional premium payable is Rs.2000 for both parents; & Rs.1500 for single parent,

regardless of age group.

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Who is our TPA and what’s the ROLE of our TPA?• E-Meditek is our Third Party Administrator (TPA).• E-Meditek is a licensed TPA to service our Mediclaim policy and will act as a facilitator

between the Insurance Company and the Hospital for InterGlobe Employees.

What SERVICES by TPA would be provided?• Issuing E-cards and on-line profile management at www.emeditek.com for all employees and

dependents covered under the policy.• 24-Hour Assistance through Call Centre through a Toll Free Line – Information source for

location of doctors / medicos / diagnostics / hospitals, etc., telephone consultation with doctors and referral services to the closest and most appropriate medical service provider.

• Cashless Medical Service Facilitation at Network-Hospital/Nursing-home (upto the coverage limit), interaction with hospitals/insured regarding medical diagnosis of insured, bills scrutiny, medical procedure audit – elimination of unnecessary prescriptions, case management and liaison with Insurance company.

• In case of Non-Network Hospital/Nursing-Home: Coordination with Insurance Company for settlement of reimbursement of expenses (upto the coverage limit) for the claim/bills submitted by the employee within 20 days of the discharge from the hospital.

• On-line assistance during Hospitalization and filing of claim documents.• Ambulance facility for emergency.

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Why should I go to a NETWORK Hospital?• A Network Hospital/Nursing-home, which is on the list of TPA (E-Meditek), will offer

you Cashless Medical Services upto the coverage limit. TPA will facilitate authorization for Cashless Medical Services and, will do the coordination with the Hospital and Insurance

Company.

Which NON-NETWORK Hospital Can I go to? A Non-Network Hospital MUST meet with the following conditions: • Non-Network Hospital/Nursing-home should be registered with the local authorities, and should

be running under the supervision of a registered and qualified medical practioner, or should comply with minimum criteria as under:-

– Registration with local authority, with a Registration Number under its name.– At-least 15 in-patient beds (In Class “C” towns: 10 beds).– Having fully qualified doctors in-charge round the clock and fully qualified nursing staff

under its employment round the clock.– Must be fully equipped with an operation theatre of its own, wherever surgical operations are

carried out.

What do I need to do BEFORE Hospitalization?• Keep your e-card and the important contact numbers handy.• Identify a Network Hospital/Nursing-home in your area, for cashless medical service. A list of

hospitals is available on www.emeditek.com or call 24-Hour Toll Free Helpline 1800-113-242 orCall Dedicated Lines for Cashless: Tel.: 0124-4555031-32, Fax: 0124-4555071-73 or Cashless Cell: Tel.: 0124-4555030-39.

• In case of Network Hospital/Nursing-home not being available in your area, identify a Non-Network Hospital/Nursing-home, meeting minimum criteria mentioned above.

• Emergency Hospitalization: Call TPA for any assistance on 24-Hour Toll Free Helpline: # 1800-113-242 or 24-Hour Helpline: Tel.: 0124-2562994-97. Call Dedicated Lines for Cashless: Tel.: 0124-4555031-32, Fax: 0124-4555071-73 or Cashless Cell: Tel.: 0124-4555030-39.

• For pre-planned Hospitalization, an advance notification of 4-6 days is required for TPA toarrange cashless medical service.

• Intimate BU-HR for any other assistance.

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• Select Network Hospital/Nursing-home.• Display your Mediclaim E-Card• Network Hospital/Nursing Home submits the ‘Cashless Form’ duly filled and signed by the

employee to E-Meditek for authorization of cashless medical services (Call Dedicated Lines for Cashless: Tel.: 0124-4555031-32, Fax: 0124-4555071-73; Or Cashless Cell: Tel.: 0124-4555030-39; Or 24-Hour Toll Free Helpline 1800-113-242 or www.emeditek.com).

• E-Meditek issues ‘Pre-Authorization Letter’ to the Network Hospital/Nursing Home• Patient undergoes treatment and takes the discharge after completion of treatment.• Network-Hospital/Nursing-home then submits, the duly filled claim form, patient record,

bills, etc., and other relevant documents, to E-Meditek for settlement of payment.• E-Meditek settles payments/dues with the Network Hospital/Nursing-home.• Intimate HR for any other assistance.

Note: Cashless Hospitalization Facility is available only at Network Hospitals/Nursing-homes.

HR ExpressWhat’s the procedure for CASHLESS Hospitalization at NETWORK HOSPITALS?

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How do I CLAIM REIMBURSEMENT for Mediclaim expenses, in case I have been to a

Non-Network Hospital?• Settle your dues/payment for hospitalization at the Non-Network Hospital/Nursing-home and

intimate E-Meditek/BU-HR• Ensure you have the following documents at the time of discharge from the Hospital:

- The detailed Discharge Summary from the Hospital/Nursing-home.- All receipts/memos, in original, for any payments made to the hospital/chemist,

supported by the proper prescriptions.- Receipts and Pathological Test/Investigation/Diagnosis Reports from Pathologist

supported by the note/prescriptions from attending Medical Practioner/Surgeon/ Consultants/Specialist/Anesthetist demanding such pathological tests.

- Registration Number of the Hospital OR a 15-bed confirmation letter from the hospital.- Surgeon’s Certificate stating nature of operation performed, Surgeon’s bill and receipt.- Record of any treatment taken prior to hospitalization.- Final bill, duly stamped by the hospital, for payments.- Copy of E-card.

• Submit with HR the Claim Form, duly filled and signed by claimant, alongwith the above documents within 20 days of discharge from the hospital, to be forwarded to E-Meditek. Forms are available on www.emeditek.com or with your BU-HR/Intranet

• HR will coordinate with E-Meditek to facilitate the Claim Reimbursement, as per the policy.• E-Meditek will send the Claim to the Insurance Company for settlement after verifications and

scrutinizing process at their end.• Settlement of Claim will take place between the TPA and the Insurance Company. Neither

employee nor the company (InterGlobe) will have any role in it, as long as the medical bills are within the TPA and the insurance company’s guidelines.

• HR/TPA may ask for any other supporting documents, if required, from time to time.• On receipt of the approved voucher from the Insurance Company, the insured receives the

claim reimbursement.

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What do I need to keep in mind when I am LEAVING THE HOSPITAL

on completion of treatment?Network Hospital/Nursing-home: • Please know how much you are being charged, as overcharge will reduce your Sum Insured

kitty. Sign all relevant documents/papers before getting discharged and ensure that you keep a copy of the same for future referrals, in case required.

Non-Network Hospital/Nursing-home (or when Cashless Medical Services is denied): • Settle your dues/payment at the Non-Network Hospital/Nursing-home.• Ensure that you have collected, in original, all Payment Receipts, Test/Diagnosis Reports

with Doctors prescriptions and Discharge Summary, along with all other relevant documents related to treatment and the hospital, which are required to be submitted to E-Meditek for Claim Reimbursement.

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What are the important contact numbers?E-Meditek (TPA) Contact Numbers:

• 24-Hour Toll Free Helpline : 1800-113-242• 24-Hour Helpline Number : Tel.: 0124 – 2562994-97• Dedicated Lines for Cashless : Tel.: 0124 – 4555031-32, Fax: 0124 – 4555071-73• Cashless Cell : Tel.: 0124 – 4555030-39• E-Meditek Gurgaon HeadOffice : E-Meditek Solutions Limited 45, Nathupur Road, DLF Phase-3, Gurgaon 122002

Tel.: 0124 – 4555000-10• Email : [email protected]• Website : www.emeditek.com

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SAMPLE FORMS

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Cashless Request FormAddition/Deletion Form

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Claim Form for Re-imbursementHR Express

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COMING SOON….

Compensation Guidelines

THANK YOU!!!HR Express