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Presentation on Health Benefits Plan 2010-11

TOTAL OUTSOURCE INDIA PVT LTDGMC POLICY no. 604200/46/10/8500000031

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Index Service Providers & Roles

Policy Highlights

Standard Exclusions

Basic Health Plan Services

Modality

Important Contact Numbers

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The Services Providers & Roles

Medimanage Insurance Broking PL. Health Plan Consultant, Value Added Services Provider & Overall

Services Integrator

Mediassist India Pvt. Ltd. Third Party Administrator who would settle all your Hospitalization Claims,

Thru Cashless route or Reimbursement route

The National Insurance Company Ltd Insurer & the underwriter of Risk

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Policy Highlights Payments under Standard Mediclaim Policy of The National Insurance

company limited for any hospitalization in India

Family Floater Cover

Sum Insured of Rs. 1,50,000/- per family

Coverage for Employee + Spouse + 2 Children + 2 Dependent

Parents (1+5)

Female employees can either add parent or parent-in-laws

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Policy Highlights Special Benefits

Pre-Existing Diseases Cover from Day One

Maternity Benefit Cover from Day One with the limit of up to Rs. 25,000/-

for normal & Rs. 50,000/- for Caesarian section

New Born Child Cover from Day One (Provided there is intimation of babysbirth within 7 days after birth) Waiver of First Year Exclusions

Waiver of 30 Days Waiting Period

Waiver of Pre-health check up

Cover for Hospitalization due to Terrorism Effect

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Policy Highlights Specific Limits Room, Boarding & Nursing Expenses limited to 1% of Sum Insured per

Day or Rs. 2500/- whichever is lower

ICU Unit Expenses limited to 2% of Sum Insured per day or Rs.

5,000/- which ever is lower

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Policy Highlights You can avail benefits

If you are already in employment before 15th April 2010, then

immediately

If you have joined recently, then after your enrollment process is

completed as per intimation from HR.

The Insurance cover ends on Standard Termination of the Policy i.e. 14th April 2011 at 12:00

midnight

Separation from Total OutSource India Pvt Ltd

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Policy Highlights The insurance cover Pays for.

Only Inpatient Expenses i.e. only when you are hospitalized &

Treated for disease (minumum 24 hrs hospitalization)

Pre-Hospitalization Expenses for 30 days prior to date of Admission

in hospital & related to same illness

Post-Hospitalization Expenses for 60 days after the date of

Discharge from hospital & related to same illness

But does Not Pay for. Out Patient Expenses i.e. Diagnostics, investigations, consultations

etc. which do not result into hospitalization

Non Medical Expenses like Telephone Charges, Food Bill of

attendants, Registration Charges, Toiletries, Service Charges etc.

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Standard Exclusions HIV and AIDS

Intentional Self-Injury, Use of intoxicating drugs/alcohol

Venereal Diseases, Naturopathy

All psychiatric & psychosomatic disorders

Injury or Disease caused directly or indirectly by nuclear weapons /war

Expenses on Vitamins/Tonics unless forming part of treatment

Cost of Spectacles or Contact Lenses, Correction of eye sight, Hearing Aid etc.

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Standard Exclusions Any cosmetic or plastic surgery except for correction of injury

Any hospitalization for Diagnostic tests only

Infertility treatment

Any hospitalization less than 24 hours except for specific treatments like Dialysis,

Chemotherapy, Radiotherapy, Cataract Surgery, Lithotripsy, Tonsillectomy etc.

Any Non Medical Expenses like Registration Fees, Admission Fees, Charges for

Medical Records, Cafeteria Charges, Telephone Charges, Service Charges etc.

Any dental treatment or surgery which is corrective, filling of cavity, root canal

etc.

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Standard ExclusionsExpenses incurred for investigation or treatment or irrelevant to the diagnosed

during hospitalization

Genetical disorders & stem cell implantation / surgery

Change of treatment from one stream to the other (for example switching over

from allopathy to homeopathy etc) recommended by consultant

Treatment of Obesity & any other weight control program

Any treatment required arising from insureds participation in any hazardous activity

Any stay in the hospital for any domestic reason or no active regular treatment is

given

Massages, Steam bathing, Shirodhara & alike treatment under Ayurveda

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Standard Exclusions Doctors home visit charges, Attendant/Nursing Charges during pre &

post Hospitalization

Treatment which is continued before & after hospitalization for an

ailment / disease / injury different from one for which hospitalization

was necessary.

Voluntary Termination of Pregnancy

Outpatient Diagnostic, Medical or Surgical procedures or treatments,

non-prescribed drugs & Hormone replacement Therapy, Sex Change

Any treatment received in convalescent home, convalescent hospital,

health hydro, nature care clinic

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Basic Health Plan Services Enrollment ID Card for identification at network hospitals How to avail Basic Insurance Services? How to use Medimanage Portal? Claims Settlement Medimanage Contact Details for Insurance related queries

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Enrollment

Health Insurance is for common good, use it judiciously

Enrollment for dependants will be through online process use the following

steps to submit the enrollments.

Log on to https://www.medimanage.com

Use your Employee ID followed with an underscore and 8-digit DOB in

DDMMYYYY format to login-in. Password will be your 8-digit DOB in

DDMMYYYY format.

(Example: If your Employee ID is 123456 & date of birth is 05-Nov-1969, then your login-in ID will be 123456_05111969 and password will

be 05111969)

On completion of enrollment, confirmation will be sent to your

a. Official email ID

b. SMS to your mobile no.

c. Email is sent to your private/personal email ID.

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Enrollment Update status changes in the family within 30 days

If Married, provide info about spouse (Name/DOB/Relationship)

Had a baby, provide info about baby (Name/DOB/Relationship)

If any member covered under plan Expires, Please inform.

Please note that you cannot change your dependents during the

currency of the policy except for the events like Marriage & New Child

Birth. The details given by you at commencement of policy would

be FINAL.

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ID Cards for Hospitalization Identifies you as Total OutSource India Pvt LTD. Health Plan member

Photo for identification

If hospital insists on photo identification, can be produced along

with any other Photo ID like Total Outsource I.D.

Each Health Plan member gets separate card.

Non-Transferable

Provides you Emergency admission at Network hospital

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How to use Medimanage portal? Log-on to your account by using the alternate e-mail id as log-in id and

your DOB in DDMMYYYY as the password.

You will view the main Dashboard Member Central of the application.

Please click on the My Communication tab to proceed further.

Select a category of support request.

Enter a Subject of your request & then enter the Message describing

your request.

Attach documents if any and then Submit the Support Request.

A Ticket No. will be generated and will be reflected in the History of all

your requests.

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How to use Medimanage Portal Immediately after you submit a request, you will receive a

acknowledgement e-mail on the registered e-mail ids.

When Medimanage representative responds to your Message, you will

get an alert about the same on the registered e-mail ids.

To check the response from Medimanage, pick the particular Message

from the History or Search with Ticket no. Or Subject of your Message.

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How to avail Basic Insurance Services? HOSPITALISATION AT NETWORK HOSPITAL

If the hospitalization is in the Network Hospital of Mediassist, you

need to fill up Cashless Request Form & follow process of

Cashless Route

HOSPITALISATION AT NON NETWORK HOSPITALIf the hospitalization is in the Non-network Hospital, you complete

your hospitalization, pay the bills & follow process of

Reimbursement of expenses.

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In case of Planned Hospitalization Obtain the Pre-Authorization Form from Mediclaim Desk of Network Hospital

Fill by yourself the details like

Name of the person to be hospitalized

Mediassist ID & Employee ID No.

Relationship (Self/Spouse/Son etc.)

To be filled by Treating Doctor

Proposed date of admission

History of illness / ailment

Approximate duration of hospitalization

Approximate Expenses (to be filled in by Hospital administration)

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In case of Planned Hospitalization Hospital Administration would fax the Pre-authorization Form to Mediassist

The Mediassist Staff would scrutinize the form

Mediassist will fax the Authorization Letter to the concerned hospital within24 hours.

You can get hospitalized & the treatment can start.

On discharge, Sign the bills, claims form & pay the non-medical charges

only.

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In case of Emergency Hospitalization

Get the patient hospitalized at the desired / nearest network hospital

In case, if the hospital insists for deposit, pay the same & get it

returned once Mediassist settles the claim with the Hospital.

Let the patient stabilize

Follow up the standard Pre-Authorization process

Follow the standard discharge process

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Cashless Hospitalization Please Remember.

Mediassist will only pay for the Medical Expenses

You need not make any payment for any of the medical expenses.

You must pay for the non-medical expenses on discharge or

whenever asked by hospital

The bills for medical expenses would be sent to Mediassist by thehospital & they would directly settle the same with hospital

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Non Network Hospitalization

You get hospitalized in any hospital registered with local municipal

authority or a hospital having minimum 15-beds

Get Discharge Summary after making all the necessary payments.

Also obtain the Hospital Registration No.

Submit all the necessary documents (in ORIGINAL) along with Claim

Form within 30 days to your HR dept.

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Documents to be submitted for ReimbursementClaims

All documents mentioned herein should be submitted in ORIGINAL

Discharge Card / Summary

Detailed Hospital Bill

Pre-numbered Cash Paid Receipts for payments made to hospital

Prescriptions, Reports & Bills for all Diagnostics Tests (No Films, only

Reports)

Prescriptions & Bills for all Medicines purchased

Gravida Status (No. of Living Children) in case of Maternity

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Reimbursement Claims All Main Hospitalization bills should be submitted for claim within 30

days from Date Of Discharge.

All Pre-Hospitalization bills should be submitted for claim along with the

main bills only.

All Post-Hospitalization bills can be separately submitted or claimed within

60 days from Date Of Discharge after completion of the treatment.

NOTE: In case ofPost hospitalization treatment ensure to provide appropriate

intimation to HR dept upon discharge to enable to process the pre / main

hospitalization claims separately & post hospitalization claims separately. In case no

intimation is provided while submitting main bills the post hospitalization claims would

not be considered for further processing.

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Important Contact Numbers

Health Insurance is for common good, use it judiciously

Contact Person Role Voice Contact Details Responsibility

Manjula RFor Enrollment &

queries+ 91 97390 10123 All India

Vanitha Cashless Coordinator +91 97422 46961 All India

Manjunatha Claims Executive +91 98864 98076 All India

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Thank You

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