Group Mediclaim Insurance Policy

Document Release Notice

This policy on Group Mediclaim Insurance Policy is released for use in Tata
Communication Limited with effect from 31st March 2016 and it supersedes any
other policy communication in this regard.
Table of Contents:

1.0 Introduction .................................................................................................................. 4

2.0 Objective ....................................................................................................................... 4

3.0 Scope ............................................................................................................................. 4

4.0 General Provisions ....................................................................................................... 4

5.0 Coverage ....................................................................................................................... 4

6.0 Sum Insured .................................................................................................................. 5

7.0 Premium ........................................................................................................................ 5

8.0 Salient Features ............................................................................................................ 5

9.0 Benefits with capping on admissibility ………….………………………………………………………….7

10.0 Benefit for retired employee………………………………………………………………………………. .. 8

11.0 Exclusion………………………………………………………………………………………………………...... ..…8

12.0 Process for availing benefits ……………………………..…………………………………………………..10

13.0 Policy Administration……………………………………………………..……………………………………….11

14.0 Process to obtain e-medical cards ………………………… ..…………..………………………………….11

15.0 General ………………..……………………………………… …………..…………………………………………….11

16.0 Escalation Matrix……………………………………………………………..………………………………………….12

Terminology

Human Resources Group Mediclaim

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Hospital/ Nursing Home: It means any institution in India established for indoor care and treatment
of sickness and injuries and which
Either
a) Has been registered either as a Hospital or Nursing Home with the local authorities and is
under the supervision of a registered and qualified Medical Practitioner.

Or

b) Should comply with minimum criteria as under

i. It should have at least 15 in-patient beds
ii. Fully equipped operational theatre of its own wherever surgical operations are carried
out
iii. Fully qualified nursing staff under its employment round the clock
iv. Fully qualified Doctor(s) should be in charge round the clock.

NB: (In class C towns condition of number of beds be reduced to 10)

Surgical Operation means manual and/or operative procedures for correction of deformities and
defects, repair of injuries, diagnosis and cure of diseases, relief of suffering and prolongation of life.

TPA: A TPA is a company appointed by the insurer for smooth functioning of the policy. The TPA i.e.
Third Party Administrator performs the following function:
 It maintains database of policyholders
 Issue health insurance identity card with unique identification numbers
 Handle all the post policy issues including claim settlements, cashless benefits etc.
 TPA appoints doctor’s to study all claims to determine the pay ability of the same as per the
policy issued by the Insurance Company.

Human Resources Group Mediclaim

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 Group Mediclaim Insurance Policy

1.0 Introduction:

Group Mediclaim Insurance Policy is introduced to enable employees to avail cashless medical benefit
or reimbursement of hospitalization expenses incurred in India for the medial treatment sustained by
employees and their declared dependents.

2.0 Objective:

The purpose of Group Mediclaim Insurance Policy is as follows:

2.1 To provide employees and their family prompt and easy access to medical facilities
2.2 To provide financial assistance to employees towards hospitalization for defined medical
treatments
2.3 To ensure continued health and well-being of employees and their family post retirement
subject to the following conditions mentioned in clause 10.0 of the policy

3.0 Scope:

The policy is applicable to:

3.1 All permanent employees on rolls of Tata Communications and subsidiaries

3.2 Retired employees of Tata Communications and subsidiaries

4.0 General Provisions:

4.1 The Oriental Insurance Co. Ltd. is our service provider for FY 2016-17 with Paramount
Health Services being the Third Party Administrator (TPA)

4.2 Administration of claims will be managed by TPA

4.3 For queries employees can write to corpomediclaim@tatacommunications.com

5.0 Coverage:

5.1 The Company will provide a floater Hospitalization Insurance Coverage 1 + 5 (Employee +
Partner + 2 set of Parents or in Laws + 2 Children (whether adopted/biological)

5.2 There is no age bar criteria for employees and their dependents

5.3 Only unemployed and unmarried Children up to the age of 25 years will be considered
as dependents for the purpose of medical benefits.

Human Resources Group Mediclaim

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6.0 Sum Insured:

6.1 Basic Cover: All eligible employees are covered for a Basic sum insured as mentioned in
the table below:

Band Sum Insured (Per Family)

B1-1 to B4-2 3,00,000 P.A
B5-1 & Above 5,00,000 P.A

Additional Cover (Top Up): An additional flat top up cover of INR 400,000 per annum
(over and above the Sum Insured) can be opted by an employee by paying premium of
INR 11,500/- plus applicable service tax. It is at the discretion of employees to opt for
additional cover. This option is available till 30th June, 2016.

New joiners in the current policy year have the option of increasing their Sum Insured
by opting for Top up of 4lacs within 3 months of their date of joining.

Employees may send the request to Askhr@tatacommunications.com to avail the top

up facility.

Benefits of top up:-

 Increased medical coverage from INR 3 and 5 Lakhs to INR 7 Lakhs and 9 Lakhs
respectively to provision for unforeseen medical emergencies of self and dependents.
 Tax deduction – INR 11,500 top up premium will qualify for deduction under section
80D

7.0 Premium:

7.1 Premium for basic cover for employees (self) and dependents is entirely borne by Tata
Communications.
7.2 The top up premium of INR 11,500/- for flat additional cover of INR 4,00,000 will be entirely
borne by employee and recoverable from the salary in one lump sum
7.3 There will be no refund of unutilised Top up premium in the event of separation from
service during the policy year

8.0 Salient Features:

8.1 Minimum 24 hours of hospitalization for treatment of an ailment is a must to avail

benefits of the policy.

8.2 However, the minimum hour of hospitalization is waived off in case of specific
treatment such as Cataract, Chemotherapy, Radiotherapy, Haemodialysis, Eye Surgery
(including lens implants, Injection Macugen (Pegabtanib) and Injection Avastin and
Lucentis), Dental Surgery, Lithotripsy (Kidney stone removal), Dilation and Curettage
(D&C), Tonsillectomy etc, taken in the Hospital/ Nursing Home and the Insured is
discharged on the same day; the treatment will be considered to be taken under
Hospitalisation Benefit.

Human Resources Group Mediclaim

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 8.3 Base and top-up sum Insured can be fully/ partly used for any member of family,
including self.

8.4 Pre-existing diseases: All pre-existing diseases (not otherwise excluded from the
policy) are covered. All diseases will be covered from the day one of the policy start
date without any waiting period.

8.5 Domiciliary Hospitalization: Domiciliary hospitalization is covered in the policy.

8.6 Pre Hospitalization: Relevant medical expenses incurred 30 days prior to the
hospitalization date on disease/ illness/injury sustained shall be considered as part of
claim.
8.7 Post Hospitalization: Relevant Medical expenses incurred 60 days after the discharge
date from the hospital on disease/ illness/ injury sustained shall be considered as part
of claim.

8.8 Expenses incurred towards OPD treatment for injuries arising out of accidents are
covered.

8.9 Emergency Ambulance cover is restricted to INR 2500 per incident.

8.10 Mid-term inclusions are permitted only in the case of new joiners for new born and
spouse on account of marriage. Intimation of the same to be informed to HRSSC –
Benefits Team within 30 days of the event.

8.11 The treatment for the following diseases are covered under the policy:

 Cancer (all types of treatment and chemotherapy radiation, injection and oral
medicines including oral treatment/ cyber knife and Stem cell transplant). NO
tobacco/ smoking history are considered for processing the claims.
 Internal and external congenital anomalies
 Infertility treatment covered and capped at 10k maximum.
 Robotic surgery
 Sleeve Gastrostomy (above BMI index of 50)
 Skin treatment – Psoriasis as an OPD
 Psychiatric treatment
 PET Scan for all treatment
 Cerebrovascular Stroke
 Kidney/ major organ Transplant
 Liver Transplant
 Coronary arteries bypass graft
 Haemodialysis, Radiotherapy
 Eye Surgery, Laser Eye Treatment (including lens implants)
 Eye treatment through – Inj. Macugen (pegabtanib) and Inj Avastin/Lucentis are
covered. (Only treatment for correction of refractive error is not covered)
 Dental Surgery arising out of accident/ dental disease including periodontal Flap
surgery.
 Lithotripsy (Kidney Stone Removal), Dilation and Curettage (D&C)
 Tonsillectomy, etc even hospitalization is less than specified period
 Hepatitis Virus (All types)

Human Resources Group Mediclaim

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  Treatment of AIDS (Acquired Immune Deficiency Syndrome)
 Central Precocious Puberty (CPP) (hormonal disorders are covered even if treated
in OPD.

9.0 Benefits with Capping on Admissibility:

9.1 Room Charges:

9.1.1 Room rent is capped at 2% of Sum Insured or Single AC Room whichever is less.

9.1.2 No capping on room charges for ICU.

9.1.3 Please ensure that you opt for a room as per your eligibility. In case, room
opted higher than eligibility, all cascading charges will be borne by employees.
Like surgeon charges, Operation theatre charges, Anaesthesia & anaesthetist
charges, doctor’s daily visit charges, Investigation charges & other hospital
charges excluding Pharmacy & consumables.

9.2 Maternity Benefit:

9.2.1 Insurance Company shall reimburse to the employee actual expenses not
exceeding an amount of INR 75,000/- for normal delivery and INR 100,000/-
for caesarean section.

9.2.2 However, any treatment arising from traceable pregnancy including maternity
related disease is covered under normal sum insured.

9.2.3 Insured can claim maternity expenses for only first two living children.
However maternity benefits can be extended to the 3rd child in respect of
following scenarios:

 Twins in case of second delivery having one child alive

 First delivery twins and second deliver is normal child

9.2.4 New born babies are covered right from the time of birth. Name of the infant
to be intimated to HR Shared Service Team within 30 days of the event.

9.2.5 Pre and post-natal expenses are covered up to a limit of INR 5,000.

9.3 Dental Treatment:

9.3.1 Root Canal Treatment is covered per family for limit of INR 30,000.

9.3.2 Any dental treatment or surgery which is corrective cosmetic or aesthetic

procedure including wear and tear is not included.

9.4 Eye Cataract:

9.4.1Surgery cost of all types of Intraocular lenses (IOL) necessitated with eye
operation is covered. Maximum admissible cost INR 40,000.
9.5 Coverage of AYUSH Treatment:

Human Resources Group Mediclaim

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 9.5.1 AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) treatment are
covered up to 25% of the Sum Insured provided the treatment for illness/ disease and
accidental injuries in such cases is taken in Government hospitals or a hospital attached to
a medical college. Any rejuvenation therapies including wellness, massage and usage of
SPA will not be covered under this policy.

9.6 Infertility treatment:

9.6.1 Infertility treatment covered and capped at INR 10,000 maximum. IVF & IUI
not covered.

10.0 Benefits for retired employees:

10.1 All employees of Tata Communications and its subsidiaries enrolled under the policy
can continue with the existing policy post retirement at the same rate of premium as
applicable under the policy in the concerned financial year, however pro-rated
premium amount for the remaining period of the policy will be borne by the retiring
employee.

For e.g. if an employee retires in the month of June and chooses to continue with the
policy then in this case the premium for the period post June till 30th March will be borne
by the retiring employee as per the applicable rate for that year.

10.2 The premium rates are charged on a family floater basis irrespective of number of
family members covered.

10.3 For continuation of the coverage in the subsequent years, retired employees are
required to communicate their decision to HR Shared Services team in the month of
March every year.

10.4 Retired employees have the option to continue with the medical coverage year on year
provided there is no break in the period of coverage.

11.0 Exclusion:

The company shall not be liable to make any payment under this policy in respect of any
expenses whatsoever incurred by any Insured person in connection with or in respect of:-

11.1 Injury/ disease directly or indirectly caused by or arising from or attributable to War
invasion, Act of foreign enemy, war like operations (Whether war be declared or not).

11.2 The cost of Cosmetic Surgery, Spectacles and Contact lenses, hearing aids.

11.3 Expenses on Vitamins and tonics unless forming part of treatment for injury or disease
as certified by the attending physician.

11.4 Circumcision unless necessary for treatment of a disease not excluded here under or
as may be necessitated due to an accident, vaccination or inoculation or change of life
or 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.

Human Resources Group Mediclaim

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 11.5 Hospitalization occurring on account of suicide attempt will not be covered.

11.6 Any hospitalization occurring on account of voluntary abortion will not be covered.
However if the doctor advises abortion on account of any health problems of the
patient/ insured will be covered.

11.7 Beauty treatment of any description

11.8 Family Planning Operations (Vasectomy or Tubectomy) etc.

11.9 Plastic Surgery (other than necessitated due to accident)

11.10 Accident treatment under the influence of Alcohol or intoxicating drugs

11.11 Injury or Disease directly or indirectly caused by or contributed to by nuclear

weapons/ materials

11.12 Naturopathy Treatment

11.13 Disease or accident due to adventure sports

11.14 Vaccinations given to the new born baby after birth

11.15 Any Medical test or treatment related to Genetic disorder will not be payable

11.16 Hospital Charges and consumable medical items as declared by the IRDA are not
covered under the Policy:

 Telephone/ Fax expenses

 Private nurses, conveyance bills, food and beverages
 Washing and Laundry charges, transportation charges
 External implants and accessories like crutches, abdominal belts, waterbed,
spectacles etc.
 Expenditure on Non-medical items as declared by the Insurance company in the
Paramount portal will be borne by the employee and paid directly to the hospital
 Cosmetic items like Soap, Oils, and Powders etc.
 Other expenditure which is not related to the illness/ hospitalization
 Expenses incurred on any accompaniment family or others during the hospital
stay will not be covered under the policy

The above list is illustrative and not comprehensive.

Cost of such services have to be borne by the employee and paid directly to hospital
at the time of discharge.

12.0 Process for Availing Benefits:

Human Resources Group Mediclaim

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 12.1 Cashless Hospitalization - Admission: Under this option, the insurance company pays
the Hospital Authorities upfront on behalf of the floater policy holder provided the
necessary conditions are satisfied. This is applicable only in case of Network hospitals,
i.e. the hospital that insurance company has tie ups with. Pre-Authorization is
necessary to avail of the cash free services in the hospitals. Although, in some hospitals
as per their norms, the insured person might need to pay a sum of deposit, which on
discharge will be reimbursed to them by the hospitals.

 The insured person to contact with the hospitals in advance; visit TPA website for
the latest list of hospitals.
 The insured person needs to fill the pre-authorization form at hospital’s TPA
helpdesk.
 The hospital fills the pre-authorization form with estimated expenditure,
complete medical details, line of treatment etc. with hospital’s authorized
person’s signature and hospital stamp.
 Pre-Authorization form to be sent to TPA by the hospital prior to admission into
the hospital.
 After due scrutiny of the medical case and taking into consideration terms,
conditions exclusion clauses, cover limits etc., once the insured person’s eligibility
is established, TPA will issue an Authorization Letter to hospital within 2 hours of
receiving of the complete documents from the hospital. The insured person needs
to approach the Reception Counter of the hospital with his/ her ID card on the
day of admission to the hospital. The Hospital/ Nursing Home will admit him/ her
and extend the credit facility up to the amount guaranteed by TPA subject to
availability of bed.
 The original documents will be retained by the hospital and sent to TPA within
7days of discharge. The insured person should also keep a copy of all documents.
 The patient or hospital has to check and sign the final hospital bills at the time of
discharge from the hospital.
 In case one chooses to get treated in a non-network hospital, no cashless facility
would by extended by TPA.

12.2 Reimbursement Facility: In case one chooses to get treated in a non-network hospital,
no cashless facility would by extended by TPA. However employee may settle the bill
and claim for the reimbursement as per eligibility.

 The insured person/ family to get admitted as per the rules of hospital and make
payments for the treatment taken.
 Pay the hospitalization bill.
 Employee within 30 days of discharge of patient to send across the list of relevant
documents in original along with completely filled claim form to Corpo Mediclaim
Helpdesk, A 10 Building, 4th floor, Alandi Road, Dighi, Pune – 411 015.
 On clearance, TPA would settle the claim reimbursement amount directly to the
employee’s bank account via NEFT within 15 days based on the details mentioned
in the blank cheque submitted by the employee along with the claim form

12.3 Checklist for submission of Claims:

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  Claim Form duly filled and signed
 All Hospital Bills/ Payment receipts in original
 Discharge Summary/ Card in original
 All investigation report in original
 Bills and receipt for investigation done outside the hospital in original
 Prescription, Pre hospitalization bills in original
 Bills of medicines and surgical appliances if purchased by employee in original
 Blank cheque required for claim settlement
 Copy of ID proof (voter’s ID, driving license or PAN Card) and address proof in
case the claim reimbursement amount is INR 1,00,000 or above

13.0 Policy Administration:

13.1 Group Mediclaim Insurance Policy will be coordinated on Pan India basis by the HR
Shared Services Team.

14.0 Process to obtain e-medical cards

 Logon to http://www.paramounttpa.com/tcom
 Enter your employee code as “User Name”
 Enter your date of birth in DD/MM/YYYY format as your “Password”
E.g. If your employee code is 37725 and date of birth is 14-Dec-1970, then:
User Name: 37725
Password: 14/12/1970
 Click on the submit button
 Select e-medical cards to print and click on the ‘Print’ button

15.0 General

15.0 You can access the following by logging onto www.paramounttpa.com/tcom.

 Claim forms
 Claim procedures
 Claim status
 Helpline numbers
 Cashless procedure
 List of Pan India network hospitals

16.0 Escalation Matrix

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 Please use the escalation matrix below for further support

Category Representing the TPA Representing Tata Communications

Mr. Pradeep Patil Mr. Rahul Chalke

corpomediclaim@tatacommunications.com Rahul.chalke@tatacommunications.com
Level 1
Ph: 020 – 6734 7726, IP: 517726 Ph : 020 6734 7701, IP 517701
Mobile : 8055109929 Mobile : 086579 98708

Dr. Vaibhav Patil Ms. Yasmeen

vaibhav.patil@paramounttpa.com Yasmeen@tatacommunications.com
Level 2
Ph: 020 – 6615 3541, IP: 513541 Ph : 044 66774183, IP 514183
Mobile : 08055739599 / 074988 88531 Mobile : 092822 30428

Mr. Vinayak Palav Mr. Sunny Achantani

Mobile : 7710041052 Sunny.achantani@tatacommunications.com
Level 3
Vinayak.Palav@paramounttpa.com Ph: 020 66153530, IP 513530
Manager Mobile: 08237004454

Ms. Roshni Ganjawala

Ph: 02266620875 – Mobile - 09323036115
Level 4
Roshni.Ganjawala@paramounttpa.com
AVP - CUSTOMER RELATIONS

*****

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