TOTAL OUTSOURCE INDIA PVT LTD GMC POLICY no.

604200/46/10/8500000031

Presentation on Health Benefits Plan 2010-11

Index

Service Providers & Roles Policy Highlights

Standard Exclusions Basic Health Plan Services

Modality Important Contact Numbers
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Health Insurance is for common good, use it judiciously

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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Health Insurance is for common good, use it judiciously

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 babys birth 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

Health Insurance is for common good, use it judiciously

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.

Health Insurance is for common good, use it judiciously

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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Health Insurance is for common good, use it judiciously

Standard Exclusions
Expenses 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
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-Nov1969, 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 HOSPITAL If 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 within 24 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 the hospital & 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 Reimbursement Claims

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 of Post 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

Contact Person Manjula R Vanitha Role For Enrollment & queries Cashless Coordinator Voice Contact Details + 91 97390 10123 +91 97422 46961 Responsibility All India All India

Manjunatha

Claims Executive

+91 98864 98076

All India

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Thank You

Health Insurance is for common good, use it judiciously

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