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Reference No: HRI/110/1.

Mediclaim Policy- INHOUSE

Mediclaim Policy - INHOUSE


Last Updated: 26th July 2011

Objective
The objective of the Mediclaim Policy is to provide the proper guidelines for the smooth knowledge transfer and settlement in any event of hospitalisation.

Scope:
This policy explains the eligibility and process to avail the Mediclaim facility. It provides the reimbursement of hospitalisation/ domiciliary hospitalisation expenses for illness/diseases suffered or accidental injuries sustained during the policy period.

Eligibility:
Employees are eligible to include maximum of 3 dependants, who can be spouse, child, dependent parents or in-laws (combination of parents and in-laws are not allowed) along with himself/ herself in the Mediclaim Insurance. All the employees and their dependents, who are covered under the Mediclaim insurance and have been hospitalised for more than 24 hours during the policy period, can claim the Mediclaim insurance.

Procedure:
All the covered employees are provided with the Mediclaim insurance cash less card, which they can show to the hospital covered under the list of network hospitals to avail the cash-less facility during the hospitalisation. In case wherein the employee or his/ her dependant has been hospitalised in the hospital, which is not covered in the list of network-hospitals, he / she can fill the hospitalisation claim form for the reimbursement of hospitalisation expenses. The employee has to inform about the name of the hospital and the name of the patient to HR Dept. immediately. After the discharge of the patient, the employee has to submit the hospitalisation form along with the discharge summary, reports and bills of the medicine to HR Department within one-month. The payment against the claim would be remitted to the Bank Account of the employee only after Artech receives the amount from the Insurance Company. Insurer National Insurance Co. Ltd Policy Period - 26th July, 2011 to 25th July, 2012 Third Party Administrator (TPA) Medi Assist India Pvt. Ltd

Artech Infosystems Pvt. Ltd

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Reference No: HRI/110/1.5 Procedure to generate ID card

Mediclaim Policy- INHOUSE

URL: https://www.mediassistindia.com/Login.aspx?LoginTypeID=3 Use following ID & Password and Enter: Login ID: artechinfo Password: artechinfo Click on Beneficiary Search In next screen Select policy number from drop down button and Search Beneficiary with Employee Code and on display of employees details click on Ecard to view and print, if necessary. Procedure to view claims status URL: https://www.mediassistindia.com/Login.aspx?LoginTypeID=3 Use following ID & Password and Enter: Login ID: artechinfo Password: artechinfo Click on Claim Search In next screen Select policy number from drop down button and Search Beneficiary with either with claim number, Employee Code or MediAssist ID Number. Contact Details: Toll Free No. Point of contact: Leena 1800-425-9449 9886109579 leenad@mediassistindia.com You need to give the employee and the company name as Artech You need to give the employee and the company name as Artech

Responsibilities:
S. No. 1 2 3 4 5 Activity Identify the insurance institution and policy Facilitating and administrating individual employee claims Providing information prior to hospitalisation, treatment, consultation etc. Claims submission providing Medi-assist with relevant paper work, documents etc to make claims Claims administration, liaising with the insurance co etc. for claim reimbursements Page 2 of 7 Responsibility HR HR & Mediassist HR HR HR / Admin

Artech Infosystems Pvt. Ltd

Reference No: HRI/110/1.5

Mediclaim Policy- INHOUSE

Salient Features:
Cashless Hospitalisation. Hospital is any institution with more than 15 inpatient beds, with a fully equipped operation theatre, fully qualified nurses and fully qualified medical practitioners available round the clock. The sum insured for each family can be Rs. 1 Lac, Rs. 1.5 Lacs, Rs. 3 Lacs and Rs. 4 Lacs depending on the employees designation. A floater / umbrella cover is provided to each family unit for the total sum insured. The systems of Allopathy, Ayurveda, Homeopathy and Unani are generally covered by Health Insurance, subject, however to the terms and conditions of the policy. Pre-existing diseases are covered. First Year exclusions along with 30 days waiting period are waived. Midterm inclusion of dependents allowed only in case of spouse (on account of marriage) and children (childbirth during policy period). The minimum requirement to claim the Mediclaim Insurance is 24 hours stay in hospital except for certain specific treatments as Dialysis, Chemotherapy, Radiotherapy, Eye surgery, Lithotropsy, Tonsillectomy, anti-rabies vaccination, Hysterectomy, Appendectomy, Coronary Angiography, Dental surgery following an accident, piles/fistula, Prostate, Eye surgery, Fracture/dislocation excl Hairline, Sinusitis, Gastrointestinal Tract system, Stone in Gall Bladder, Pancreas and Bile duct, Tonsilletomy, Haemo-Dialysis, Tonsillectomy, Hydrocele, Urinary Tract System., The medical expenses would include hospital / nursing home charges / nursing expense, surgeon anaesthetist, consultant fees and cost of blood, oxygen, operation charges, medicines, diagnostic expenses, artificial implants on organs and similar expenses. Maternity benefit would be given to the employees with cap on normal as Rs.30,000/- and for caesarean Rs.50,000/-. Maternity benefit would be given to the people who are enrolled with the policy since beginning (from 26th July11) and nine months should have been completed since the enrolment in the Mediclaim Insurance. However, the maternity benefit cannot be availed for the 3rd child. Child Cover from Day 1 subject to declaration. Medical expenses incurred 30 days prior and post 60 days, after the hospitalisation is considered as part of claim, except for Maternity. Room Rent is restricted to 1% of the total sum insured and no limits if admitted to ICU. Maximum Entry Age limit is 80 years.

Sum Insured 1 lac 1.5 lacs 3 lacs 4 lacs

Monthly Premium amount (with dependents) Rs 175 /Rs 300 /Rs 500 /Rs 600 /-

Monthly Premium amount (without dependents) Rs 150 /Rs 300 /Rs 500 /Rs 600 /-

Artech Infosystems Pvt. Ltd

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Reference No: HRI/110/1.5

Mediclaim Policy- INHOUSE

Expenses Covered
Hospital / Nursing home charges would be covered Nursing expenses, operation charges, diagnostic expenses & similar expenses would be covered. Surgeon, anaesthetist, consultant fees, cost of blood, oxygen, artificial implantation of organs medicines would be covered.

Expenses Not Covered


Domiciliary Hospitalisation Voluntary medical termination of pregnancy during the first 12 weeks from the date of conception would not be covered. There is no Dental Coverage except in case of a Road traffic accident, which warrants hospitalization & requires surgeries under general anesthesia. Cost of Spectacles, Hearing Aids, crutches or any external implants. Investigation, evaluation & observation will not be admissible, even if hospitalization is for more than 24 hrs like expenses incurred at the Hospital or Nursing Home primarily for diagnostic, X-Ray or laboratory examinations or other diagnostic studies not consistent with the positive existence or Presence of any ailment, sickness or injury for which confinement is required at a Hospital / Nursing home would not be covered. Any treatment which can be done on OPD Basis will not be covered. Exceptions are Dialysis, Chemotherapy, Cataract, Radiotherapy, Lithotripsy etc. Vaccinations are not covered. Expenses on Convalescence, general debility, run-down condition, congenital external disease or defects, sterility, venereal disease, intentional self-injury and use of intoxicating drugs / alcohol would not be covered. Circumstances unless necessary for treatment of disease not excluded here under or as may be necessitated due to an accident, vacation, or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to accident or as part of any illness would not be covered. Accident related to Drink & Drive cases are not covered. Expenses on Vitamins and Tonics not forming part of injury /diseases would not be covered. Expenses on various conditions commonly referred to as AIDS would not be covered. Expenses on naturopathy treatment would not be covered. Expenses on HIV treatment would not be covered. Injury or disease directly or indirectly caused by or arising from or attributable to War invasion, Act of foreign Enemy warlike operations would not be covered. Total claim exceeding the sum insured is not payable.

Related Forms:
Hospitalization Claim Form is enclosed in Annexure A.

Artech Infosystems Pvt. Ltd

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Reference No: HRI/110/1.5

Mediclaim Policy- INHOUSE

Recommended by:

(Manager Human Resources)

Approved by:

(Sr. Vice President & Country Head)

Contact Us:
Artech Infosystems Pvt Ltd (Formerly Softek Pvt Ltd), A - 4 & 5, 2nd Floor, Logix Park, Sector - 16, Noida 201301, Ph: +91-120-40 33333, Fax: +91-120-251 7165

Artech Infosystems Pvt. Ltd

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Reference No: HRI/110/1.5

Mediclaim Policy- INHOUSE

Annexure A
HOSPITALIZATION CLAIM FORM FOR REIMBURSMENT

Issuance of This Form Does Not Amount To Admission of Any Liability under the Claim On The Part Of the Insurers Please Give The Following Information Correctly & Completely (To Be Filled In Block Letters)
CLAIM CONTROL NO: ____________________ 1. NAME OF INSURED: ____________________________________________ 2. POLICY NO: ________________________________________ 3. DETAIL OF THE CLAIMANT: (in respect of whom the claim is made) a. Name of claimant: ________________________________________ b. Relationship with insured: __________________________________ c. Present age: ________________________________ 4. a) Nature of Disease/Illness contracted or injury suffered: _______________________ __________________________________________________________________________ b) Date of Injury, or Disease/Aliment contracted/Detected, for which the expenses are Claimed hereby i) When 1st detected: ______________________________ ii) When Cured: __________________________________ iii) If not Cured, give complete history__________________________________________________________________________ _______________________________________________________________________________ ______________________________ 5. Name & Address of the hospital/Nursing Home/Clinic admitted to i) Date & Time of admission: ______________________________ ii) Date & Time of discharge: ______________________________ 6. Total Amount Claimed: ____________________________________ I have on the treatment of Disease/Illness/Injury referred to above. In support of the above claim, I enclose the following documents: (Please tick the followings) a. Discharge Summary of the Hospital/Nursing Home b. Cash Memo/Bills supported by proper prescriptions c. Receipt, Pathological tests reports supported with prescriptions. d. Hospital Bill with receipt of payment. e. Breakup of each heads of hospital bill. f. Any other detail/documents which substantiate the claim g. Hospital Declaration Form (Over leaf to be filled by the hospital) I hereby warrant the truth of the foregoing particulars in every respect & I agree that if I have made or shall make any false or untrue statement or concealment may right to claim reimbursement of the expenses shall be absolutely forfeited. I further declare that in respect of the above treatment no benefits are admissible under any other medical scheme or insurance. Signature of Insured Signature of claimant

Artech Infosystems Pvt. Ltd

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Reference No: HRI/110/1.5

Mediclaim Policy- INHOUSE

(TO BE FILLED BY THE HOSPITAL/NURSING HOME/CLINIC AUTHORITY) This is to certify that ____________________________________________________________

CERTIFICATE

was admitted under my treatment from ___________at ________to__________at ______and detail information is as under: 1. Name of Hospital/Nursing Home_____________________________________________ 2. Whether the same is registered with the local authority or not_______________________ 3. If so, Registration No___________________________________ 4. If not answer the following queries: A. No of inpatient beds in the Hospital/Nursing Home: ____________________ B. Whether you have fully equipped operation theatre of your own: C. Whether you have fully qualified Nursing Staff in your employment round the clock: D. Whether you have qualified Doctor in Charge round the clock 5. Date/ Time of Admission_________________________________________ 6. Date/Time of Discharge__________________________________________ 7. History of present illness with duration of the presenting complaints: (a). What is the exact nature of complaint with which the patient first presented(seen)________________________________________ Yes/No Yes/No Yes/No

(b). since how long he/she has been suffering for the same.____________________________________________________________ 8. Past History of the disease__________________________________________________

Signature of Doctor OR Hospital Authorities (Seal of Hospital)

Artech Infosystems Pvt. Ltd

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