Comprehensive Employee Benefits Manual
This Employee Benefits Manual covers Group Medical Benefits, Employee Medical Plans, Employee Base Plan, Employee Top-Up Plan, and Parents Base Plan. It includes details on coverage, policy periods, insurance companies, room rent limits, sum insured limits, members covered, age limits, co-payments, and important points for employees and their families. The manual provides a detailed overview of the various plans offered to ensure employees have access to comprehensive health insurance coverage.
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Group Medical Benefits Know your benefits Group Medical policy covers expenses incurred by the insured member(employee & family members covered) on account of hospitalization due to sickness or accident.
Employee Medical Plans 01st October 2019 to 30th September 2020 Policy Period Insurance Company The New India Assurance company Employ ee Base Plan Employees Top Up (Voluntary) United Healthcare Parekh Insurance TPA Private Limited TPA Employees Parents Plan (Voluntary) Sum Insured Type Family Floater Geographic al Limits India
Employee Base Plan Plan name Employee Base plan Room Rent: Normal- Tier 1 INR 7500, Tier 2 INR 5000, Tier 3 INR 4000 ICU- -Tier 1 INR 10000, Tier 2 INR 7500, Tier 3 INR 6000 Sum Insured Limits: INR 300,000 for Employee with parents INR 500,000 for Employees without parents Sum Insured Limits Employee opting for a higher room category will have to bear the proportionate increase in cost on all categories / heads Members Covered: Employee + Spouse + 3 Dependent Children Members Covered Age Limit: Dependent children covered up to age 25 Age Limit
Employee Top-Up Plan Plan name Employees Top-Up (Voluntary) Voluntary employee paid INR 2,00,000 Employee who has opted for parental cover get covered in Top Up Plan and the above option which remains unchanged for that fiscal / policy period Sum insured is enhanced i.e. base plan + Top up sum insured Except in case of capped ailments for rest all claims employee will have to pay the co-payment cost in case of Parents The Policy has 10% of Co-pay on admissible claim for Parents Plan Sum Insured Limits Members Covered Same as base plan Age Limit Same as base plan
Parents Base Plan Voluntary Plan name Parent / Parent in law - Base plan Sum Insured Limits: INR 200,000 , INR 3,00,000, INR 4,00,00 Per set of parents and Per set of Parent in law 10% co payment for all claims on admissible cost (except in capped or ailments having differential co-payment applicable) Room Rent: Normal Room Category was 1.5% of SI per day & ICU 2% of SI per day. Employee opting for a higher room category will have to bear the proportionate increase in cost on all categories / heads Important points : * No cross selection (anti selection) is allowed i.e. No coverage only for one parent or one parent in law The sum insured shown above cannot be transferred or used interchangeably i.e. Sum insured allocated to parents cannot be used for Parent in laws & vise versa Sum Insured Limits The parent / parent in law medical insurance base plan has lock in period where employees can neither add or opt out any enrolled member from the plan while in employment with Ecolab India except in case of death / legal separation of the enrolled member. The current lock in period ends September 2021. Employee who have their parents / parent in laws enrolled would be required to continue with their enrollments for tenure of lock in period and pay the premium during the lock in period at defined rate for each year (which may change year on year based on overall Parent policy claim ratios) The premium charged is per life/parent insured In case of death of any enrolled member, the employee will be eligible for refund of prorated premium. The refund shall not be applicable if there is any existing claim in the parent or parent in law policy for that policy period. Any and all taxes shall not be part of refund amount Members Covered Age Limit Up to 4 Members (2 Parents & 2 Parents in Law) Entry age up to 95 Years
Medical Plan Coverages Employee Base Mediclaim Plan Parents Mediclaim (Voluntary) *Employee has to submit the declaration within 30 day from the Date of Birth to ensure coverage under the Group medical plan Baby Covered* in Family Floater Sum Insured (From Day 1) Not Applicable Domiciliary Hospitalization Not Covered Not Covered No timelines shall be possible exceptions to the Cataract (Upto INR 24,000 per eye) (Upto INR 24,000 per eye) Internal Congenital Diseases Covered Covered Pre-hospitalization Expenses (Up to 30 days) (Up to 30 days) The above details are only snapshots of the benefits provided under your group medical plan. Please refer attached document for complete information on Coverage & exclusions or contact your Anviti focal.
Medical Plan Coverages *Although you are covered for post hospitalization claims for 60 days after discharge, you are expected to file all Post reimbursement claim with the TPA within 7 days of incurring the expense. ***Ayush treatment should in taken in govt. hospital, the patient should be treated for defined ailment and per prescription medical practitioner as line of treatment ****(Ambulance Charges : INR 3000 per case) Employee Base Mediclaim Plan Parents Mediclaim (Voluntary) Hospitalization Post-hospitalization Expenses* (Up to 60 days) (Up to 60 days) External Congenital Diseases (Only life- threatening conditions) Lasik Surgery** (Cover for number more than +/ -7.5) of registered Ayush*** (Up to 25% of Sum Insured) Oral Chemotherapy Ambulance Charges**** The above details are only snapshots of the benefits provided under your group medical plan. Please refer Policy document for complete information on Coverage & exclusions.
New Coverage Highlights Parents Mediclaim (Voluntary) Employee Mediclaim Plan Implication of 10% co-pay for all Parental admissible claim Maternity Coverage for first three children Maternity limit enhanced to 75 k for C-Section Oral Physcratic Treatment Chemotherapy Maternity Coverage for first three children Maternity Limit for C-Section Enhanced to INR 75,000 Physcratic Treatment Covered up to 30,000 for Employee Only -5 Cases , the claim will be settled on first come first basis if there are more then 5 cases reported
Group Medical Plan General inclusions Refer Additional Information Document on the Intranet Nursing, blood, oxygen, operation theatre charges, surgical appliances Intensive Care Unit Inpatient Treatment Doctors fees Room rent Pre-existing Diseases Covered and No waiting period applicable Costs of prosthetic devices (surgical procedure) Diagnostic procedures (Related to hospitalizatio n) Organ Medicines, drugs and consumables ` transplantation except costs of the organ Expenses that are of a diagnostic nature only or are incurred from a preventive perspective with no active line of treatment and do not warrant a hospitalization admission are not covered under the plan.
Maternity benefits INR 50,000 for Normal and INR 75,000 C- Section within Sum Insured Limit covered from day one Within maternity limit Covered from day 1, However need to declare within 30 Days from DOB Maternity Limit New Born Baby Pre and Post Natal Expenses Note: 1. Please submit your maternity reimbursement claim within 15 days from the date of discharge even though you are on maternity leave. Delay in claim submission may result into the denial of claim Please share New Born Baby details for addition with the Anviti Team or update the same on Anviti Portal (by raising a ticket) to have hassle free hospitalization for New Born Baby in case of any complications In case of any query please connect with Anviti Team 2. 3.
Your plan details -General exclusions War, War like operations (whether war be declared or not) or by nuclear weapons / materials. Surgery for correction of eye sight, cost of spectacles, contact lenses, hearing aids etc. Any dental treatment or surgery unless arising from disease or injury and which requires hospitalization for treatment. Congenital external diseases or defects or anomalies, sterility, any fertility, sub-fertility or assisted conception procedure, venereal diseases, intentional self-injury/suicide, all psychiatric and psychosomatic disorders and diseases / accident due to and or use, misuse or abuse of drugs / alcohol or use of intoxicating substances or such abuse or addiction etc. Any cosmetic or plastic surgery except for correction of injury Expenses incurred at Hospital or Nursing Home primarily for evaluation / diagnostic purposes which is not followed by active treatment for the ailment during the hospitalized period. Exclusions Expenses on vitamins and tonics etc. unless forming part of treatment for injury or disease as certified by the attending physician. Miscarriage, abortion or complications of any of these including changes in chronic condition as a result of pregnancy except where covered under the maternity section of benefits.
Your plan details -General exclusions Doctor s home visit charges, Attendant / Nursing charges during pre and post hospitalization period. Naturopathy treatment, unproven procedure or treatment, experimental or alternative medicine External and or durable Medical / Non medical equipment of any kind used for diagnosis All non medical expenses including Personal comfort and convenience Exclusions Change of treatment from one pathy to other pathy unless being agreed / allowed and recommended by the consultant under whom the treatment is taken. Treatment of obesity or condition arising therefrom (including morbid obesity) and any other weight control program, services or supplies etc.. Any treatment required arising from Insured s participation in any hazardous activity Any treatment received in convalescent home, convalescent hospital, health hydro, nature care clinic or similar establishments. Any stay in the hospital for any domestic reason or where no active regular treatment is given
Your plan details -General exclusions Hormone replacement therapy, Sex change or treatment which results from or is in any way related to sex change. Outpatient Diagnostic, Medical or Surgical procedures or treatments, non-prescribed drugs and medical supplies, lab tests Expenses incurred for investigation or treatment irrelevant to the diseases diagnosed during hospitalization or primary reasons for admission. Private nursing charges, Referral fee to family doctors, Out station consultants / Surgeons' fees etc. Vitamins and tonics unless used for treatment of injury or disease Infertility treatment, Intentional self Injury, Outpatient treatment. Exclusions Family planning Operations (Vasectomy or tubectomy) etc. All expenses arising out of any condition directly or indirectly caused by or associated with Human T-cell Lymphotropic Virus Type III (HTLD - III) or Lymohadinopathy Associated Virus (LAV) or the Mutants Derivative or Variations Deficiency Syndrome or any Syndrome or condition of similar kind commonly referred to as AIDS, HIV and its complications including sexually transmitted diseases. External and or durable Medical / Nonmedical equipment of any kind used for diagnosis and or treatment like Prosthetics etc. Lasik treatment or any other procedure for correction/enhancement of vision is not covered (only covered if the number is > +/ -7.5) Any device/instrument/machine that does not become part of the human anatomy/body but would contribute/replace the function of an organ is not covered. Warranted that treatments on trial/experimental basis are not covered under scope of the policy.
Process for cashless claims submission Approach hospital s Insurance/ TPA Desk 48 hrs. prior to admission with Health Card Fax Pre- Authorization to Cashless Department of Mediassist for Approval Post document verification will issue authorization letter to hospital within 3 hours If Any additional information is required, TPA will inform the Hospital / Employee If the case is Declined, Denial Letter will be issued to hospital Planned Hospitalizatio n Admission in Hospital - Pre- Authorization formalities to be completed within 24 hrs completed within 24 hrs Claim form and Checklist attached for reference and use reference and use Any Admission in Hospital - Pre- Authorization formalities to be Post document verification HAT will issue authorization letter to hospital within 3 hours If the case is Declined, Denial Letter will be issued to hospital Claim form and Checklist attached for additional information is required, HAT will inform the Hospital / Employee Emergency Hospitalizatio n Employee going to the Network Hospital would not go for reimbursement , always use Cashless. In case employee go for reimbursement claim in Network Hospital , the claim will be settled as per the Insurance Company Tariff with Hospital, the employee will born all the charges over and above the Insurance Company Tariff.
Group Medical Reimbursement Collects all original documents, receipts and investigation reports from Hospital Insured visits non network hospital for treatment Takes discharge , pays for treatment Incase additional information is required, TPA will inform the employee via email with reminders, If documents are not submitted within 15 days, claim may be closed/ declined Submits all original Hospital documents along with filled claim form & cancelled cheque within 15 days from date of discharge TPA acknowledges receipt of claim documents via email and commences claim process Online Claim Status (Cashless/ Reimbursement) can be viewed on: If claim is payable, payment will be made to employee via NEFT If claim is declined, denial mail will be sent. TPA Website
Group Medical Reimbursement Investigations Follow-up advice or letter for line of treatment after discharge from hospital, from Doctor.) Bill & Receipts Original reports/ attested copies for Medicines, Investigations along with Doctors prescription in Original and Laboratory Discharge Card Attending doctors bills and receipts and certificate regarding diagnosis (if separate from hospital bill) Hospital bills Letter for line of treatment Original Discharge Card Claim Form Main Hospital bills (with bill no; signed and stamped by the hospital) with all charges itemized and the original receipts *Employee has to submit the declaration within 30 days from the Date of Birth to HR to ensure coverage of new born under Group Medical Insurance plan Signed Claim form (KYC form is mandatory for claims above INR 100,000) No exception to the submission timelines shall be available
Medical Plan Timelines Claims Submission Timeframes 15 days from date of discharge No extension on above mentioned timelines can be considered Claims Intimation Timeframes Within 7 days of admission
Group Personal Accident Benefit Know your benefits Group Personal Accident policy covers expenses insured by the enrolled member (employee only coverage) on account of death or permanent / temporary, total or partial disability due to an accident
Group Personal Accident Plan 01st October 2019 to 30th September 2020 Policy Period Insurance Company The New India Assurance company Group Personal Accident Plan Employee Members covered Sum Insured 6.5 times of Annual Basic Salary Geographic al Limits 24* 7 Worldwide
Group Personal Accident Plan Accidental Death : Covered up to the full sum insured limit ( 6.5 times of employee Annual Basic Salary) Permanent Total Disablement: Covered up to the full sum insured limit Permanent Partial Disablement: Covered up to a specified percentage of the full sum insured limit Temporary Total Disablement (Weekly Benefit): TTD is paid for maximum 100 weeks 1% of Comprehensive Sum Insured or INR 10,000 per week or actual salary whichever is less Medical Expenses: Medical expenses with a limit of 20% of CSI or 40% of admissible claims amount or actual whichever is lower
Group Personal Accident Plan Accidental Death : Covered up to the full sum insured limit Permanent Total Disablement: Covered up to the full sum insured limit Permanent Partial Disablement: Covered up to a specified percentage of the full sum insured limit Temporary Total Disablement (Weekly Benefit): TTD is paid for maximum 104 weeks for BPO entity and 100 weeks for other entities , limited to 1% of Comprehensive Sum Insured or INR 100,000 per week whichever is less Medical Expenses: Reimbursement up to INR. 20,000/- per incidence both on OPD and IPD basis irrespective of disability claims
Other Benefits Repatriation of remains -2% of SI max up to 2500 Don t forget to nominate you re immediate family members, as policy Nominee Claims are payable to nominees only, You can submit the same to your HR Family Transportation Limit 10% of Total SI subject to max up to Rs. 50,000 Funeral Charges 1% of SI subject to max 10,000 Transportation (Repatriation) cost up to INR 25,000 including family transportation for 2 members (within transportation limit) Children Education Bonus (CEB) paid is maximum INR 15,000/- per child for maximum 2 children below age of 19 years, applicable in the event of an admissible Accidental Death claim. "Beneficiary will be employee". Ambulance in case of Emergency: Up to INR 2,500/-
Your Plan Details-Key Exclusions Suicide, attempted suicide (whether sane or insane) or intentionally self-inflicted Injury or illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS), Human Immune-deficiency Virus (HIV) infection; or Being under the influence of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a Physician and taken as prescribed; or Key Participation in an actual or attempted felony, riot, crime, misdemeanor, (excluding traffic violations) or civil commotion; or Exclusions Operating or learning to operate any aircraft, or performing duties as a member of the crew on any aircraft; or Scheduled Aircraft.; or Self exposure to needless peril (except in an attempt to save human life); Lossdue to child birth or pregnancy (as not termed a Personal Accident ).
Group Term Life Benefits Know your benefits Group Term Life Insurance Scheme is meant to provide life insurance protection to Ecolab & Nalco employees (only).
Group Term Life Benefits 01st April 2019 to 31st March 2020 Policy Period Insurance Company Future Generalli Life Insurance Co. Group Term Life Plan Employee Members covered Sum Insured 5 times of Annual Basic Salary Geographic al Limits 24* 7 Worldwide
Group Term Life Benefits Death Cover: Natural or Accidental death is covered under this Plan Mid Term enrollment of New Joiners: Allowed Mid-Term revision of sum insured: Allowed(Due to change in employee s compensation)
Making a Claim-Claim Procedure & Claim Documents Employer s Certificate, Leave Records for the past 3 years Death (all causes of death #) Critical Illness and Disability Post-mortem Report & Chemical Viscera Report, Beneficiary ID, Attested True Copies of Indoor case Papers of the hospital(s) Medical Cause of Death Certificate Death Certificate Claim Forms Proof of Accident Panchnama / Inquest Report All Police Reports & Final Investigation Report Newspaper cutting / Photographs of the accident if available Death due to Accident The above is an indicative list of documents and the insurer reserves the right to ask for additional proofs & documents in support of the claim. Policyholder shall inform the insurance company / Anviti of any claim within 30 days of the claim event.
Contact Details Cashless and Reimbursement Caims For GMC 9860649091 1st Escalation Point-Yogesh Jadhav jadhav.yogesh@uhcpindia.com 9167770474 2nd Escalation Point-Sanoj Kumar Pal sanojkumar.pal@uhcpindia.com 8623016933 3rd Escalation Point Gorakh Shah gorakh.shah@Anviti.com For Group Accident & Life Insurance Plan 8623016933 SPOC - Gorakh Shah gorakh.shah@Anviti.com
