Comprehensive Employee Benefits Manual

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Employee Benefits Manual
 
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.
Group Medical Benefits
 
Employee Medical Plans
Employees
Parents
Plan
(Voluntary)
Employees
Top Up
(Voluntary)
Policy
Period
Insurance
Company
TPA
Sum
Insured
Type
Geographic
al Limits
01st October 2019 to 30th September 2020
The New India Assurance company
United Healthcare Parekh
Insurance TPA Private Limited
Family Floater
Employ
ee Base
Plan
India
 
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
Employee opting for a higher room
category will have to bear the
proportionate increase in cost on all
categories / heads
 
Employee Top-Up Plan
Voluntary – employee paid
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
 
Parents Base Plan – Voluntary
 
Medical Plan Coverages
*Employee has to submit
the declaration within 30
day from the Date of Birth
to ensure coverage under
the Group medical plan
No exceptions to the
timelines shall be possible
 
 
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 Hospitalization
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 of registered
medical practitioner as line of
treatment
****(Ambulance Charges : INR 3000
per case)
 
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
Oral
Chemotherapy
Maternity limit
enhanced to 75
k for C-Section
Physcratic
Treatment
Maternity
Coverage for
first three
children
Implication of 10% co-pay for all Parental admissible claim
Employee
Mediclaim
Plan
Parents
Mediclaim
(Voluntary)
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
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.
Inpatient
Treatment
Room rent
Doctors fees
Intensive
Care Unit
Nursing, blood,
oxygen,
operation
theatre charges,
surgical
appliances
Medicines,
drugs and
consumables
`
Diagnostic
procedures
(Related to
hospitalizatio
n)
Costs of
prosthetic
devices
(surgical
procedure)
Organ
transplantation
except costs
of the organ
Pre-existing
Diseases
Covered and
No waiting
period
applicable
Refer Additional
Information
Document on
the Intranet
 
Maternity benefits
 
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
2.
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
3.
In case of any query please connect with Anviti Team
INR 50,000 
for 
Normal
and 
INR 75,000 
C-
Section 
within Sum
Insured Limit covered
from day one
Maternity Limit 
Within maternity limit
Covered from day 1,
However need to
declare within 30 Days
from DOB
Pre and Post Natal
Expenses
New Born Baby
 
Your plan details -General exclusions
War
, War like operations (whether war be declared or not) or by nuclear
weapons / materials.
Exclusions
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.
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.
Exclusions
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
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.
Exclusions
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.
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
Admission in
Hospital - Pre-
Authorization
formalities to be
completed
within 24 hrs
Claim form
and
Checklist
attached
for
reference
and use
Planned
Hospitalizatio
n
Emergency
Hospitalizatio
n
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 the case is
Declined, Denial
Letter will be
issued to
hospital
If Any  additional
information is
required, TPA  will
inform the Hospital
/ Employee
Admission in
Hospital - Pre-
Authorization
formalities to be
completed
within 24 hrs
Claim form
and
Checklist
attached
for
reference
and use
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
Any
additional
information is
required, HAT
will inform the
Hospital /
Employee
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
 
Group Medical – Reimbursement
Claim Form
Hospital bills
Discharge Card
Letter for line of
treatment
Bill & Receipts
Investigations
*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
No exception to the submission
timelines shall be available
 
Medical Plan Timelines
Claims Submission
Timeframes
Claims Intimation
Timeframes
15  days from date of
discharge
Within 7 days of
admission
No extension on
above mentioned
timelines can be
considered
 
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
Benefit
 
Group Personal Accident Plan
 
Accidental Death :
Covered up to the full sum insured limit (“6.5” times of employee Annual Basic Salary)
Group Personal Accident Plan
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
 
Accidental Death :
Covered up to the full sum insured limit
Group Personal Accident Plan
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
 
Repatriation of remains -2% of SI max up to 2500
Other Benefits
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/-
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
 
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
Participation in an actual or attempted felony
, riot, crime, misdemeanor, (excluding
traffic violations) or civil commotion; or
Key
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);
Loss
 due to child birth or pregnancy (as not termed a “Personal Accident”).
 
Know your benefits
Group Term Life Insurance Scheme is meant to
provide life insurance protection to Ecolab & Nalco
employees  (only).
Group Term Life Benefits
 
Group Term Life Benefits
Group
Term Life
Plan
Policy
Period
Insurance
Company
Members
covered
Sum
Insured
Geographic
al Limits
01st April 2019 to 31st March 2020
Future Generalli Life Insurance Co.
Employee
5 times of Annual Basic Salary
24* 7 Worldwide
 
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)
Group Term Life Benefits
 
Making a Claim-Claim Procedure
& Claim Documents
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.
Claim Forms
Death
Certificate
Medical Cause
of Death
Certificate
Attested True
Copies of Indoor
case Papers of
the hospital(s)
Post-mortem
Report & Chemical
Viscera Report,
Beneficiary
ID,
Death (all
causes of death
#)   Critical
Illness and
Disability
Employer’s
Certificate,
Leave Records
for the past 3
years
All Police
Reports & Final
Investigation
Report
Proof of
Accident –
Panchnama /
Inquest
Report
Newspaper
cutting /
Photographs of
the accident –
if available
Death due to
Accident
 
Contact Details
 
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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.

  • Employee Benefits
  • Health Insurance
  • Medical Plans
  • Policy Coverage
  • Insurance Details

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  1. Employee Benefits Manual

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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/-

  24. 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 ).

  25. Group Term Life Benefits Know your benefits Group Term Life Insurance Scheme is meant to provide life insurance protection to Ecolab & Nalco employees (only).

  26. 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

  27. 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)

  28. 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.

  29. 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

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