Group Health Insurance Cholamandalam MS General Insurance Co. Ltd.

Contents A. Policy Coverage B. Claim Process

A. Policy Coverage A.1 Policy Parameters A.2 Policy Benefits A.4 Maternity Benefit A.5 Other Benefits A.3 Customized Benefits

A.5 Other Benefits Pre – Hospitalization ExpensesExpenses related and incurred prior to 30 days from the date of hospitalization for which claim is admissible Post – Hospitalization ExpensesExpenses related and incurred after 60 days from the date of discharge for which claim is admissible Ambulance ServicesUpto 1% of the Sum Insured subject to maximum of Rs. 1000/- per person per policy Room RentSingle standard AC or Non AC room due to hospitalization for all Co PaymentN/A

B. Claim Process B.2 Claims Process & Network B.3 Claim Excellence - Health B.5 Customer Support B.6 Escalation Matrix B.4 Web Access & Mobile App B.7 Awards and Recognitions B.1 Organization Structure

CHOLA MS HELP – Claims Process “CHOLA MS HELP” is The brand name for the Health claims servicing team of CHOLA MS”

Experienced Medical team (8 doctors at HO & 3 doctors at RO) for cashless and reimbursement claims processing. More than claims handled for current financial year with a TAT of 7 days, promising the best TAT in the industry for claim adjudication. Cashless issuance TAT is maintained at less than 1 hour. Health claims processing on a workflow (CORDYS) facilitating transparency / stage-wise status at all points. Auto SMS & mailers to customer & web portal, mobile app updating the claim status at all the stages. Salient Feature of Chola MS HELP:

B. 2 Types of Claims 1.Cashless 2.Reimbursement 3.Pre & Post hospitalization claim 4.Daycare procedures

Cashless Claim 1) Fresh pre authorization request: Cashless access is possible only at Chola MS HELP network hospitals (Approximately 5200 in number). Please refer our website for updated list of network hospitals. Insured should approach the hospital insurance desk, with the health card issued by Chola MS HELP along with a valid photo ID proof. Hospital will send filled pre authorization request, copy of health card, valid photo ID proof and all necessary medical records (prior consultations, lab reports) through toll free FAX ( ) to Chola MS HELP. Cashless approval will be provided by Chola MS HELP with in 2 hours, if the claim is admissible under policy terms & conditions. Cont..

2) Query Process : In case of any deficiency of necessary documents, Chola MS HELP will raise a query to the hospital, within 2 hour of receipt of the cashless request. On receipt of the query response from the hospital, the same will be processed within 1 hour. 3) Enhancement Process: If the expenses of treatment exceeds the initial cashless approval, hospital will send enhancement request to Chola MS HELP along with the necessary documents (Bills and treatment summary) Enhancement request will be processed within 1 hour from the time of receipt of the necessary documents from the hospital

Reimbursement Claim All reimbursement claims should be intimated to Chola MS HELP immediately or before discharge from the hospital, through toll free number or at Reimbursement claim should be submitted with in 30 days from the date of discharge at any regional office of Chola MS or HO. Claims submitted at regional offices will be registered on the same day and forwarded to Chola MS head office for adjudication. Chola MS HELP team will scrutinize the claim and it will be settled within 30 days of receipt of the documents, if the claim documents are complete and claim is payable as per the policy terms and conditions. Cont..

Mandatory documents for claim: Claim form duly filled and signed. Hospital final bill along with payment receipt. Detailed discharge summary Medical bills along with supporting prescriptions. All investigation reports along with bills. Invoice or sticker for implants used in surgery. Copy of policy certificate / health card. Medico Legal Certificate (MLC) / FIR in case of road traffic accidents (RTA) AML documents for above 1 lac claims other than group health claims Note: All the above documents to be submitted in original Cont...

Query Process: In case of any deficiency of necessary documents, Chola MS HELP will raise a query to the insured / corporate, within 3 working days of receipt of the claim at HO. Query follow up will be done as mentioned below: 1 st Query letter – Day 1 Reminder letter – 15 th day after 1 st query Final reminder cum closure letter – 30 th day after 1 st query Claim will be closed on 45 th day in the absence of query response from the insured.

Pre & Post Claim: Pre & post hospitalization bills should be submitted within 30 days from the time of completion of the treatment or post hospitalization period defined in the policy, which ever is earlier. Claims is payable, if the main claim is admissible under the policy subject SI availability Daycare Procedures: No need for 24 hrs hospitalization for these procedures. Prior intimation and approval from Chola MS HELP is mandatory. Procedures defined under the policy only payable. Pre & Post and Day Care Procedures

15 We have empanelled nearly 1500 hospitals during the year and now have presence through our Network Hospitals across 750 towns with tie up of 5200 Hospitals for cashless claim servicing. We have identified and empanelled nearly 1200 Value added services, who are offering the best discounts on their services to Chola MS HELP customers. Network Hospitals & Value Added Services Health claims average settlement TAT is consistently maintained at around 7 days in the current FY. Average cashless approval TAT at Chola MS HELP is 45min which is one of the best TAT in the industry. Health Claims - TAT More than 95% of the health customers are found to be happy with our services on an independent feed back survey being done by our CRM team. Customer Feed back We have launched mobile app (wellness on the go) for retail customers last year and the same is extended to GH & OTC customer this month. We have conducted 450 free health camps in FY New Initiatives CORDYS workflow system for health claims is launched in Dec 14 which enables auto SMS, mailers at all stages of claim processing and also brings more process efficiencies and controls etc.. CORDYS Workflow B.3 Claims Excellence - Health

Ageing of OS Health Claims - Mar 16 Band Days Days Days Days DaysAbove 90 DaysGrand Total Claim Count % 74%12%5%4%2%3%100% Disposal Claims - Health Claims Band Days Days Days Days DaysAbove 60 DaysGrand Total Count (Mar 16) % (Mar 16) 69%27%3%1%0% 100% YTD (Mar 16) % (YTD Mar 16) 62%24%12%1%0% 100% 86% of the claims are settled within 15 days.

17 StateNo of CitiesNo of Hosp MAHARASHTRA83852 TAMIL NADU93614 KARNATAKA56423 GUJARAT53421 UTTAR PRADESH56381 TELANGANA21259 HARYANA35285 RAJASTHAN44267 KERALA81233 DELHI7222 PUNJAB36225 ANDHRA PRADESH34223 WEST BENGAL46188 MADHYA PRADESH19111 BIHAR2668 ODISHA1443 JHARKHAND837 UTTARAKHAND929 CHHATTISGARH626 ASSAM724 GOA1016 CHANDIGARH111 HIMACHAL PRADESH716 PUDUCHERRY113 JAMMU & KASHMIR27 DAMAN & DIU13 TRIPURA12 ANDAMAN11 ARUNACHALAPRADESH11 MANIPUR11 MEGHALAYA11 NAGALAND11 SIKKIM11 Grand Total

Online E-Cards and claims status on To access the E-cards and claims status follow the below mentioned Steps. Step 1 - Go To e-card Step 2 - Click on individual Login Icon Step 3 - Enter Policy Number Step 4 - Enter Employee ID as Login ID Step 5 - Enter Employee ID as Password Promise of complete transparency with necessary details available on Web B.4 Web Access

1)Download Procedure: Log on to website. Please click on Chola MS Wellness on the go app for downloading (down arrow) in to your mobile. Once you click on the app for downloading, it will ask you to enter your name and mobile number to download. Once the app is downloaded, Install the same in your mobile Note: This app has to be downloaded from the above mentioned URL only and it is not available in play store (Android app store). Cont…

2)Registration: After downloading and installation of the app, you have to register the same to login in to the app. Please enter the policy number followed by employee ID. Then it will prompt you to login through face book, google or with your own PIN opted. If you wish to login to through own PIN, you have to chose 6 digit PIN of your own choice, and alternatively you can login using your face book or google account. Note: You need to have GPRS facility in your mobile in order to access the above facilities except for My policy details, health card, storage of medical documents & BMI which works offline also. Cont…

Salient features of the app are as followed: Health Card on mobile Nearest Network hospitals details on google map Nearest Ambulance services details on google map Store Medical files and Pill reminder Value added services Nearest Services (Labs, Pharmacy and scan centre) BMI calculator Pedometer BP/Sugar reading /Trend My contact Contact Chola MS Care Policy details Cover Benefits Claim intimation

22 B.5 Customer Support Chola MS HELP line customer support operates 24/7 basis. Toll Free Phone No: Toll Free FAX No: Mail:

B.6 Escalation Matrix Reimbursement Claims EscalationNameContact Number Level 1Sathish G R044 - Level 2Dr Rajesh Kanna P044 - Level 3Dr Bharathi S044 Level 4Dr Madhusudan Rao K044 - Cashless Approvals EscalationNameContact Number Level 1FAX Health / Dr. Amuthone / / Level 2Dr Bharathi S044 - Level 3Dr Madhusudan Rao K044 -

B. 7 Awards and Recognitions Health Claims process at Chola MS HELP is now ISO 9001:2008 certified

“Health Insurer Claims Team of the Year for the year 2013”

Thank You