Universal Sompo General Insurance Company Ltd In House Claims Management- Overview

Over View In- house Claims setup Started In House Health Claim Management in the year 2015 Operation – Centralized Location – Noida Support – 365 days (9 AM to 9 PM) Cashless Management Claim Reimbursement Card Issuance Claim Payment- In house Claims Dedicated Team available from 9 AM to 9 PM 365 days Medical team for Cashless and Reimbursement claims Customer Care & Grievance Management Enrollment & Cards Investigation & Audit Dedicated Toll free Help line No – 24X7 365 days Robust Application for Health Policy Administration- HPAS

Demographic Pan India Presence- Network Hospitals - 3827 North Zone 1044 South Zone 1584 East Zone 336 West Zone 863

State wise- Network Hospitals No of Hospitals ANDHRA PRADESH 194 ASSAM 24 BIHAR 35 CHANDIGARH 13 CHHATTISGARH DELHI 179 GOA 6 GUJARAT 199 HARYANA 177 HIMACHAL PRADESH 7 JAMMU AND KASHMIR 3 JHARKHAND 26 KARNATAKA 448 KERALA 161 State No of Hospitals MADHYA PRADESH 106 MAHARASHTRA 528 MANIPUR 1 ODISHA 55 PONDICHERRY 8 PUNJAB 144 RAJASTHAN 153 TAMIL NADU 502 TELANGANA 271 TRIPURA 2 UTTAR PRADESH 329 UTTARAKHAND 39 WEST BENGAL 193

Service Overview Member Enrollment & Card Issuance Cashless Management Reimbursement Claims Customer Support Services Grievance Management Claims Payment Claims Audit & Investigation Provider Management MIS

Cashless Process Receive Fax document & Segregrate Attach Card No /Claim No Intimate Claim Update Cashless Request Form Cashless Process by doctor and recommened to Coommittee Committee takes final decision on case Issue Authrization Letter /Rejection letter /raise Query Inform Hospital thru Fax & Email Cashless case Close Hospital sends Original Claim dcoument for Payment

Claim Reimbursement Process Receipt of Claim Document from Insured and Hospital Capture Information in Inward Module and Segregate and tag document tpe Intimate the Claim and update claim form information Scanning of Documents Enter Hospital bills details Claim Process by Doctors and recommend for approval Claim approved /reject /raised query by committee Payment advice note send to accounts Amount paid to Insured /hoispital thru NEFT NEFT details updated in the system and mark claim as paid claim Claim file sent to Store for Storage.

Application Overview- HPAS In built Document Digitization module Fax Server/ Mail Server Inward & Outward Management Document Management System Integrated Alert Management for real time update Integrated with SMS Auto mailer Hospital Management through Application Tariff & Discount Update Facilities update Hospital Empanelment Process Integrated Policy Administration System Insured Policy enrollment and card issuance Addition and deletion of members Policy benefit Management

Application Overview- HPAS Contd.. Cashless & Claim Management Request through Fax/Mail / Inward & Outward Module Update through SMS & Email to Insured for claims update Integrated with Policy Benefits & Hospital Tariff Online Cashless & Claim document view Claim Payment Electronic Fund transfer for Claim payment Bank interface for claim payment Inward & Outward Document collection though Inward module Acknowledgement of Claim documents Dispatch of Claim documents through Outward Module

Support Services 24X7 365 Days Toll free Health Helpline Number : 1800 200 5142 Toll Free Fax Number : 1800 200 9134 Health Direct No : 022 -39635200 Single ID support for all queries related to Health Claims & Cards Single ID Support : Healthserve@universalsompo.com Auto mailer & SMS update at each stage to Insured Hospital Address details through SMS Real time update through SMS with link to download letter

Web Portal – Health Portal Web Portal for Real time access for - Claim Tracking & E-Card Employee Corporate HR Member Login Bank Partners Broker /Agents/Web Aggregator through IMD login USGI Branch Office Sales Manager

Claim Document Submission Universal Sompo General Insurance Co Ltd Health Department 5th Floor Assotech One, C-20/1 A, Block- C, Sector-62, Noida, Uttar Pradesh - 201309

Web Login Access Login Option User Type User ID Broker /Agent Broker HO IMD CODE Broker Branch Office SUB -IMD CODE Individual Agents Web Aggregators Bank Partners Bank HO Bank Branch Office Bank Branch Code Sales Manager Banca Assurance Executive Primary Manager Code USGIC Office USGICL Branch Office USGI Branch Code Member Individual Insured Health Serve Card Number Corporate Employee Employee Employee Code/Health Card No. Corporate Corporate HR Corporate Code

Features of Web Portal View & Download E-Card Track Claims Status View & Download Communication letters Claim Intimation Letter Cashless Authorization Letter Claims Query Letter Claims Settlement Letter Search Network Provider Download Forms Claim Form Cashless Request Form Electronic Fund transfer Form Reimbursement Claim Form Feed back form Cashless & Reimbursement Claims Process Contact Details

Service Standards Claims Settlement TAT 7 days Card Issuance Physical Card Issuance 7 days E Cards 24 hrs Customer Query response 24 hrs Claim Payment 48 hrs Cashless Authorization Response Time Fresh cashless request 60 mins Query reply cases 45 mins Discharge cases 60 mins

Value Added Services Fortnightly Claims MIS to Corporate Real time Web portal access to Corporate Single ID support for employees & HR for prompt response. Discounted Coupons for Employees Outbound call support to employees for Query Cases E -Card on SMS Corporate Guide Book Web portal Manuals for Employees & HR

Discounted Diagnostic Centre Network for USGI Cardholders Provider Name No Centers Discount offered SRL Limited 18 20% discount on routine Pathology & Radiology test Apollo Health& Lifestyle 56 • 10% discount on In House Diagnostics • 15% discount on Standard Health Check ups Express Clinic 30% discount on routine Pathology Tests Thyrocare PAN India Discounted Packages for USGICL Policy Holders

Key Differentiators Direct Connect with Insured’s- Reduce response time Faster Claim Settlement to Insured & Hospitals Direct payment to hospitals – better hospital discounts Robust Health Claims Application-minimize cost of operation & Improve Processing TAT 100% Digitization of claims documents Real time update on claims tracking through SMS and Auto mailer Link on SMS to download E-card & Communication letter Quality network of hospitals and diagnostic centers 100% electronic fund transfer for all payments

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