Medical Benefits Next 05 May 2018
Medical Benefit Coverage Details - Team Members Non-Cashless Coverage Details – Parents Claims Document List Limits & Eligibility- Team Member Benefits Extensions – Definitions Limits & Eligibility- Parents General Exclusions Enrollment in the program-Team Members Top-Up Plan Enrollment in the program Parents Claim Optimization Retrieving e-Card GMC Contact Details Cashless Process FAQ’s 05 May 2018
Medical Benefit- Team Member – Coverage Details Policy Parameter Insurer Reliance General Insurance Co. Ltd. TPA FHPL TPA Pvt. Ltd. Policy Start Date 1st April 2015 Policy End Date 31st March 2016 Coverage Type Floater Dependent Coverage Team Member + Spouse + Children (max 2 children) Sum Insured INR 300,000 Benefits / Extensions Coverage Standard Hospitalization Yes TPA services Pre existing diseases Covered From Day 1 Waiver on 1st year exclusion Waiver on 30 days excl. Maternity benefits Pre & Post Natal Expenses Limits & Eligibility Benefits / Extensions Coverage Baby cover day 1 Yes Ambulance Services Day Care Domiciliary Hospitalization No Dental Restrictive Vision Pre-Post Hospitalization Exp. Team Member contribution of premium Parents Coverage Next 05 May 2018
Medical Benefit Parents– Coverage Details Policy Parameter Insurer Reliance General Insurance Co. Ltd. TPA FHPL TPA Pvt. Ltd. Policy Start Date 1st April 2015 Policy End Date 31st March 2016 Coverage Type Floater Sum Insured Dependent Coverage Optional – (any two) – Parents (Father / Mother) OR Parent in Laws (Father in Law / Mother in law) Sum Insured INR 200,000 per family Benefits / Extensions Coverage Standard Hospitalization Yes TPA services Pre existing diseases Covered from Day 1 Waiver on 1st year exclusion Waiver on 1st 30 days excl. Ambulance Services Limits & Restrictions Benefits / Extensions Coverage Day Care Yes Domiciliary Hospitalization No Dental Restrictive Vision Pre-Post Hospitalization Exp. Team Member Contribution of premium Please Note: Parental cover is optional and the 20% of the premium cost has to be borne by the Team Member. The cost as mentioned in the following slides would be deducted from the salary of the Team Member. Next 05 May 2018
Medical Benefit – Dependent Coverage Team Member Policy Maximum no of Members insured in a family 1 + 3 Team Member Yes Spouse Children Yes (for the first 2 living Children) till the age of 21 Siblings No Others Mid Term enrollment of existing Dependents Disallowed Mid Term enrollment of New Joinees (New Team Members +their Dependents) Allowed Mid term enrollment of new dependents (Spouse/Children) Parents Policy Maximum no of Members insured in a family 1 + 1 Parents Optional Entry age restricted to 85 years Parents-in-Law Optional age restricted to 85 years Siblings No Others Mid Term enrollment of existing Dependents Disallowed Mid Term enrollment of New Joinees (Dependents) Allowed Next 05 May 2018
Medical Benefit – Policy Period Existing Team Members + Dependents Commencement Date 1st April 2015 Termination Date 31st March 2016 New Joinees + Dependents Date of joining New Dependents (due to Marriage / Birth) Date of such event** *Dependent coverage for all new joiners would be subject to the declaration made in enrolment portal. In case the one has not been enrolled the cover would be extended in subsequent renewal post March 2016 only. Enrolment details ** Declarations for new additions in the family to be made in prescribed format within 30 days of the event . Failing which the cover would be extended in subsequent renewal post March 2016 only. Next 05 May 2018
Medical Benefit – Coverage Levels Sum Insured – Team Members Floater Team Member Fixed Sum Insured of INR 300,000 per Family Dependents Restrictions on sum insured Not Applicable Applicable Sum Insured- Parents Individual Parent Member Sum Insured of INR 200,000 per family (2 parents or 2 in-laws or a combination restricted to 2 individuals) Restrictions on sum insured Applicable Dependents Next 05 May 2018
Medical Benefit – Standard Coverage Covers expenses related to Room and boarding Doctors fees Intensive Care Unit Nursing expenses Surgical fees, operating theatre, anesthesia and oxygen and their administration Physical therapy Drugs and medicines consumed on the premises Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests) Dressing, ordinary splints and plaster casts Costs of prosthetic devices if implanted during a surgical procedure Radiotherapy and chemotherapy OPD / Domiciliary coverage of Cancer and Dialysis (CKD) Oral Chemotherapy A) The expenses are payable provided they are incurred in India and within the policy period. Expenses will be reimbursed to the covered member depending on the level of cover that he/she is entitled to. B) Expenses on Hospitalisation for minimum period of 24 hours are admissible. However this time limit will not apply for specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye & Dental Surgery (due to accident), Lithotripsy (kidney stone removal), Tonsillectomy, D & C taken in the Hospital/Nursing home and the insured is discharged on the same day of the treatment will be considered to be taken under Hospitalisation Benefit. Next 05 May 2018
Pre & Post Hospitalization Expenses Pre-hospitalisation Expenses Definition If the Insured member is diagnosed with an Illness which results in his / her Hospitalization and for which the Insurer accepts a claim, the Insurer will also reimburse the Insured Member’s Pre-hospitalisation Expenses for up to 30 days prior to his / her Hospitalization. Covered Yes Duration 30 Days Post-hospitalisation Expenses Definition If the Insurer accepts a claim under Hospitalization and immediately following the Insured Member’s discharge, further medical treatment directly related to the same condition for which the Insured Member was Hospitalized is required, the Insurer will reimburse the Insured member’s Post-hospitalisation Expenses for up to 60 day period. Covered Yes Duration 60 Days Next 05 May 2018
Maternity Benefits Next Benefit Details Benefit Amount INR 50,000 for Normal Delivery INR 50,000 for C section (Cesarean) Delivery Restriction on no of children Maximum of 2 living children 9 Months waiting period Waived off These benefits are admissible in case of hospitalisation in India. The baby is covered from Day 1 for any treatment within the family floater, subject to the intimation to the insurance company through the Insurance desk/HR within 30 days of the birth. The expenses incurred on account of Vaccinations, baby check up and other well baby charges will not be covered in the Policy Covers for first two children only. Those who already have two or more living children will not be eligible for this benefit. Expenses incurred in connection with voluntary medical termination of pregnancy during the first 12 weeks from the date of conception are not covered. Next 05 May 2018
Limits & Eligibility – Team Member Policy Room Rent eligibility up to 1% of sum insured - INR 3000 per day for normal non ICU admission 2% of sum insured – INR 6000 per day for ICU & CCU. In event of a member opting for a higher category/ room rent – escalation cost of all other expense due to the room upgrade would be borne by the member covered. Explanation: The cost of treatment (consultation, procedure charges etc) are directly related to the category of room Example 1- Member opts for a room which is INR 6000 per day. This is two times the eligibility. The actual escalation in cost is not determined. Hence only 50% of the admissible claim would be paid. Example 2- Member opts for a room which is INR 7000 per day. This is more than two times the eligibility. The actual escalation in cost of treatment is determined and the difference is borne by the insured. Room rent to includes nursing charges Maternity INR 50,000 for normal delivery INR 50,000 for C Section (Caesarean) delivery Any further expense have to borne by the insured / claimant. Ailment capping – No Ailment caps Next 05 May 2018
Limits & Eligibility – Parents Policy Room Rent eligibility up to 1.5 % of sum insured – INR 3000 per day for normal Non ICU admission 3% of sum insured- INR 6000 per day for ICU & CCU In event of a member opting for a higher category/ room rent – escalation cost of all other expense due to the room upgrade would be borne by the insured / member covered. Explanation: The cost of treatment (consultation, procedure charges etc) are directly related to the category of room Example 1- Member opts for a room which is INR 6000 per day. This is two times the eligibility. The actual escalation in cost is not determined. Hence only 50% of the admissible claim would be paid Example 2- Member opts for a room which is INR 6000 per day. This is two times the eligibility. The actual escalation in cost is determined and is the difference is borne by the insured Room rent to includes nursing charges Ailment Capping Cataract - INR 27,000 per eye Please confirm if the 3lac category to be mentioned ?? Next 05 May 2018
Medical Benefit – Enrollment of Parents Parental base coverage is optional. Team Member can choose to cover parents on agreement to share premium cost with Target India in proportion of 20:80 where Team Member pays 20% of the annual premium and Target India shares 80% of the premium. For new joiners, only pro-rata premium i.e. premium for the remaining number of days in the policy would be charged. There will be a refund of pro-rata premium for terminated team members provided there is no claim during the policy period. Annual Premium per parent family Target’s Contribution Team Member’s contribution INR 17,240 INR 13,792 INR 3,448 Next 05 May 2018
Medical Benefit – E Cards Log on to FHPL website https://www.fhpl.net Click on the Logins -> E-Card Tag Key in the Corporate ID – 840 Key in the Login ID and the Password ** Click on Login Click on the Member Details Click on E-Card option to view / print the card ** Unique User id and password for each team member will be been sent by e-mail. In case you have not received the same please write to insurance.helpdesk@target.com Next 05 May 2018
Medical Benefit – Cashless Process Cashless means the Administrator may authorize upon a Policyholder’s request for direct settlement of eligible services and it’s according charges between a Network Hospital and the Administrator. In such case the Administrator will directly settle all eligible amounts with the Network Hospital and the Insured Person may not have to pay any deposits at the commencement of the treatment or bills after the end of treatment to the extent as these services are covered under the Policy. List of hospitals in the FHPL network eligible for cashless process Please refer to the updated list from the TPA website by following the link https://www.fhpl.net/NetworkHospitals/NWHospitals.aspx Contact Customer Service Line : Toll Free No:1-800-425-4033 Planned Hospitalization Emergency Hospitalization Note : Patients seeking treatment under cashless hospitalization are eligible to make claims under pre and post hospitalization expenses. For all such expenses the bills and other required documents needs to submitted separately as part of the claims reimbursement. Next 05 May 2018
Admission, Treatment & discharge Planned Hospitalization Step 1 Pre-Authorization Member intimates TPA of the planned hospitalization in a specified pre-authorization format at-least 48 hours in advance Claim Registered by the TPA on same day TPA authorizes cashless as per SLA for planned hospitalization to the hospital Yes All non-emergency hospitalisation instances must be pre-authorized with the TPA, as per the procedure detailed below. This is done to ensure that the best healthcare possible, is obtained, and the patient/Team Member is not inconvenienced when taking admission into a Network Hospital. No Pre – Authorization Form https://www.fhpl.net/Forms/PreauthForm.pdf Follow non cashless process Pre-Authorization Completed Step 2 Admission, Treatment & discharge Member produces ID card at the network hospital and gets admitted Member gets treated and discharged after paying all non entitled benefits like refreshments, etc. Hospital sends complete set of claims documents for processing to TPA After your hospitalisation has been pre-authorized, you need to secure admission to a hospital. A letter of credit will be issued by TPA to the hospital. Kindly present your ID card at the Hospital admission desk. The Team Member is not required to pay the hospitalisation bill in case of a network hospital. The bill will be sent directly to, and settled by TPA Please Note: At the time of discharge when the TPA receives the final bill, they try to renegotiate with the Hospital for a better price. Hence it may take some time for TPA to revert back with final approval. This exercise helps as a cross-check in case the hospital has overcharged you and ensures that your sum insured utilization is optimum and is saved for any future exigencies.. Please be patient Claims Processing & Settlement by TPA & Insurer Next 05 May 2018
Pre-Authorization by hospital Emergency Hospitalization & Process Step 1 Get Admitted In cases of emergency, the member should get admitted in the nearest network hospital by showing their ID card. P R O C E S Pre-authorization given by the TPA Member gets admitted in the hospital in case of emergency by showing his ID Card No Non cashless Hospitalization Process Step 2 Pre-Authorization by hospital Relatives of admitted member should inform the call centre within 24 hours about the hospitalization & Seek pre authorization. The preauthorization letter would be directly given to the hospital. In case of denial member would be informed directly Yes Member/Hospital applies for pre-authorization to the TPA within 24 hrs of admission Member gets treated and discharged after paying all non medical expenses like refreshments, etc. TPA verifies applicability of the claim to be registered and issue pre-authorization Hospital sends complete set of claims documents for processing to the TPA Step 3 Treatment & Discharge After your hospitalisation has been pre-authorized the Team Member is not required to pay the hospitalisation bill in case of a network hospital. The bill will be sent directly to, and settled by TPA Next 05 May 2018
Non-Cashless Claims Process Claim Docs Next Admission procedure In case you choose a non-network hospital you will have to liaise directly with the hospital for admission. However you are advised to follow the pre authorization procedure to ensure eligibility for reimbursement of hospitalisation expenses from the insurer. Discharge procedure In case of non network hospital, you will be required to clear the bills and submit the claim to TPA for reimbursement from the insurer. Please ensure that you collect all necessary documents such as – discharge summary, investigation reports etc. for submitting your claim. Submission of hospitalisation claim You must submit the final claim with all relevant documents within 30 days from the date of discharge from the hospital. Post 30 days the reimbursement claims will not be considered. Claims Process Claim Docs Next 05 May 2018
Non-Cashless Claims Process Member intimates TPA before or as soon as hospitalization occurs Claim registered by TPA after receipt of claim intimation Insured admitted as per hospital norms. All payments made by member Insured sends relevant documents to TPA office within 30 days of discharge A Is claim payable? Is document received within 30 days from discharge TPA performs medical scrutiny of the documents Members will create the summary of Bills (2 copies) and attach it with the bills The envelope should contain clearly the Team Member ID & Team Member e-mail Yes Yes No No Claim Rejected Is documentation complete as required Payment to be made to Insurance Help Desk . The discharge voucher and copy of payment receipt to be sent to Insurance Help Desk . TPA checks document sufficiency Claims processing done as per SLA Yes No Send mail about deficiency and document requirement A Next 05 May 2018
Claims Document List Next Completed Claim form with Signature Hospital bills in original (with bill no; signed and stamped by the hospital) with all charges itemized and the original receipts Discharge Report (original) Attending doctors’ bills and receipts and certificate regarding diagnosis (if separate from hospital bill) Original reports or attested copies of Bills and Receipts for Medicines, Investigations along with Doctors prescription in Original and Laboratory, Stickers in case of Implants E.g.: Lens ( Cataract), Stents ( Heart Surgery) etc. Follow-up advice or letter for line of treatment after discharge from hospital, from Doctor. Provide Break up details including Pharmacy items, Materials, Investigations even though it is there in the main bill In case the hospital is not registered, please get a letter on the Hospital letterhead mentioning the number of beds and availability of doctors and nurses round the clock. In non- network hospital, you may have to get the hospital and doctor’s registration number in Hospital letterhead and get the same signed and stamped by the hospital, if required. Claims Form https://www.fhpl.net/Forms/RGIC_ClaimForm.pdf https://www.fhpl.net/Forms/Checklist.pdf *Please retain photocopies of all documents submitted Next 05 May 2018
First 30 day waiting period First Year Waiting period Benefit Extensions – Definitions Benefits Coverage Definition Pre existing diseases R Any Pre-Existing ailments such as diabetes, hypertension, etc or related ailments for which care, treatment or advice was recommended by or received from a Doctor or which was first manifested prior to the commencement date of the Insured Person’s first Health Insurance policy with the Insurer First 30 day waiting period Any Illness diagnosed or diagnosable within 30 days of the effective date of the Policy Period if this is the first Health Policy taken by the Policyholder with the Insurer. If the Policyholder renews the Health Policy with the Insurer and increases the Limit of Indemnity, then this exclusion shall apply in relation to the amount by which the Limit of Indemnity has been increased First Year Waiting period During the first year of the operation of the policy the expenses on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Diseases, Fistula in anus, Piles, Sinusitis and related disorders are not payable. If these diseases are pre- existing at the time of proposal they will not be covered even during subsequent period or renewal too Baby Cover Day 1 This policy is extended to cover the new born child of a Team Member covered under the Policy from the time of birth till 90 days. Not withstanding this extension, the Insured shall be required to cover the newly born children after 90 days as additional member as mentioned elsewhere under this Policy. Ambulance The Insurer will pay for Emergency ambulance and other road transportation by a licensed ambulance service to the nearest Hospital where Emergency Health Services can be rendered. Coverage is only provided in the event of an Emergency. Dental Q Any treatment or surgery of a corrective, cosmetic or aesthetic nature unless it requires Hospitalization; is carried out under general anesthesia and is necessitated by Illness or Accidental Bodily Injury Vision Any vision treatment or surgery of a corrective, cosmetic or aesthetic nature unless it requires Hospitalization; is carried out under general anesthesia and is necessitated by Illness or Accidental Bodily Injury. Excludes cosmetic treatment, frames, contact lenses & hearing aid cost. **Covers procedures like Cataract , Incision of tear glands , Other operations on the tear ducts, Incision of diseased eyelids, Excision and destruction of diseased tissue of the eyelid etc Next 05 May 2018
Domiciliary Hospitalization Benefit Extensions – Definitions Benefits For Target Definition Day Care R Day Care Procedure means the course of medical treatment or a surgical procedure listed in the Schedule which is undertaken under general or local anesthesia in a Hospital by a Doctor in not less than 2 hours and not more than 24 hours. Generally 8 aliments (i.e. Dialysis, Chemotherapy, Radiotherapy, Lithotripsy (kidney stone removal), Tonsillectomy, D & C) Domiciliary Hospitalization Q DOMICILIARY HOSPITALISATION BENEFIT means Medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a hospital/ nursing home but actually taken whilst confined at home in India under any of the following circumstances, namely: The condition of the patient is such that he/she cannot be removed to the hospital/nursing home or The patient cannot be removed to the hospital/nursing home for lack of accommodation therein Benefits not covered Expenses incurred for pre and post hospital treatment, and Expenses incurred for the treatment for any of the following diseases: Asthma Bronchitis Chronic Nephritis and Nephritic Syndrome Diarrhea and all types of dysentries including Gastroenteritis Diabetes Mellitus and Insipidus Epilepsy Hypertension Influenza, Cough, and Cold All Psychiatric or Psychosomatic disorders Pyrexia of unknown origin for less than 10 days Tonsillitis and upper respiratory tract infection including Laryngitis and Pharyngitis Arthritis, Gout and Rheumatism Note: When treatment such as Dialysis, Chemotherapy, Radiotherapy is taken in the Hospital/Nursing Home/Clinic and the insured is discharged the same day the treatment will be considered to be taken under Hospitalisation Benefit section and thus covered. Next 05 May 2018
Medical Benefit – General Exclusions (Indicative) Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations Circumcision unless necessary for treatment of disease Congenital external diseases or defects/anomalies HIV and AIDS , Venereal diseases Hospitalisation for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol. Injury or disease caused directly or indirectly by nuclear weapons Naturopathy, Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, etc Cost of spectacles, contact lenses, hearing aids and various other external prosthetic devices like cochlear implants, crutches, wheel chairs etc. Any cosmetic or plastic surgery except for correction of injury due to accident Hospitalisation for diagnostic tests only, well baby charges, no active line of treatment, no diagnosed ailment, less than 24 hrs of Hospitalization (except day care procedure listed in the policy) Psychiatric treatment Vitamins and tonics unless used for treatment of injury or disease Infertility treatment , Sterility and related treatments. Voluntary termination of pregnancy during first 12 weeks (MTP) Immunization, Vaccinations, Inoculations. OPD Claims, Health foods , Costs incurred as a part of membership/subscription to a clinic or health centre or stay at rehabilitation center for alcoholics, drug or narcotics Next 05 May 2018
Voluntary Top Up Insurance A Voluntary, Affordable solution to enhance your Target Medical Insurance Where the Target-funded group medical cover stops, medical top-up begins! Advantages Access. You have access to insurance coverage that may not be available in the market Discount. The policy is eligible for group discount rates since it is bought in the name of Target Voluntary. You can choose to/ not to participate based on your need Personalized. You can opt for additional insurance of INR 100,000, INR 200,00 or INR 300,000 Tax advantage. The premium you pay is eligible for a tax break subject to Income Tax rules Easy. Single online-enrolment window where you can sign-up for everything at one go Convenient. You don’t need to remember to pay any premium, we will deduct it from your paycheck Next
Why Top-Up? Next No maximum age limit at the time of enrollment Day 1 coverage for pre-existing illness No health declaration No medical testing for dependents above the age of 65 years Access to FHPL’s cashless hospital network Coverage across 3 sum insured options: INR 100,000, INR 200,000 or INR 300,000 Better access and lower premium than an individual insurance plan Next
Top-Up Plan – Cover For Dependents Cover for your family (self spouse and children) 3 sum insured options of INR 100,000 , INR 200,000 & INR 300,000 on a family floater basis (excluding parents), as per declaration made under the base policy. Coverage applicable for Self, Spouse and 2 children Premium in 2 equal instalment (Top up plan does not change / enhance the existing sub-limits like Maternity benefit, Cataract & room rent) Cover for your parents or parents in law 3 sum insured options of INR 100,000, INR 200,000 & INR 300,000 on a family floater basis for parents. Coverage on 1+1 floater basis. Can cover parents and in laws in any combination restricted to 2 individuals (as per base family policy) (Top up plan does not change / enhance the existing sub-limits like Maternity benefit, cataract & room rent) Next
Premium Rates Next * Inclusive of service tax -12.36% Premium to increase your insurance cover for self, spouse and 2 children Premium to increase your insurance cover for parents or parents in law Sum Insured Premium* 100000 3,600 200000 5,000 300000 5,700 Sum Insured Premium* 100000 8,600 200000 12,100 300000 15,600 * Inclusive of service tax -12.36% Next
Top-up Plans-Comparison with Individual Plans Medical Individual Medical Insurance Plan Group Top Up Plan Pre Existing Diseases Covered only from 3rd or 4th year onwards Covered from Day 1 Age limit Typically restricted to 65 years No age limit Maternity Maternity expenses are not covered Maternity expenses are covered. Usually there is a pre-defined limit for the expenses Waiting Period Waiting periods are applicable Hernia, Hydrocele etc. shall be covered after a waiting period of 1 year. Certain diseases like Cataract, Hysterectomy shall be covered after a waiting period of 2 years from commencement of Policy. Joint replacement surgery shall be covered after a waiting period of 3 years from commencement of Policy except done due to an accident. Baby is covered after three months only No waiting periods are applicable All these ailments are covered from Day1 Next
Top-up Plans-Comparison with Individual Plans Medical Individual Medical Insurance Plan Group Top Up Plan Pre-policy Health Declaration / Medical test Health Declaration is mandatory for all GMC Retail Policies Medical Test is necessary for incumbents older than 35 yrs. of age Not Required Claims Handling Directly by Insurance Company (little control on processes and delays) Through the Third Party Administrator. There are various advantages of having a TPA. Access to their cashless network across the country Faster settlement of claims Standard claims adjudication & reporting process Premium For a sum insured ranging from INR 100,000 to INR 10,000,000 Premium rates vary from INR 9,000 to INR 32,000 20% - 30% Cheaper Next
Top-Up Plan-Terms and Conditions (T&C) 3 sum insured options of INR 100,000 ,INR 200,000 & INR 300,000 on a family floater basis for Team Member policy and parental policy, as per declaration made under the master policy. The same coverage conditions as under the base policy to apply, including caps, co-pay and room rent restrictions. Lock-in period for 2 years with no increase in premium or top-up sum insured. The claim experience and premium revision would be for the group as whole and would not be benefitting or penalizing individuals for claiming or not claiming under the policy. The option for voluntary top up cover would be extended only at the renewal for existing Team Members and to new Team Members on 1st October every year. Existing Team Member can opt for Top-Up cover only in the subsequent renewal if they do not enrol during the enrolment period. Premium would be deducted from payroll in 2 instalments; April and May Team Members who join Target between April and September can enroll for medical top-up effective October 1 and premium would be recovered from October payroll. Next
Top-Up Plan - Terms and Conditions (T&C) The Top-up option will be available with a minimum lock-in of 2 policy years irrespective of claims made. Team Member can choose to upgrade to higher Sum Insured after the lock-in at renewal Team Member can choose a lower coverage/Sum Insured at renewal only if in the previous year there were no claims after completion of the lock-in. In case a Team Member leaves Target in between the year, there shall be prorated refund of premium in case of no-claim status under the Top-Up policy. On separation, the coverage will cease as of the last worked day. In case of payment of premium by instalment, the Team Member will be liable to pay the balance premium in case he/she leaves the organization prior to the payment of all instalments. The premium shall be deducted from his/her F&F settlement. (Applicable for resigning Team Members only) Next
Top-Up - Covers Offered & Exclusions All the benefits covered under the Target base policy which include Hospitalization Expenses including: Hospital (Room & Boarding and Operation theatre) charges Fees of Surgeon, Anesthetist, Nurses, Specialists Cost of diagnostic tests, medicines, blood, oxygen Cost of appliances like pacemaker, artificial limbs and organs Pre Hospitalization Expenses Post Hospitalization Expenses Pre-existing Diseases Ambulance Charges Any other benefits offered by current health policy* Exclusions The policy terms and exclusions shall be as per the current medical insurance policy (base policy). Please refer the base plan details for the Sum Insured and Sum Insured options with respect to these benefits Next
Claim Optimization Next Health Insurance is a benefit for the Team Member and the dependents. One has to utilize the benefit with utmost caution and respect the benefit extended from the organization. The ever increasing cost for the benefits require a proactive involvement from the Team Members. The following steps are recommended, ensuring the benefits extended are adequately utilized by the Team Member and dependents covered Please ensure to crosscheck the final bill sent to the TPA for the following: Billed only for the services utilized for e.g. category of room, diagnostics undergone Total of the bill In case of any planned hospitalization, approach the hospital in advance (48 hrs) and request pre authorization- this enables TPA to further negotiate the rates To approach hospitals with caution – most expensive is not necessarily the best. One can explore Preferred Partner Hospitals for special discounts Try to negotiate ( you as a consumer have the right to negotiate)-Ask WHAT and WHY Next 05 May 2018
Email & Communicator : insurance.helpdesk@target.com Medical Benefit – Contact Details Insurance Help Desk Email & Communicator : insurance.helpdesk@target.com Name Contact Details Name: Vignesh Email ID : insurance.helpdesk@target.com Mob: +91 99728 42810 Direct : +91 80 4223 5057 Name: Praveen Chandrashekar Email: pravin.chandrashekar@marsh.com Mob: +91 99860 16536 Escalation Point Name: Rahul Krishnan Email: rahul.krishnan@fhpl.net Mob: +91 92434 68395 Bineesh Sadasivan Email: bineesh.sadasivan@marsh.com Mob: +91 97390 22239 Please Note : Help desks are available between 10.00 am to 5.30 pm all working days at GWS - Manyata Tech Park Campus The help desk to provide assistance on Information on policy, claim procedure & claim status. Claim / Shortfall Documents to be submitted at the Insurance Help Desk Claims document can be sent using shuttle services from EGL office to insurance desk. Claim would be settled via ECS only. Cheque/DD payments are not applicable. Next 05 May 2018
FAQs & Common Definitions Documents and links FAQ’s Definitions Important Websites IRDA (Insurance Regulatory and Development Authority) Reliance General Insurance Co Marsh India Insurance Brokers Private Limited http://www.irdaindia.org http://www.reliancegeneral.co.in www.marsh.co.in Next 05 May 2018