Group Mediclaim Policy An in-depth review 22 August 2019 Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

First, our sincere thanks to you for choosing us as your official insurer and also giving us this exciting opportunity Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

WHY THIS POLICY ? CASHLESS TREATMENT IF TAKEN IN NETWORK HOSPITALS FOR REIMBURSEMENT OF HOSPITALISATION EXPENSES IF TAKEN IN NON NETWORK HOSPITAL ONLY FOR ILLNESS & DISEASES CONTRACTED / INJURY SUSTAINED BY THE INSURED PERSON DURING THE POLICY PERIOD Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

WHAT IS HOSPITALISATION ? STAY AS INPATIENT IN A HOSPITAL OR NURSING HOME FOR A MINIMUM PERIOD OF 24 HOURS EXCEPT IN SPECIFIED CASES IN ANY HOSPITAL IN INDIA FOR INDOOR CARE AND TREATMENT Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

WHAT IS A HOSPITAL ? REGISTERED AS SUCH WITH THE LOCAL AUTHORITIES AND IS UNDER THE SUPERVISION OF A REGD MEDICAL PRACTITIONER WHICH HAS SPECIFIED MINIMUM NUMBER OF BEDS,OPERATION THEATRE AND ROUND THE CLOCK QUALIFIED DOCTORS AND NURSES Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

WHAT IS NOT A HOSPITAL? A CLINIC TO TREAT OUT-PATIENTS A PLACE OF REST A PLACE FOR THE AGED A PLACE FOR DRUG ADDICTS / ALCOHOLICS A HOSTEL ANY OTHER SIMILAR PLACE Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

WHO IS A MEDICAL PRACTITIONER ? A PERSON WHO HOLDS A DEGREE OR DIPLOMA OF A RECOGNISED MEDICAL INSTITUTION AND IS REGISTERED AS A MEDICAL PRACTITIONER BY THE MEDICAL COUNCIL Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

HOSPITALISATION EXPENSES PAYABLE EXPENSES REASONABLY AND NECESSARILY INCURRED FOR ROOM, BOARDING, AND NURSING SURGEON, ANAESTHETIST, MEDICAL PRACTITIONER, CONSULTANT AND SPECIALIST FEES ANAESTHESIA, BLOOD, OXYGEN OPERATION THEATRE CHARGES, SURGICAL APPLIANCES MEDICINES AND DRUGS, DIAGNOSTIC CHARGES, X-RAY COST OF ORGANS, PACEMAKERS, ARTIFICIAL LIMBS Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

HOSPITALISATION EXPENSES PAYABLE PRE-HOSPITALISATION EXPENSES: BEING RELEVANT MEDICAL EXPENSES INCURRED DURING THE PERIOD UPTO 30 DAYS PRIOR TO HOSPITALISATION POST HOSPITALISATION EXPENSES: BEING RELEVANT MEDICAL EXPENSES INCURRED DURING THE PERIOD UPTO 60 DAYS AFTER HOSPITALISATION Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

HOSPITALISATION EXPENSES PAYABLE TREATMENT OF SPECIFIED AILMENTS SUCH AS CATERACT, HYSTERECTOMY, HERNIA, HYDROCELE, FISTULA, PILES, SINUSITIES, ETC., Expenses for the above are payable though they do not require hospitalization and may be treated under day care procedure Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

EXPENSES WHICH ARE NOT PAYABLE COST OF SPECTACLES, CONTACT LENSES, HEARING AIDS DENTAL TREATMENT OR SURGERY OF ANY KIND UNLESS REQUIRING HOSPITALISATION (MOSTLY DUE TO AN ACCIDENT) VACCINATION, INOCULATION, CHANGE OF LIFE, OR COSMETIC OR AESTHETIC TREATMENT OF ANY DESCRIPTION CIRCUMCISION, PLASTIC SURGERY UNLESS NECESSITATED DUE TO AN ACCIDENT EXPENSES FOR CONVALESCENCE Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

EXPENSES WHICH ARE NOT PAYABLE GENERAL DISABILITY, RUN-DOWN CONDITION, REST CURE CONGENITAL EXTERNAL DISEASES / DEFECTS STERILITY, VENERAL DISEASE INTENTIONAL SELF INJURY OR USE OF INTOXICATING DRUGS / ALCOHOL EXPENSES DIRECTLY / INDIRECTLY RELATED TO TREATMENT OF AIDS & HIV DIAGNOSTIC, X-RAY OR LAB EXAMINATION OR OTHER DIAGNOSTIC STUDIES INCURRED AS ROUTINE CHECK UP AND/OR OBSERVATION PURPOSES Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

EXPENSES WHICH ARE NOT PAYABLE EXPENSES ON VITAMINS AND TONICS UNLESS FORMING PART OF TREATMENT OF INJURY OR DISEASE AS CERTIFIED BY THE ATTENDING PHYSICIAN TREATMENT ARISING FROM OR TRACEABLE TO PREGNANCY, INFERTILITY TREATMENT AND ABORTION (unless medically advised) NATUROPATHY TREATMENT Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

COVERAGE DETAILS TOTAL FAMILIES – 750 SUM INSURED Rs. 100,000 for 1599 Members Rs. 200,000 for 606 Members Rs. 300,000 for 16 Members FAMILY DEFINED AS 1+5 SELF SPOUSE 2 CHILDREN 2 DEPENDENT PARENTS Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

COVERAGES IN THE POLICY PRE-EXISTING DISEASES COVERED NO WAITING PERIOD (Usually 30 days) 1ST AND 2ND YEAR EXCLUSIONS WAIVED MATERNITY COVER NORMAL DELIVERY – Rs. 25,000 CAESARIAN – Rs. 50,000 NEW BORN FROM DAY ONE MATERNITY WAITING PERIOD OF 9 MONTHS WAIVED Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

COVERAGES IN THE POLICY For Employees with S.I. Rs.1.00 lakh Room Rent agreed is the actual incurred but not exceeding Rs.3,000- per day and ICU Charges not exceeding Rs.6.000- respectively For Employees with S.I. Rs.2.00 lakh Room Rent agreed is the actual incurred but not exceeding Rs.4,000- per day and ICU Charges not exceeding Rs.8,000- respectively For Employees with S.I. Rs.3.00 lakh Room Rent agreed is the actual incurred but not exceeding Rs.5,000- per day and ICU Charges not exceeding Rs.10,000- respectively Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

ADDITIONAL FEATURES ADDITIONS AND DELETIONS WILL BE DONE ON A MONTHLY BASIS AND PREMIUM CHARGED IS ON PRO RATA BASIS DELETIONS IF ANY IS PERMISSIBLE PROVIDED THERE ARE NO CLAIMS REGISTERED/SETTLED FOR THAT PARTICULAR INDIVIDUAL UPON INTIMATION OF THE NEW BORN CHILD FOR DAY ONE COVER AND FOR ADDITIONS THE PREMIUM SHALL BE DEBITED FROM THE ADVANCE PREMIUM DEPOSIT ACCOUNT(APD). Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

ADDITIONAL FEATURES No Mid Term interchange of parents shall be allowed during the currency of the policy. No increase/decrease of Sum Insured shall be allowed during the currency of the policy. CASHLESS FACILITY EXTENDED SUBJECT TO APPROVAL OF TPA (TTK HEALTHCARE SERVICES) Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

Claims Procedure Cashless Reimbursement Pre-authorization Post Cashless Post-authorization Full reimbursement Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

Cashless – Planned / Emergency admission Planned admission Identify Network hospital Approach hospital Billing dept. 24 hrs Prior to admission Cashless facility Provided. You may still have to Pay for non-medical expenses Approaches TPA for approval in given format Maximum 6 hours In case of emergency, please request the billing department to send TPA the request immediately TPA panel doctor scrutinizes And approves Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

Original receipts, reports, Reimbursement claims Non-network Admission or Not/Partially availed cashless Ensure that all Original receipts, reports, Prescriptions and discharge Summary is attached Use the CLAIM FORM. Ensure to Claim Within 30 days Of discharge Reimbursement TPA will Process within 15 working days Settlement Cheque Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

ASSISTANCE & ESCALATION Divisional Manager Highest Level Branch Manager Second level First Level NIA Dev.Officer TTK Ground level Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai