ICSL – FHPL Mediclaim Policy How to Access you Mediclaim Card.

Policy Details: Policy No. : 161000/48/11/41/00000458 Policy Period : 02/05/2012 To 01/05/2013 Insurance Company : United India Insurance Company Limited TPA : Family Health Plan (TPA) Limited Premium Rate for Employee : Rs.2371/- Premium Rate for Dependant : Rs.415/-(Rs.830/-) Add Service Tax : 10.30% Coverage of Rs.1 Lacs for Family Floater

Policy Details Maximum family size allowed : 4 (1+3) Definition of Family : Employee + Spouse + 2 Dependent Children (unmarried & non-earning only) OR 2 Dependent Parents (Father, Mother). Nomination Process: During policy period additions of newly married & new born baby are only allowed in case member has less than three dependents covered. Others are not allowed during policy period. Changes of nominations during policy period will not be allowed.

Coverage Details Basic Sum Insured / Limit Per family : Rs.1 Lacs per family on Floater Basis Claim Co Payment(employee) : 90%(Insurance):10%(Employee) Ratio Claim Copayment (Dependent) 85%(Insurance):15%(Employee) Ratio Pre-Existing Diseases : Covered from day 1 Pre & Post Hospitalization Expenses: Covered upto 30 days and 60 days respectively Maternity Benefit: Allowed Max. upto 2 children (2 deliveries) Normal Rs.20,000/- & Caesarian Rs.25,000/- No Cashless will be given for maternity. No pre-post expenses allowed. Dental Coverage : Not Covered

Coverage Details Ambulance Charges : Ambulance Charges Rs.1,500/- depending on case to case Room Rent : Room rent restricted to 1%, ICU 2% of sum insured Monthly addition of employees: Coverage for new joinees from the date of joining by paying Pro-rata Premium Monthly deletion of Employees : Coverage ceases from the date of leaving the organization/retirement with refund on Pro-rata basis Domiciliary Hospitalization not covered

How to access Mediclaim E-card?

Type www.fhpl.net

Click on login & Select E-card

Enter Corporate ID : 174, User Name as Emp__code and PASSWORD :First letter of your name in CAPITAL AND last three digits of your Emp_Code and click on Login

Click on Member Details to see your nominees details

Your nomination details are displayed To check claims status click on claims Click to get E-cards of your family members Your nomination details are displayed

Click on Open

Take Printout of E-cards

How to avail benefits under your policy Member approaches with Network Hospitals with ID Hospital sends Intimation to FHPL Eligibility Member approaches Any other Hospital Out of Pocket payment Not Covered Avails treatment, makes upfront payment Submits bills to FHPL for reimbursement Covered TAT : less than 2 hr for routine cases Emergency : No authorization required Regularization within 24 Hrs Authorization as per eligibility Cashless treatment at NWH

Do’s Carry your ID card (IDEA)/ E Card (FHPL) at the time of admission at network hospitals Incase of emergency admission kindly contact FHPL within 24 hrs of hospitalization Incase of emergency kindly refer your companies name and your Emp No at the time of admission Take a pre approval from FHPL for all the elective cases Sign on the final bill at the time of discharge from the hospital For any other assistance call the account manager

What are the documents essential for claiming for reimbursement? Original detailed discharge summary Original investigation reports along with bill Original Hospital Bill-consolidated and with detail breakup of every component of the bill with the patients signature on it. Incase of surgical packages – detail breakup of the package Medicine bills with prescriptions. Claim Form – ( available on FHPL website ) MLC Certificate from the hospital in the case of Road traffic accident. Or a certificate from the treating doctor mentioning that the patient was not under the influence of alcohol at the tome of Accident. Obstetric history (GPLA) in the case of maternity claims  Payment receipt for the payment done to the hospital. Original investigation reports along with bills & receipts Consultation receipts.

Hospitalization Intimation Please send the intimation mail within 24 hours with following details on mail IDs info@fhpl.net or vimalkumar.sinha@fhpl.net with a cc to HR on manish.dabhi@idea.adityabirla.com Intimation Details:- Employee Name             : Employee Code             : Name of Patient             : Relationship with Employee : Name of Hospital/Doctor : Date of Admission          : Also remember to submit your claims within 7 days from date of discharge from the hospital.

All India FHPL Contact Numbers Hyderabad 040-23556464 Delhi 011-41678916 Mumbai 022-22834686 Kolkata 033-24659421 Chennai 044-28293222 Jaipur 0141-5170502 Pune 020-4024022 Jharkhand Bangalore 080-22356256 Chandigarh 0172-2603264 Ahmedabad 07926441773 Vimal Sinha 9227207002 Guwahati 0361-2340599 Cochi 0484-2350115 Jammu 0191-2473971 Nagpur 0712-3096446 Bhubneswar 0674-2534560 Coimbatore 0422-2540036 Srinagar 0194-2442065 Indore 0731-5045400 Madurai 0452-3106620 Lucknow 0522-2239804 Bhopal 0755-2572110 Vizag 0891-2526938

Thank You  Any Suggestions/Feedback!! Good Luck