Insurer : Bajaj Allianz General Insurance Co. Ltd Group Mediclaim Top-Up Policy : 2013-14 Insurer : Bajaj Allianz General Insurance Co. Ltd

Top Up Policy – Features of the policy   This is a Top up cover over the Group Mediclaim Family Floater Policy for the employees and dependents of United Phosphorous & Tatva Global Group. The Sum Insured under the Top up cover is on individual basis and will remain the same for the entire family. The cover would trigger after the exhaustion of the limit of sum insured under the base policy vide policy No: OG-14-1901-8403-00000037 and 8403-00000036 Family definition – As per base policy. Coverage remains the same as the employee policy but this policy can be utilised only when the base policy sum insured gets exhausted Pre-existing diseases covered and all pre-existing diseases would be covered without any waiting periods under the scheme. Maternity benefit : Maternity limit Rs.35,000/- for normal and Rs.45,000/- for Caesarian Cashless e-cards will be provided for each family covered under the base policy. Cashless Facility only to employees and not to dependants. Only addition for new joinees/spouse/new born baby allowed during the policy period subject to getting enrolled to the policy.

Premium: Per family premium table inclusive of service tax Top Up Sum Insured Premium With Maternity Cover Premium Without Maternity Cover   Annual Prorata 01/09/2013 Prorata we.f 100000 8136 5276 7160 4806 150000 8946 5803 7873 5284 200000 9760 6331 8589 5765 300000 11714 7598 10308 6919 500000 16867 10941 14843 9963 1000000 29195 18937 25691 17245   Service Tax @ 12.36% included in the above Above quote and Premium would be available subject to 30% of the employees getting enrolled under the Additional/Top-UP Cover.

Claim Intimation and Escalation Matrix All reimbursement claim intimation emails to be sent directly to: healthclaims.mumbai@bajajallianz.co.in Escalation Matrix: Levels Contact Person Contact nos Email ids First point Saveena Hegde 022-66197508 healthclaims.mumbai@bajajallianz.co.in Second Point Dr. Rashmi Sachdev 7738395815 rashmi.sachdev@bajajallianz.co.in   Ajay Kurup 7738257002 ajay.kurup@bajajallianz.co.in Third Point Jayesh Kadam 8451914209 Jayesh.kadam@bajajallianz.co.in For any other issues/queries please call on the below Nos: Cashless: 020 -30305858 or send an emai to: preauth@bajajallianz.co.in General queries on e-cards – email to: health@bajajallianz.co.in All other queries: jayesh.kadam@bajajallianz.co.in,

Necessary Documents for claim submission Bajaj Allianz claim form duly signed by insured with a copy of the E-card Reimbursement check list Bill detail sheet First Consultation Letter Original Discharge Summary Original Final Hospital Bill giving detailed break up of all expense heads mentioned in the bill Stamped receipt for final hospital bill Pharmacy cash receipts/ cash bills along with supporting prescription Reports towards investigations done, Pathology/ Radiology/ Cardiology Original paid receipt towards the investigation charges In case of a Cataract Operation, the IOL Sticker ( Each bill with prescription pasted & numbered on separate paper)

Claims Procedure & Health Helpline In case the claim amount is more than the base sum insured both the card details to be updated. BAGICL Register claim & intimate requirements to insured Process claim after receipt of complete documents Dispatch Cheques along with discharge vouchers are sent to Insured Health Helpline Exclusive Health Call Centre to service our cardholders 24 X 7 helpline available for emergencies Facility to send online requests /queries & response Turn Around Time 20 Min. Follow up with member for complaints received Information on special discounts / packages / schemes Information on hospitals, doctors, diagnostic centres, ambulance services and health products