1. Know Your Mediclaim Policy “Mediclaim Policy for the students of IIT” By Safeway TPA Services

2. POLICY DETAIL INSURER:National Insurance Co Ltd Policy No: 354100/48/15/8500000719 POLICY START DATE:13 August 2015 COVERAGE VALID UP TO:12 August 2016 SUM INSURED:100000/- (Per Student) POLICY TYPE:TAILOR MADE PERIOD:13.08.2014 TO 14.08.2014

3. COVERAGE 1) Room, Boarding expenses as provided by the Hospital/Nursing Home. Room rent capping Room Rent:2% of Sum insured Maximum – 2000/- (Per Day) ICU:2% of Sum insured Maximum – 2000/- (Per Day) 2) Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees. 3)Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical appliances any disposable consumables, Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of pacemaker, Artificial Limbs and cost of Stents and implants

4. COVERAGE PRE - HOSPITALIZATION :-Relevant Medial Expenses incurred during period up to 30days prior to hospitalization on disease/illness/injury sustained will be admissible POST – HOSPITALIZAION :- Relevant Medical Expenses incurred up to 60days after hospitalization will be admissible.

5. GENERAL POLICY T&C 1). Pre-Existing:- Covered. 2). 30 Days waiting: - Applicable. 3). 1, 2 years Exclusions: - 1 Year Exclusions are Applicable. 4). Co Payments: - No Copayment. 5). Pre & Post Hospitalization: - 30 / 60 Days. 6). Domiciliary Hospitalization Charges: - Not Covered. 7). Dental & Spectacles & Hearing aids: - Not Covered. 8). Health Check-up: - Not Covered.

6. RESTRICTIONS DiseasesIn-Patient TreatmentOthers Plastic Surgery (Cosmetic) Laboratory Expenses not consistent with treatment. Spectacles,Contact Lens, Hearing Aid Orthodontics TreatmentVitaminsUse of intoxicating drugs/ alcohol Sterility/Venereal Disease/Circumcision Tonic inconsistent with treatment. Naturopathy Intentional Self InjuryTelephone,Fax,Barber,Photoc opy, Vaccinations,Toiletries and TV charges AidsSpecial diet and extra diet for patients (unless prescribed by the Doctor) Congenital Diseases (External) e.g. An operation to remove a 6 th finger, Skin Graphting External Implants e.g. An operation to remove a 6 th finger, Skin Graphting Registration fees

7. RESTRICTIONS DiseasesIn-Patient TreatmentOthers Convalescence / General Debility. Supports and Accessories, e.g. Crutches Admission fees Service, Maintenance and Surcharges Food & Beverages Special Nursing, Attendant PassTelephone/Fax Health Drinks: e.g. Horlicks, Complan etc Medical records/ Stationary Xerox or Certifying charges Abortion done for voluntary reasons & before 12 weeks Attendants Charges Food and Beverage for RelativesSpecial Nursing charges Diagnostic Expenses (only for out-patient) Extra Bed/ Bed retaining charges Damage done by the patient (accidentally). Damage charges not covered. TV/ Laundry

8. RESTRICTIONS DiseasesIn-Patient TreatmentOthers Convalescence / General Debility. Supports and Accessories, e.g. Crutches Admission fees Service, Maintenance and Surcharges Food & Beverages Special Nursing, Attendant PassTelephone/Fax Health Drinks: e.g. Horlicks, Complan etc Medical records/ Stationary Xerox or Certifying charges Abortion done for voluntary reasons & before 12 weeks Attendants Charges Food and Beverage for RelativesSpecial Nursing charges Diagnostic Expenses (only for out-patient) Extra Bed/ Bed retaining charges Damage done by the patient (accidentally). Damage charges not covered. TV/ Laundry

9. RESTRICTIONS  Injury/disease directly or indirectly caused by or arising from or attributable to War, invasion, Act of Foreign enemy, War like operations (whether war be declared or not)  Cost of spectacles and contact lenses, hearing aids.  Dental treatments except arising out of an accident and requiring hospitalization.  Convalescence, general debility, “Run-down” condition or rest cure, obesity treatment and its complications including morbid obesity, Congenital diseases/defects or Anomalies, treatment relating to all psychiatric and psychosomatic disorders, infertility, sterility, venereal disease, Intentional self- injury and use of intoxicating drugs/alcohol.  All expenses arising out of any condition directly or indirectly caused to or associated with Human T- Cell Lymphotropic Virus Type III (HTLB –III) or Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any Syndrome or condition of a similar kind commonly referred to as AIDS.  Charges incurred at Hospital or Nursing Home primarily for diagnosis x-ray or Laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any ailment, sickness or injury, for which confinement is required at a Hospital/ Nursing Home.

10. RESTRICTIONS  Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician.  Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon/ materials.  Naturopathy Treatment, acupressure, acupuncture, magnetic therapies, experimental and unproven treatments/therapies.  Genetic disorders and stem cell implantation/surgery.  Change of treatment from one system of medicine to another unless recommended by the consultant/hospital under whom the treatment is taken.  Treatment for Age Related Macular Degeneration (ARMD), treatments such Rotational Field Quantum Magnetic Resonance (RFQMR), Enhanced External Counter Pulsation (EECP), etc.  All non medical expenses including convenience items for personal comfort such as charges for telephone, television, ayah, private nursing/barber or beauty services, diet charges, baby food, cosmetics, tissue paper, diapers, sanitary pads, toiletry items and similar incidental expenses.  Any kind of services charges, surcharges, admission fees/registration charges, luxury tax and similar charges levied by the hospital.

11. CLAIM PROCESS

12.  Eligibility Covered Not Covered Hospital sends Intimation to SAFEWAY Authorization as per eligibility Out of Pocket payment TAT : less than 2 hr for routine cases Emergency : No authorization required Regularization within 24 Hrs Member approaches with Network Hospitals with ID Cashless treatment at NWH HOW TO AVAIL BENEFITS UNDER YOUR POLICY Member approaches Any other Hospital Avails treatment, makes upfront payment Submits bills to SAFEWAY for reimbursement

13. CASHLESS CLAIMS To avail cashless hospitalization treatment at network hospitals – Step 1: SAFEWAY will provide the list of network hospitals offering cashless facility for treatment. Step 2: The claimant needs to produce the SAFEWAY Health card at the hospital. Step 3: Hospital sends Pre-authorization Request with the treatment details; past history and clinical notes along with estimate of hospitalization expense to SAFEWAY local office. Step 4: SAFEWAY issues a letter authorizing treatment to the Hospital the approved amount up to the Sum Insured limits. Cont………

14. CASHLESS  Step 5: In case the treatment is taken at other non network centers, the Insured is reimbursed the cost of treatment, subject to the provisions of the Policy on the basis of Admit Card/Discharge Card, Diagnostic Reports and Bills/Prescriptions.

15. RE-IMBURSEMENT PROCESS Step 1: Please intimate,SAFEWAY TPA Services within 48 hours about the hospitalization. Claim intimation can be done by the following methods. Inform the Call Centre at Toll Free No: 1800-102-5671 / 45451300 And intimate the claim to support@safewaymediclaim.com support@safewaymediclaim.com Step 2: At the time of intimation, the customer should provide the following a. SAFEWAY ID card No b. Date of Hospitalization c. Ailment d. Approximate Date of Discharge e. Approximate Date of Claim submission. Step 3: Download the Claim Form & Medical Certificate Form from our website and fill all columns. The Medical Certificate Form will be filled by the treating doctor. Step 4: Submit filled and signed Claim and Medical Certificate Forms to your HR Deptt. Cont……..

16. RE-IMBURSEMENT Step 5: SAFEWAY will assess the validity of the claim based on the documents submitted, validate the policy, validate the treatment undergone and settle the claim within the claim settlement parameters. In case of claim is not adhering with parameters, the case would be rejected. Step 6: SAFEWAY will correspond with you within 7 days of Claim receipt - Step 7: – Event of Settlement: Please sign the Discharge Voucher and send it back to local SAFEWAY office – Event of Shortfall: Please forward the requested documents for settlement of claim to local SAFEWAY office. – Event of Disallowance: Please forward the necessary documentation not submitted before to process disallowance and for addendum settlement

17. RE-IMBURSEMENT Documents Required for Re-imbursement Claims 1.Original detailed discharge summary 2.Original investigation reports along with bill 3.Original Hospital Bill-consolidated and with detail breakup of every component of the bill with the patients signature on it. 4.Incase of surgical packages – detail breakup of the package 5.Medicine bills with prescriptions. 6.Claim Form – ( available on Safeway’s website www.safewaymediclaim.com )www.safewaymediclaim.com 7.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 time of Accident. 8.Payment receipt for the payment done to the hospital. *30 Days pre & 60 Days Post hospitalization Original investigation reports along with bills & receipts 1.Consultation receipts. 2.Medicine bills with prescriptions 3.Investigation Reports-Bills with Prescriptions if any

18. DO’S 1.Carry your ID card (Student ID Card- IIT) at the time of admission at network hospitals 2.Incase of emergency admission kindly contact Safeway within 24 hrs of Hospitalisation 3.Incase of emergency kindly refer your Roll No at the time of admission 4.Take a pre approval from Safeway for all the elective cases 5.Sign on the final bill at the time of discharge from the hospital 6.For any other assistance call the account manager

19. PERSONAL ACCIDENT POLICY PA under Table 1A for S.I Rs 50000/- per student. PA under Table II for S.I Rs50000/- per student. Disclaimer : Please note that all PA(Personal Accident) Claims are being dealt by Insurance Company Directly, for more details please contact “Student Affair Section”. There is no direct/indirect role of SAFEWAY TPA under this section of coverage.

20. Your CRM For any assistance you contact your CRM at below mentioned details Mr Rahul Vij Mail : realtech.consultant@gmail.comrealtech.consultant@gmail.com Mob : +91-92-122-31982 +91-85-888-84533 Desk : +91 11 47551982 Safeway TPA Services Pvt Ltd Gurpreet Singh Mob : + 91 999 00 79269 Toll Free : 1800 – 102 -56-71 Phone:+91 45 45 1300 Mail : support@safewaymediclaim.comsupport@safewaymediclaim.com