Medical Insurance Policy

Objective

To provide for, comprehensive health insurance coverage, arising owing to medical exigencies to employees &their immediate family dependants and suitably support with adequate ff nancial assistance.

Applicability

The policy covers all permanent employees of Infrastructure Services on India payroll.

• Employees do not have an option to opt out of Medical Insurance Policy, enrolment of “Self ” is mandatory.

• Probationers on rolls of the Company are also covered under the policy for hospitalization beneff ts.

• The current policy period is from December 10, 2015 to September 30, 2016.

Domiciliary claim(s) is not a part of this Medical Insurance policy. Instead, a separate component, by name of‘Medical Allowance’ in your compensation structure is available to take care of such expenses.

Employees covered under ESI, would by default not be covered under HCL’s private Medical Insurance policy, however, one time option to enroll under this policy will be available for employees in the month of December2015. In such a case, the additional cost of annual medical premium has to be borne by the employee as perterms and conditions elucidated in this policy. The additional contributions for such coverage have been mentioned in the “Dependant Coverage” section mentioned below. EHS will write to all ESI covered employees,seeking their desire to get this additional cover, at the beginning of every medical year policy period. New Joinee’s falling under ESI cover will be required to send request Arun Kumar Yadav (Arun . y a d a v@hcl . c o m) within 15 days of joining to get themselves enrolled under this additional cover. Existing employees fallingunder ESI coverage who want to opt for the medical Insurance Policy may also send request Arun Kumar Yadav(Arun . y a d a v@hcl . c o m) on or before December 31, 2015.

An employee is expected to peruse through the Medical Insurance Policy document carefully and make oneselfconversant with the coverages off ered, standard deff nitions, wordings and exclusions.

Definitions

HO SP I T A L /N U R S IN G HO M E : A hospital/Nursing home means any institution established for in- patient careand day care treatment of illness and / or injuries and which has been registered as a hospital with the localauthorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under theenactments speciff ed under the Schedule of Section 56(1) of the said Act OR complies with all minimumcriteria as under:

• Has qualiff ed nursing staf under its employment round theclock;

• Has at least 10 inpatient beds, in towns having a population of less than 10, 00,000 and 15 inpatient bedsin all other places;

• Has qualiff ed medical practitioner (s) in charge round theclock;

• Has a fully equipped operation theatre of its own where surgical procedures are carried out;

• Maintains daily records of patients and makes these accessible to the Insurance company’s authorizedpersonnel.

The term ‘Hospital/Nursing Home’ shall not include an establishment which is a place of rest, a placefor the aged, a place for drug addicts or a place for alcoholics, a hotel or a similar place.

Note: In case of Ayurvedic / Homeopathic / Unani treatment, Hospitalisation expenses are admissible onlywhen the treatment is taken as in-patient, in a Government Hospital / Medical College Hospital.

SU R G IC AL O P E R A TI O N : Surgery or Surgical Procedure means manual and / or operative procedure (s)required for treatment of an illness or injury, correction of deformities and defects, diagnosis and cure ofdiseases, relief of suff ering or prolongation of life, performed in a hospital or day care centre by a medicalpractitioner.

HO SP I T A L I S A TI O N P ER IO D : Expenses on Hospitalisation are admissible only if hospitalisation is for aminimum period of 24 hours. However,

(A) This time limit will not apply to the treatments mentioned in Annexure 1 and such speciff c treatmentstaken in the Network Hospital/Nursing Home where the Insured is discharged on the same day. Suchtreatment will be considered to be taken under Hospitalisation Beneff t.

(B) Further if the treatment / procedure / surgeries of above diseases are carried out in Day Care Centre,which means any institution established for day care treatment of illness and / or injuries OR a medical set-up within a hospital and which has been registered with the local authorities, wherever applicable, and isunder the supervision of a registered and qualiff ed medical practitioner AND must comply with all minimum criteria as under:-

1. Has qualiff ed nursing staf under itsemployment;2. Has qualiff ed medical practitioner (s) incharge,3. Has a fully equipped operation theatre of its own, where surgical procedures are carried out-4. Maintains daily records of patients and will make these accessible to the Insurance company’s authorized personnel,THEN, the requirement of minimum number of beds is overlooked.

(C) This condition of minimum 24 hours Hospitalisation will also not apply provided, medical treatment,and/or surgical procedure is:

1. Undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hrsbecause of technological advancement, and

2. Which would have otherwise required a hospitalization of more than 24 hours.

*Above are admissible subject to terms & conditions of the policy.*NOTE: procedures / treatments usually done in out patient department are not payable under the policyeven if converted to day care surgery / procedure or as in patient in the hospital for more than 24 hours.

DO M ICI L I A R Y HO SP I T A L I S A TI O N B E N E FI T: Domiciliary hospitalization means medical treatment for a periodexceeding three days for such an illness/disease/injury which in the normal course would require care andtreatment at a hospital but is actually taken while conff ned at home under any of the followingcircumstances:

- The condition of the patient is such that he/she is not in a condition to be removed to a hospital, or

- The patient takes treatment at home on account of non-availability of room in a hospital.

Subject however to the condititi on that Domiciliary Hospitalisatiti on benefit shall not cover

a) Expenses incurred for pre and post hospital treatment andb) Expenses incurred for treatment for any of the following diseases:

• Asthma• Bronchitis• Chronic Nephritis and Nephritic Syndrome• Diarrhoea and all types of Dysenteries including Gastro-enteritis• Diabetes Mellitus and Insipidus,• Epilepsy• Hypertension• Inff uenza, Cough and Cold,

• All Psychiatric or Psychosomatiti c Disorders,

• Pyrexia of unknown origin for less than 10 days

• Tonsillitis and Upper Respiratory Tract infection including Laryngitis and Pharingitis,

• Arthritis, Gout and Rheumatism.

Other Definitions and interpretations:

N E TWO RK P R O V ID E R : Means hospitals or healthcare providers enlisted by an insurer or by a TPA and insurertogether, to provide medical services to an insured on payment, by a cashless facility.

HO SP I T A L I S A TI O N P E R IO D : The period for which an insured person is admitt ed in the hospital asinpatient and stays there for the sole purpose of receiving the necessary and reasonable treatment for thedisease / ailment contracted / injuries sustained during the period of policy. The minimum period of stayshall be 24 hours except for speciff ed procedures/ treatment where such admission could be for a period ofless than 24 consecutive hours.

P R E - HO SP I T A L I S A TIO N E X P E N S E S : Medical Expenses incurred during the period upto 30 days prior to thedate of admission, provided that:

• Such Medical Expenses are incurred for the same condition for which the Insured Person’sHospitalisation was required, and

• The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.

P O S T - HO SP I T A L I S A T IO N E X P E N S E S : Medical Expenses incurred for a period upto 60 days from the date ofdischarge from the hospital, provided that:

• Such Medical Expenses are incurred for the same condition for which the Insured Person’sHospitalisation was required, and

• The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.

ME DIC AL P R A C TITI O N E R : A Medical practitioner is a person who holds a valid registration from the MedicalCouncil of any state or Medical Council of India or Council for Indian Medicine or for Homeopathy set up bythe government of India or a State Government and is thereby entitled to practiti ce medicine within itsjurisdiction; and is acting within the scope and jurisdiction of license.

Q U A L IFI ED N U R SE: Qualiff ed nurse is a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any state in India.

P R E -E X I S TIN G DI S E A S E S : Any condition, ailment or injury or related condition(s) for which you had signs orsymptoms, and / or were diagnosed, and / or received medical advice / treatment within 48 months prior tothe ff rst policy issued by the insurer.

Further any complicatiti ons arising from pre-existiti ng ailment / disease / injuries will be considered as apart of that pre-existiti ng health condititi on.

IL L NE SS: Illness means a sickness or a disease or pathological condition leading to the impairment of normalphysiological function which manifests itself during the Policy Period and requires medical treatment.

• Acute condititi on - Acute condition is a disease, illness or injury that is likely to respond quicklyto treatment which aims to return the person to his or her state of health immediately before suff eringthe disease/ illness/ injury which leads to full recovery.

• Chronic condititi on - A chronic condition is deff ned as a disease, illness, or injury that has one or moreof the following characteristics:—it needs ongoing or long-term monitoring through consultations,examinations, check-ups, and / or tests—it needs ongoing or long-term control or relief o f symptoms— itrequires your rehabilitation or for you to be specially trained to cope with it—it continues indeff nitely—itcomes back or is likely to come back.

INJ U R Y: Injury means accidental physical bodily harm excluding illness or disease solely and directly caused byexternal, violent and visible and evident means which is veriff ed and certiff ed by a Medical Practitioner.

C ON GE N I T AL A NO MA L Y : Congenital Anomaly refers to a condition(s) which is present since birth, and which isabnormal with reference to form, structure or position.

• Internal Congenital Anomaly: Which is not in the visible and accessible parts of the body is called InternalCongenital Anomaly;

• External Congenital Anomaly: which is in the visible and accessible parts o f the body is called ExternalCongenital Anomaly

IN - P A TI E N T: An Insured person who is admitt ed to hospital and stays for at least 24 hours for the solepurpose of receiving the treatment for suff ered ailment / illness / disease / injury / accident during thecurrency of the policy.

R E AS ON A B L E A N D C U S T O MA R Y CH A R G E S : means the charges for services or supplies, which are thestandard charges for the speciff c provider and consistent with the prevailing charges in the geographicalarea for identical or similar services, taking into account the nature of the illness / injury involved.

For a networked hospital means the rate pre-agreed between Networked Hospital and the TPA forsurgical / medical treatment that is necessary, customary and reasonable for treating the condition forwhich insured person was hospitalized.

NOTE: Any expenses (as mentiti oned above) which are not covered under the policy and / or which are notreasonable, customary and necessary, the same have to be borne by the insured person himself.

C AS HLE SS F ACI L IT Y: It means a facility extended by the insurer to the insured where the payments of thecosts of the treatment undergone by the insured in accordance with the policy terms and conditions, aredirectly made to the network provider by the insurer to the extent of pre- authorization approved.

I . D . C AR D : means the card issued to the Insured Person by the TPA to avail Cashless facility in the NetworkHospital.

D A Y C ARE P R OC E D UR E : Means the course of Medical treatment / surgical procedure listed above, inNetworked specialised Day Care Centre which is fully equipped with advanced technology and specialisedinfrastructure where the insured is discharged on the same day, the requirement of minimum beds will beover looked provided other conditions are met.

L I M I T O F IND EM N I T Y: Means the amount stated in the schedule against the name of each insured personwhich represents maximum liability for any and all claims made during the policy period in respect of thatinsured person in respect of that insured person in respect of hospitalization taking place during currency ofthe policy

A N Y ON E IL L NE SS: Any one illness means continuous Period of illness and it includes relapsewithin 45 days from the date of last consultation OR 105 days from the date of discharge,whichever is earlier, from the Hospital/Nursing Home where treatment may have been taken.

A C TI VE L IN E O F T R E A T ME N T : The line of treatment which is aimed at immediate cure of an ailment /disease / illness or injury. However, if the treatment though aimed at immediate cure of an ailment /injury but normally done on OPD basis will fall under exclusion in Health Insurance Policies.

There are various deff nitions like Symptomatic Treatment (treatment directed toward relief ofuntoward symptoms, leaving the cure of the disease to natural forces), Palliative Treatment (notaimed at curing the disease but to relieve pain), Preventiti ve treatment or prophytiti c treatment(where the aim is to prevent the occurrence of the disease such as Vaccinations, Inoculations etc).Some of these lines of treatment are not admissible.

M A T ER NIT Y E X P E N SE B E N E FI T : Means treatment taken in Hospital/Nursing Home arising from ortraceable to pregnancy, childbirth including normal / Caesarean Section.

T P A: Means a Third Party Administrator who holds a valid License from Insurance Regulatory andDevelopment Authority to act as a THIRD PARTY ADMINISTRATOR and is empanelled by the Companyfor the provision of health services as speciff ed in the agreement between the Company and TPA.

Insurer : The Oriental Insurance Company Ltd.

TPA : Vidal Health TPA Pvt Ltd.

Escalatiti on Matrix and Point of Contact

• In case of any hospitalization support or queries regarding claims, you can reach out to the dedicated TPA toll free no provided for HCL – 18004251820. You may also write your queries to h c li n f r a @ v i da l h e a l t h tp a . c om . In case you are not able to connect to the toll free number or you do notreceive a call back, kindly feel free to reach out to the representative mentioned below:

Level 1

Location Name Email ID Mobile No

Noida Gurprit Singh gurpr it .s i ngh @ v i da l hea l t h t pa.c o m 8800585510

Bangalore Divya gh m i b l r @ hc l . com 9916330499

Hyderabad Divya gh m i b l r @ hc l . com 9916330499

Chennai Murli G HM I He l pdesk2 @ hc l .c o m 8939629974

Other Locations Gurprit Singh gurpr it .s i ngh @ v i da l hea l t h t pa.c o m 8800585510

ESCALATION MATRIX:

Level 2

Location Name Email ID Mobile No

Noida Dr Yagdeep y a g d ee p.c @ v i d a l he a lt h t pa . com 7838243703

Bangalore Janardhan H Janardha .h @ i nd i a i nsure.com 7760976456

Hyderabad Ashish Shukla A sh i s h. s @ i nd i a i nsure.c o m 9818697203

Chennai Padmaja Suryarajan Pad m a j a .su r y a ra j an @ i nd i a i nsure.c o m 9600019585

Other Locations Ashish Shukla A sh i s h. s @ i nd i a i nsure.c o m 9818697203

Level 3

Sl No Name Email ID

1 Ashish Saxena ash i s h . saxena @ v i da l h e a lt h t pa.c o m

2 Arindam Ghosh / Vippin Chandra servehc l @ i nd i a i nsure.com

• If you have any queries regarding the enrolment process or face any technical issues during dependantdeclaration, write to h c l@i nd i a i nsu r e . c o m .

• In case of queries regarding the policy, kindly raise a titi cket on the Smart Service Desk (SSD) by following this navigation path:

My HCL > Smart Service Desk > Applicaton issue/Service request/Process & Data Issue > HR (under Business Group) > HR Policy Clariff caton (under Business process) > Medical Insurance Policy (under Business Sub- process)

D epend a n t s D e fi fini ti o n

• Spouse, Children, Parents, Dependent Brothers (unemployed below 25 Years) & Sisters (Unemployed &Unmarried)

• Under no condition will a combination of parents and parents-in-law will be covered.

• An employee opting for surrogacy and aff er completion of necessary legal formalities will be entitled to include the Child as a dependant

• An employee who legally adopts a child following due procedures will also be entitled to include the childas dependant.

• A maximum of seven dependants can be declared.

D epend a n t s D e c l a r a ti o n : The beneff t will cover dependants on the basis of declaration given by employee on the link mentioned in the Welcome Mailer during the enrolment window period.

• Existiti ng employees

• Existing employees cannot make changes / substitute in dependants data once declared at thebeginning of policy period.

• New Joinee’s

• Employees joined on or before 24th of the current month, will receive Welcome Mail to declaredependants in ff rst week of the subsequent month of joining.

• Employees joined aff er 24th of the current month, will receive Welcome Mail to declare

dependants in the ff rst week of alternate month aff er joining (e.g. Employees joining on 25 th

July or later, will get a welcome mailer in the 1st week of September).• Link to opt for medical insurance for self and dependants will be actiti ve for 14 days and will

be preceded by a Welcome Mail.• Onsite to India Return Employees

• Dependants will be covered as per employee’s initial declaration under EMCP and coverage foremployee will be eff ective from the date of his / her joining in off shore.

• Transferred Employees

• In case of onsite transfer of an employee, the case is treated as akin to cessation of servicefrom the date of departure of the employee. However, for the remaining policy period,dependants in India will be covered under the program.

• New born declarations should be made in India Insure’s portal (URL mentioned in the Welcome Mail)within 60 days from the date of birth. If no name is given to the baby, then the name should be added as“baby boy or baby girl” as the case maybe.

• Newly wedded spouse for coverage under policy should be declared in India Insure’s portal (URLmentioned in the Welcome Mail) within 45 days from the date of marriage.

The Insurance Company will not entertain any addition / deletion aff er the last date of enrolmentas mentioned in the Welcome Mail. If dependants are not updated on or before the last date of enrolment,they will not be covered in the current medical policy valid upto September 30, 2016. Any addition in theportal, aff er the cut-of date, will not be considered for medical coverage.

Re tir in g Em pl o y ee s

Employees retiring during the policy cycle will have an option to continue their coverage in the policy by payingthe premium on pro-rata basis for the remaining period of the policy. In the year of retirement, they will haveto continue with the dependants already declared for the policy and pay premium as per last drawn ‘Insuranceand Medical Beneff ts’ component. They will have to inform about their coverage in the policy within 2weeks of retirement. Next year onwards, they will have an option to opt for this beneff t where only self andspouse will be covered. The Sum Insured and premium payable will be applicable as per the policy of the newpolicy period.

De p e nd a n t C o v e r a g e

The coverage for dependants has been segregated into four plans, with the option given to the employees to select his / her medical plan coverage. The premium contribution percentages for the plans have been given inthe table below:

Plans Coverage Premium (Percentage of ‘Insurance and Medical Benefit’component in your CTC)

A Self 50%

B Spouse & Children 20%

C Parents / Parents-in-law 30% for single parent / 60% for one set of parents

D Siblings 20% each sibling

All employees are by default covered under Plan A.

Employees have the choice to opt for coverage under the other plans; the additional premium for such planswill be applicable accordingly based on a one-time annual declaration by the employee.

Premium Contributiti on & Maximum Premium Limits:

The premium payable towards various insurances ismentioned as ‘Insurance and Medical Beneff ts’ in your compensation structure. The amount mentioned in salary structure under ‘Insurance and Medical Beneff ts’ is 100% of monthly Basic.• If an employee chooses to go only for plan “A” then the diff erential of the contribution (i.e. 100% - 50%

= 50% of ‘Insurance and Medical Beneff ts’) will be paid as taxable salary.

• Similarly if an employee chooses to opt for other plans, then the medical premium contribution willincrease. Such additional premium contribution will be deducted from the employee’s salary. E.g. anemployee chooses Plan A, B, C & D whereby the total contribution comes upto 50% + 20% + 60%(assuming one set of parents) + 20% (assuming one sibling) = 150%. Since the medical premium amountmentioned in the compensation structure is only 100% of ‘ Insurance and MedicalBeneff ts’component,150% - 100% = 50% of ‘Insurance and Medical Beneff ts’ will be recovered from such employees through equated payroll deductions.

• The premium contribution by the employee cannot be used to avail the income tax exemption since thecontract is between HCL and the Insurance Company.

Ho s pit a li za ti o n L i m i t s

Sum Insured on hospitalization is mentioned below. The limits are inclusive of the service tax etc.

Band Sum Insured LimitE0 & E1 INR 3 LacsE2 & E3 INR 5 LacsE4 & above INR 7 Lacs

Co - P a y

• Self, Spouse, Children & Siblings* : 10%

• Parents* : 20%

*New norms for hospitalization (Planned): In case of planned hospitalization, an employee needs to intimate the TPA atleast 72 hours in advance. In case of failure in adhering to the timelines mentioned above, Co-Pay of 5% will be imposedover and above the normal Co-Pay limits. The above mentioned norms of cashless hospitalization will be applicable fromFebruary 1, 2015.

C o - P a y C a l c ul a ti o n

First the admissible claim amount is calculated based on the non-payable expenses (like non-medical charges,telephone charges, food expenses, etc. are also deducted at this point in time). List of non-admissible chargesare available in Annexure 3.

• Co-pay is on admissible charges only.

• Then, on this admissible claim amount, co-payment is applied so that the Insurer pays the balance and theInsured pays Co-Pay as per the limits deff ned above in ‘Co-Pay’ section.

Kindly refer to the illustrative example given below (Amount in INR). E.g. For an E2 band employee, whenhospital initimation was done 72 hours in advance.

Please note that this is an illustrative example only. Actual facts and circumstances will differ from case tocase.

Charge Type Hospital BillAmount

Payable / Entiti tlement

Non Payable Remarks

Room Rent 5,800 5,000 800 Diff erence in room charges

Medical Accessories /Admission Charges

12,038 11,667 371* Oxygen accessories, Filter, Cover kit, Gauze,Gloves, Admission charges etc., are nonpayable

OT Charges 15,400 12,834 2,566 Pro -rata deduction; Basic room rent charges, following will be calculation on nonpayable charges - E.G. for OT charges4000/4800*15400 = 12834 & likewise forthe other line items

Consultatiti on 820 683 137

Surgeon Charges 63,000 52,500 10,500

Total 97,058 82,684 14,374

• Amount Non Payable by Insurer : INR 14,374

• Assuming Hospitalisation is for Self / Spouse / Children / Siblings

• Co-pay Amount : INR 8,268.40 (10 % of INR 82,684)

• Amount Payable by Insurer : INR 74,415.60 (INR 82,684 – INR 8,268.40)

• Amount Payable by Insured : INR 22,642.40 (INR 14,374 + INR 8,268.40)

• Assuming Hospitalisation is for parents / parents-in-law

• Co-pay Amount : INR 16,536.80 (20 % of INR 82,684)

• Amount Payable by Insurer : INR 66,147.20 (INR 82,684 – INR 16,536.80)

• Amount Payable by Insured : INR 30,910.80 (INR 14,374 + INR 16,536.80)

*Amount is illustrative; any of the admission charges/ mentioned accessories charges will not be in scope ofhospitalization coverage.

M edi c a l A ll o w a n ce as a p art o f C T C

• Monthly component, part of CTC, paid up to INR 2,000 per month.

• Exempted from tax to the limit of INR 15,000/- annually (per tax year) on submission of actual medical billsas per CBDT (Central Board of Direct Taxes, Govt. Of India) guidelines in the current ff nancial year.

• Claim proofs should be from authorized medical stores / outlets only.

• All bills should be submitt ed in original, along with income tax savings proofs, basis communication from

EHS through Communication Mailers.

C e rv i c a l C a n c e r V acc i n a ti o n

• Employees will be entitled for proactiti ve vaccination as a preventiti ve measure against CervicalCancer.

• 50% of the above mentioned amount will be paid by Insurer and remaining amount by women employeesper sitting. Maximum 3 sittings will be covered under this beneff t.

• This co-pay beneff t is for self-vaccination and not available fordependants.

A rtifi fi c i al li f e / li m b s upp o r t : Expensive items like a pacemaker, artiff cial limbs repement arising out ofaccident during the policy period etc., are covered in the policy; expenses of such items would be reimbursedby the Insurer at actuals subject to the available limit under Hospitalization.

P r e - e x i s ti n g D i s e as e s: All pre-existing diseases are covered under the Medical Insurance Policy.

C o n g enit al D i s e as e s: Hospitalization expenses for congenital internal diseases are covered and congenitalexternal diseases are covered only if it is for non-cosmetic medical reasons.

H o s pit a li za ti o n C l a i m f o r H o m e o p a t hi c & A y u r vedi c T re a tm e n t s: Apart from Allopathy, employees canalso claim under hospitalization, current bills of Homeopathy, Ayurvedic treatments. However the Unani,Electropathy, Siddha and such other therapies are not covered. Treatment in government hospitals only arecovered under this beneff t.

F ac i al C o rre cti o n s: On recommendation of a Registered Practitioner, the expenses towards facial corrections,except for cosmetic/aesthetic purposes, are considered under the current policy subject to available limit under

Hospitalization depending upon the period spent under this treatment.

P r e a n d P o s t H o s pit a l i za ti o n Ben e fi fi t

30 days pre and 60 days post hospitalization can be claimed as hospitalization expenses. Maternity is notcovered under this.

R oomR e n t

• Room rent eligibility is 1% of Sum Insured in case of hospitalizations other than for ICU.

• ICU is on actuals.

• In case the employee or his/her dependants get admitt ed in higher category, the diff erence in room rent&

related charges calculated pro rata will be borne by the employee.

M a te r ni t y Ben e fi fi t

New Born inclusion will be from the Birth of the child. If no name is given to the baby, then the name should beadded as “baby boy or baby girl” as the case maybe.

• Beneff ts for maternity are applicable for self or spouse (as applicable) and the newborn child as part ofthe limit for hospitalization.

• The maximum amount of claim under maternity for delivery is INR 50,000; in case of twins/triplets themaximum amount of claim under maternity for delivery is INR 70,000.

• Claim in respect of delivery for only first two (2) children and/or operations associated therewith willbe considered in respect of any INSURED PERSON covered under the policy.

• The new born baby will be covered within the overall maternity limit

• However in case of complications during child birth, the baby's name will be enrolled in the system and thebaby expenses will be part of the family hospitalization expenses and will not be considered a part of thematernity sublimit. Respective employees will be required to enroll the child’s name in the dependant list.

• The newborn is covered additionally & separately as dependant from the date of birth, and the child’s nameshould be added as dependant within two month (60 days) from the date of birth of the child, to the list ofdependants.

Maximum amount of claim under maternity INR 50,000 for single delivery

INR 70,000 for twins/triplets

Waititi ng period of 9 Months maternity cases Waived

Pre & post hospitalizatiti on in Maternity Not covered

Terminatiti on of Pregnancy on Doctor’s Advice Yes, however wilful termination not covered

Terminatiti on of Pregnancy: This is covered under the Hospitalization limits, but only if done on the adviceof a qualiff ed doctor and on account of medical reasons. Expenses arising out of voluntary termination ofpregnancy are not covered. However, medical expenses arising out of spontaneous termination of pregnancy(commonly termed as miscarriage) are covered.

*In case of Maternity related complications employee will be able to avail the complete Sum Insured,irrespective of the capping.

**Maternity cannot be claimed under two policies.

Ot he r Bene fi fit s:H o s pit a li za ti tio n

Limits for Facial Correctiti on Yes, but not for cosmetic medical reasons

Limits for Pace Maker / Artiti ficial Limbs Actual subject to available limit under Hospitalization

Hospitalizatiti on Covered & Day CareTreatment

The admission should be more than 24 hours. However the time limitdoes not apply for day care treatments. Any new changes in day careprocedure due to technical advancement would beaded by mutualconsent (Refer to Annexure 1)

Dental surgery due to accident (RTA) Covered

Treatment of External Congenital Covered only if it is for non-cosmetic reasons

Stem Cell / related surgery 50% payable

Robotiti c Surgery / Gamma Ray Surgery Payable for cancer treatment only

Cyber-knife surgery 50% of entitled amount for cancer treatment only

Hepatiti titi s virus (injectiti on charges) Interferon

50% of entitled amount is payable

Ambulance charges In case of emergency hospitalization INR 2,000 (Only from place ofincidence to hospital and not vice versa)

Ot he r Bene fi fit s: N o n - H o s pit a li z ati o n

Oral Chemotherapy To be purchased through TPA only

Preventiti ve Health Check-Up • Employees above the age of 40 are eligible toclaim expenses of self Master / Executive /Comprehensive Health check up to a maximum limitof INR 3,000.

• Employees below the age of 40 are eligible to claimexpenses of self Master/Executive/ComprehensiveHealth check up to a maximum limit of INR 1,000.

• This amount can be claimed once in the policy cycle.

Ca ppe d A il m e n t s:

Ailment Caps (subject to Sum Insured available/remaining or capped ailmentamount;whichever is lower) *

Cataract – INR 30,000

Hysterectomy – INR 60,000

Piles – INR 40,000

Cholecystectomy (Gall bladder stonereomoval) – INR 60,000

Fistulas – INR 35,000

Knee Joint Replacement – INR 2,00,000 / joint

Hernia – INR 60,000

Hip Replacement – INR 3,25,000 / hip

Coronary Angiogram – INR 18,000

* Any complications arising out of ‘Ailments Capped’ will be restricted within the above mentioned limits onlyand above limit is including pre and post hospitalization expenses. Also note that the limits mentioned aboveare NOT over and above the Sum Insured limit.

**Capped Ailments cannot be claimed under two policies.

O P D ben e fi fi t f o r P a re n t s

Employees have the option (voluntary) to provide OPD beneff t to their parents / parents-in-law. The variousoptions and the negotiti ated denominations in which this beneff t can be availed are mentionedbelow.This beneff t will be self funded by the employee.

Categories Optiti on 1 (in INR)

2 (in INR)

Optiti on 3 (in INR)

Medicines 15,000 20,000 25,000Preventive Health Check up 2,000 3,500 4,500Spectacles 1,000 1,500 1,500Dental Covered (not cosmetic) 4,000 5,000 7,000Hearing Aid 4,000 5,000 6,000Premium Payable by Employee (1 parent / 2 15,000 / 18,500 / 24,600 /parents)* 17,500 23,500 28,500

* Service tax of 15% on premium payable will be applicable

T o p U p

In case you feel that there is a need to additionaly secure yourself / dependants from medical insuranceperspective, we have negotitia ted special rates with The Oriental Insurance Company Ltd. for increasing theSum Insured. This additional Sum Insured has to be funded by the employee. This kind of a beneff t, if takenfrom the market is substantially more expensive than the negotiti ated rates.

Base SumInsured

Top Up Sum Insured (in INR Lacs)

Limits 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20(Deductibleto the Top

Up)

INR 3 Lacs 2,150 2,450 2,750 3,000 3,850 4,500 5,500 6,500 7,000 not provided

INR 5 Lacs 2,150 2,450 2,750 3,000 3,850 4,500 5,500 6,500 7,000 8,000 8,350 8,500 9,000 9,500 10,150 not provided

INR 7 Lacs 2,150 2,450 2,750 3,000 3,850 4,500 5,500 6,500 7,000 8,000 8,350 8,500 9,000 9,500 10,150 10,500 10,900 11,100 11,300 11,500

* Service tax of 15% on premium payable will be applicable

Maximum limit of additonal sum insured under Top Up is linked with your current sum insured

Top Up policy period will be December 10, 2015 to September 30, 2016.

If an employee opts for Top Up during December 10, 2015 to September 30, 2016 policy cycle, it will be mandatory for the employee to opt for Top Up in the next policy cycle as well i.e. October 1, 2016 to September30, 2017. Also, only an employee who opts for Top Up during December 10, 2015 to September 30, 2016 policycycle will be eligible to opt for Top Up during the subsequent policy cycle i.e. October 1, 2016 to September 30,2017.

T o p U p E x c lu s i o n s :

In case an employee who has availed Top Up quits HCL Technologies Ltd. then their applicable base Sum Insuredwould be the remaining Sum Insured at the time they quit the organization.For Example: If an employee’s base Sum Insured is INR 7 Lacs and he/she has opted for a Top Up of INR 2 Lacs.Let us assume the employee has utilized INR 4 Lacs during his/her tenure with HCL Technologies Ltd. thenhis/her remaining Sum Insured is INR 3 Lacs when he/she quits. In case an employeethe employee incurs ahospitalization expense of INR 4 Lacs post his/her leaving HCL Technologies Ltd. then he/she is eligible for INR 1Lac from Top Up Policy and not INR 2 Lacs, as Top Up Policy will come into force only when the employeeexhausts his/her remaining Sum Insured (INR 3 Lacs in this case).

T a x Ben e fi fi t o n T o p U p P re m iu m P a i d b yEm pl o y e e

Tax beneff t can be availed on the premium paid under Section 80D of the income Tax Act for the Top Uppolicy premium only. You will receive a certiff cate from Insurer for the same in the successive month aff erenrolment. The methodology of declaring and giving proofs to EHS remains the same as with any other taxsaving instruments. Declaration can be given in the tax declaration workff ow available in ‘MYHCL’.

P o li cy E x c lu s i o n s

Broad Principle:

• GHMI Program would pay for expenses (excluding non-medical items which are not payable) which are“reasonable” during hospitalization of any employee and / or dependant i.e. within alternatives oftreatment available, the GHMI program would reimburse / pay for THE MOST REASONABLE OPTIONAND NOT OTHERWISE.

• Should an employee / dependant choose any other option beyond the reasonable option, thediff erence in cost has to be borne by the employee

• In case of treatments involving latest technology and such treatment being an option which isexpensive and the only option as advised by the treating doctor, such cases would be referred to theTPA Doctor and India Insure Doctor. Based on the opinion of all 3, the case would be referred to the HCLGoverning Council. The Governing Council would decide on the merits of such cases and decideaccordingly;

Multifo cal

NormalStent(Metalli c)

DES(DrugEluting

Bio-Absorba ble

TURP

Laser LapColecystect omy

Robotiti cChole

Depends on thetype of drug and

duration oftherapy

35000-60000

1.2L - 1.6L 1.8L-2.8L 3L-4.5L 50K-80K

90K-1.5L

50K-1.2K >2.5L

Example: The below mentioned table clearly indicates 5 treatments where there are multipletreatment options (from a cost standpoint) which are available. The list of treatments mentionedbelow is for example only and the list is not exhaustiti ve.

Cataract PTCA Prostate Robotiti c HormonalTherapies in

Cancer

Unifocal

18000-29000

The Company shall not be liable to make any payment under this policy in respect of any expenses whatsoeverincurred by any Insured Person in connection with or in respect of:

• Injury or disease directly or indirectly caused by or arising from or atributable to War, Invasion, Act ofForeign Enemy, War like operations (whether war be declared or not) or by nuclear weapons /materials;

• Circumcision (unless necessary for treatment of a disease not excluded hereunder or as maybe necessitated due to any accident), vaccination, inoculation or change of life or cosmetic or ofaesthetic treatment of any description, plastic surgery other than as may be necessitated due to anaccident or as a part of any illness;

• Surgery for correction of eye sight, cost of spectacles, contact lenses, hearing aids etc.

• Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, fflli ngof cavity, root canal including wear and tear etc unless arising from disease or injury and whichrequires hospitalisation for treatment.

• Convalescence, general debility, “run down” condition or rest cure, congenital external diseases ordefects or anomalies, sterility, any fertility, sub-fertility or assisted conception procedure, venerealdiseases, intentional self-injury/suicide, all psychiatric and psychosomatic disorders and diseases /accident due to and or use, misuse or abuse of drugs / alcohol or use of intoxicating substances orsuch abuse or addiction etc.;

• All expenses arising out of any condition directly or indirectly caused by, or associated with Human T-cell Lymphotropic Virus Type III (HTLD - III) or Lymohadinopathy Associated Virus (LAV) or theMutants Derivative or Variations Deff ciency Syndrome or any Syndrome or condition of similar kindcommonly referred to as AIDS, HIV and its complications including sexually transmitt ed diseases;

• Expenses incurred at Hospital or Nursing Home primarily for evaluation / diagnostic purposes which isnot followed by active treatment for the ailment during the hospitalised period;

• Expenses on vitamins and tonics etc unless forming part of treatment for injury or disease ascertiff ed by the att ending physician;

• Any Treatment arising from or traceable to pregnancy, childbirth, miscarriage, caesarean section,abortion or complications of any of these including changes in chronic condition as a result ofpregnancy;

• Naturopathy treatment, unproven procedure or treatment, experimental or alternativemedicine and related treatment including acupressure, acupuncture, magnetic and such othertherapies etc.;

• Expenses incurred for investigation or treatment irrelevant to the diseases diagnosed duringhospitalisation or primary reasons for admission. Private nursing charges, Referral fee to familydoctors, Out station consultants / Surgeons fees etc.;

• Genetical disorders and stem cell implantation / surgery.

• External and or durable Medical / Non-medical equipment of any kind used for diagnosis and ortreatment including CPAP, CAPD, Infusion pump etc., Ambulatory devices i.e. walker, Crutches, Belts,Collars ,Caps , splints, slings, braces ,Stockings etc. of any kind, Diabetic foot wear, Glucometer /Thermometer and similar related items etc. and also any medical equipment which is subsequentlyused at home etc.;

• All non medical expenses including Personal comfort and convenience items or services such astelephone, television, Aya / barber or beauty services, diet charges, baby food, cosmetics, napkins ,toiletry items etc, guest services and similar incidental expenses or services etc.;

• Change of treatment from one pathy to other pathy unless being agreed / allowed and recommendedby the consultant under whom the treatment is taken;

• Treatment of obesity or condition arising therefrom (including morbid obesity) and any other weightcontrol programme, services or supplies etc.;

• Any treatment required arising from Insured’s participation in any hazardous actiti vity including butnot limited to scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing etc unlessspeciffc ally agreed by the Insurance Company;

• Any treatment received in convalescent home, convalescent hospital, health hydro, nature care clinic orsimilar establishments;

• Any stay in the hospital for any domestic reason or where no active regular treatment is givenby the specialist;

• Out-patient Diagnostic, Medical or Surgical procedures or treatments, non-prescribed drugs

and medical supplies, Hormone replacement therapy, Sex change or treatment which resultsfrom or is in any way related to sex change.

• Massages, Steam bathing, Shirodhara and alike treatment under Ayurvedic treatment

• Any kind of Service charges, Surcharges, Admission fees / Registration charges etc. levied by the hospital.

• Doctor’s home visit charges, Att endant / Nursing charges during pre and post hospitalisation period.

• Treatment which is continued before hospitalization and continued even aff er discharge for an ailment /disease / injury diff erent from the one for which hospitalization was necessary.

• Infertility Treatment expenses are also not covered under the policy.• Cost of spectacles and contact lenses and hearing aids.• Dental treatment or surgery of any kind unless requiring hospitalization due to RTA (Road Traff c

Accident). (Except for employees of 40 years and above age. For these employees Dental treatment uptoINR 10,000reimbursable.

• Lucentis / Avastin injections are not payable.

• Convalescence, general debility; run-down condition or rest cure, congenital external disease (except fornon-cosmetic reasons) or defects or anomalies, Sterility, Venereal disease, intentional self injury and use ofintoxication drugs / alcohol.

• Charges incurred at Hospital or Nursing Home primarily for diagnosis x-ray or Laboratory examinations orother diagnostic studies not consistent with or incidental to the diagnosis and treatment of positiveexistence of presence of any ailment, sickness or injury, for which conff nement is required at a Hospital/ Nursing Home or at home under domiciliary hospitalization as deff ned.

• Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certiff ed bythe att ending physician.

• Treatment arising from or traceable to pregnancy (including voluntary termination of pregnancy).• Naturopathy Treatment.• Hospitalization without active line of treatment is not payable.• Hospitalization only for observation or Investigation even if the admission to hospital is more than 24 hours

is not payable.

• Rituximab, herceptiti n, zolodronic injections (Any non-chemo drugs) are not payable since it doesnot warrant hospitalisation and also not listed under day care procedure list.

E n c l o s e d i n t h e F o rm S e cti o n o n P o li cy P o rt al

• Annexure 1: Day Care Procedures

• Annexure 2: Critical Illness

• Annexure 3: Non Admissible Expenses

• Annexure 4: Delisted Hospitals

E x c ep ti o n s

In the event of both husband and wife, being on permanent rolls of HCL Technologies, one of the members hasan option to opt out of the Medical Insurance Policy on the condition that the other member will cover thespouse as dependant.

However, in the event of enrolled member separating from the services of the company; following would be thetreatment:

• It will render the dependant member without any insurance coverage for the remaining policy period /medical year

• Separation from services of the company of enrolled member, will not entitle any automatic transfer ofinsurance coverage to the dependant member.

S P O C D e t a ils

Name: Arun Kumar Yadav

Phone Number: 9911745534

Email Id: Arun . y a d a v @ h c l . c om

P r oc e ssClaim Process – Health Check-up / Cervical Cancer

Vaccinatiti on• Submit all your General / Master / Executive / Comprehensive Health check up claims, through the

‘Medical Claims’ portal available on ww w . m y h c l . c om > My Transactions > Medical Claims.

• Att ach the bills and reports in original with print out of Claim form for expenses incurred and put it in the Mediclaim drop box in your facility by making a clear note on an envelope with the following details.

• Mention on the top of the envelope - Proactive Health Checkup or Cervical Cancer Vaccination.

• Employee SAP Code & Employee Name.

• Claimed Amount

• Claim Number

• Employee will be allowed to claim the refund under this category only once in a policy cycle. Hence billsand prescriptions of expenses incurred under the deff nition of this category needs to be preserved so that the same can be submitt ed while claiming. The current claim cycle is December 10, 2015 to September 30, 2016.

Claim Process – Day Care Procedures• For claiming hospitalization expenses, a minimum period of 24 hours of hospitalization is required.

• However, the time limit does not apply for day care surgeries where the insured is discharged on thesame day. The list of such day care surgeries are given in Annexure 1;

• Day Care Surgeries are treatments; such that:

• It necessitates hospitalization and the procedure involves specialized infrastructural facilitiesavailable in hospitals.

• Due to technological advances, hospitalization is required for less than 24 hours only.

• Bills for hospitalization expenses submitt ed are to be accompanied by the following documents

• Original Discharge summary

• Discharge Summary should include

• Presenting Illness

• Treatment given/course during hospitalization

• Date & Time of admission & discharge

• Diagnosis FIR/MLC/AR should be att ached in case of accident

• Original Hospital Main Bill/IP bill/Final bill

• Original Medicine Bills

• Original Reports/ Tests

• Original Bills of reports/ Tests

• Break up details for hospitalization Final bill

• Pre numbered cash paid receipt for Hospitalization Payment

• Signed Print out of the Claim Form

• Staple all the supports carefully to ensure there is no loss in transit.

• While there is no deff ned category of approved hospitals & nursing homes for this purpose, it is recommended that employees use reputed hospitals or at least one with a minimum capacity of 15 beds as such hospitals then necessarily have to comply with certain minimum infrastructural and othernecessary standards.

• Claims from Delisted hospitals will not be entertained. List of such hospitals is provided in Annexure 4.

• The hospitalization expenses pertaining to employees or dependants will be reckoned with, from the “date of admission” to the hospital and not the date of discharge from the hospital. Accordingly, the claims will be honored during the transition period from one policy to another E.g. If an employee or dependant (s) are admitt ed in the hospital on or before December 09, 2015 and get discharged on or aff er December 10, 2015, the claim is sustainable under the old policy and does not come within the purview of the current policy.

Procedure for Planned CashlessHospitalizatiti on

• All employee needs to intimate the TPA ( toll free number 18004251820) at least 72 hours in advance.

• Cashless Facility is provided by the TPA for hospitalization treatments in the panel of hospitals listedwith the insurer.

• It is prudent that every insured individual should carry their Medical E-Card with them at all times. Youcan never predict an emergency!

• At the time of hospitalization at a network hospital, you will have to produce the E-Card as proof ofbeing covered by a health insurance policy along with some form of photo ID (Ration card, Driving license, Voted Id card, etc.) with you in case the hospital wants to verify your identity.

• The network hospitals have a preauthorization request form available with them. This form can also bedownloaded from Vidal Health’swebsite. The form has to be jointly ffll ed in by you and your treating doctor. Please make sure all the details asked in the form are completely ffll ed. This will ensure speedy processing of your request.

• This form is then faxed by hospital to Vidal Health’s toll free fax number

• On receipt of the form, Vidal Health processes it. The medical team at Vidal Health will determinewhether the condition requiring admission and the treatment plan are covered by your health insurance policy. They will also check with other terms and conditions of your insurance policy.

• In case coverage is available, Vidal Health will issue an approval to the hospital for a speciff ed amount depending on the disease, treatment, how much you are insured for, etc. This is sent by fax and/or

email (if available). The approval is called a "Preauthorization". This preauthorization entitles you toavail cashless facility at the hospital without paying for the medical expenses. Note: Further enhancement approvals may be issued on request, subject to terms and conditions of the policy.

• At the time of discharge, please make sure that you check and sign the original bills and discharge summary. Please carry home a copy of the signed bill, discharge summary and all your investigationreports. This is for your reference and will also be useful during your future healthcare needs

• The hospital will ask you to pay for all the Non-Medical Expenses & co-payment in your bill. You have tomake this payment before discharge.

• In case, for whatever reason, the preauthorization request cannot be approved, a lett er denying preauthorization will be sent to the hospital. In this case, you will have to setle the hospital bill in fullby yourself.

• The Company /TPA reserves the right to deny pre-authorisation in case the hospital / insured person isunable to provide the relevant information / medical details as required by the Company /TPA. In suchcircumstances denial of Cashless Access should in no way be construed as denial of claim. The insuredperson may obtain the treatment as per his/her treating doctor’s advice and later on submit the fullclaim papers to the Company /TPA for reimbursement within 7 days of the discharge from Hospital /Nursing Home.

• Should any information be available to the Company /which makes the claim inadmissible ordoubtt ul requiring investigations, the authorisation of cashless facility may be withdrawn. Howeverthis shall be done by the Company /TPA before the patient is discharged from the Hospital.

Eff ective from February 1, 2015, employees must make sure to follow the Planned Hospitalization guidelines and of informing the TPA 72 hours prior to admission. If an employee does not follow the process mentioned above in case of a treatment that could have been planned, an additional co-pay of 5%will be imposed over and above the co-pay limits mentioned in the policy section.

In case of Emmergency situation, the E-Card can be shown at the network hospital to avail cashless admission facility. The preauthorization request can be sent to Vidal Health within four hours aff er admission. Whether the situation is an emmergency or not will be certiff ed by treating doctor and basis the treating doctor’s comments, TPA will ascertain if 5% additional Co-Pay can be waived of or not.

Claim Process – Hospitalizatiti onIn the event of opting for a “reimbursable” mode for claims – following procedure would apply(Documentation requirements, however, will be common for availing Cashless Facility as well)

• Submit all your Medical Hospitalization claims, through the ‘Medical Claims’ portal available atww w . m y h c l. com > My transactions > Medical Claims

• Fill in the claim details in the application using “New Claims” option

• Fill in the details of your claim online and submit.

• Att ach the documents (whatever is applicable) with this print out:

• Drop it in the medical Hospitalization drop box

• Remember to make the entry of your claim in the register kept near the Medical Drop Box

• Please drop the stapled claim in Medical Hospitalization Drop Box kept in your facility

• Norms of Prescriptiti on: Prescriptions should preferably be on the Doctor’s or Institution’s lett erhead, or else the registration number of the signing doctor should be legible. Signature of the Doctor, not below the rank of MBBS or equivalent is mandatory for processing of admission under the scheme. However, for hospitalization, prescription slips for the Institution those are generally given by the nursing staf or purchase of medicines will be adequate.

• Original Bills, reports to be submitt ed: In case of hospitalization all bills & reports submitt ed must be in original, as photocopies will not be accepted. It is mandatory to produce all bills, Diagnostic reports, Discharge summaries and Reports of investigations in original. Please note that there will be noexceptions to this.

• All the medical claims in case of Hospitalization should be submitt ed within 30 days from the dateof expenses incurred. If the claim is not submitt ed within 30 days from the date of expensesincurred it will not be considered for payout by the Insurance Company.

• Bills for recommended investiti gatiti ons: These, if submitt ed, must be accompanied by the doctor’s prescription as well as the report of the investigation.

• Reasonableness of claims: The policy does not prescribe too many limits on amounts that can be claimed or on medical institutions / practitioners that an employee may approach. However, this is withthe overriding provision that the entity concerned, the Insurer, and HCL Technologies have the right to question a claim, even if technically correct in all respects, if prima facie the amount claimed isevidently disproportionate to the services rendered by the medical institution or practitioner. Observations in this regard will be referred to medical consultant (appointed by the Company) whosedecision will be ff nal and binding on this account.

The responsibility of implementing the above terms of policy rests with the Insurer and the HR Head.

• Denied/Repudiated claims: Bills pertaining to denied/ repudiated claims would be returned by TPA toEHS who in turn would return back to the employee and should not be submitt ed for claims again.

Escalatiti on Matrix and Point of Contact

• In case of any hospitalization support or queries regarding claims, you can reach out to the dedicated TPA toll free no provided for HCL – 18004251820. You may also write your queries to h c li n f r a @ v i da l h e a l t h tp a . c om . In case you are not able to connect to the toll free number or you do notreceive a call back, kindly feel free to reach out to the representative mentioned below:

Level 1

Location Name Email ID Mobile No

Noida Gurprit Singh gurpr it .s i ngh @ v i da l hea l t h t pa.c o m 8800585510

Bangalore Divya gh m i b l r @ hc l . com 9916330499

Hyderabad Divya gh m i b l r @ hc l . com 9916330499

Chennai Murli G HM I He l pdesk2 @ hc l .c o m 8939629974

Other Locations Gurprit Singh gurpr it .s i ngh @ v i da l hea l t h t pa.c o m 8800585510

ESCALATION MATRIX:

Level 2

Location Name Email ID Mobile No

Noida Dr Yagdeep y a g d ee p.c @ v i d a l he a lt h t pa . com 7838243703

Bangalore Janardhan H Janardha .h @ i nd i a i nsure.com 7760976456

Hyderabad Ashish Shukla A sh i s h. s @ i nd i a i nsure.c o m 9818697203

Chennai Padmaja Suryarajan Pad m a j a .su r y a ra j an @ i nd i a i nsure.c o m 9600019585

Other Locations Ashish Shukla A sh i s h. s @ i nd i a i nsure.c o m 9818697203

Level 3

Sl No Name Email ID

1 Ashish Saxena ash i s h . saxena @ v i da l h e a lt h t pa.c o m

2 Arindam Ghosh / Vippin Chandra servehc l @ i nd i a i nsure.com

• If you have any queries regarding the enrolment process or face any technical issues during dependantdeclaration, write to h c l@i nd i a i nsu r e . c o m .

• In case of queries regarding the policy, kindly raise a titi cket on the Smart Service Desk (SSD) by following this navigation path:

My HCL > Smart Service Desk > Applicaton issue/Service request/Process & Data Issue > HR (under Business Group) > HR Policy Clariff caton (under Business process) > Medical Insurance Policy (under Business Sub- process)

FAQ’s

Q. I have not covered my father/ mother as he/she was working and was covered under government scheme.Can I cover him/her now?

A. Sorry, interim addition is not possible except for newborn and newly wedded spouse

Q. Is treatment of external congenital covered in the policy?

A. Treatment of external congenital is covered in the policy only if it is for non-cosmetic reasons.

Q. Who all from my family can be covered as dependants under this policy?

A. The policy coverage is available for a maximum of 7 dependants in the family of an employee. The definition of thedependants covers following; Spouse, Children, Parents / Parents-in-law, Dependent Brothers (unemployed below 25years) & Sister (Unmarried).

Q. Can I have my father and mother-in-law as dependant?

A. No, you can only have one set of parents as dependants either your parents or parents-in-law, there cannot be anycross combination.

Q. Are there any changes to the applicable limits for preventive health check-up?

A. Employees above the age of 40 are eligible to claim expenses of self-health checkup up to a maximum limit of INR3,000. Employees below the age of 40 are eligible to claim expenses of selfhealth checkup up to a maximum limit ofINR 1,000.

Q. Can I nominate my parents-in-law instead of my own parents or vice versa?

A. Yes, but this can be done only at the beginning of the policy period when you declare your dependants. Interimsubstitution of parents with in-laws is not allowed.

Q. Will I be able to cover a single parent? How will the premium amount get calculated in thiscase?

A. You can cover a single parent under the Medical insurance program. The premium amount calculated will then be30% of ‘Insurance and Medical Benefits’component in your salary per parent.

Q. Do the dependants get covered automatically in this policy or do I need to update their details somewhereto avail the benefit under this policy?

A. Dependants need to be declared by every employee on the URL provided in the Welcome Mailer in beginning of thepolicy cycle. A Welcome Mailer will be sent to all employees asking them to declare the dependants for the policyperiod. The benefits can be availed after this updation has happened. In case of new joinees, this declaration needs tobe done within 14 days of receipt of Welcome Mailer.

Q. If I like to change/ add my beneficiaries, how do I go about it?

A. You cannot make changes / substitute your dependants data once declared at the beginning of policy period orafter you have joined, whichever is later, except for following events: (1) In case you got married after the initialdeclaration of dependants and want to add your spouse as your dependant, then you can add your spouse on VidalHealth’s website within 45 days from the date of marriage using the login ID and Password sent to you earlier or youcan update through Myhcl.com. (2) In case you are blessed with a baby after the initial declaration of dependants andwant to add your baby as your dependant, then you can add your baby on Vidal Health’s website within 60 days fromthe date of birth using the login ID and Password sent to you earlier or you can update through Myhcl.com. (3) One

time substitution of parents-in-law with parents or vice versa is permissible if no claim has been made for thatparticular dependant.

Q. Can an employee opt out of medical policy? If yes, how is the balance amount paid?

A. All employees are by default covered under the Medical Plan ‘A’ and hence cannot opt out of the medical policy.

Q. Me and my spouse both are working in HCL. Can one opt out of the Policy?

A. Yes, in the event of both husband and wife, being on permanent rolls of HCL Technologies, one of the members hasan option to opt out of the Medical Insurance Policy on the condition that the other member will cover the spouse asdependant and this should be intimated to EHS well in the beginning of the policy period (December). However, in theevent of enrolled member separating from the services of the company; following would be the treatment: (a) It willrender the dependant member without any insurance coverage for the remaining policy period of current year. (b)Separation from services of the company of an enrolled member, will not entitle any automatic transfer of insurancecoverage to the dependant member.

Q. My spouse has joined HCL recently. I have covered my spouse in medical insurance already. Can my spouseopt out of the medical policy?

A. Yes, your spouse can opt out of the Medical policy provided you have covered your spouse in company medicalinsurance policy. This should be intimated to EHS within 15 days from the joining date of later.

Q. I did not declare by spouse as dependant as he/she was working and covered under his/her company medical insurance policy. Now my spouse has resigned and is not working anywhere. Can I cover my spouse inmiddle of the policy period?

A. Sorry, interim addition is not possible except for newborn and newly wedded spouse.

Q. Can I add a dependant who is not in India?

A. This policy covers only those dependants who are in India and expenses incurred in India alone will be processed.

Q. I do not have father and mother. Can I add my guardians /grandparents under MedicalInsurance?

A. Employee cannot cover anyone apart from the following member as their dependant under Medical Insurance.Spouse, dependant children, dependant parents, dependant brothers (who are unemployed but below the age of 25)and unmarried sisters.

Q. I am at onsite. Can I cover my dependants in India?

A. Yes. The dependants in India can be covered under EMCP (Extended Medical Coverage Program) by paying apremium INR 23,940 (inclusive of Service Tax). The insurance coverage would be INR 7,00,000. Please refer EMCP Policyfor further details.

Q. I want to declare my new born baby as a dependant. When can I declare thesame?

A. The declaration of new born baby should be incorporated within 60 days from date of birth on India Insure’s websiteotherwise dependants will not be covered in current policy and employee cannot claim bills for new born if notdeclared in time.

Q. I have not decided the name of my new born baby. How to add in Insurance?

A. If you have not named your baby, please update detail on Vidal Health’s website as ‘baby girl’ or ‘baby boy’. Oncethe baby is named, kindly update on India Insure website.

Q. I want to declare my newly wedded spouse. When can I declare the same?

A. The declaration of newly wedded spouse should be incorporated within 45 days from date of marriage on IndiaInsure’s website , otherwise dependants will not be covered in current policy and employee cannot claim bills forhis/her spouse if not declared in time.

Q. Is Pre-Existing disease covered?

A. Yes, all pre-existing diseases are covered.

Q. Can I receive any advance from the company against the claim?

A. No.

Q. Is there a Limit on room rent in Hospitalization?

A. Yes there is a limit for room, board and nursing expenses as provided by the hospital/nursing home, the same iselucidated in the policy.

Q. What will be the process if I chose a room rent beyond my eligibility?

A. In case the employee or his/her dependants get admitted in higher category, the difference in room rent & relatedcharges calculated pro-rata will be borne by the employee.

Q. I am not able to update my newborn / spouse name on TPA’s website?

A. Please write to ashish . s @indi a in s ur e . com and share details mentioned below: F or Newly b orn: • Employee ID •Name of the New Born Baby • Date of Birth (DD/MM/YYYY) • Gender • Relationship ; F or a dding s pou s e p o s tm a rri a g e : • Employee ID • Name of the Spouse • Date of Birth (DD/MM/YYYY) • Date of Marriage • Gender •Relationship

Q. How much do I have to contribute from my salary structure for MedicalExpenses?

A. The company will deduct premium based on the plans opted by the employee. All employees are by default coveredunder Plan ‘A’. Apart from that, employee can opt for a combination of any of the remaining three plans. E.g. - Anemployee opts for a combination of all plans and his/her ‘Insurance and Medical Benefits’ component in salarystructure is INR 10,000. Then the premium contribution will be equal to INR 15,000; (50% for self + 20% for spouse &children + 60% for one set of parents/in-laws +20% for one sibling) of 10,000.

Q. Is Stem Cell related surgery payable?

A. Yes, 50% of entitled amount is payable.

Q. Is Hepatitis virus (injection charges) payable?

A. Interferon is payable upto 50% of entitled amount.

Q. Is Day care treatment payable?

A. Day Care treatments listed in the Annexure 1 are covered.

Q. What is the period covered for pre and post of hospitalization?

A. Claims pertaining to 30 days before date of admission and 60 days after date of discharge will be considered underthe main hospitalization claim if the treatment is related to the same hospitalization.

Q. Are the expenses arising out of medical termination, miscarriage covered under medicalpolicy?

A. Yes it is covered under hospitalisation limit only if done on the advice of a qualified doctor and on account ofmedical reasons. Expenses arising out of voluntary termination of pregnancy are not covered. However, medicalexpenses arising out of spontaneous termination of pregnancy are covered.

Q. Are pre and post Hospitalization Expenses in Maternity covered?

A. Maternity is a special case i.e. put under hospitalization and has a limit of INR 50,000 ; and INR 70,000 in case oftwins/triplets. Thus the pre and post of maternity hospitalization would not come under normal pre/posthospitalization.

Q. Will the co-pay be applicable to maternity expenses also?

A. No. Co-Pay is not applicable on Maternity.

Q. Will the co-pay be applicable to capped Ailments also?

A. No. Co-Pay is not applicable on Capped Ailments.

Q. Is Lasik treatment covered under the insurance claim?

A. No, Lasik surgery is not covered and would not be paid.ai

Q. Is multifocal lens payable?

A. No, it is not payable.

Q. If an hospitalization taken by an employee is for investigation purposes, will such expenses be covered?

A. If there is no active line of treatment and the hospitalization done is just for investigation /observation purposesthen it is not payable.

Q. What is meant by active line of treatment?

A. The active line of treatment means the treatment which is aimed at immediate cure of an ailment/disease/illness orinjury. However, if the treatment though aimed at immediate cure of an ailment/injury but normally done on OPD basiswill fall under exclusion in Health Insurance Policies.

Q. Is Congenital internal diseases covered?

A. Yes.

Q. Are genetic disorders payable?

A. No.

Q. Is Congenital external diseases covered?

A. Covered but only for non-cosmetic reasons

Q. Is Dental surgery covered?

A. No, but surgery due to road accident is covered. Dental treatment is covered for employees above 40 years of ageup to a maximum limit of INR 10,000.

Q. Is admission less than 24 hours payable?

A. No, however the time limit does not apply for Day Care procedures listed in Annexure 1.

Q. Is Cyber-knife surgery payable?

A. Yes, 50% of entitled amount is payable.

Q. Is Ambulance charge payable?

A. Yes, but only in case of emergency hospitalization and maximum limit will be INR 2,000 (only from place ofincidence to hospital and not vice versa).

Q. I am covered under ESI. Can I be covered under the medical insurancepolicy?

A. Yes, you can be covered and cover your dependants as well, however at an additional cost of premium as applicablefor self and dependants coverage as specified in the policy will be borne by you.

Q. Is robotic surgery payable?

A. No.

Q. Is hospitalisation for injection like Herceptin, Lucentinetc payable?

A. No, hospitalisation only for injection administration is not payable.

Q. Is maternity related complication part of maternity limit?

A. No. In case of complications arising out of maternity, Family Sum Insured will be open and hence would not berestricted to maternity limit.

Q. Is genetic disorder payable?

A. No, Genetic disorder is not payable.

Q. Will the Top Up Policy be valid even if I quit HCL during the Policy Period?

Yes. Top Up is an individual policy over and above the Base Policy. Even when an employee quits HCL, his/herTop Up policy remains applicable. But aff er an employee moves out of HCL his/her Top Up policy becomeshis/her base policy. The standard conditions applicable to retail policy will be applicable here. Longivity ofperson in HCL’s Top Up program will be considered while he/she moves out of HCL and when his/her Top UpPolicy becomes his/her base policy.

For Example: If an employee’s base Sum Insured is INR 7 Lacs and he/she has opted for a Top Up of INR 2 Lacs.Let us assume the employee has utilized INR 4 Lacs during his/her tenure with HCL Technologies Ltd. thenhis/her remaining Sum Insured is INR 3 Lacs when he/she quits. In case an employeethe employee incurs ahospitalization expense of INR 4 Lacs post his/her leaving HCL Technologies Ltd. then he/she is eligible for INR 1Lac from Top Up Policy and not INR 2 Lacs, as Top Up Policy will come into force only when the employeeexhausts his/her remaining Sum Insured (INR 3 Lacs in this case).

Q. How much is my copay?

A. 10% for non-parents claims and 20% for parents claims. In case of planned hospitalization, an employee needs tointimate the TPA at least 72 hours in advance. In case of failure in adhering to the timelines mentioned above, Co-Pay of 5%will be imposed over and above the normal Co-Pay limits

Q. Is my dental/MHC/CCV limit part of my Sum Insured or in addition to Sum Insured?

A. There will not be any amount paid over and above the Sum Insured. All expenses will be within the Sum Insuredonly.

Q. I am covered under ESI and would like to opt for medical Insurance program, what is the timeline to opt thisprogram?

A. EHS will write to all ESI covered employees, seeking their desire to get this additional cover, at the beginning ofevery medical year policy period. New Joinee’s falling under ESI cover will be required to send an email to

Arun . y a d a v @ h c l . c om within 15 days of joining to get themselves enrolled under this additional cover.

Q. What is a PPN network? Where will I find the list of PPN network?

A. PPN Hospitals refers to Insurer & TPA's preferred network of hospitals where we will get specially negotiated ratesfor hospitalization, thus allowing us to conserve our sum assured limits for future needs. There are 800+ leadinghospitals spread across 7 cities in India which are covered under PPN network. The list is available in our Policy as a linkas well as on TPA’s website

Q. How do we claim our Medical Expenses?

A. Submit all your Medical Hospitalization claims, through w w w . m y hcl . c o m > My transactions > Medical Claim. If it isnot submitted online, then the Insurance/TPA will not accept the claim for processing & the possible reimbursementcould not be made. Below are the steps: Fill the claim details in the application using “New Claim” option & providethe below documents along with claim form. Original discharge summary (as per checklist), FIR/MLC/AR (in case ofaccident), Original Medicine Bills , Original Reports/Tests, Original Bills for reports/Tests ,Break-up details forhospitalization Final bill ,Pre-numbered cash paid receipt for hospitalization Payment ,Hospital is 15 bedded &registered with 24 hours duty doctor & nurses ,Signed print out of the claim form ,Stapled carefully and put it in sealedenvelope to avoid the loss of document in transit. Ensure that you enter the details of your claim in both theapplication and in the register kept near EHS Medical drop box and drop the claim in the drop box.

Q. Is it mandatory to have the time of admission and discharge in the discharge summary and final bill?

A. Yes, it is mandatory as it is required to calculate the number of days of hospitalization.

Q. Is there any printed form to claim for the reimbursement? From where can I get thisform?

A. There is no printed medical claim form for offshore employees and employee can apply their claim in Medicalapplication in Myhcl.in.

Q. How can we avail Cashless Hospitalization?

A. If you are planning the treatment in network hospital, then you may avail this facility through cashlesshospitalization. (1)Please get in touch with the Corporate Desk at the Hospital Lobby with the patient e-card. (2)Youwill get the cashless request form of TPA. (3) It needs to be filled in and signed by the treating doctor. (4) Same has tobe signed by you or any family member who are covered as your dependant in our group medical Insurance policy.(5)Ensure that the form is completely filled in before signing (6) This form is then to be faxed to TPA by the hospital forprocess. (7) If the treatment is planned; kindly get the form filled in at least 3 days in advance and have it faxed to TPA.(8) If you are treated at non network hospital you have to submit claim form and relevant documents for possiblereimbursement within 30 days of discharge.

Q. My claim is under ‘Information Required’ status. How should I resubmit it? "Process to Re-submit a claim inMedical Claim Application”:

A. Re-submit only through the medical claim application in myhcl. This is to track your claims. (1) Click on partiallyapproved claim number to get the option -“please give your remarks and click this button “submit to EHS” forresubmission. (2) Then take a printout of the claim form, attach the required documents along with the claim form. (3)Sign the claim form. (4) If it is a hospitalization claim, legibly enter in the Register maintained near the Medical ClaimDrop Box and drop the claim in it.

Q. What is the procedure to submit pre & post hospitalization bills?

A. Raise a new claim in Medical application for Pre & post hospitalization and submit the bills along with a photocopyof the discharge summary.

Q. Is treatment towards psychological problem or depression payable?

A. Treatments related to psychological problems are not payable.

Q. Will bills issued on letter head be paid?

A. No, bills will be paid only if it is a cash-paid receipt.

Q. What treatments are covered under Day Care?

A. List of Day Care procedures is available in Annexure 1.

Q. What treatments are covered under Critical Illness?

A. List of Critical Illness is available in Annexure 2.

Q. If I am undergoing a treatment which is other than allopathy, can I claim theexpenses?

A. Homeopathy & Ayurvedic treatment will be paid basis on the treatment given only in Government Hospital. Hence,kindly get the concurrence form TPA before hospitalization.

Q. My spouse underwent hospitalization and we informed for cashless within 4 hours of hospitalization. As itwas an emergency hence we were unable to inform the TPA 72 hours prior to the hospitalization. In spite of anemergency situation, an additional 5% co-pay was charged.

Whether the hospitalization was done in an emergency or could have been planned will be specified by the treating doctor. While cashless request goes to the TPA, the TPA will liaison with treating doctor to confirm if it is emergency orcould have been a planned hospitalization. Based on the inputs, the TPA will ascertain if additional 5% co-pay will be applicable.

Q. My father underwent a cataract operation, the cost of which was INR 38,000 out of which only INR 25,000was approved. My Sum Insured remaining during his hospitalization was INR 25,000. As cataract is a cappedailment; the limit of which is INR 30,000, why was INR 30,000 not approved?

Ailment Caps are subject to a condition that the amount payable will be the available/remaining Sum Insured orthe limit of the capped ailment. As your remaining SI during hospitalization was lower than the limit of thecapped ailment, hence the approval was made basis your SI.