Mediclaim Policy for Employees & their Family

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Benefits of the PolicyBenefits of having a Corporate Policy in compared to Individual Retail Policy are as follows:

RETAIL POLICY CORPORATE POLICY

Pre-existing disease is covered after 3 years Pre-existing disease is covered from Day 1

30 Days waiting period applicable 30 Days waiting period not applicable

Pre-policy medical tests are required above 45 years of age Pre policy medical tests are not required

Congenital Internal Ailments are not covered Congenital Internal / External Ailments are covered

Maternity not covered Maternity is covered

Capping on room rent is limited No capping on room rent

PREMIUM AMOUNT PAID BY COMPANY

PAID BY EMPLOYEE

SELF 100% -

SPOUSE 100% -

CHILD-1 100% -

CHILD-2 100% -

CHILD-3 (+) 50% 50%

DEPENDENT PARENT

If Residing with employee(JAJPUR,CHANDIKHOL,CUTTACK,BHUBANESWAR)

100% -

If not Residing with employee 50% 50%

PREMIUM AMOUNT

COVERAGE AMOUNT

NOPR

CASE COVERAGE AMOUNT COVERED

OPD Rs. 4000Per Insured Person

HOSPITALISATION Rs.2,00,000 Family Floater

PREMIUM CHART

NOPR

AGE BAND INCLUDING SERVICE TAX

0-65 Rs. 3,576/-

66-70 Rs. 6,780/-

70+ Rs. 9,234/-

Features

Family Floater Sum insured for hospitalization – Rs. 2,00,000.

Domiciliary (OPD) expenses – Rs 4,000 per insured person

No premium recovery from employee for self, spouse and two dependent children ( Dependent children implies unemployed sons up to 25 years of age / unemployed and unmarried daughters).

50% of applicable premium for third and more child to be borne by the employee. If dependent parents are residing (Jajpur, Chandikhol,Cuttack & Bhubaneswar)

with the employee, no recovery of premium from the employee but if the dependent parents are not residing with the employee, 50% premium to be recovered.

• Maternity: Maternity Benefit covered subject to a maximum of Rs. 30,000/- Normal and 50,000 Caesarean without 9 months waiting period.

• New Born Dependant : Covered from day of birth within the overall family floater limits and also subject to family not exceeding the stipulated size as above on inclusion of the baby.

• Mid-term inclusion of existing employee’s newly acquired dependent (newly married spouse/new born baby/newly adopted child ) is allowed subject to declaration

• Corporate Floater : Available to each family unit up to the limit of Sum Insured opted by them and on expiry of their sum insured.

• Type of Treatment shall include Allopath and or Homeopath and or Ayurved and or any other recognized practices covered provided for a limit up to 10% of sum insured for treatment taken in registered government hospitals

• Ambulance charges @ 1% of Sum Insured subject to a maximum of Rs. 2,000/- per person per event subject to overall admissibility of the claim.

Features

List of Exclusions

SN List of Exclusions

1 Intentional self injury / use of intoxicating drugs or liquor or Disease directly due to one or more of them.

2 Vaccination / Inoculation / Circumcision other than medical grounds.

3 Congenial defects / anomalies / Venereal diseases.

4 Beauty treatment (Including plastic surgery unless necessitated by an accident).

5 Cost of eye glasses / Lenses / Frames.

6 Cost of Diagnostic studies not related to medical treatment covered under this policy.

7 Injury / Disease related to radio activity.8 Injury / Disease due to war and war related operations. 9 Cost of special diet.

Claim Documents Submission process :

All Claim documents for reimbursement should be submitted within 30 days from the date of discharge in case of claim for Pre-hospitalization and Hospitalization expenses. For Post Hospitalization expenses, all claim documents should be submitted within 15 days of completion of post hospitalization treatment / period stipulated ( 60 days from discharge) for post hospitalization expenses coverage as per policy , whichever is earlier .

Day Care Procedures are Covered as per standard list

Pre Hospitalization Cover Post Hospitalization Cover

Documents Required for OPD Claim Submission• Duly Filled & Signed Claim Form• All investigation & test reports- including ECG, X-Ray,

Ultra-Sound, CT Scan, MRI • All original pharmacy bills & prescriptions.• All original consultation papers/documents against

bill/receipt submitted along with Claim form .

Documents Required for Reimbursement Claim Submission

• Duly Filled & Signed Claim Form• Original Discharge Summary• Original hospital bills/ receipts & supporting annexures. . (please make sure

patient name is mentioned on every bill/document submitted) • Final / Advance paid receipt with receipt no.• All investigation & test reports- including ECG, X-Ray, Ultra-Sound, CT Scan, MRI • All pharmacy bills & prescriptions.• All consultation papers/documents against bill/receipt submitted along with Claim

form .

https://www.mediassistindia.net/IWP

Process of log-in & checking calim Status

empcode@tatasteelkpo

DOB(DDMMYYYY)

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FAQ1) What is the validity period of the policy ?

The policy is valid for 1 year from the inception date i.e. 16-Sept-15.

2) Can I purchase this policy for self and family in any month?

You can enrol only in the month of September and October within the enrolment date. There after, we will be accepting applications of new joiners only within 2 months from their date of joining.

3) During renewal, will the premium remain the same ?

The premium may increase or decrease or remain same next year depending upon the claim history of the policy.

4) I am having a mediclaim policy for my family which I purchased of my own. Can I opt for this policy as well ?

Yes, you can opt for this policy. It is an additional benefit for you.

5) Can I opt out of the policy during the policy period ?

No, you cannot opt out of the policy during the policy period since it is a corporate policy.

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FAQ Continues…..

6)What is the Maximum Entry Age in the policy?

There is no maximum entry age in this policy .

7) I am an unmarried employee. If I get married, will I be allowed to add my spouse as a family member in later year?

Yes you are allowed to add your spouse as a family member during the policy.

8) What are the tax benefits which can be availed under this plan?

Deduction u/s 80 D of income tax act is available from taxable income for premium paid towards health insurance.

A) For self, spouse and children - (Maximum Rs.15000/-)B) For parent (s) (Maximum Rs.15000/-)* In case parent (s) are resident senior citizen (Maximum (Rs.20000/-)

9) I want to purchase this policy for my family. Is it mandatory that I enrol myself as well ?

Yes, it is mandatory that as per the terms & conditions of the policy, an employee has to enrol himself / herself as well.

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FAQ Continues…..10) What do you mean by the Family floater?

In a family floater sum insured covers all the members in the family who has enrolled in the policy. For eg: In the family if one of the member have utilized the amount of Rs.1 lakh from the total coverage of Rs.2 Lakhs, the remaining amount can be utilize by the other members of the family.

11) In case own parents have expired and the parents-in-law are dependent on the employee (spouse being the only child) - can they be covered?

As per the mediclaim policy, only parents of the employee are covered

12) What is the amount of coverage for maternity benefits?

The maternity benefit covered upto Rs.30,000/- for normal and Rs.50,000/- for caesarean.

The benefit is applicable for first 2 living children only.

13) I have joined Tata Steel on 01 January, 2016. Can I purchase this policy for self and family?

Yes, you can purchase this policy for self and family within two months of joining . The premium will be charged as per pro rata basis.

• BISWA PRAKASH DASH - 9040094930

• HAMUEL PANI- 9861157264

• PHONE : 06726-606045

Contact details for Mediclaim related Issues

MEDICLAIM FOR DETs24 AUGUST 2013THANK YOU