SIDDAGANGA INSTITUTE OF TECHNOLOGYYear 2012 - 2013

FOR

POLICY OVERVIEWINSURED SIDDAGANGA INSTITUTE OF TECHNOLOGY

INSURER THE NATIONAL INSURANCE COMPANY LTD

POLICY NUMBER 604203/48/12/8500000613 604203/48/12/8500000609 604203/46/12/8500000058

THIRD PARTY ADMINISTOR

MEDI ASSIST INDIA TPA PVT LTD

PERIOD OF INSURANCE FROM 19/10/2012 TO 18/10/2013

Please Note:

Policy features detailed in the following slides are only important highlights which are subject otherwise to the Terms, Conditions and Limitations of the Policy. Please refer to the Policy Schedule/Wordings issued by the Insurer for more details of the same.

3Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation

Mohali

JaipurDelhi

Lucknow Patna

Jamshedpur

Kolkata

Bhubaneswar

Vishakhapatnam

Guwahati

Hyderabad

Bangalore

ChennaiCoimbatore

Trivandrum

Cochin

Mangalore

Pune

Mumbai

NagpurSurat

AhmedabadBhopal

Indore

Corporate Office•BangaloreRegional Offices•Mumbai•Bangalore•Chennai•Kolkata•New Delhi

Branch Offices - 19

Our Offices

Corporate office

Regional offices

Branch offices

Year

2007

2008

2009

2010

2011

2012

Manpower Strength

400

525

750

830

1010

1350

PAN India Presence

The Mediclaim Policy Reimburses Hospitalisation Expenses incurred due to:-Disease Illness or any bodily injury sustained through Accident

Treatment done in a Hospital /Nursing Home / Day Care Centre on the advice of a qualified Physician / Medical Specialist / Surgeon

As an Inpatient in the Hospital (fulfilling the definition of Hospital)

For a minimum of duration of 24 hours

POLICY COVERAGE

An institution established in India for indoor care & treatment of sickness and injuries

Registered as Hospital or Nursing Home with local authorities

Under supervision of registered & qualified medical practitioner

Has minimum of 10 inpatient beds (In towns having less than 10 Lakhs population OR

15 inpatient beds if located in other towns

Has fully equipped operation theatre of its own

Has fully qualified Nursing Staff and Doctors and Maintains Daily Record for each Patient

The Term Hospital or Nursing Home shall not include an establishment which is a place of rest, a place for the aged, a place for drug-addicts or place for alcoholics a hotel or a similar place

DEFINITION OF HOSPITAL

Day Care Procedures where 24 hours hospitalization is not applicable

POLICY COVERAGE

Anti Rabies Vaccination HysterectomyAppendectomy Inguinal/ventral/Umbilical/ Femoral HerniaCoronary angiography Parenteral chemotherapyCoronary angioplasty Piles/ fistula

D&C of cervix ProstrateDental surgery following accident Lithotripsy (Kidney Stone Removal)

Eye surgery RadiotherapyFracture/dislocation excluding hairline fracture Sinusitis

Gastro Intestinal Tract System Stone in Gall Bladder, Pancreas and Bile Duct

Haemo Dialysis TonsillectomyHydrocele Urinary Tract System

Note: All ailment mentioned above will not be payable for the first two years of operation of the policy.

2.1 Room, Boarding and Nursing Expenses as provided by the Hospital / nursing home not exceeding 1% of Sum Insured Per Day for Normal Room or actual amount whichever is less.

2.2 Intensive Care Unit (ICU) Expenses not exceeding 2% of sum Insred Per Day or actual amount whichever is less

2.3 Surgeon, Anaesthetist, Medical Practitioner, Consultants’ Specialist fees.

2.4 Anesthesia, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, cost of Artificial limbs, Cost of Prosthetic devices implanted during surgical procedure like Pacemaker and relevant laboratory/Diagnostic tests, X-ray and other medical expenses related to the treatment.

2.5 Pre-Hospitalization medical charges up to 30 days period immediately before insured’s admission to hospital for that treatment of illness or injury

2.6 Post-Hospitalization medical charges up to 60 days period immediately after insured’s admission to hospital for that treatment of illness or injury

IMPORTANT NOTEThe amounts payable under 2.3 and 2.4 shall be at the rate applicable to the entitled room category. In case Insured opts for a room with rent higher than the entitled category as under 2.1,the charges payable under 2.3 and 2.4 shall be limited to the charges applicable to the entitled category.

No payment shall be made under 2.3 other than part of the hospitalization bill.

Expenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government Hospital

EXPENSES COVEREDExpenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government HospitalExpenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government HospitalExpenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government Hospital

Expenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government Hospital

Expenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government Hospital

Following are few Non Medical Expenses which are not reimbursable under the Policy: Telephone charges Attendant's charges Home Visit/Nursing charges - at residence after discharge Assistant fee/Follow up charges in advance Sundry/Medico Legal Charges/Diabetic chart charges Thermometer Charges Container for Specimen/Disposable Bag charges Admission Kit External Surgical Aids: Lumbo-sacral/Collar belt /Knee cap/Knee brace/ walker/hot water bag/baby

kit/urine pot / traction kit/ folding commode etc Inhaler/ Nebulizer /Glucometer or any other equipments Diet charges Special/protein diet/health drinks unless prescribed by the doctor Documentation/Folder/Stationery/In Patient chart charges Expenses on vitamins and tonics unless forming part of treatment Naturopathy Treatment, Acupressure, Acupuncture, Experimental and unproven

treatment/therapies. (ABOVE LIST IS NOT EXHAUSTIVE. TO SEE THE COMPLETE LIST OF NON MEDICAL EXPENSES PLEASE VISIT OUT WEBSITE

WWW.MEDIASSISTINDIA.COM)

FEW NON MEDICAL EXPENSES NOT PAYABLE

FEW MAJOR EXCLUSIONS Circumcision, Cosmetic or Aesthetic Treatment, Plastic Surgery unless required to treat any injury

or illness Vaccinations and Inoculations, Vitamins and Tonics unrelated to treatment Cost of braces, equipment or external prosthetic devices, non-durable implants, eye glasses, cost

of spectacles and contact lenses, hearing aids including cochlear implants and durable medical equipment

All types of Dental treatments except arising out an accident Obesity treatment and its complications, congenital external disease/defects or anomalies,

Treatment related to all psychiatric and psychosomatic disorders, Infertility, sterility, use of intoxicating drugs/alcohol, use of tobacco leading to cancer Intentional self inflicted injury, attempted suicide and arising out of non adherence to any medical

advice Participation in hazardous sports of any kind, or any criminal act STD, AIDS and other related conditions Diagnostic, X-Ray or Lab expenses not consistent with or incidental to the diagnosis of positive

existence of ailment Voluntary Termination of Pregnancy Naturopathy treatment, Experimental/Unproven treatment Service Charges and All Non Medical Expenses Domiciliary Hospitalization, Treatment taken outside India Note : Please refer to policy condition for full list of exclusions

This service enables the customer to avail treatment at the Network Hospital without being required to pay for the treatment.

All expenses incurred will be paid to the Hospital after deducting non medical expenses subject to maximum limit of sum insured

Please produce your Medi Assist ID Card to the Network Hospital where you wish to avail treatment. Additionally you will be required to provide a valid Photo ID proof such as Voter ID, PAN Card, Driving License etc to the hospital

Kindly fill in the Medi Assist Card Number, Name of the Patient, Age & Contact Number in the Cashless Request Form

The treating doctor/ hospital will fill in the remaining part of the Request Form & Fax it to Medi Assist for approval.

Pre Authorisation approval for Cashless will be sent through Fax / Email to the Hospital

Please Check & Sign the hospital bill before Discharge

Avoid informing the hospital your total coverage details to prevent inflated billing

CASHLESS CLAIMS PROCESS

Claims Processing – Pre-Authorization/ Cashless

11Medi Assist India TPA Pvt. Ltd | Private & Confidential

Network of Hospitals – Pan-India

Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 12

State No. of Hospitals

Number of Packages

Hospitals with Discounts

Andhra Pradesh 582 192 418Assam 30 - 11Bihar 29 2 18Chandigarh 27 14 17Chattisgarh 13 3 7

Dadra & Nagar Haveli 1 - -

Delhi 214 153 158Goa 7 1 4Gujarat 495 60 243Haryana 204 103 160

Himachal Pradesh 13 5 8

Jammu & Kashmir 15 2 5

Jharkand 26 1 9Karnataka 645 188 399Kerala 200 22 91Madhya Pradesh 82 9 40Maharashtra 771 331 402Nagaland 2 - -Orissa 49 11 11Pondicherry 10 - 2Punjab 190 85 122Rajasthan 130 33 103Tamil Nadu 499 243 197Tripura 2 - 2Uttar Pradesh 234 85 166Uttaranchal 23 8 19West Bengal 197 75 92 Grand Total 4690 1626 2704

657 1282

1400

1351

Zones Hospital NetworkWest 1351

Bangalore 657South 1282

North East 1400Total 4690

Please submit the following documents in original

Discharge Summary. (Original ) .

Final Hospital Bill (with detailed break-up) &Cash paid Receipts (Original)

Medicine Bills along with Doctor Prescriptions.

Investigations & Test Reports. (Original)

Duly Filled Claim Form with Signature. (can be downloaded from website: www.mediassistindia.com

Bank Account Details of the Employee to be provided containing following details Name of Account Holder (Employee) as per Bank Records Bank Account Number Bank Name and Address IFSC Code Copy of cancelled cheque with all the above details Note: In case of non-availability of prescriptions, kindly ask your Physician to countersign on

the reverse of pharmacy bills.

PROCEDURE FOR REIMBURSEMENT CLAIMS

Claims Processing - Reimbursement Claims

14Medi Assist India TPA Pvt. Ltd | Private & Confidential

PROCESS TO DOWNLOAD ID CARDS FROM MEDI ASSIST WEBSITE

HR can access Medi Assist Website by following the steps below:-

Log in to Medi Assist website www.mediassistindia.com

Select Corporate Login from the Log in Title

Log in Name shall be Employee Number followed by short name of Corporate

Password will be shared separately by a welcome mail

Employee can view the names of enrolled.

Medi Assist India TPA Pvt. Ltd

Turn Around Time (TAT)

16Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation

Process Turn Around Time (TAT)

PRE-AUTHORIZATION Approvals processed within 1 Hour to 3 Hours maximum Planned hospitalization can be availed 2 days prior to admission

REIMBURSEMENT CLAIMS Settlement: 15 working days by Electronic Fund Transfer (EFT) (after receipt of complete claim documents)

Mandatory Requirements for EFT Transfer

Bank Account Details to be shared containing the following details in addition to all claims documents

• Full Name of Account Holder (Employee) as per Bank Records • Name and Address of Bank• IFSC Code• Copy of Cancelled cheque containing all above details

Submitting document without claim form Quoting wrong claim amount on claim form Enclosing certificate from doctor instead of detailed discharge summary Not attaching original cash paid receipts and submitting details on

prescription / hospital letter head instead of proper numbered receipt Incomplete documents: non submission of Lab reports, breakup for bills

and medicine prescriptions Not providing Bank Account Details for effecting settlement of claims

through EFT mode Providing Bank Account Details of a beneficiary instead of Employee Bank

Account Claim Documents submitted after 30 days of Discharge for Main

Hospitalization and beyond 7 days for Post Hospitalization Expenses. (Waiver of this condition is considered by Insurer in extreme cases of hardship where it is

proved to the satisfaction of the Company that under the circumstances in which the insured was placed it was not possible for him or any other person to give such notice or file claim within the prescribed time-limit)

SOME COMMON ERRORS THAT DELAYS SETTLEMENT OF REIMBURSEMENT CLAIMS

CUSTOMER SERVICE CONTACTSName Bhavya A L

Email Bhavya.l@mediassistindia.com

Mobile 9342529734(Temp)

Corporate Response 080–32942863 (9-30 am to 6 pm)

Call Centre Toll Free Number 1800 425 9449

Accessible from any location in India. Multi lingual support available in English, Kannada, Hindi)

ESCALATION MATRIX

FIRST LEVELRajesh sEmail-rajeshs@mediassistindia.comMobile- 9379761657

SECOND LEVELShashikala ( Manager )Email – shashikalag@mediassistindia.comMobile – 9379427268

Medi Assist India TPA Private LimitedBangalore BranchNo 45/A, “Green Arch", B Block, II Floor 1st Main Road, J P Nagar Phase III,Sarakki Industrial Layout, Bangalore 560078

Website: www.mediassistindia.com

ADDRESS FOR CORRESPONDENCE

MediAssist Online!

We are pleased to introduce to you MediAssist Online!

This is a web-based self-service platform provided. With this self-service application, you will be able to download soft copies of the Medi Assist cards for you and also check the reimbursement claim status.

Steps to be followed for:

Coporate HR Login

Features:

Beneficiary details

Claims details

E-card

Change password option

Click- on the tab login in the home page

Logon to

www.mediassistindia.com

Online Access

Click here- to enter your login details

Online Access

Click the TabCorporateemployee

Please enter your user name and

password

Online Access

Usernameempcode@cegedim

Password

For Beneficiary

DetailsClick this

Tab

For E CardsClick this

Tab

E CardsCan Be

Printed

E CARDS CAN BE

PRINTED

CLAIMS INFORMATION

BY CLICKING

THIS HYPERLINKGET MORE

INFORMATION

CLAIMBREAK

UPDETAILS

YOU CAN GET YOURCLAIM

DEDUCTIONS

CHEQUE DETAILS

Online Issues

If you have forgotten your password, or have problems logging into the system, please contact MediAssist directly by emailing

quoting employee code and corporate name

contact

Ms. Bhavya A L

Bhavya.l@mediassistindia.com

The same will be ratified within 3 working days from the receipt of the mail.

Wish you a healthy life and

happy future !

Thank you !!!