Presentation of Services

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Medi Assist India Pvt Ltd

Policy Over ViewPolicy Over View

Qwest Telecom Software Services Pvt LtdQwest Telecom Software Services Pvt Ltd

TPA ServicesTPA Services

United India Insurance Co. Ltd United India Insurance Co. Ltd

28/04/2010   To   27/04/201128/04/2010   To   27/04/2011

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The Mediclaim Policy Reimburses Expenses incurred due to DiseaseIllness

or Accident.The Mediclaim Policy stipulates that a claim is admissible when the insured (beneficiary)is admitted in a hospital for a minimum of 24 hours and treatment of a positive illness Insurance reimburses Reasonable, Customary & necessary expenses.

MEDI CLAIM POLICY

Cont…

24 hours hospitalization is not applicable for:

Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Tonsillectomy, Lap Appendicectomy, lithotripsy, Hernia

Repair, Coronary Angioplasty, Fracture or dislocation, Prostrate surgery, Other surgeries done under Anaesthesia

taken in the Hospital/Nursing Home and the Insured is discharged on the same day.

The treatment will be considered under hospitalization Benefit and has to be availed as An inpatient only.

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

Registered with local authorities

Under supervision of registered & qualified medical practitioner

Minimum of 15 inpatient beds( In Smaller cities/ towns the same is reduced to 10 beds)

Fully equipped operation theatre

Fully qualified nursing staff 24/7

Fully qualified doctors 24/7

Definition of Hospital

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Sum Insured- 2 Lacs /Family Family Definition- Employee, Spouse,

2 Children and 2 parents All Pre- existing ailments are covered. No 30 day waiting period.

Policy Benefits

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Expenses Payable

A. Room Rent, Boarding, Nursing Charges and ICU charges restricted to Rs. 3500/-. This also includes RMO charges, IV fluids/blood transfusion or Injection administration charges & similar expenses.

B. Surgeon, Anaesthetist, Consultants, Medical Practitioner, Specialist fees.

C. Anaesthesia, Blood, Oxygen, O. T. charges, Surgical Appliances, Medicines & drugs, Artificial Limbs, Cost of Prosthetic Devices like pacemaker, Implants, and Relevant Laboratory/Diagnostic test and Similar expenses

D. Pre Hospitalization Expenses: Expenses incurred 30 days prior to date of admission( Consultation / Test Charges )

E. Post Hospitalization: Expenses incurred up to 60 days from the date of discharge.

F. Ayurvedic, Homeo patic and Unani Treatment covered if taken in a registered hospital based on line of treatment on the scrutiny of the document under reimbursement claim.

Please note the Pre & Post Natal Expenses is not payable. If new born does not have any complication claim not admissible

10% co-pay applicable for parents claim

Maternity Benefits

Maternity benefits covered for employee/ spouse Rs. 50,000/-

Maternity & Child Coverage from Day One Expenses incurred on any disease / complication, arising during maternity for new born child will be covered from day 1, within Floater SI

Child data to be given to HR within 30 days.

Maternity expenses are covered for first TWO children.

Normal baby expenses not payable.

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Expenses Not Payable

Admission/Registration Telephone chargesAttendant's charges Home Visit/Nursing charges - at residence after dischargeAssistant fee/Follow up charges in advance Sundry/Medico Legal Charges/Diabetic chart chargesThermometer ChargesContainer for Specimen/Disposable Bag chargesAdmission Kit External Surgical Aids: Lumbo-sacral/Collar belt /Knee cap/Knee brace/ walker/hot water bag/baby kit/urine pot / traction kit/ folding commode etcInhaler/ Nebulizer /Glucometer or any other equipmentsDiet chargesSpecial/protein diet/health drinks unless prescribed by the doctor Documentation/Folder/Stationery/In Patient chart charges

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General Policy Exclusions

Injuries or diseases caused by war and war like operations Circumcision, Vaccination, Inoculation, Cosmetic treatment, Plastic

surgery Corrective eye surgery, Spectacles, Contact lenses, Hearing Aids Dental Treatment without hospitalization unless arising due to an

accident Convalescence, General weakness, Sterility, Venereal disease,

Alcohol use, Self injury AIDS Diagnostic expenses not followed by active treatment for the

ailment. Vitamins and Tonics unrelated to treatment Injuries or diseases caused by nuclear weapons Abortion during first three months of pregnancy ( Voluntary) Naturopathy treatment & Alternate Medicine / Therapy

POLICY PARAMOUNTAt all times the policy issued by the Insurer shall prevail & supersede

this presentation.

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TPA SERVICES

ENROLMENT ID cards – Photo ID cards

CLAIMS ADMINISTRATION

CASHLESS HOSPITALISATION (THROUGH NETWORK available at website www.mediassistindia.com)

Reimbursement claim

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4800+ Hospitals across the country

Covering 20 states

Average 25 Hospitals being added every month

Complete hospital list available at www.mediassistindia.com

Provider Network-Cashless

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Cashless Hospitalisation

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 deducting the non

medical expenses

Please produce your Identity Card and photo ID proof of claimant at the hospital on network where you wish to avail treatment.

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.

For Emergency Request- TAT – maximum 4 - 6 hours Planned Admissions: Approval can be availed 3 days in advance.

Procedure for cashless Hospitalization

Admission PA request Info ApprovalTreatment

& Discharge

You are advised

admission by your doctor

Pre-auth request is

submitted to Medi Assist by the hospital

and is processed at Medi Assist

In case any further info is required, the

hospital is asked to

submit the info and processing

happens

Approval or denial is issued

as per the terms and

conditions of your insurance

policy

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Procedure For Reimbursement of Claims

Please submit the following documents in originalDischarge Summary. (Original ) 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 to be submitted.

Note: In case of non-availability of prescriptions, kindly ask your Physician to countersign on the reverse of pharmacy bills.

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Turn Around Time [TAT]

Identity Card - - 8 working days

Cashless Hospitalisation – planned admission: 48 to 72 hrs - Emergency : 6 to 8 hrs hours

Reimbursement claimsMaximum of 10 working daysSubject to complete documentation

& availability of all information required to settle a claim

Customer Service

CALL CENTRE: 1800 4259 449Single Toll free number, accessible from any location in IndiaFull-fledged call centre working 24x7x365Multi lingual supportOther Prime Number- 080-26537870

Address for correspondence

Customer Care In charge: Ms. Triveni B N

Email: trivenibn@mediassistindia.com

Medi Assist India Private LimitedNo:797, Annapoorna, 10th Main Road, 4th Block , JayanagarBangalore- 560 011Ph: 26538790/91/92

Toll Free No: 1800 4259 449 Toll Free Fax: 1800 4259 559

Wish you a healthy and happy future !

Thank you

Medi Assist India Pvt. Ltd.www.mediassistindia.com