Leadership, Knowledge, Solutions…Worldwide.

Employee Benefits Manual

Client JLL (India)

Document No JLL/2017/EBM

2

Prepared by

Marsh India Insurance Brokers Private Ltd.

21/3, DLF Square, DLF City, Phase - II, M-Block, Jacaranda Marg,

Gurgaon, Haryana, India 122002.

Copyright © 2010. All rights reserved. No part of this publication may be reproduced, stored in

the retrieval system, or be transmitted in any form or by any means, electronic or mechanical,

photocopying, recording or otherwise, without the prior written permission of MARSH.

Disclaimer:

This manual is intended to be general summary of the benefits provided by JLL & should be regarded as guide only.

While HR shall make every reasonable effort to ensure the accuracy and validity of the information provided here in

this document. HR accepts no liability or responsibility for any errors or omissions in the content or for any loss or

damages arising out of your reliance on information provided here. If there is a conflict in interpretation or benefit

applicability, then the terms & conditions of the policy will prevail.

3

Group Medical

Program Details

FAQs & Common Definitions

Provides insurance coverage to employees for expenses related to hospitalization due to illness, disease or injury

Frequently Asked Questions & Common Definitions

Group Personal Accident Provides insurance coverage against the risk of death / injury during the policy period sustained due to an accident caused by violent, visible and external means

4

5

Medical Benefit

General Exclusions

GMC Contact Details

Coverage Details (Employee)

Claims Process

Claims Document List

Prudent Utilization of Benefit

Cashless Process

Non-Cashless

Benefits Extensions – Definitions

6

Medical Benefit – Coverage Details For Employee Policy

Policy Parameter

Insurer The New India Assurance Company Limited

TPA MediAssist Insurance TPA Pvt. Ltd.

Policy Start Date 27th January’2017

Policy End Date 26th Januray’2018

Coverage Type Family Floater (1+3) Max 4. Employee, Spouse, Children and Parents.

Dependent Coverage Employee , Spouse, Children, Parents (Max 4)

Sum Insured Graded - 1.5 L- upto Sr. Manager, 2.5L for Above Sr. Manager, For IFM –UHG INR 2 Lacs and for IFM –N.T – INR 5 Lacs

Benefits / Extensions Coverage

Domiciliary Hospitalization Not Covered

Pre-Post Hospitalization Exp. 30 days and 60 days

Pre and Post Natal INR 2500 within maternity limit

Well Baby Expenses INR 2500 within maternity limit

Room Rent Capping Normal – INR 2000 and as per actuals for ICU.

Deductible and Copay Non Medical and 10% Copay for admissible claim amount

Benefits / Extensions Coverage

Standard Hospitalization • Yes

TPA services • Yes

Pre existing diseases • Yes

Waiver on 1st year exclusion • Yes

Waiver on 1st 30 days excl. • Yes

Maternity benefits • Normal – 30K and C-Sec

– 50K

Baby cover day 1 • Yes

Ambulance Services • As Per actuals

(Emergency only)

7

Medical Benefit – Dependant Coverage

*No Individual should be covered as dependent of more than one employee

Next

Maximum no of Members insured in a family 1 + 3 (Max 4)

Employee Yes

Spouse Yes

Children Yes

Parents Yes

Parents-in-Law Yes

Siblings No

Others No

Mid Term enrollment of existing Dependents Disallowed

Mid Term enrollment of New Joinees (New employees +their

Dependents) Allowed

Mid term enrollment of new dependents (Spouse/Children) Allowed

8

Medical Benefit – Policy Period

Existing Employees + Dependents

Commencement Date 27th January’2017

Termination Date 26th Januray’2018

New Joinees + Dependents

Commencement Date Date of joining

Termination Date 26th Januray’2018

New Dependents (due to Marriage / Birth)

Commencement Date Date of such event

Termination Date 26th Januray’2018

9 Employee Benefits Manual

Medical Benefit – Standard Coverage

A) The expenses are payable provided they are incurred in India and within the policy period. Expenses will be

reimbursed to the covered member depending on the level of cover that he/she is entitled to.

Covers expenses related to

B) Expenses on Hospitalisation for minimum period of 24 hours are admissible.

However this time limit will not apply for specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye

surgery, Lithotripsy (kidney stone removal), Tonsillectomy, D & C taken in the Hospital/Nursing home and the

insured is discharged on the same day of the treatment will be considered to be taken under Hospitalisation

Benefit.

• Room and boarding- Normal –INR 2000 and as per actuals for ICU

•Doctors/Medical Practitioner fees

• Intensive Care Unit

• Nursing expenses

• Surgical fees, operating theatre, anesthesia and oxygen and their administration

• Drugs and medicines consumed on the premises

• Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)

• Costs of prosthetic devices if implanted during a surgical procedure

• Radiotherapy and chemotherapy

10

Post-hospitalisation Expenses

Definition

• If the Insurer accepts a claim under Hospitalization and immediately following the

Insured Member’s discharge, further medical treatment directly related to the same

condition for which the Insured Member was Hospitalized is required, the Insurer will

reimburse the Insured member’s Post-hospitalisation Expenses for up to 60 day

period.

Covered • Yes

Duration • 60 Days

Pre & Post Hospitalization Expenses

Pre-hospitalisation Expenses

Definition

• If the Insured member is diagnosed with an Illness which results in his / her

Hospitalization and for which the Insurer accepts a claim, the Insurer will also

reimburse the Insured Member’s Pre-hospitalisation Expenses for up to 30 days prior

to his / her Hospitalization.

Covered • Yes

Duration • 30 Days

*Any One Illness: A claim is considered as a single illness if it has a continuous period of illness or results in a relapse within 45 days of the earlier treatment.

11 Employee Benefits Manual

Maternity Benefits

• These benefits are admissible in case of hospitalisation in India.

• Covers first two children only. Those who already have two or more living children will not be eligible for this benefit.

• Expenses incurred in connection with voluntary medical termination of pregnancy during the first 12 weeks from the date of

conception are not covered.

Benefit Details

Benefit Amount • INR 30,000 for Normal & C-section., INR 50,000

Restriction on no of children • Maximum of 2 children

9 Months waiting period • Waived off

Pre and Post Natal • INR 2500 within maternity limit

Well Baby Expenses •INR 2500 within maternity limit

12

Medical Benefit – Cashless Process

Cashless means the Administrator may authorize upon a Policyholder’s request for direct settlement of eligible

services and it’s according charges between a Network Hospital and the Administrator. In such case the

Administrator will directly settle all eligible amounts with the Network Hospital and the Insured Person may not

have to pay any deposits at the commencement of the treatment or bills after the end of treatment to the extent

as these services are covered under the Policy.

Hospitals in the network (please refer to the website for the updated list)

For Updated List visit to Mediassist link as below:

https://network.medibuddy.in/

You can find network hospitals list in bottom of the webpage.

Note : Patients seeking treatment under cashless hospitalization are eligible to make claims under pre and post hospitalization expenses. For all such

expenses the bills and other required documents needs to submitted separately as part of the claims reimbursement.

Emergency Hospitalization Planned Hospitalization

13

P

R

O

C

E

S

S

Emergency Hospitalization & Process

Step 1 Get Admitted

Step 2 Pre-Authorization by hospital

Step 3 Treatment & Discharge

In cases of emergency, the member

should get admitted in the nearest

network hospital by showing their ID

card.

Relatives of admitted member

should inform the call centre within

24 hours about the hospitalization &

Seek pre authorization. The

preauthorization letter would be

directly given to the hospital. In

case of denial member would be

informed directly

After your hospitalization has been

pre-authorized the employee is not

required to pay the hospitalization

bill in case of a network hospital.

The bill will be sent directly to, and

settled by Mediassist

Member gets admitted in

the hospital in case of

emergency by showing his

ID Card

Member/Hospital applies

for pre-authorization to

Mediassist within 24 hrs of

admission

Mediassist verifies

applicability of the claim to

be registered and issue pre-

authorization

Pre-

authorization

given by

Mediassist

No

Member gets treated and

discharged after paying all

non medical expenses like

refreshments, etc.

Hospital sends complete set

of claims documents for

processing to Mediassist

Yes

Non cashless

Hospitalization

Process

14

Member intimates Mediassist of the

planned hospitalization in a

specified pre-authorization format

at-least 48 hours in advance

Claim

Registered by

Mediassist on

same day

Follow non cashless

process

No

Mediassist authorizes

cashless as per SLA for

planned hospitalization to

the hospital

Yes

Pre-Authorization

Completed

Pre – Authorization Form

Member produces ID card

at the network hospital

and gets admitted

Member gets treated and

discharged after paying

all non entitled benefits

like refreshments, etc.

Hospital sends complete

set of claims documents

for processing to

Mediassist

Claims Processing &

Settlement by

Mediassist & Insurer

Step 1 Pre-Authorization

All non-emergency hospitalization

instances must be pre-authorized

with Mediassist, as per the

procedure detailed below. This is

done to ensure that the best

healthcare possible, is obtained,

and the patient/employee is not

inconvenienced when taking

admission into a Network Hospital.

Step 2 Admission, Treatment &

discharge

After your hospitalization has been

pre-authorized, you need to secure

admission to a hospital. A letter of

credit will be issued by Mediassist

to the hospital. Kindly present your

ID card at the Hospital admission

desk. The employee is not required

to pay the hospitalization bill in case

of a network hospital. The bill will be

sent directly to, and settled by

Mediassist

Planned Hospitalization

15

Non-Cashless

Admission procedure

• In case you choose a non-network hospital you will have to liaise directly with the hospital for admission.

• However you are advised to follow the pre authorization procedure to ensure eligibility for reimbursement of

hospitalization expenses from the insurer.

Discharge procedure

• In case of non network hospital, you will be required to clear the bills and submit the claim to Mediassist for

reimbursement from the insurer. Please ensure that you collect all necessary documents such as – discharge

summary, investigation reports etc. for submitting your claim.

Submission of hospitalization claim

• You must submit the final claim with all relevant documents within 30 days from the date of discharge from

the hospital.

16

Non-Cashless Claims Process

Member intimates Mediassist

before or as soon as

hospitalization occurs

Insured admitted as per hospital

norms. All payments made by

member

Claim registered by Mediassist

after receipt of claim intimation

Insured Submits relevant

documents the Help desk

within 30 days of discharge

Is document

received

within 30 days

from

discharge

Claim Rejected

No

Mediassist performs medical

scrutiny of the documents

Is claim

payable?

Yes

Mediassist checks document

sufficiency

No

Yes

Is

documentatio

n complete

as required

Claims processing done as per

SLA

Receives mail about deficiency

and document requirement A

A

Payment to be Employee at the

help desk. The discharge

voucher and copy of payment

receipt to be sent to HR. Yes

No

•Insured will create the

summary of Bills (2 copies)

and attach it with the orignal

bills

•The envelope should

contain clearly the

Employee ID & Employee e-

mail

17

Claims Document List

Completed Claim form with Signature

Hospital bills in original (with bill no; signed and stamped by the hospital) with all charges itemized and the original receipts

Discharge Report/Certificate/card (original)

Attending doctors’ bills and receipts and certificate regarding diagnosis (if separate from hospital bill)

Original reports or attested copies of Bills and Receipts for Medicines, Investigations along with Doctors prescription in Original and Laboratory

Follow-up advice or letter for line of treatment after discharge from hospital, from Doctor.

Provide Break up details including Pharmacy items, Materials, Investigations even though it is there in the main bill

In case the hospital is not registered, please get a letter on the Hospital letterhead mentioning the number of beds and availability of doctors and nurses round the clock.

In non- network hospital, you may have to get the hospital and doctor’s registration number in Hospital letterhead and get the same signed and stamped by the hospital, if required.

*Please retain photocopies of all documents submitted

Claims Form

18

Benefits For

Marsh Definition

Pre existing diseases

Covered Any Pre-Existing ailments such as diabetes, hypertension, etc or related ailments for which care, treatment or advice was recommended by or received from a Doctor or which was first manifested prior to the commencement date of the Insured Person’s first Health Insurance policy with the Insurer

First 30 day waiting period

Waived Off

Any Illness diagnosed or diagnosable within 30 days of the effective date of the Policy Period if this is the first Health Policy taken by the Policyholder with the Insurer. If the Policyholder renews the Health Policy with the Insurer and increases the Limit of Indemnity, then this exclusion shall apply in relation to the amount by which the Limit of Indemnity has been increased

First Year Waiting period

Waived Off During the first year of the operation of the policy the expenses on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Diseases, Fistula in anus, Piles, Sinusitis and related disorders are not payable. If these diseases are pre- existing at the time of proposal they will not be covered even during subsequent period or renewal too

Benefit Extensions – Definitions

X

X

√

19

Medical Benefit – General Exclusions

• Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations

• Circumcision unless necessary for treatment of disease

• Congenital external diseases or defects/anomalies

• HIV and AIDS

• Hospitalisation for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.

• Venereal diseases

• Injury or disease caused directly or indirectly by nuclear weapons

• Naturopathy

• Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone

charges, etc

• Cost of spectacles, contact lenses, hearing aids

• Any cosmetic or plastic surgery except for correction of injury

• Hospitalisation for diagnostic tests only

• Vitamins and tonics unless used for treatment of injury or disease

• Infertility treatment

• Voluntary termination of pregnancy during first 12 weeks (MTP)

• OPD Claims

• Claims (of high value) submitted without prescriptions/diagnosis

• Health foods

• Costs incurred as a part of membership/subscription to a clinic or health centre

• Naturopathy

• Cost of appliances, spectacles, contact lenses, hearing aids

• Non-medical expenses like Hospital surcharge, telephone bills, cafeteria bills

20

Extra Dependent Policy

WHAT THIS POLICY COVERS

This would cover the dependents of an employee who are not included in the Main policy (i.e. 1+3)

ADVANTAGES

the premium as compared to last year has been reduced by 10%.

Nomination for Extra Dependent policy is done once a year and not in between policy period, except for new joiners

The coverage is identical to the main medical policy terms and conditions

Employee will get S.I value as per the employee designation(refer to below table)

The extra dependent coverage will discontinue once the employee resigns

Extra dependents would include only parents, spouse and upto two kids

In laws and siblings are not covered

Maternity claims are not allowed as part of this policy

Employee gets a tax benefit on the premium paid towards the policy

Levels Sum Insured Premium per life (Inclusive of Taxes)

Up-to Senior Managers 100000 5015

Associate Director & above 150000 5712

21

Top Up Medical Plan

WHY EVALUATE A TOP UP MEDICAL PLAN

Healthcare costs are rapidly rising with medical inflation being in the range of 15% to 20%. In such a situation, an employee may feel that his or her insured amount in the group health insurance is inadequate. Top up provides an additional coverage to employees over and above the company sponsored limit.

The premium rates are lower as compared to employee purchasing an additional retail insurance policy

The premium as compared to last year top up policy has been reduced by 9-10%

ADVANTAGES

Coverage is identical to main medical policy

Employee can choose the said sum insured as per his/her needs

The main medical plan and the top up plan can be claimed together for the same hospitalization.

Employee gets a tax benefit on the premium paid towards the top up plan.

22

Enrollment Period for New Joinees for Voluntary Program

The new joinees can declare their dependents for the voluntary program with 15 days from their date of joining.

Post the declaration window closes, no request for enrollment shall be entertained.

23

Top Up Medical Plan

OPERATIONAL ASPECTS

The sum insured is INR 1Lac, 2 Lacs, 3 Lac, 4 Lac, 5 Lac and 10 Lac

The top up plan is placed with the same insurer and TPA who underwrites the Group Medical Policy for operational efficiency

Nomination for top up policy is done once a year & not in between the policy period except for the new joinees

When the main medical plan sum insured is exhausted, only then the top up plan pays for the claim (amount over and above it).

The top up sum insured could be utilized for ailments, except for Maternity

Additional Sum Insured Premium (Inclusive of Taxes)

INR 1,00,000 6875

INR 2,00,000 8938

INR 3,00,000 12833

INR 4,00,000 16821

INR 5,00,000 19938

INR 10,00,000 40975

24

Prudent Utilization of Benefit

Health Insurance is a benefit for the employee and their dependents. One has to utilize the benefit with utmost caution and prudence.

The ever increasing cost for the benefits require a proactive involvement from all of us.

The following steps are recommended, ensuring the benefits is prudently utilized by the employee and dependents

Please ensure to crosscheck the final bill sent to the TPA for the following:

You are Billed only for the services utilized for e.g. category of room, diagnostics undergone ,

medicines consumed

Total of the bill

In case of any planned hospitalization, approach the hospital in advance(48 hrs) and request pre

authorization- this enables TPA to further negotiate the rates

To approach hospitals with caution – most expensive is not necessarily the best.

To cross check the tariff with the Bench Mark Rates provided- the benchmark rates would give an idea

the general spend for the treatment or procedure.

Try to negotiate

Ask WHY & WHAT is billed to you ( as a consumer , we have the right to know)

25

Medical Benefit – Contact Details

Provider List

Primary Contact - Endorsements Escalation Point - Endorsements and Claims

Insurer

The New India Assurance Co Ltd

Mukta Kansal (Relationship Manager)

Mob: 9871717872

Email: mukta.kansal@newindia.co.in

Rita Bawa (Sr. Divisional Manager)

Mob: 9911656060

Email: rita.bawa@newindia.co.in

26

Escalation Matrix

Medi Assist India TPA Pvt. Ltd.

Tower D, 4th Floor, IBC Knowledge Park, 4/1

Bannerghatta Road, Bangalore – 560029

JLL Toll Free No : 1800 208 1038.

Level- 1

Mr. Chandra Shekhar - JLL HD

Mob: 7022034727

Email id – insurancehelpdesk.in@ap.jll.com

Escalation Matrix for TPA

27

Marsh India Insurance Brokers Pvt. Ltd.

Registered office at 1201-02, Tower 2,

One Indiabulls Centre, Jupiter Mills Compound,

Senapati Bapat Marg, Elphinstone Road (W), Mumbai 400 013 .

ESCALATION 1

Vikas Chauhan

Email id: jll@marsh.com

Mob: 9643315133

ESCALATION 2

Sapna Bedi

Email id: sapna.bedi@marsh.com

Contact Details – Marsh India Insurance Broker

28

29

Group Personal Accident Policy

Policy Details

Benefit extension

Claims Procedure

General Exclusions

Contact Details

Document Check List

30

GPA – Benefit Details

All employees will be provided with a Personal Accident insurance policy through- New India Assurance Co. Ltd, based on company rules (you may contact your HR for further details). This insurance provides compensation/payment up to a financial limit as assigned by the company, to the insured person or his legal personal representative, if the insured person suffers death or disablement due to an accident. The cover is worldwide but payment of claim can only be made in India and in Indian Rupees.

Policy Parameter

Insurer Religare Health Insurance Company Ltd

Policy Start Date 27-Jan-2017

Policy End Date 26-Jan-2018

Coverage For Employees Only

Sum Insured Graded – Executive and Sr. Executive – INR 3 Lac, Asst Manager and

Manager – INR 5 Lac, Sr. Manager and Associate Director – INR 15 Lac,

Local Director and above – INR 30 Lac

Accidental Death Yes

Permanent Total Disability Yes

Permanent Partial Disability Yes

Temporary Total Disability Yes, upto 104 weeks. 1% of Sum Insured subject to maximum of INR 5K

per week, which ever is lower

Medical Extension 10% of SI or 40% of admissible claim or actuals, whichever is less

Terrorism Yes

Geographical Limit world wide

MARSH

Benefit Extensions

This policy covers the following benefits-

• Permanent Total Disability (PTD)

• Permanent Partial Disability (PPD)

• Temporary Total Disability (TTD)- up to 104 weeks. 1% of Sum Insured subject to

maximum of INR 5K per week, which ever is lower

• Medical Extension-10% of SI or 40% of admissible claim or actuals, whichever is

less

• Coverage operates world wide on 24 hours basis.

• Terrorism cover.

• Education benefit @ 10% of SI or INR 100,000 which ever is lower

• Repatriation of remains & cremation charges INR 5000

• Coverage for adventure sports

32

GPA – Claims Process

Claimant / Nominee notifies HR, who in turn would intimate Insurer and submit

required claim documents within 30 Days of the event

On obtaining all relevant documents, Insurance Co. will begin processing

the claims

Claim Investigation and Review of submission of all the required

documents

Is claim payable?

Cheque is sent to Employer (HR), from where it is given to the Claimant/ Assignee

Insurer provides a valid reason for the rejection to HR (death) no death

(Claimant)

No

Yes

33 Employee Benefits Manual 33 14 February 2017

Group Personal Accident – Claims Document Checklist

GPA Claim Form

Weekly Benefit Claims

1. Completed Claim form

2. Doctor's Report

3. Disability Certificate from the

Doctor, if any

4. Investigation/ Lab reports (x-ray

etc.)

5. Original Admission/discharge

card, if hospitalized

6. Employers Leave Certificate &

Details of salary

Death Claims

1. Completed claim form

2. Attending Doctor's report

3. Death Certificate

4. Post Mortem/ Coroner's report

5. FIR ( First Information Report)

6. Police Inquest report, wherever

applicable

Dismemberment/ Disablement

Claims 1. Completed claim form

2. Doctor's Report

3. Disability Certificate from the

Doctor

4. Investigation/ Lab reports (x-ray

etc.)

5. Original Admission/ discharge

card, if hospitalized.

6. Police Inquest report, wherever

applicable

34 Employee Benefits Manual

GPA – General Exclusions

1. Service on duty with any armed force

2. Insanity

3. Venereal disease

4. AIDS

5. Influence of intoxicating drink or drugs

6. Aviation other than as a passenger (fare paying or otherwise) in any duly licensed standard type of

aircraft any where in the world

7. Nuclear radiation or nuclear weapons material

8. Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared or

not), civil war, rebellion, revolution, insurrection, mutiny, military, or usurped power, seizure,

capture, arrest, restraint, detainment’s of all kings, princes, and people of whatever nation,

conditions and qualities so ever

9. Childbirth, pregnancy or other physical causes peculiar to the female sex

10. While committing any breach of law with criminal intent

35

FAQ’s & Common Definitions

Documents and links

FAQ’s

Definitions

IRDA (Insurance Regulatory and Development Authority)

http://www.irdaindia.org/

36

Thank You!