creating a collaborative ecosystem to simplify healthcare Mediclaim

…creating a collaborative ecosystem to simplify healthcare

Mediclaim Policy reimburses expenses incurred towards the treatment of a disease or illness for which hospitalization is warranted. The policy is issued by The New India Assurance Company Limited Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 2

What is Mediclaim Policy ? Mediclaim Policy reimburses expenses incurred towards the treatment of a disease or illness for which hospitalization is warranted. There are 2 ways through which a claim can be preferred- a) Cashless Hospitalization- Enables employee to avail treatment from network hospitals. b) Reimbursement Claim- Treatment is taken in non network hospital & claim submitted for reimbursement. Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 3

Documents Required for Reimbursement Claim • 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. Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 4

Hospital/ Nursing Home- Definition Hospital is a medical institution in India where sick or injured people are given medical or surgical care. The Hospital has to be either registered as a hospital or nursing home with the local authorities and Is under the supervision of a registered and qualified medical practitioner Or • • • Should at least have minimum of 15 beds (for class C cities 10) Fully Equipped Operation Theatre Fully Qualified Nursing Staff for 24 Hrs. Fully Qualified Medical Practioneer -24 Hrs Maintains Daily Medical Records Is not a Place of rest , Place for aged /drug addicts /alcoholics. Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 5

Tata Power Co. Ltd. – Policy Benefits-1 • Policy Period- 1 st April 2016 - 31 st March 2017 • Sum Insured- Family Floater as per eligibility. • Room Rent- Room rent is restricted to 1%. Incase of ICU room rent is restricted to 2. 5% (Union Category no capping is applicable) • Pre Hospitalization Expenses: Expenses incurred 30 days prior to hospitalization • Post Hospitalization: Expenses incurred up to 60 days from the date of discharge forming part of the treatment for which hospitalization was required. • Lasik Treatment is covered for eye power beyond 5. 5. Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 6

Tata Power Co. Ltd– Policy Benefits-2 • All Pre Existing Diseases are covered. • Duration of Hospitalization: Minimum 24 hours. However the following illness/ disease the 24 hours duration is not applicable. • Congenital external to be covered. • Infertility treatment - 1 lac - IVF including OPD basis. • Ambulance charges covered upto Rs, 10, 000/- • HIV/AIDS cover within S. I. • Cataract is covered Upto Rs. 45000/- per eye. (Union Category no capping is applicable) Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 7

Tata Power Co. Ltd– Policy Benefits-3 Day Care Procedures : Cataract Haemo -Dialysis Parenteral Chemotherapy Radiotherapy Dental Surgery- Following an accident Lithotripsy Dilatation & Curettage Anti- Rabies Vaccination Appendectomy Hysterectomy Piles /Fistula Prostrate Fracture/ dislocation excluding hair line fracture Sinusitis Gastrointestinal System Stone in Gall Bladder, Pancreas Hydrocele Urinary Tract Syste, Coronary Angiography Coronary Angioplasty Tonsillectomy Inguinal / Ventral/ Umbilical/ Femoral Hernia Repair Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 8

Expenses Payable under the policy v. Room Rent & Nursing Expenses. Room rent is restricted to 1% of sum insured. Incase of ICU room rent is restricted to 2. 5% of sum insured. (Union Category no capping is applicable) v. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees. (All these should form part of hospitalisation bill) v. Anaesthesia, Blood, Oxygen, OT charges, Surgical expenses. v. Medicines & Pharmacy Expenses. v. Diagnostic materials and X-ray Expenses. v. Dialysis, Chemotherapy, Radiotherapy Expenses. v. Cost of pacemaker, Artificial Implants & similar expenses. Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 9

Pre-Authorization (PA) & Reimbursement claim Process Reimbursement claims Process Pre-Authorization (PA) Process Customer visits the Medi Assist network hospital for admission, hospital sends PA request with copy of photo ID proof to Medi Assist Post hospitalization, employee submits duly filled claim form along with all original documents to Medi Assist help desk executive at Head office Medi Assist registers Pre-Auth request and Liability checks done as per policy terms and conditions Medi Assist registers the claim and sends acknowledgement to employee through SMS/e-mail If more information required, Medi Assist to seek Information Required from hospital. Medi Assist to process Pre-Authorization (Approved/Denied) Hospital to send the Discharge summary and Final bills to Medi Assist for PA settlement • Employee have to send all the claims documents to corporate office. Medi Assist validates the claim and carries out liability check as per policy terms and conditions If more information is required, Medi Assist sends Information Required (IR) letter to employee o SMS/ email alerts are sent at every stage of the processing; alongside access to Medi. Buddy: On receipt of complete documents, Medi Assist processes the Reimbursement Claims Denies Approves Payment is done through NEFT and settled Denial letter is sent Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation Queries Registration Information Required (IR) Approval Denial Settlement 10

Medi-Buddy Portal Once the enrollment is done employees can view below mentioned details from Medibuddy portal Steps: 1) Login to portal. medibuddy. in from Mozilla Firefox or Google chrome 2) Give username as Empid@tatapower (Ex: if Empid. is 1234, then the username should be - 1234@tatapower and password: tatapower ). Employee login: Username : Empcode@tatapower Password : tatapower Note : Medibuddy portal is under preparation will start at the earliest. Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 11

Medibuddy| Employee Login Pages | Login Page Enter your User Name Your Password Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation Username : Empid@tatapower Password : tatapower 12

Medibuddy| Employee Login Pages | Home Page Click here to know the claim status Click on Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation Click here to download the E card 13

How can I track claims- Medi-Buddy Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 14

Medi-Buddy | Medi Assist’s mobile solution Find the nearest / most conveniently located network hospital View your Medi Assist e-card and list of beneficiaries Send claims intimation ahead of emergency / planned hospitalization Send reimbursement claim intimation for speedy claims processing Track the status of your claims at real-time even without signing in Get instant notification on approval of pre-authorization for cashless hospitalization Purchase discounted wellness packages; enroll for corporate annual health checks Get reminders and alerts for upcoming health checks / appointments with your doc Order medicines and health supplements for door delivery Carry your health records and claims history in digital format Visit www. medibuddy. in or Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 15

Get On Speedy Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 16

Medi Assist- Relationship Team For any queries / clarification feel free to contact : Ms. Tejeshree Gujar Designation: Executive – Customer Relation E-mail Id: tejeshree. gujar@mediassistindia. com Hand Phone: -7718813070 For Escalations you can contact : Escalation Level 1: Name: Ms. Smita Khedekar Designation: Asst. Manager Corporate Customer Relation. Email: smita. khedekar@mediassistindia. com Hand Phone: 8451050893 Escalation Level 2: Name: Mr. Nikhil Ashokan Designation : CRM Manager Email: nikhil. ashokan@mediassistindia. com Hand Phone: 7710069279 Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 17

Wishing you good health Medi Assist India TPA Pvt Ltd. 1 ST Floor, North Wing, Plot No. 7, Excom House, Saki Vihar Road, Saki Naka, Andheri East, Mumbai- 400 072 info@mediassistindia. com | www. mediassistindia. com Medi Assist India TPA Private Limited | Private & Confidential | Not for Circulation 18