GMC Policy Presentation Health Insurance Administrator TPA VA

GMC Policy Presentation Health Insurance Administrator (TPA) VA Tech WABAG www. mediassistindia. com Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 1

Disclaimer Salient features of the Policy are given in this presentation. For Complete Information Please Refer the Policy Documents. Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 2

What is Mediclaim Insurance ? The insurance provides cashless/ reimbursement of hospitalization expenses incurred in India for the treatment of illness/diseases or injuries sustained by the insured person during the period of insurance. Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 3

Policy Conditions • Sum Insured : The Amount up to which a claim for medical hospitalization can be made. Coverage is individually (Rs. 100000 / Rs 200000 / Rs. 300000) • Current Policy period : 16/06/2013 to 15/06/2014 • Major exclusions applicable for standard policies are waived in this policy. Hence the policy has wider cover as follows: • All pre existing diseases are covered from day one • First 30 days waiting period not applicable. • 1 year, 2 years & 4 years exclusions for specific ailments/treatments not applicable • Family definition: Self, Spouse , 2 dependent children and 2 dependent parents • New born baby covered from day one • Internal Congenital disease covered under life threatening circumstance Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 4

Hospital / Nursing Home Any institution in India established for Indoor care and treatment of sickness and injuries and which either: • has been 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 comply with minimum criteria as under: ü At least 15 in-patient beds (for class C cities 10) ü Fully Equipped operation Theatre of its own wherever surgical Operations are carried out. ü Fully Qualified Nursing staff under its employment round the clock The term Hospital/Nursing home shall not include an establishment , which is a place of rest, a place for the aged , a place for drug addicts or for alcoholics , a hotel or a similar place Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 5

What are the expenses Reimbursable? The below given medical Expenses are payable If any insured person suffers an illness or accident during the policy period which requires the hospitalization as an inpatient • Room Rent, Boarding Expenses & Nursing: 1% of S. I + Rs. 2000 * • Intensive care Unit: 2% of S. I + Rs. 4000 * • A Medical practitioner, • Anesthesia, Blood , Oxygen, Operation theatre charges , surgical appliances • Medicines, drugs and consumables • Diagnostics procedures • The cost of prosthetic and other devices or equipment if implanted internally during a surgical procedures • Disease wise Capping: Cataract Rs. 24000 Per eye and No Capping for other diseases Hospitalization: Admission into hospital for medically necessary treatment as an inpatient for continuous period of at least 24 hours * Proportionate clause applicable if room rent exceeds eligibility limit Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 6

Maternity Benefit • Maternity expenses are covered for 2 children. The insured person who are already having two or more living children will not be eligible for this benefit • Normal Delivery Expenses Capped To : Rs. 25000 • Cesarean (C-section) Delivery Expenses Capped To: Rs. 50000 • 9 months waiting period waived • Pre-natal and post-natal expenses are not covered unless admitted in Hospital/Nursing Home and treatment is taken there • New Born Baby covered from day one Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 7

Pre and Post Hospitalization Pre-Hospitalization: • The Medical Expenses incurred due to an Illness in the 30 days immediately before the Insured Person was Hospitalized, provided that: • Such Medical Expenses were in fact incurred for the same condition for which the Insured Person’s subsequent Hospitalization was required Post-Hospitalization: • The Medical Expenses incurred in the 60 days immediately after the Insured Person was discharged post Hospitalization provided that: • Such costs are incurred in respect of the same condition for which the Insured Person’s earlier Hospitalization was required Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 8

Day care procedure Treatment undertaken in a hospital/Nursing Home on the recommendation of medical Practitioner for the following diseases, Illness or injury which requires hospitalization for less than 24 hours: • Dialysis • Chemotherapy • Radiotherapy • Eye Surgery • Lithotripsy (Kidney stone removal) • Tonsillectomy • Dilatation & Curettage • Hydrocele Surgery • Hernia Repair Surgery • Sinusitis • Coronary Angiography Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 9

Policy Exclusion • LASIK surgery for correction of eyesight, Contact lens, Spectacles, Hearing aids including Cochlear implants • Dental treatment unless arising due to accident • Medical termination of pregnancy / abortion within 12 weeks • Sterilization procedures, treatment of infertility/sub-fertility/ Assisted conception procedures • Plastic and cosmetic surgery, vaccination, inoculation, circumcision • External “congenital” disease, anomalies, defects • Intentional self injury / suicide attempt, psychiatric and psychosomatic disorders • Direct / indirect effects of use of alcohol / intoxicating drugs • AIDS and related syndromes • “Technical admission” –Admission for diagnostic/evaluation without active line of treatment • Expenses on vitamins or general tonics • Naturopathy treatment

Policy Exclusion • Pre and post expenses related to maternity claim • Unproven procedure/ treatment, experimental or alternative medicine/treatment including acupuncture, acupressure, magnetotherapy, RFQMR, etc. • Genetic disorders/stem cell implantation/surgery • External equipments like CPAP, CAPD, infusion Pump etc. , ambulatory devices like walker/ crutches/ belts/ collars/caps/ splints/ slings/ braces/ stockings/ diabetic foot-wear/ glucometer/ thermometer & similar related items & any medical equipment which could be used at home subsequently • Treatment for obesity or condition arising therefrom (including morbid obesity) and any other weight control program/ services/ supplies. • Massages/ Steambath/ Surodhara & alike Ayurvedic treatment. • Any kind of service charges/surcharges, admission fees/registration charges etc. levied by the hospital.

E - Login Actionable By Employee: Login to www. mediassistindia. com Click on “Login” link in the website Click on “Corporate Employee” Login through below given credentials Update Your Mobile Number & Email ID under “Employee Contact Details” § Check Data under “Beneficiary Details” § Change Password by Clicking “Forgot Password” in Login Page § Always click “Log out” after accessing your account § § § Employee login: § Username : Empid@vatechwabag § Password : vatechwabag Snapshots are given in following slides for easy reference. Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 12

E – Login Cont… Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 13

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Cashless Facility Planned Admission (48 hrs in advance) Insurance Help Desk at the Hospital Emergency Admission Hospital Admission Insurance Help Desk Pre-Authorization Process

Process of Reimbursement • Please submit the following documents in original along with completed claim form within 15 days from the date of discharge • Discharge Summary • Final Hospital Bill (with detailed break-up) & Receipts • Medicine Bills along with Doctor’s Prescriptions • Investigations & Test Reports with Doctor’s prescriptions. If original is required for future treatment, please submit photocopies duly attested by the treating doctor with his signature & seal • In case of non-availability of prescriptions, kindly ask your Physician to countersign on the reverse of pharmacy bills Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 17

Please send all the documents to Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 18

Escalation Matrix Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 19

Thank you… Health Insurance Administrator (TPA) Wish You & Your Family A Healthy & Happy Future !!! -Team & Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 20