Presentation on Group Mediclaim Policy of Mahindra Rural

Presentation on Group Mediclaim Policy of Mahindra Rural Housing Finanace Limited (2017 -2018) For Internal Circulation only 1

MEDICLAIM POLICY The Mediclaim Policy Reimburses Expenses incurred due to v. Disease v. Illness vor 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 for an active line of treatment Insurance reimburses Reasonable & Customary Expenses within the scope of the policy towards treatment in Hospital. For Internal Circulation only 2

Continue………. Ø 24 hours hospitalization is not applicable for: § Dialysis, Chemotherapy, Radiotherapy § Eye Surgery § Tonsillectomy, Sinusitis § Lap Appendectomy, Hysterectomy, lithotripsy, Hernia Repair, Piles, Hydrocele § Coronary Angioplasty § Fracture or dislocation, Prostrate surgery Ø The above list is not exhaustive, hence the employees can check with Health India TPA in case of any treatment which is for less than 24 Hrs. For Internal Circulation only 3

Definition of Hospital § 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 For Internal Circulation only 4

Family Coverage & Sum Insured Ø Coverage § Family Definition- 1+5 (Self + Spouse + 2 Children (upto 25 years of age) + 2 Dependent Parents Only § Mid-term addition of dependents are not allowed in policy except in case of marriage provided the employee informs the HR about the same within 30 days from the date of marriage For Internal Circulation only 5

Policy Benefits § All Pre- existing ailments are covered. § Waiting Period of 30 days waived. § Waiver on 1 st Two years exclusion § Room rent cover restricted up to 1. 5% of SI for Normal & 3% of SI for ICU & all other hospital charges will be paid proportionately. § 9 months waiting period for maternity claims waived off § Pre & Post hospitalization expenses are covered for 30 & 60 days respectively. For Internal Circulation only 6

Expenses Payable ¡ Room, Boarding, Nursing Charges ¡ ICU Charges ¡ Surgeon, Anaesthetist, Consultants, Medical Practitioner, Specialist fees. ¡ 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 ¡ Pre Hospitalization Expenses: Expenses incurred 30 days prior to date of admission( Consultation / Test Charges ) ¡ Post Hospitalization: Expenses incurred up to 60 days from the date of discharge. For Internal Circulation only 7

Maternity Benefits ¡ Maternity benefits covered Ø Normal Delivery: 50, 000/Ø C-Section: 50, 000/- ¡ Maternity expenses are covered for first TWO children ¡ Expenses during hospitalisation will only be covered & not the prepost maternity expenses For Internal Circulation only 8

Expenses Not Payable ¡ ¡ ¡ ¡ Admission/Registration 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 Diet charges Special/protein diet/health drinks unless prescribed by the doctor Documentation/Folder/Stationery/In Patient charges For Internal Circulation only 9

General Policy Exclusions § Injuries or diseases caused by war and war like operations § Circumcision, Vaccination, Inoculation, Cosmetic treatment, Plastic surgery § Surgery for correction of Sight, Spectacles, Contact lenses, Hearing Aids § Dental Treatment without hospitalization unless arising due to an accident § Convalescence, General weakness, Congenital external disease, Infertility & Related ailment, 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 § Expenses related to pregnancy incl. Abortion during first three months of pregnancy. § Naturopathy treatment, Unproven procedures, experimental or alternative medicine. For Internal Circulation only 10

TPA SERVICES • ENROLMENT • IDENTITY CARDS • CLAIMS ADMINISTRATION • CASHLESS HOSPITALISATION (THROUGH NETWORK HOSPITAL) • REIMBURSEMENT CLAIMS For Internal Circulation only 11

Provider Network-Cashless 4500 + Hospitals across the country Covering 32+ states Average 20 Hospitals being added every month Complete hospital list available at www. hdfcergo. com For Internal Circulation only 12

Cashless Hospitalisation q This service enables the customer to avail treatment at the Network Hospital without being required to pay for the treatment. q All expenses incurred will be paid to the Hospital deducting the non medical expenses q Please produce your Identity Card at the hospital on network where you wish to avail treatment. q Kindly fill in the Health India TPA Card Number, Name of the Patient, Age & Contact Number in the Cashless Request Form q The treating doctor/ hospital will fill in the remaining part of the Request Form & Fax it to Health India TPA for approval. q For Emergency Request- TAT – 4 - 6 hours q Planned Admissions: Approval can be availed 3 days in advance. For Internal Circulation only 13

Procedure for cashless Hospitalization Admission PA request You are advised admission by your doctor Pre-auth request is submitted to Health India TPA by the hospital and is processed at Health India TPA For Internal Circulation only Info Approval In case any further info is required, the hospital is asked to submit the info and processing happens 14 Treatment & Discharge Approval or denial is issued as per the terms and conditions of your insurance policy

Cashless Hospitalisation-Know Your Rights § Check & Sign the hospital bill. If possible ask for a copy of the bill. § Copy of your medical records. § Avoid informing the hospital your total coverage details- as hospitals have a tendency to inflate credit bills. For Internal Circulation only 15

Claim documents required in case of Reimbursement • • • • Standard Check list for submission of claim Original Claim Form duly signed by you. (Fill the claim amt in Signed Claim Form) Original Main Hospital bill with Bill Number & break up, (With detailed break up of various heads like Room Rent/OT charges/Nursing etc). Original Discharge summary (Gives the summary of diagnosis and treatment in hospital) Original Death summary (Only in case of death of Patient during Hospital stay). Original Hospital Payment Receipt with receipt number (With seal & signature of hospital) (if main bill does not carry a bill number). Original Payment Receipt with receipt number (For consultation/surgeon charges if charged outside the main hospital bill). Hospital registration number (Registration No. & Number of beds, on hospital letterhead with signature) Doctor’s registration number (On doctor’s letterhead with signature). Original Pharmacy and Investigation bills (Along with prescriptions & Lab reports). Original prescriptions (On doctor’s letterhead mentioning duration and dosage for medicines and advice for diagnostic tests). investigation reports in original/attested from hospital (Reports for all tests done along with images) Police FIR / Medico Legal Certificate (MLC) (Mandatory for All Road traffic accidents-Duly attested by Police Note - The above list of documents is indicative. In case of any other document requirement as specified by the insurance company our Document recovery Team will contact you on receipt of your claim documents by us. For Internal Circulation only 16

Important Points to remember - 1 Ø 1. 2. 3. 4. 5. 6. Please retain a copy of all documents submitted to us for further reference Please retain POD copy of the courier for tracking your consignment in case of any delay etc. For implants used in Cataract, Heart Valve Surgeries, CABG, Abdominal Surgeries, Knee replacement surgeries. Please submit the bill (in case purchased outside) from the vendors for the prosthetic devices used along with Sticker Please arrange the enclosures as per checklist. E. G. of documents required in case of Cataract , Maternity & Accidental Case Cataract – Discharge Card of the hospital or nursing home. Detailed hospital Bill (Main Bill / Final Bill). Invoice Of Lens ( With IOL sticker) A-Scan Report All medicine bills & investigation report with respective prescriptions. Maternity – Discharge Card of the hospital or nursing home. Detailed hospital Bill (Main Bill / Final Bill). Last Sonography report (USG report). Letter from treating doctor with Gravida Details (G P L A; No. of Living children ). Cash payment receipt for all transaction made in case. Indoor Case Paper (ICP) For Internal Circulation only 17

Important Points to remember - 2 Ø 1. 2. 3. 4. 5. 6. Accidental Case – Discharge Card of the hospital or nursing home. Detailed hospital Bill (Main Bill / Final Bill). Investigation report in support of diagnosis MLC / FIR Copy Certificate from treating doctor for influence of Alcohol Detailed narration of the incidence from treating doctor * Please note Indoor case papers will be required for processing of claim if proper treatment details are not available on discharge card & if TPA or Insurance Company want s to review day to day condition of the patient For Internal Circulation only 18

Turn Around Time [TAT] Identity Card Web cards by the 30 th of the following month from DOJ Cashless Hospitalisation Emergency cases: 3 -4 hours Planned: 48 -72 hours Reimbursement claims settlement Maximum of 15 – 20 working days Subject to complete documentation & availability of all information required to settle a claim In case of Shortfall the same will be intimated in 3 working days For Internal Circulation only 19

Escalation. Matrix of Health India TPA for all Mediclaim Related Queries Contact Person Contact No. E mail ID First point of Contact Pradeep Aswani 8828405223 corporate@healthindiatpa. com Second point of Contact Chanda Vishwakarma 7738899953 corporate@healthindiatpa. com Escalation Point Dr. Yogita For Internal Circulation only 7738899947 yogita. nandgaonkar@healthindiatpa. com 20

Escalation. Matrix of MIBL for all Mediclaim Related Queries Contact Person Contact No. E mail ID First point of Contact (Reimbursement) Neha Balakrishnan 02261468132 Balakrishnan. neha@mahindra. com First point of Contact (Cashless) Jacob Joji 9920790280 Jacob. joji@mahindra. com Second point of Contact Rajesh Yadav 9664820784 Yadav. rajesh 5@mahindra. com Escalation Point Nitin Bhavsar For Internal Circulation only 9920244110 21 Nitin. bhavsar@mahindra. com

Escalation. Matrix of MMFSL for all Mediclaim Related Queries Contact Person Contact No. E mail ID First point of Contact Archana Budke 02266523631 Dhopte. rajesh@mahfin. com Second point of Contact Ajay Shingare 02266523520 Shingare. ajay@mahindra. com Escalation Point Sachin Joshi For Internal Circulation only 02266523735 Joshi. sachin 4@mahindra. com 22

Wish you a healthy and happy future ! Thank you For Internal Circulation only 23