FAQS FOR GENPACT Group Mediclaim Policy

Transcription

1 FAQS FOR GENPACT Group Mediclaim Policy - What is the Medical Insurance Cover? Who bears the cost of the insurance premium? Genpact provides medical insurance benefits to cover all the hospitalization related expenses as per the guidelines mentioned below. Any cost of insurance premium is borne entirely by Genpact only and is provided free of cost to the employees and their dependents as per the eligibility criteria mentioned below. - Who is eligible for Medical Insurance cover? All Genpact India permanent employees are eligible for Medical Insurance. In addition, Band 4 & above employees can cover up to 3 dependents in the policy. Employees on deputation, movement for business reasons outside Genpact India payroll will not be covered in this policy. - Who all can be covered in Medical Insurance cover? Self Dependents Band 5 Yes No Band 4 & above* Yes Spouse and 2 Children (Below 18 years) * Employee who joined or got promoted to Band 4 or above before 1st February 2009, existing coverage would continue * Employee who joined or got promoted to Band 4 or above after 1st February 2009, Can not enroll there parents. Only spouse and children are allowed. - Do I have to bear any expenses at the time of availing this benefit? 100% of the claim for the employees (subject to the guidelines below) is paid by the insurer. For claims for the dependents, there is a 10% Co payment charge applicable on the bill at the time of discharge, Employees can opt for a room in higher category subject to bearing the additional expenses. For e.g. (The % of the difference in actual room rent and room rent limit shall be calculated and the same % of the whole bill will be borne by employee.) - What is the Insurer and TPA (Third party Administrator)? Insurer is the company which provides the group insurance cover to all the Genpact employees. Currently our Insurer is National Insurance Company. TPA is the nodal agency which works with Insurer, Genpact and employees to complete all the transactional related work. Also, employee can avail cashless hospitalization in TPA s network hospitals by showing their ID card issued by the TPA. Currently our TPA is Family Health Plan limited (FHPL). - What is the procedure for enrolling in the insurance cover?

2 Employees are covered from the day they join the company after completing their onboarding. In case of dependents, cover starts from the time the employee submits the enrolment form to Insurance TPA specified by Genpact (currently it is Family Health Plan). - What are the timelines of enrolling the dependents? Employees need to enroll dependents within 30 days of the following: Date of joining in case of new joiners Date of promotion in case of promotion from Band 5 to Band 4 Date of marriage in case of marriage Date of birth of child in case of newborn * If the employee does not add his dependents within this period, the dependents can be added only during the next policy renewal. - Can the dependents be changed/added during the policy period? Dependents can be changed /added during the policy period only under the following conditions within 30 days (only if slot vacant in the dependant listings) In event of death of an existing dependent (with no claim taken in the policy year) In event of marriage (Scanned marriage card to be sent) In event of newborn (within 30 days from the date of Delivery, if slot vacant) - Which expenses are covered under the insurance cover? Following expenses can be covered under the insurance cover:- Only in-patient hospital expenses. A minimum of 24 hrs of hospitalization for treatment of an ailment is essential except for some specified day care surgeries/treatments; admission to hospital for 24 hrs for diagnostics is not covered. Hospital/nursing home should have a minimum of 15 beds, an operation-theatre, 24 hour nursing and a doctor-in-charge Hospital should be registered with the state govt., in case of re-imbursement claim, Diseases that do not require 24 hrs hospitalization Dialysis Chemotherapy Radiotherapy Eye Surgery (Cataract/Glucoma) Lithotripsy (Kidney stone removal) Tonsillectomy D & C (Dilatation and Curettage) - Which expenses are not covered? Following expenses are not covered in the insurance cover.

3 *The exclusions list below is not exhaustive; there may be other exclusions specific to that particular treatment/procedure. Get in touch with FHPL for further information: Domiciliary hospitalization (Patient being treated at home and not in a Hospital) 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 diseases Dental treatment of any kind congenital external diseases or defects/anomalies. Abortion / MTP/Infertility/IVF. Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol. Venereal diseases. Injury or disease caused directly or indirectly by nuclear weapon Administrative expenses e.g. Admission charges, Registration charges, Medico-legal charges, Attendant stay charges, Relative stay charges, Additional stay, Gate pass / Attendant pass, Overhead charges, Establishment charges, Tax, Surcharge, Incidental charge, Waste disposal charges Documentation Expenses e.g. Documentation charges, Discharge summary, Medical records charges, Birth certificate, Death certificate, Medical certificate Consumables e.g. Antiseptic/disinfectant solutions, Soap, Powder (talc), Oil, Cream, Sanitary pads, Cassette / CD / Film charges Services charges e.g. Private nurse charges, Telephone charges, Fax charges, Food / beverages, Diet Appliances charges e.g. Water bed / Air cushion, Alpha bed, Kidney tray / Sputum cup, Thermometer, Glasses / lenses / goggles / Frames, Dentures/dental braces/tooth implants, Glucometer, B.P. Monitoring device, Miscellaneous charges e.g. Electricity charges, Water charges, T.V. / internet charges, Newspaper / magazines, A/c charges, Stationery charges, Linen / laundry charges, Mortuary / coffin charges, Ambulance charges, RFQMR Therapy (Rotational Frequency Quantum Magnetic resolution therapy), ARMD ( Age related Macular Disease wherein Injection Lucentis/ Avastin are required) related eye Treatment. Sum insured will be considered from the date of admission & not from the date discharge at the time of renewal of the policy. - Is there any maternity benefit provided in the policy?

4 Maternity benefits are provided to all the female employees and dependent spouse (for band 4 & above) for first two pregnancies only. Maternity charges are covered up to Rs. 40,000 for Normal Delivery and Rs. 50,000 for Caesarean operations. This cannot be clubbed with the overall limit of employee medical insurance benefits. In the unusual circumstances if the total maternity expense exceeds the above specified limits, employee will need to bear that expense and there will be a 10% Co- payment charge for dependant spouse as per the policy terms and conditions. There is no pre-post coverage for Maternity. Only the expenses for hospitalization during delivery are covered. New born baby expenses are covered with in maternity limit. - Is there any Cap on room rent for the hospitalization? The cap on Room Rentals is: Class A hospital - Rs. 4,000 (applicable for Max hospitals, Paras, Medicity Medanta, Apollo hospitals (except Apollo cradle), Fortis Hospitals (except la femme) Class B and below - Rs (all the hospital except for above A cat list) Employees can opt for a room in higher category subject to bearing the additional expenses. For e.g. (The % of the difference in actual room rent and room rent limit shall be calculated and the same % of the whole bill will be borne by employee.) - Are there any specific guidelines I should follow to avail the Insurance cover? Employee should be aware of the following terms and conditions of the insurance cover:- Member/ patient should carry FHPL E- card while availing treatment at Network Hospital or attach FHPL E- card while filing reimbursement claim. Insurance Enrolment is mandatory for the employee/dependent going in for Hospitalization. Requests for enrolment prior to hospitalization will not be entertained. FHPL will administer the policy basis the terms and conditions of the Genpact policy and is authorized to deny credit in case a particular procedure is outside the policy guidelines. Tests/Diagnosis (i.e. HIV test) carried out, not pertaining to that particular Hospitalization will need to be settled by the employee at the time of discharge. The policy allows inpatient hospitalization for active treatment for over 24Hrs, however in case of hospitalizations for 24hrs or more only for Diagnosis/tests and no active treatment is given, it will not be covered under the policy. Packages offered by Hospitals for certain procedures will need a complete break up of cost; the components allowed under the policy will be paid by FHPL. Employees/dependents should verify the amounts charged by the Hospital before signing off, and pay the unauthorized expenses before leaving the hospital. FHPL has negotiated discounts for Genpact from all Leading Hospitals; the employee should check that the discounts have been given before signing off the amount.

5 Post Hospital Discharge, the employee should log on the FHPL website to check that the correct amount (i.e. amount used for hospitalization) has been debited from his Insurance cover. What is the procedure for the claiming the hospitalization charges? Documents mentioned below need to be sent to FHPL within 30 days of discharge failing the same might attract denial. Mandatory documents for reimbursement of claim. Duly filed claim Form E-card of the patient Any valid photo Id of the patient (photocopy copy) like Voter ID, DL etc. Company ID of the employee(photocopy copy) Discharge Summary (Original Copy.) Final Bill (Original Copy.) Break-up of Final Bill (Original Copy.) All Investigation Report (Original Copy.) All Cash Receipt (Original Copy.) In case of non-empanelled hospitals, the registration number of the hospital has to be mentioned or a copy of the registration certificate is required. MLC/FIR copy in case of Accidental Claim GPLA/Obstetric History incase of Maternity Claim. Any valid address proof, if claim amount is more than one lakh. One cancel cheque with IFSC code Mandatory documents for reimbursement of pre/post claim. The documents should be submitted with in 7 days from completion of post limit (60 days) period. Duly filled claim Form E-card of the patient Any valid photo Id of the patient (photocopy copy) like Voter ID, DL etc. Company ID of the employee(photocopy copy) All Investigation Report (if any for pre-post period) All consultation Receipt if any with prescriptions of the doctor for same date. (Original Copy.) all the medicine bills with prescription of doctor ( original ) One cancel cheque with IFSC code - What is the process of cashless hospitalization? The employee first has to check whether the hospital he or she is getting admitted to, is on the list of Network hospitals / Paneled hospitals. If the hospital is on the Panel after checking the list of Network hospitals, the employee has to go to the billing section at the hospital either a day or two in

6 advance or at the time of hospitalization and ask for an FHPL pre-authorization form. Once he/she has that form, will need to fill in his/her details, enter details of the patient, get it signed and stamped by the doctor who is treating the patient. Once the form has been signed and stamped by the attending doctor, will then need to submit the form at the TPA (third party administrator) section or the billing section. The employee will also need to attach a print out of the E-card and a copy of any one of the govt ID s asked for (Pan Card/Driving License/Passport/Voters ID). The billing may ask the Employee to deposit an advance amount at the time of admission, which is settled / refunded to the employee at the time of discharge. The hospital will then fax the complete set to the TPA and based on the nature of hospitalization, the approval or rejection will be sent by FHPL to the hospital. In certain cases FHPL also asks for additional documents from the hospital before they can approve the claim, hence the whole procedure takes 3-4 hours. Once the case is approved, FHPL will initially send an approval of only 40-50% of the amount asked for, by the hospital and the balance is settled at the time of discharge, this is done to avoid hospitals overcharging on the bills. - Where can I get the listing of all the network hospitals? Employees can login at click on Network hospitals on the top, Select National insurance co. enter the name of the city, for example, if looking for hospitals in Delhi, will need to enter New Delhi and click on GO and can see the Network/ Paneled hospitals in Delhi. - Where can I check status of the claim and take a print out of the E-card? Employees can login at select your corporate as Genpact, enter their OHR and P/w and can then check their details online. Employees can also take a print out of the E-card available online and can even check the status of their claim online. * The guidelines mentioned above highlight a few features of the policy. If you have any doubt or query, please feel free to contact FHPL for further details. How can I contact FHPL in case I have a query or need some assistance? FHPL helpdesk / SPOCs are located in each of Genpact site. In case of Emergency please call FHPL 24 Hr Toll Free Number at You can also log on to or send a mail to crmdelhi@fhpl.net. Please specify your Genpact OHR ID and employee code while contacting FHPL. Help Desk Locations across Genpact Sites. Delhi IT Park, Wednesday 1400 hrs to 2000 hrs. 8 th Floor Reception area. 22B Gurgaon Friday 1300 hrs to 1830 hrs. 1 st Floor Opposite BCP Command room. Silokhera Monday 1300 hrs to 1830 hrs. Phase - 5 Gurgaon Tuesday / Thursday 1300 hrs to 1830 hrs. Mail room, ground floor.

7 Hyderabad Uppal Monday, Wednesday, Thursday, Friday 11 am to 7 pm, Ground floor/tuesday Cyber gateways 11 am to 7 pm HRSS area. Bangalore Surya Park Building, Basement, 1pm to 9pm Monday to Friday. Mumbai, available on call, as per case requirement. Jaipur Sitapura site on call as per requirement, available round the clock Kolkatta DLF Site, Rajarhat, available on call as per requirement. (For Cashless Status) FHPL ESCALATION MATRIX Note: Direct no. of Cashless Department : (FHPL Gurgaon) works from 9 am to 7 pm & on restricted holiday & Sundays work from 10 am to 4 pm M , , Fax no. Gurgaon /29 delhipreauth@fhpl.net, chandra.sekhar@fhpl.net; (FHPL Hyderabad) Land Line Number: Fax no / Preauthfax@fhpl.net Level 1: (For general Queries & Claim Status) (24*7) Toll Free Number: (24*7) Land Line Number: Fax no /6262 (Hyderabad) Landline Gurgaon (9 am to 5:30 pm) at Delhicallcenter@fhpl.net ; crmdelhi@fhpl.net Fax no. Gurgaon /29 CRM Department FHPL Gurgaon crmdelhi@fhpl.net, or call on (Works from 9 am to 5.30 pm on all working days) For quick reply in relation to Enrollment Queries on Pan India basis, forward mail to ashwinisharma@fhpl.net

8 Level 2: Respective location FHPL Spoc. for helpdesk and documents submission. Name Location ID Contact No. Anirudh Gautam Delhi IT Park, Wednesday 1400 hrs to 2000 hrs. 8 th Floor Reception area. Anirudh Gautam 22B Gurgaon Friday 1300 hrs to 1830 hrs. 1st Floor Opposite BCP Command room. Vicky soni Phase - 5 Gurgaon Tuesday / Thursday 1300 hrs to 1830 hrs. Mail room, ground floor. Anirudh Gautam Silokra Monday 1300 hrs to 1830 hrs. helpdeskggn@fhpl.net / helpdeskggn@fhpl.net / helpdeskggn@fhpl.net helpdeskggn@fhpl.net / Raj Reddy Harish Rawat Mr. Subir Nag Hyderabad Monday, Wednesday, Thursday, Friday 11 am to 7 pm, Ground floor/tuesday Cyber gateways 11 am to 7 pm HRSS area. Jaipur Sitapura site on call as per requirement, available round the clock Kolkata DLF Site, Rajarhat, available on call as per requirement. raj.reddy@genpact.com harishrawat@fhpl.net subirnag@fhpl.net Sujatha N Bangalore Surya Park Building, Basement, 1pm to 9pm Monday to Friday. genpactblr.insurance@genpac t.com Mr. Sanoj Kumar Pal Mumbai available on call, as per case requirement. sanojkumar.pal@fhpl.net Deepak Mehta, , deepak.mehta@fhpl.net --Account Manager Level 3 Parikshit Singh, , parikshitsingh@fhpl.net Mr. Harsh Bhalla, M: , harsh.bhalla@genpact.com

9 Level 4: Mr. Shirish K Singh, M: , Shirishk@fhpl.net Mr. Yogesh Vashisht, M: , yogesh.vashisht@genpact.com