Employee Benefits (GMC, GPA & GTL) Key Features

Transcription

1 Employee Benefits (GMC, GPA & GTL) Key Features November, 2014

2 GMC Policy - (EMPLOYEE + SPOUSE + DEPENDENT CHILDREN): BENEFITS SYNOPSIS Coverage Type Dependent Coverage Sum Insured Family Floater Sum Insured Self + Spouse + Dependent Children Only employee - INR 200,000 / Employee + 1 Dependant - INR 300,000 Employee + 2 Dependants - INR 400,000 / Employee + 3 & more Dependants - INR 500,000 Pre Existing diseases 30 Days & 1 st year waiting period Waived ( All covered from Day 1) Maternity benefits ( Only for Employee & Spouse) Pre-Post Natal Expenses (only for Hospitalization cases) Baby cover day 1 Congenital Illness from day 1 [Normal INR 50,000 & INR 75,000 for C-Section ] for first 2 instances of the maternity are covered. Pre natal starts from date of conceiving and post natal ends 15 days after delivery. within the Maternity Limit over and above maternity benefit within family floater Congenital Internal diseases to be covered and Congenital External Ailments which are not cosmetic in nature, but life threatening and need to be operated due to medical reasons to be covered. Emergency Ambulance Pre-Post Hospitalization Exp. Less than 24 hrs of Hospitalization Ailment wise Capping Co-Pay only for Emergency & Accidental cases Benefit is on basis of Actual or maximum up to INR 2,000 per incident Only if hospitalization Claim is admissible as per policy [Pre 30 & Post 60 days] Excluding Maternity Cases under the day care procedures For Selected Cases ( Dialysis, chemotherapy, Kidney stone, Cataract, D&C etc. ) Cataract is restricted to INR 35,000 per eye including Lens cost 10% co-pay on each and every Claim, Co pay will be applicable on Admissible claim amount and not on Sum Insured, Not applicable on Cataract Group Insurance Policy _15 Ericsson Internal EGI-14: Uen, Rev A Page 2

3 Room Rent Terrorism risk Sleep Apnea Medical Evacuation Surgical Vision correction Hospital Cash Benefit Voluntary Top-up Portability Oral Chemotherapy Obesity treatment Reparation of remains Single AC Deluxe Room Room Rent differential for higher room category to be borne by employee, ICU- As per Actual Treatment is, Including Air Ambulance only for Employees For the eye sight: +/- 5.5 to +/- 7 up to limit of INR 25,000 per person. For eye sight above +/- 7 on actual Only for Employees Only for the employees: Benefit is INR 3,000 per day for Hospitalization in excess of 10 days ( Applicable for Hospitalization from 11th Day to 40th day) In Multiple of INR 100,000 Maximum up to INR 500,000, - Existing Employees need to enroll within specified renewal window period & 30 days window period to be given to new joiners for enrollment Provided for Retail Policy without any medical check-ups, Waiting period for 1st, 2nd year and PED to get reduced by the no of years the employee has been under the group plan. Continuity to be given from DOJ in Ericsson Oral chemotherapy is covered within full sum insured if done in hospitalization or at home Bariatric surgery covered only in case of life threating condition. ( weight loss through surgeries eg. Adjustable Gastric band, Sleeve Gastrectomy, Gastric Bypass, Biliopancreatic Diversion with Duodenal Switch (BPD/DS) NOTE - bariatric surgery does not include liposuction as latter is a purely cosmetic surgery done to change body shape. Only for death due to illness only of INR within full sum insured Group Insurance Policy _15 Ericsson Internal EGI-14: Uen, Rev A Page 3

4 GMC POLICY (EMPLOYEE + SPOUSE + DEPENDENT CHILDREN): SPECIAL TERMS Family Floater = any member in the family can make claim up to the total family floater cover limit within the policy year - this being the overall limit for the family for the year. Family means Employee + Spouse + Dependent Children VOLUNTARY TO-UP & PORTABILITY: Employees are allowed to top-up the employer provided policy in multiples of INR 100,000: maximum top-up amount is restricted to INR 500,000 (Illustration) Top-up Sum Insured will be used only after full utilization of the base Sum Insured Assistance through Corporate Buffer will be provided subject to guidelines, however, such assistance will be provided only on total utilization of the sum insured (Employer provided cover + Individual Voluntary Top-Up) All existing employee will be able to top-up within the specified renewal window period. For all new joiners, the same window period of 30 days from the date of joining will be applicable. Employees will be allowed portability from the Group Policy to Individual Policy with NIC on resignation / retirement from Ericsson Group Group Insurance Policy _15 Ericsson Internal EGI-14: Uen, Rev A Page 4 Continuity benefit under the Group Policy to be given to employee considering first policy date as DOJ in Ericsson Group / in case of Parents policy this will be enrolment date of parent(s) in the policy beginning 9 th November 2010 (provided coverage is continuous i.e. without breaks)

5 No individual underwriting (which includes medical checkup) needs to be done at the time of portability Terms & Condition for Individual policy will be as per the Retail plan of Insurer at the time of porting ( i.e. Room rent restriction, ailment capping, co-pay, Maximum sum Insured etc.) Continuity benefits during the Portability are: Pre-Existing Illness covered if the person has four (4) claim-free year under Ericsson Policy For portability the no of years will be reduced from Individual policy by the no of years employee been with Ericsson 1st year exclusion : there are certain illnesses which are not covered in the first policy year like ( ENT disorder, Cataract, Hernia, Hydrocele, Piles etc.) If employee were covered under the Ericsson Policy for 1 year before porting the policy, these restriction will not apply to them. Group Insurance Policy _15 Ericsson Internal EGI-14: Uen, Rev A Page 5

6 RATES FOR TOP-UP PLAN & ILLUSTRATION OF VARIOUS BENEFITS With Tax Rates (INR) Premium for top-up are in INR & inclusive of S.Tax and these are per family premium. Illustration for Top-up Sum Insured: An employee along with Spouse: Default coverage of INR 300,000. If he opts for additional Top-up of INR 200,000 he needs to pay INR 2,640 (ref to grid above) and the total coverage for his family would be INR 500,000. Illustration for Hospital Cash Allowance: An employee is admitted in hospital for 10 days : This benefit is not applicable. An employee is admitted in hospital for 12 days : Excess days over 10 days are 2 days and the benefit given will be 2x 3,000 = INR 6,000 over and above his hospitalization expenses to take care of miscellaneous non-medical expenses. This benefit is part of Total Sum Insured of Employee & non-available for dependents Emergency Ambulance Cover: This cover is available up to actual amount spent for ambulance with an upper cap of INR 2,000 Benefits are provided, subject to: Registered Ambulance facility is used. Only for shifting patient from Residence to hospital if admitted in ICU or emergency ward (OR) from one hospital to another hospital. BACK Group Insurance Policy _15 Ericsson Internal EGI-14: Uen, Rev A Page 6 Quantum of Top-Up Sum Insured - Over and Above Base Sum Insured Employer Provided Sum Insured 100, , , , , , ,776 2,604 3,432 4, ,000 1,321 2,640 3,959 5,278 6, ,000 1,458 2,915 4,373 5,830 7, ,000 1,765 3,530 5,295 7,060 8,824

7 GMC POLICY (PARENTS): BENEFITS SYNOPSIS Coverage Type Dependent Coverage Sum Insured Pre Existing diseases (PED) Individual Sum Insured Option for covering both Sets of parents and parents In-laws, Combination of parent & Parent In-law on selection basis is not allowed. Option of INR 200,000 / 300,000 / 400,000 / 500,000 each Parent and/or Parent-in-law ( Sum Insured for both the parents have to be same) 30 Days & 1 st year waiting period Waived ( All covered from Day 1), 60 days waiting period in case of re-entry for parents of existing employees. Emergency Ambulance Less than 24 hrs of Hospitalization Pre-Post Hospitalization Exp. Ailment wise capping Co-Pay Corporate Buffer Room Rent Terrorism risk Sleep Apnea Oral Chemotherapy Obesity treatment Reparation of remains Keratoconus treatment Portability only for Emergency & Accidental cases Benefits is on basis of Actual or maximum up to INR 2,000 per incident Only if hospitalization Claim is admissible as per policy under the day care procedures For Selected Cases ( Dialysis, chemotherapy, Kidney stone, Cataract, D&C etc. ) [Pre 30 & Post 60 days] Excluding Maternity Cases Cataract is restricted to INR 35,000 per eye including Lens cost 10% Co-pay applicable on each and every claim. Co pay will be applicable on Admissible claim amount and not on Sum Insured, Not applicable on Cataract Not available Single AC Deluxe Room Room Rent differential for higher room category to be borne by employee, ICU as per actual. Oral chemotherapy is covered within full sum insured if done in hospitalization or at home Bariatric surgery covered only in case of life threating condition. ( weight loss through surgeries eg. Adjustable Gastric band, Sleeve Gastrectomy, Gastric Bypass, Biliopancreatic Diversion with Duodenal Switch (BPD/DS) NOTE- bariatric surgery does not include liposuction as latter is a purely cosmetic surgery done to change body shape. Group Insurance Policy _15 Ericsson Internal EGI-14: Uen, Rev A Page 7 Only for death due to illness only of INR within full sum insured -Cone shaped eye, corneal ectasia Yes, portability to a Retail Policy as per retail guidelines. Waiting period of 1st, 2nd Year and PED to get reduced by the no of years parents has been under the group plan. Continuity to be given from 9th Nov 2010 or last enrolment date which ever is later.

8 GMC POLICY (PARENTS): SPECIAL TERMS Parents Policy Rates- Per Parent including service tax Sum Insured Rate Sum Insured Rate 200,000 INR 12, ,000 INR 17, ,000 INR 15, ,000 INR 19,855 PARENTAL POLICY: NEW ADMINISTRATIVE PROVISIONS PROPOSE Employee will be allowed to only select same sum Insured for both parents and/ or parents In-Laws (if both sets of parents are enrolled). Change in the Sum Insured during the renewal is allowed only up to 1 slab-up or 1 slab-down. In case last year one has covered only Father or Mother, the same would remain this year and addition of not covered Father or Mother is not allowed. Intra Company transfer Sum Insured needs to be considered retroactive for the policy year (Example: An employee in EIL opts for parental coverage of INR 5L for father on 9th November 2013 and a claim is incurred of INR 2L on 1st January The employee gets transferred to EGI on 1st February There will not be any premium implication on the employee, however, Sum Insured for Father will stand reduced to INR 3L till 8th November Employee has an option to cover both sets of Parents and or Parents-in-Laws however Combination of parent & Parent In-law on selection basis is not allowed. Swapping of parents and / or Parent In-Laws will not be allowed at the next year renewal for both existing and new joinees during the policy period. In case, it is found out that there was a combination for parents covered which was not supported by natural deletion, it will lead to rejection of the claim and permanent removal from the policy. Group Insurance Policy _15 Ericsson Internal EGI-14: Uen, Rev A Page 8

9 GPA POLICY: BENEFITS SYNOPSIS Basis Of Coverage Sum Insured Parameters Benefits Multiple of Salary 36 times of Monthly ( Basic +HRA + 100% of CA) Min 1000K & no upper capping Accidental Death ( AD) Permanent total Disability (PTD) Loss of both the hands / Loss of both eyes / loss of both legs / loss of one leg & one hand etc. Permanent Partial Disability (PPD) Loss of body part which does not completely disable the person to do his / her routine work Temporary Total Disability (TTD) Accident resulting in temporary incapacitation preventing employee to resume duties for a temporary period. Medical Extension Terrorism risk Repatriation of Mortal Remains and Funeral Expenses Child Education Benefits On death Benefits is up to 100% of Sum Insured as per standard table (Range from 1% of CSI to 100% of CSI) 1% of Sum Insured OR Actual weekly salary (Basic + HRA + 100% of CA) OR INR 10K (whichever is lower) per week up to a maximum of 104 Weeks. Actual or INR 10,000 per event whichever is lower on standalone basis (INR 20K on death per child up to a maximum of 2 children child should be less than 21 years of age as on the date of death of the employee) Cover for the accident in North East & J&K If employees are based in North East & J&K OR traveling to this states on business purpose Additional Sum Insured of INR 10 Lacs for AD, PTD & PPD Group Insurance Policy _15 Ericsson Internal EGI-14: Uen, Rev A Page 9

10 GTL POLICY: BENEFITS SYNOPSIS Parameters Basis Of Coverage Sum Insured Basic Life Cover (BLC) Death due to any cause Free Cover Limit No Medical checkup required up to this limit (including top-up Sum Insured) Terrorism risk Portability Benefits Multiple of Salary 24 times of Monthly ( Basic +HRA + 100% of CA) Min 1000K INR 25,000,000 Provided Provided Group Insurance Policy _15 Ericsson Internal EGI-14: Uen, Rev A Page 10

11 GTL POLICY: ADDITIONAL BENEFITS Voluntary top-up plans Employees can voluntarily opt for higher sum insured by paying additional premium at group rates Maximum Sum Insured ( Employer provided + Voluntary Top-up) would be 7 times of Annual Salary ( Basic + HRA + 100% of CA) No medical check ups required up to Free Cover Limit including the too up Sum Insured (FCL = INR 25,000,000) Employees get tax benefit under section 80C for the premium paid by them Premium of Voluntary top-up is INR 63 for Sum Insured of INR 100,000 ( Including S. Tax) Illustration: Annual Salary ( Basic + HRA + 100% of CA) of the Employees is INR 10 Lacs By default cover provided by Company is INR 20 Lacs ( 2 times of annual salary) Maximum Sum Insured which employee can opt is INR 70 Lacs i.e. employee can opt for maximum voluntary sum Insured of INR 50 Lacs ( INR 70 Lacs INR 20 Lacs) Premium to be paid by employee for INR 50 Lacs is INR 3,150 ( INR 63 x 50 ) Group Insurance Policy _15 Ericsson Internal EGI-14: Uen, Rev A Page 11

12 Conversion Option (Portability) Conversion option allows an insured employee under a group policy to continue coverage by taking life coverage under an individual policy, with the same Insurer - whenever he resigns or retires. Portability is applicable for the Total Sum Insured at the time of porting ( i.e. Employer provided + Voluntary Sum Insured opted) At the time of portability individual underwriting norms & Rates will be applicable as per Insurer guidelines prevailing at that time. Group Insurance Policy _15 Ericsson Internal EGI-14: Uen, Rev A Page 12

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