Dell s - Hospitalization Insurance Policy (For Deputed Team Members - 7th November 2014 to 6th November 2015)

Transcription

1 Dell s - Hospitalization Insurance Policy (For Deputed Team Members - 7th November 2014 to 6th November 2015) Objective: To provide a hospitalization Insurance plan for onsite Team Members and their dependents as described under the plan. Eligibility: All deputed Team Members of Dell International Services (I) Pvt Ltd (earlier known as AS/IS/ Perot TSI) and their dependents in India as defined under: Spouse Children Parents (Basis on the option selected during registration process) Summary: The company will cover the Team Member, his/her spouse, children and parents (in India) provided the Team Member registers themselves and their dependents in the stipulated time given. Policy does not hold good for anyone who has not registered. Valid enrolment and payment of premium is mandatory to ensure coverage under Dell s medical insurance policy. In case the Team Member has registered under any of the below listed medical insurance coverage options then in case of a new addition in your family, the new born child / spouse in case of marriage, Team Member needs to fill in the required declaration form within 30days of child birth and from the date of marriage with the third party administrator (FHPL) or intimation can be sent via to BLR_Mediclaim@Dell.com for registration. Coverage Details There are 4 medical insurance coverage options provided. Team Members have an option of selecting any one of them based on their requirements. Option 2 Option 3 Option 4 Option 5 Eligible Members Team Member, Spouse, Child & Parents Team Member, Spouse, Child & Parents Team Member, Spouse, Child & Parents Team Member, Spouse, Child & Parents Family Coverage Claims Co-pay Family coverage of INR 300,000* & parents cover up to 1 Lakhs (Room Rent for parental claim restricted to INR 2,500/- per day) 15% co-pay for Team Member+ Spouse+ Children and 10% copay for parents Family coverage of INR 300,000* & parents cover up to INR 200,000 15% co-pay for Team Member+ Spouse+ Children and 10% copay for parents Family coverage of INR 300,000* & parents cover up to INR 300,000 15% co-pay for Team Member+ Spouse+ Children and 10% co-pay for parents Family coverage of INR 300,000* & parents cover up to INR 500,000 15% co-pay for Team Member+ Spouse+ Children and 10% co-pay for parents Ailment Caps Applicable Applicable Applicable Applicable Team Member s contribution towards premium coverage for parent s policy INR 9,679 INR 19,088 INR 29,272 INR 41,530

2 * In case of medical exigency, further extension of sum insured up to a limit of INR 200,000 per family upon approvals will be provided. ** Premium inclusive of service tax at 12.36% Important: We strongly advise continuation with the policy to cover risks. Team members will have only one opportunity (now or in future) during their tenure with Dell to enroll their parents under the available voluntary options (options 2, 3, 4 and 5). In case a team member voluntarily opts out of the above options he/she will not be eligible to enroll his/her parents again. Also, please note that the change within the options 2, 3, 4 and 5 will be allowed during policy renewal only. Policy in detail There would be an additional premium applicable towards the higher options 2 to 5. To avail these options, Team Member will have to pay the differential premium amount. The maximum sum insured on family floater basis to be offered to any Team Member, Spouse or Children will not exceed INR 300,000 under options 2 to 5. In case of a medical exigency, if family floater sum insured is exhausted, the same will be enhanced up to a maximum of INR 200,000 on family floater basis for Team Member / Spouse / Children basis internal approvals. Upper age limit for covering Children is 21 years & for Parents it is 80 years. Team Member would need to co-pay 15% of the total billed hospitalization amount for Team member/spouse/children and 10% co-payment will be applicable on all parental claims reported with FHPL. Co-Payment will be applied on total billed amount. This would mean that the Team Member would need to bear 15% (Team member/spouse/children) & 10%(Parents) of the total billed amount. In cases where ailment caps are applicable if the amount after applying co-pay is greater than the ailment cap in that scenario, the payable amount will be restricted at ailment cap levels. Coverage for certain ailments are restricted. Please look at the details below for the maximum coverage limits. Other than a new born baby or the Team Member getting married after the registration date, dependents cannot be added under this policy once the stipulated time for registration expires. Pre-existing illness is covered under the plan. The Team Member and their dependents are covered from the date of joining provided the registration is completed within the stipulated time. Pre and Post Hospitalization: 30 days pre-hospitalization and 60 days posthospitalization expenses would be covered. This will be applicable only for the ailment for which hospitalization occurred and was approved by the insurer. Infant Cover: All expenses incurred on account of hospitalization for the infant stands covered from day one provided the infant is registered under the hospitalization policy within the 30 days of birth and infant leads to any complication post birth. Any expenses incurred for routine investigation carried out for new baby (well care baby) is not covered under this program. Dental Treatment - All expenses incurred on account of dental treatment stands covered. However, the dental expenses incurred on account of preventive care, cosmetic treatment, surgery & cosmetic implants & the cost of crown are not payable. Maximum limit applicable is given below. Vision Correction Treatment This is applicable ONLY for Team Members. Under this coverage Team Members can undergo vision correction treatment in case vision is +/ This coverage will not pay for contact lenses and spectacles. Only the actual cost

3 of vision correction treatment is payable. Cap of INR 25,000 per eye is applicable on this coverage. Please note, coverage for cataract treatment is not part of vision correction. The Insurer has the right to reject any claim that is not covered under the policy, is not as per Insurance Regulatory and Development Authority (IRDA) regulations, where the documentation is incomplete or any other reason determined. In such an event, Dell will not be responsible to cover this claim. Ayurvedic and naturopathy treatments would not be covered under Dell s medical insurance program. Please note that investigation expenses are not payable at the initial stage. Within 30 days, if the investigation leads to hospitalization (minimum of 24 Hrs hospitalization) then this can be claimed from the insurance company as reimbursement. Restriction on Downward movement under voluntary options: An Employee who has made a claim for parents under the voluntary option shall not be allowed to choose an option with a lower Sum Insured in the subsequent policy years. Eg. An employee who has chosen Option 3 and has raised claim for parents shall not be allowed to move to Option 2 or Option 1 where the Sum Insured is lower in the subsequent policy year. Employee is allowed to remain in Option 3 or move to the options that offer higher cover i.e. Option 4 or 5. Employee is provided opportunity to choose an option with higher cover only at time of renewal of the policy. In case of team member exiting Dell, Team Member contribution towards voluntary options (Option 2 to 5) would be refunded back on pro-rata basis. This is subject to no claims made by any of the declared member under the policy period 7th Nov 2014 to 6 th Nov Dell has introduced Voluntary Top-Up plan for Team Members who would be keen on having additional medical insurance cover for Team member, Spouse and Children Kindly refer to FAQ s for more details on the Voluntary Top-Up plan. Caps applicable for options 2 to 5: Ailment / Procedure Applicable cap in INR Maternity Normal INR 40,000, Caesarean INR 50,000 Cataract Hernia Appendectomy Hysterectomy Ambulance Angioplasty INR 28,000 per eye per year INR 65,000 per incident INR 50,000 per incident INR 65,000 per person INR 2,000 per incident INR 135,000 per person Stent Dental Vision Correction Trans Urethral Resection Prostrate {TURP} Room rent INR 100,000 per stent INR 10,000 per person per year with a cap of INR 40,000 per family INR 25,000 / eye. Coverage applicable only for Team Member treatment. INR 60,000 per incident For treatments undertaken in Delhi, Gurgaon or NOIDA: INR 4,000 per room per day for all registered members. For treatments undertaken in rest of India: INR 3,500 per room per day for all registered members. For GMC Policy Option 2 : INR 2,500 for parental hospitalization. (Irrespective of location of treatment)

4 To Note: The room rent is applicable based on the location / city where the treatment is undertaken and not based on Team Member location. Room Rent as defined under Dell coverage does not include nursing, consumables and medical equipment related charges. Some hospitals provide the break-up of the room rent components. If for a given hospital the room rent break-up includes nursing, consumables and medical equipment related charges, then the nursing charges shall be paid as a separate head as per the hospitalization policy. However Hospitalization Insurance Policy excludes consumables and medical equipment related charges and hence the same shall not be payable. To Note: Dell holds the right to verify the records of the dependents covered under the policy or any claim submitted by the Team Member. In the event that any information so submitted is found to be untrue or false then the Team Member could be subject to disciplinary proceeding leading up to termination of employment in accordance with Dell's service rule and code of conduct. Cashless Treatment: Dell has tied up with a TPA (Third Party Administrator) to take care of cash less transaction when hospitalized. The TPA is Family Health Plan Limited (FHPL). Cash less transaction is applicable only if the hospital is covered under network hospitals list of FHPL Process for Cashless Treatment: o In the event of hospitalization of an insured member, the TPA representatives are to be contacted as per the contact details mentioned below and details requested need to be furnished. o Team Member will need to contact the public relations officer in the hospital and mention the medical insurance coverage from Dell along with the following documents - Government issued Photo id proof of the patient, FHPL E card, Dell ID card. In case the Team member is a new joinee and has not received the FHPL E-card then the Team Member needs to carry Dell ID card along with Government Issued Photo ID proof of the patient. o Public relations officer requests for authorization from TPA for cashless facility. TPA authorizes the concerned hospital after checking the Team Member documents as per the limits applicable and arrange to pay them directly. o The Team Member will be required to pay the expenses not covered under the Insurance policy to the hospital directly. Please refer the medical insurance policy for exclusions under the policy. Non-cashless hospitalization insurance claim: Process for Reimbursement of expenses: The Team Member may decide to pay the hospitalization expenses directly upon the claim intimation through calling the TPA toll free number / sending a mail to intimation@fhpl.net and claim the same subsequently through the TPA help desk. The following supporting documents are required to be submitted in originals: Inpatient bill with itemized break-ups with cash payment made receipt. Discharge summary/treatment summary on hospital letterhead with seal and sign. It should contain complaints, diagnoses, treatment summary (complete), advice of discharge. Any Pharmacy bills/medicine bills should follow with prescription. Lab (bio chemistry, histopathology, etc.) bills should follow with original reports. X-ray, scan, etc. any taken needs to be submitted in original Duly filled Claim form along with bank account details Claim Intimation reference ID

5 Cancelled cheque pertaining to the bank account details provided in the claim form has to be provided mandatorily Team Member Badge ID Photocopy, Patient E-Card & any Government Photo Id proof Any other documents that TPA or the insurance company may ask for. The settlement amount will be credited directly to your bank account via NEFT (electronic fund transfer). For reimbursement claims, prior intimation of the hospitalization to the TPA is mandatory for processing your claims. In case of emergency hospitalization, the TPA can be intimated within 24 hours of hospitalization. You will have to intimate TPA (FHPL) by either calling their call centre at or by sending an to along with the necessary details like company name, Team Member ID, hospital where the Team Member / dependent is getting admitted along with the type of treatment. Pre and Post Hospitalization related claims: Documents pertaining to the claims related to pre and post hospitalization expenses will have to be submitted within 7 days of the last event. Expenses Not Covered Injury or disease directly or indirectly caused by or arising from or attributable to war or war-like situations Conditions that do not require 24 hr hospitalization and are treated at home Pre-Post and domiciliary hospitalization (Maternity) Vaccination Circumcision unless necessary for treatment of disease Congenital diseases HIV and AIDS Hospitalization for convalescence, general debility, intentional self-injury (or suicide), use of intoxicating drugs/ alcohol. Accident under the influence of alcohol is non-payable Venereal diseases Injury or disease caused directly or indirectly by nuclear weapons Naturopathy Any claims related to Ayurveda treatment Dental Treatment / surgery of any kind unless it warrants hospitalization. Infertility treatment, fertility, sun fertility or assisted conception operation or sterilization or any other procedure / treatment relating to fertility or infertility. Occupational accidents like car racing, circus parachute gliding, military activity & piloting Third Child in case of maternity Loss of wages are not covered Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, etc. Cost of spectacles, contact lenses, hearing aids Any cosmetic or plastic surgery Hospitalization for diagnostic tests only Vitamins and tonics unless used for treatment of injury or disease Experimental or unproven treatment Voluntary termination of pregnancy Conservative treatments, treatment involving only oral medications and Oral chemotherapy. Stem cell implantation / treatment / surgery Any other charges that may not be defined here but found not suitable for payment at the discretion of the insurance company

6 FHPL Contact List City SPOC s Name Work Location Timings Entity Mobile No ID Ms. Usha Ms. Bopaiah Dell 4, Ground Floor, behind reception E-Exit Room Dell 4, Ground Floor, behind reception E-Exit Room 10.00am 6.00pm 6.00pm am DIS,DIPL DIS,DIPL u_p@dellteam.com Bopaiah_K@DellTeam.com Bangalore Ms. Prashanth Dell 5, Ground Floor, Reception Dell 7, Opposite to Main Reception,1 st Floor HR Department Friday 12.00pm pm 10.00am-6.00pm DIS,DIPL AS/IS Prasanth_G_Reddy@DellTeam. com / blr_mediclaim@dell.com Mr. Pradeep Dell 12, Reception, Sigma Soft Tech 2.00pm 3.00pm Wyse Technology pradeep.chandrappa@fhpl.net Mr.Jeevan Kumar Dell 10, Bellandur, Near Reception 11.00am 1.00pm Sonic Wall jeevan.kumar@fhpl.net Hyderabad Chennai Coimbatore Nodia Mr.Jabez Santosh Mr. Nisar Ahmed Mr. Hemanth Kumar Mr. Kathiresan Mr. Vicky Soni Dell Campus, A-Block First Floor, near IT Team ICC - Meeting Room 2 Ambit building, 3rd Floor, Reception DLF, 5th Floor Reception Olympia Tech Park, 8th Floor, Discussion Room KG Campus, Waiting Hall Keeranatham SEZ Sector - 125, T-3, HR wing Boulevard 127, Conference room 12.00pm 8.00pm 1.00pm pm 10.00am 12.00pm 7.00pm 9.00pm Tuesday 11.00am 2.00pm 7.00pm 9.00pm 5.00pm pm 5.00pm 7.00pm Tuesday 10am-1pm 2.00pm 5.00pm DIS,DIPL,AS/I S bathula_santosh_kuma@dellte am.com DIPL-ICC nisarahmed@fhpl.net Perot BPS Force hemanath.kumar@fhpl.net / Hemanath_Kumar@DellTeam. com Perot BPS Kathiresan.krishnan@fhpl.net AS/IS VickySoni@fhpl.net SEZ Noida 11.00am pm Gurgoan Mr. Kunal Sahi 1st Floor, Payroll Department 2.00pm pm DIS,DIPL kunal.sahi@fhpl.net / Kunal_Sahi@DellTeam.com Nodia,Bangalore, Mumbai Mr. Rahul Krishnan On Call Dell Software & Gale Networks rahul.krishnan@fhpl.net

7 Level 1 Escalation: Account Managers at different locations: FHPL Account Managers Contact No Location Mr. Rahul Krishnan rahul.krishnan@fhpl.net Bangalore Mr. Jabez Santosh bathula_santosh_kuma@dellteam.com Hyderabad Mr. Parikshit Singh parikshitsingh@fhpl.net Delhi & NCR Region Mr. Gorakhnath gorakhnath@fhpl.net Pune Mr. Srinivas Kamineni srinivas.kamineni@fhpl.net Chennai Escalation Matrix: Level 2 Escalation: Mr. Parikshit Singh (parikshitsingh@fhpl.net) Level 2 Escalation: Mr. Aji Thomas (ajithomas@fhpl.net) Level 3 Escalation: Mr. Mahendran MC (Mahendran_mc@dellteam.com) FHPL - Call Centre & Toll Free no: Call centre details Contact Numbers Fax Number Toll Free Number (BSNL Land Line) Chennai / Bangalore /52/53/56/ Hyderabad / /6262 New Delhi & NCR /29 To find the network hospital list click here FHPL Hospital List (Select Insurance Company - National Insurance Co. Ltd.) * NETWORK HOSPITAL LIST IS SUBJECT TO CHANGE WITHOUT NOTICE. Dell holds the right to verify the records of the dependents covered under the policy or any claim submitted by the Team Member. In the event that any information so submitted is found to be untrue or false then the Team Member could be subject to disciplinary proceeding leading up to termination of employment in accordance with Dell's service rule and code of conduct.