KYR Know Your Benefits

Employee Insurance Program

Quick Guide to 2013 -14 Insurance Benefits
Healthy Bytes
Page 1
Content
Insurance Benefits @SEI Snapshot
Enhancements Summarized
Enrollment to Insurance Benefits
Annexure
Insurance Benefits @SEI - Detailed
Medical Insurance
Accident Insurance
Life Insurance
Critical Illness Insurance
Enrollment to Insurance Benefits
Availing Insurance Benefits
Medical Insurance
Accident Insurance
Life Insurance
Critical Illness Insurance
Retiree Policy
How to make most of your benefits?
Click on the relevant section for direct navigation
Insurance Benefits @SEI -
Snapshot
Page 3
What are the Insurance Benefits available to me in Schneider?
The benefits are renewed with Insurer on annual basis
Coverage period for 2013-2014: 1st J uly 2013 till 30th J une 2014
Fresh Enrollment / Validation of Enrollment, along with choice of Top-up Options needs to
be made by all employees by 12
th
J uly 2013 to avail the benefits
Mid-term enrolment changes are not allowed except in case of Marriage or Child birth
Schneider Electric offers
four Insurance Benefits to
employees !
Provides insurance coverage
to employees against the risk
of death / injury sustained
due to an accident
Provides life insurance
protection to employees
1. Medical Insurance
(along with Top-up Option)
2. Accident Insurance
3. Life Insurance
(along with Top-up Option)
4. Critical Illness
Provides financial support to
employees in case of
Critical Illness
Provides insurance coverage
to employees and their family
for expenses related to
hospitalization due to illness,
disease or injury
Page 4
Wellness Enhancements under Healthy Bytes
- Summarized
Medical Insurance
Coverage increased from 4L 4.5L / family
Enhancement continued from2012
Optionto include 3
rd
child in base cover
Top-upOptions to extend Hospitalization coverage by 4L or 6L
Extension of benefit to Retiringemployees at better than Market discounts
Extension of Insurance to HIV cases
Accident Insurance
Previous cover:
J M: INR 15 Lac
MM: INR 20 Lac
SM: INR 45 Lac
Grade 10 onwards 2*FC (enhanced in 2012)
New Cover in 2013
2*Fixed Compensation for all, such that
minimum of previous benefit applicable
for Grade is retained
Enhancement in 2013
Life Insurance
Previous cover:
J M: INR 5 Lac
MM: INR 10 Lac
SM: INR 15 Lac
Grade 10 onwards 2*FC (enhanced in 2012)
New Cover in 2013
2*Fixed Compensation for all, such that
minimum of previous benefit applicable
for Grade is retained
Enhancement in 2013
Top-up Options to extend Life Insurance Cover Enhancement continued from2012
Other Wellness Benefits
Health Check up benefit @2500/employee being introduced for all employees
Enhancement in 2013
(detailed in separate presentation)
Deals & Discounts (OPD, IPD and Health check up) in Health care facilities
Launch of HealthCamps - Thyroid, Cardiac, Bone Density, Eye Care, Nutrition, Blood
Sugar, Yoga, Lung Function, Physiotherapy consultation
Enhancement continued from2012
Weekly Health Tips / Communication
5
Insurance Benefits Landscape 2013 Snapshot
Health Benefits =>Insurance Benefits Overview
Enrollment to Insurance Benefits
7
02 J uly 2013
Make Sure Your Dependents Are Covered
You can enrol your spouse, dependant children and dependant parents /
parents-in-law (any one set of parents)
Make sure you add and / or edit current dependent details online at
following website within the enrolment period, failing which you will not be
able to cover them till next year
Policy period: 1
st
July 2013 till 30
th
June 2014
URL
www.emeditek.com
Select E-Enrolment > Schneider Electric option to login
Login credentials User ID : Employee Code (8 digit starting with 00) Bridge ID
Password : Employee Code (8 digit starting with 00) Bridge ID
Annual Enrollment 1st J uly to 12
th
J uly 2012. (Please validate the dependants data within the timelines
else last year details would be considered. Insurance Companies strictly do not allow
mid-term modifications.)
Home Page www.emeditek.com
Login Page
Select your Company name
Login Page
Enter Employee ID & Password
Dependent Addition Page
Update Dependent details
Available details will
appear here
12
02 J uly 2013
How To Enroll?
URL www.emeditek.com | Select E-Enrolment > Schneider Electric option to login
Login credentials User ID : Employee Code (8 digit starting with 00)
Password : Employee Code (8 digit starting with 00)
Validate
personal details
Select Top-up
Plans
Validate
Dependent Details
Check Bank
Details
Update
Nominee details
Click Save & Sign-off to
save details
Updated Employee Profile
Annexure Insurance Benefits Detailed
14
02 J uly 2013
Insurance Benefits - Detailed
1. Medical Insurance (along with Top-up Option)
2. Accident Insurance
3. Life Insurance (along with Top-up Option)
4. Critical Illness Insurance
Page 16
Medical Insurance Benefit Coverage Details
Policy Parameter
Insurer United India Insurance Company (UIIC)
Third Party Administrator E Meditek
Sum Insured 4,50,000 INR per family
Coverage Type Family Floater
Dependent Coverage
Employee +Spouse +Children (max 2 children) +2 Parents / Parents in Laws
(One set of parents)
If there are less than 5 dependents then 3
rd
child can also be covered for free else
3
rd
child can be covered at additional premium of Rs. 1,124 per year.
Note: Enrolments for family needs be done through Emeditek Gateway.
Top-up Plans
Top-up plans allow you to enhance coverage / benefit limits upon payment of
additional premium, at highly discounted prices as compared to Market.
Two options are available in Medical insurance:
Enhance cover by Rs. 400,000 for an annual premium of Rs. 3,000
Enhance cover by Rs. 600,000 for an annual premium of Rs. 3,600
Note: Enrolments for Top up can be done through Emeditek Gateway by selecting from the drop down. After your
authorization, the payments for applicable premium for Top-up plans will be routed through payroll deduction.
Co-pay on Claims
Applicable for Parent claims only @ 20%
Example: If admissible claim value is Rs. 10,000 then insurance plan will pay
Rs. 8,000 and remaining Rs. 2,000 has to be paid by you.
Page 17
Medical Benefit Coverage Details Contd.
Benefits / Extensions Coverage
Standard Hospitalization Yes
TPA services Yes
Pre existing diseases Yes
Waiver on 1
st
year exclusion Yes
Waiver on 1
st
30 days excl. Yes
Maternity benefits
Yes. INR 50,000 for
both Normal &
C-section
Pre & Post Natal Expenses
Yes only for
hospitalization.
Baby cover day 1 Yes
Benefits / Extensions Coverage
Day Care Yes
HIV / AIDS Yes
Room Rent
Yes. Up to Rs. 6000
per day
Day care Procedures Yes
Pre-Post Hospitalization Exp. Yes. 30 & 60 days
Ambulance Services
Yes. INR 1500 per
incident
Page 18
Benefits Definition
Pre existing
diseases
Any Pre-Existing ailments such as diabetes, hypertension, etc or related ailments for which care, treatment or advice
was recommended by or received from a Doctor or which was first manifested prior to the commencement date of the
Insured Persons first Health Insurance policy with the Insurer
First 30 day waiting
period
Any Illness diagnosed or diagnosable within 30 days of the effective date of the Policy Period if this is the first Health
Policy taken by the Policyholder with the Insurer. If the Policyholder renews the Health Policy with the Insurer and
increases the Limit of Indemnity, then this exclusion shall apply in relation to the amount by which the Limit of
Indemnity has been increased
First Year Waiting
period
During the first year of the operation of the policy the expenses on treatment of diseases such as Cataract, Benign
Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal
Diseases, Fistula in anus, Piles, Sinusitis and related disorders are not payable. If these diseases are pre- existing at
the time of proposal they will not be covered even during subsequent period or renewal too
Baby Cover Day 1
In consideration of additional premium, this policy is extended to cover the new born child of an employee covered
under the Policy from the time of birth till 90 days. Not withstanding this extension, the Insured shall be required to
cover the newly born children after 90 days as additional member as mentioned elsewhere under this Policy.
Pre Hospitalization
If the Insured member is diagnosed with an Illness which results in his / her Hospitalization and for which the Insurer
accepts a claim, the Insurer will also reimburse the Insured Members Pre-hospitalization Expenses for up to 30 days
prior to his / her Hospitalization.
Post Hospitalization
If the Insurer accepts a claimunder Hospitalization and immediately following the Insured Members discharge, further
medical treatment directly related to the same condition for which the Insured Member was Hospitalized is required,
the Insurer will reimburse the Insuredmembers Post-hospitalization Expenses for up to 60 day period.
Day Care
Day Care Procedure means the course of medical treatment or a surgical procedure listed in the Schedule which is
undertaken under general or local anesthesia in a Hospital by a Doctor in not less than 2 hours and not more than 24
hours. Generally 8 aliments (i.e. Dialysis, Chemotherapy, Radiotherapy, Eye surgery, Dental Surgery, Lithotripsy
(kidneystone removal), Tonsillectomy, D&C)
Benefit Extensions Definitions
Page 19
Medical Benefit General Exclusions
Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria
Cost of spectacles, contact lenses, hearing aids
Any cosmetic or plastic surgery except for correction of injury
Hospitalization for diagnostic tests only.
Vitamins and tonics unless used for treatment of injury or disease
Infertility treatment
Voluntary termination of pregnancy during first 12 weeks (MTP)
Dental treatment.
Incidence occurred while under the Influence of intoxicating drink or drugs.
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 disease
Congenital external diseases or defects/anomalies
Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.
Venereal diseases .
Injury or disease caused directly or indirectly by nuclear weapons (Nuclear radiation or nuclear weapons material) Naturopathy.
Aviation other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft any where in the world.
Incidence arising out of any breach of law with criminal intent.
Insanity
Insurance Benefits - Detailed
1. Medical Insurance (along with Top-up Option)
2. Accident Insurance
3. Life Insurance (along with Top-up Option)
4. Critical Illness Insurance
Page 21
Group Personal Accident (GPA) Benefit Details
This insurance provides compensation/payment up to a financial limit as assigned bythe company, to the insured
person or his legal personal representative, if the insuredperson suffers death or disablement due to an accident.
The cover is worldwide but payment of claimcanonlybe made in India andin IndianRupees.
Policy Parameter
Insurer Tata AIG General Insurance Company
Policy Start Date 01
st
J uly 2013
Policy End Date 30
th
J une 2014
Sum Insured 2 times of Fixed compensation (*Enhanced this year)
Coverage Details
Accidental Death Yes (100% of Capital Sum Insured)
Loss of both eyes OR 2 limbs OR 1 limb and 1 eye Yes (100% of Capital Sum Insured)
Loss of one eye OR 1 limb Yes (50% of Capital Sum Insured)
Permanent Total Disablement from injuries other
than those named above
Yes (100% of Capital Sum Insured)
Page 22
GPA Benefit Details
Coverage Details
Permanent Partial Disability Yes as per benefit chart
Temporary Total Disability (Weekly Benefit- 1% of Sum Insured subject to a
maximum of INR 5,000 for 100 weeks)
Geographical Limits World wide
Terrorism Covered
Disappearance Yes, Covered
Education benefit* ( Payable in case of Accidental
death of an employee )
Yes @10% of sum insured
(Max. Rs. 1 Lac) per child for two children up to age of 4
years is payable.
Medical Extension ( Payable towards medical
expenses for treatment of accidental injury - OPD)*
Up to INR 7500
Note: If accident requires hospital admission then your
medical insurance can be utilized. Above expenses are
available for immediate medical attention
Page 23
GPA Details for Various Disability Clauses
* Indicative list, Please refer to policy document
Insurance Benefits - Detailed
1. Medical Insurance (along with Top-up Option)
2. Accident Insurance
3. Life Insurance (along with Top-up Option)
4. Critical Illness Insurance
Page 25
Group Term Life (GTL) Benefit Details
Policy Parameter
Insurer Kotak Mahindra Old Mutual Life Insurance
Company
Policy Start Date 01
st
J uly 2013
Policy End Date 30
th
J une 2014
Sum Insured
2 times of Fixed compensation (*Enhanced this
year)
Coverage Details
Death
In the event of death of a member from any cause
(natural/accidental), provided that this shall occur while
the assurance in respect of such member shall be in
force, an amount determined in accordance with the
PolicySchedule shall be paid
Yes
Page 26 26
02 J uly 2013
What is a GTL Top up Cover ?
Top up cover is an additional life cover offered to all employees over and above the cover under
the company sponsored GTL policy .It is on a pure voluntary basis and the premium for the top-
up shall be paid by the individual employee.
Features of GTL Top up Cover :
It is very quick and hassle free
The premium rates under the Top-up plan are substantially lower an individual term plan .Thus
top up provides an additional Life cover at a very low cost.
It provides tax benefit under Section 80 C of the Income Tax Act, 1961.
The premium amount is deducted from employees payroll.
Page 27 27
02 J uly 2013
Life Insurance (Top-up Option)
A top up plan on Life insurance is a flexible option that increases your total sum insured at a
discounted premium as compared to retail / individual insurance plan available in the market.
You may select the top up option on the enrolment portal and the premium will be calculated
as per the following age band grid.
Note: The above values are rounded off.
Refer to enrollment portal for actual amount as per your selection
Base + Top-up should not be more than 10 x GC. IF it is contact your Admin before selecting
Age Band Vs.
Options
JM MM SM
500,000 1,000,000 1,000,000 2,000,000 1,500,000 3,000,000
18-30 483 966 966 1933 1449 2899
30-35 517 1034 1034 2067 1551 3101
36-40 674 1348 1348 2697 2022 4045
41-45 944 1888 1888 3775 2831 5663
46-50 1472 2944 2944 5888 4416 8831
51-55 2275 4551 4551 9101 6826 13652
56-60 3382 6764 6764 13528 10146 20292
Suicide is not covered under Voluntary Top up.
Top up is not available by just authorizing in the portal. Once the medical underwriting is completed and insurers
have accepted the case, member will be covered under voluntary top up.
In case of any claim arisen during medical underwriting requirement process Top Up Sum insured will not be paid
02 J uly 2013
GTL Top-Up Selection Process
Step 1:- Go to emeditek
enrolment portal
Step 2:- Select your Age
bracket and Top up Sum Insured
Step 3:- Answer the 4 questions
that will appear on the portal
under the Voluntary Top up Sum
Insured
As asked by the insurer
either you need to provide
the medical details to the
Doctor who would call you
from and do the tele-
underwriting.
Or else, need to undergo
medical tests and
questionnaire ,as per the
underwriting guidelines at
medical centers prescribed
by Kotak. (Medical expenses
will be borne by Kotak).
If No, then your cover would commence after
receiving approval from Kotak Life .
The applicable premium would be deducted from
your payroll.
If answer to any of these
questions is Yes then you need to
undergo medical underwriting :
Page 29
GTL Exclusions
Service on duty with any armed force
Insanity
Venereal disease
Influence of intoxicating drink or drugs
Aviation other than as a passenger (fare paying or otherwise) in any duly licensed
standard type of aircraft any where in the world
Nuclear radiation or nuclear weapons material
Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be
declared or not), civil war, rebellion, revolution, insurrection, mutiny, military, or
usurped power, seizure, capture, arrest,, restraint, detainments of all kings, princes,
and people of whatever nation, conditions and qualities so ever
Childbirth, pregnancy or other physical causes peculiar to the female sex
While committing any breach of law with criminal intent .
Insurance Benefits - Detailed
1. Medical Insurance (along with Top-up Option)
2. Accident Insurance
3. Life Insurance (along with Top-up Option)
4. Critical Illness Insurance
Page 31 31
02 J uly 2013
Critical Illness Cover
Benefit:
2L for J M
3L for MM and SM
Diseases covered under Critical Illness:
Major Heart Attack (MI)
Cancer
Stroke
Coronary Artery By-Pass Graft Surgery (CABG)
Kidney failure
Major organ transplant
Paralysis
Loss of limbs
Aorta surgery
Major burns
Heart valve surgery
Blindness
Click here for
Critical Illness
Benefit Details
Availing Insurance Benefits
1. Medical Insurance
2. Accident Insurance
3. Life Insurance
4. Critical Illness Insurance
Page 33
Cashless / Reimbursement which one to choose
Cashless claims process is more easier than Reimbursement:
No out of pocket expenditure for employees, except non payable expenses.
No requirement for document submission.
It saves times for administrative work as TPA directly coordinates with the
hospital.
Page 34
Availing Medical Benefit Cashless Process
Cashless means the Emeditek may authorize upon a Policyholders request for direct settlement of eligible
services and its according charges between a Network Hospital and Emeditek. In such case Emeditek will
directly settle all eligible amounts with the Network Hospital and the Insured Person may not have to pay any
deposits at the commencement of the treatment or bills after the end of treatment to the extent as these services
are coveredunder the Policy.
Planned Hospitalization Emergency Hospitalization
List of hospitals in the Emeditek network
Hospitals list
http://www.emeditek.com/NetworkServices.aspx
Website : www.emeditek.co.in
Contact Customer Service Line
1800-102-3242
+91-124-4466666 (Hotline)
customercare@emeditek.com
Note : Patients seeking treatment under cashless hospitalization are eligible to make claims under pre and post hospitalization expenses. For all such
expenses the bills and other required documents needs to submitted separately as part of the claims reimbursement.
Page 35
35
Emergency
Identification via Emeditek Cards. Also carry claimant ID proof
Approach Network Hospital. For updated list visit
http://www.emeditek.com/NetworkServices.aspx
Planned
Pre-authorization request to Emeditek TPA
from hospital TPA Helpdesk
Emeditek TPA Pvt Ltd will verify the documents
VERIFIED BY
DOCTOR
Authorization Issued Pre Authorization Request Denied
Queries Raised for
further Clarification

Cashless Process Flow
Page 36
Member intimates Emeditek of the
planned hospitalization in a
specified pre-authorization format
at-least 48 hours in advance
Claim
Registered by
the Emeditek on
same day
Follow non cashless
process
No
Emeditek authorizes
cashless for planned
hospitalization to the
hospital
Yes
Pre-Authorization
Completed
Pre Authorization Form
www. emeditek.co.in
Click here for
Pre
Authorization
Form
Member produces ID card
at the network hospital
and gets admitted
Member gets treated and
discharged after paying
all non entitled benefits
like refreshments, etc.
Hospital sends complete
set of claims documents
for processing to E
Meditek
Claims Processing &
Settlement by Emeditek
& Insurer
Step 1
Pre-Authorization
All non-emergency hospitalisation
instances must be pre-authorized
with the E Meditek, as per the
procedure detailed below. This is
done to ensure that the best
healthcare possible, is obtained,
and the patient / employee is not
inconvenienced when taking
admission into a Network Hospital.
Step 2
Admission, Treatment &
discharge
After your hospitalisation has been
pre-authorized, you need to secure
admission to a hospital. A letter of
credit will be issued by Emeditek to
the hospital. Kindly present your E-
card and a photo identity card at the
Hospital admission desk. The bills
related to treatment will be sent
directly to, and settled by Emeditek
at the end of the Treatment
Planned Hospitalization
Page 37
P
R
O
C
E
S
S
Emergency Hospitalization & Process
Step 1
Get Admitted
Step 2
Pre-Authorization by hospital
Step 3
Treatment & Discharge
In cases of emergency, the
member should get admitted in
the nearest network hospital by
showing their E card.
Relatives of admitted member
should inform the call centre within
24 hours about the hospitalization &
Seek pre authorization. The
preauthorization letter would be
directly given to the hospital. In case
of denial member would be informed
directly
After your hospitalisation has
been pre-authorized the
employee is not required to pay
the hospitalisation bill in case of
a network hospital. The bill will
be sent directly to, and settled by
E Meditek
Member gets admitted in
the hospital in case of
emergency by showing his
E Card
Member/Hospital applies
for pre-authorization to the
Emeditek within 24 hrs of
admission
Emeditek verifies
applicability of the claim to
be registered and issue pre-
authorization
Pre-
authorization
given by the E
Meditek
No
Member gets treated and
discharged after paying all
non medical expenses like
refreshments, etc.
Hospital sends complete set
of claims documents for
processing to the E Meditek
Non cashless
Hospitalization
Process
Yes
Page 38
Dos and Don'ts
Cashless Claims
Produce your IDcardto the hospital authorities at the time of admission.
In case of non-photo ID card, please also carry any other Photo ID Proof
with you andsubmit a photo copyof the same to the hospital.
Please informTPA well in advance (at least 48 Hours before admission)
about the hospitalization (Within 24 hours of admission, in case of
Emergency Hospitalization). This ensures that the authorization for
cashless is provided well before the patient reaches hospital and the
admissionwould be hassle free.
Make sure to fill upthe mobile number in pre-authorizationform
Non-payable items and co-payment charges have to be borne by the
Insured
Page 39
Emergency
Approach To Non Network Hospital
Planned
Intimate within 72 Hrs.
from time of admission or
before
Intimate within 24 Hrs.
from time of admission
Emeditek TPA

Submit documents within 15
days from date of discharge
from the hospital
Availing Medical Benefit
Reimbursement Process: Non Network Hospital
Page 40
Reimbursement Claims
Please intimate TPA about the hospitalization before the
admission (within 24 hours from time of admission in
case of Emergency hospitalization), even if the hospital
is not in network or you do not wish to avail cashless
facility.
Please ensure that the hospital meets the requirement
as per the definition provided in the policy.
Please collect and preserve Discharge summary,
Reports, Prescriptions, Bills and receipts in Original.
Please note that All Bills, cash memos and diagnostics
should be supported by the doctors prescription.
Submit all the documents along with a duly filled in claim
form within 15 days from the date of discharge from
the hospital (within 60 days if the claimincludes Post
Hospitalization expenses).
Page 41
Indicative list of documents to be submitted for
Reimbursement Process
Completed Claim form with Signature
Hospital bills in original (with bill no; signed and stamped
by the hospital) with all charges itemized and the original
receipts
Discharge Report (original)
Attending doctors bills and receipts and certificate
regarding diagnosis (if separate from hospital bill)
Original reports or attested copies of Bills and Receipts
for Medicines, Investigations along with Doctors
prescription in Original and Laboratory
Follow-up advice or letter for line of treatment after
discharge from hospital, from Doctor.
Provide Break up details including Pharmacy items,
Materials, Investigations even though it is there in the
main bill
In case the hospital is not registered, please get a letter
on the Hospital letterhead mentioning the number of
beds and availability of doctors and nurses round the
clock.
In non- network hospital, you may have to get the
hospital and doctors registration number in Hospital
letterhead and get the same signed and stamped by the
hospital, if required.
Claims Form
www.emeditek.co.in
Click here
for Claim
Form
*Please retain photocopies of all documents submitted
Click here for
Checklist of
Documents
Page 42
Things to remember
Always carry your TPA card with Government identity
proof while going to the hospital
Maintain all bills relating to hospitalization, including pre
and post in original
Remember to take the bills fromyour family / consulting
doctor
Before hospitalization, clarify whether the particular
disease is covered under your policy terms and
conditions or not
Request the hospital authorities to send the necessary
papers to the TPA at the earliest, without which, claim
cannot be processed &cashless cannot be granted
Feel free to consult TPA claims team anytime for any
issues. It is advisable to store TPA helpline numbers in
your mobile phone and also give it to your family
members.
Page 43
E meditek Contact Points
Southern Region Commercial Sales Offices :
1
st
Point of Contact :
Shivshankar 9620552223 shivshankar@emeditek.com
Ramesh 9845081848 In.medicalhelpdeskbanglore@schneider-electric.com.
Sundarrajan 8861005057 Helpdesk.apc@emeditek.com.
Escalations :
Vikas Anupam 8861005056 vikash.anupam@emeditek.com.
Dr Sujit Paul 9686957788 drsujit.paul@emeditek.com.
Northern Region Commercial Sales Offices :
1
st
Point of Contact :
Shatrunjay 9958793092 in.medicalhelpdeskgurgaon@schneider-electric.com, smishra@emeditek.com
Amit Kumar 9958086222 amitkumar.raman@emeditek.com.
Escalations :
Dr Faisal Khan 9910029560 drfaisal.khan@emeditek.com.
Page 44
E meditek Contact Points
Western Region Commercial Sales Offices :
1
st
Point of Contact :
Tushar Shoni 9737150883 emslbaroda@emeditek.com.
Sanjay Pawar 9594083185 Sanjay.pawar@emeditek.com, in.medicalhelpdeskmumbai@schneider-electric.com.
Escalations :
Dr Kadam 9867330175 skadam@emeditek.com.
Nishchint Kumar 9594567878 nischint.kumar@emeditek.com.
Eastern Region Commercial Sales Offices :
1
st
Point of Contact :
Ayan Mitra 9830333702 Ayan.mitra@emeditek.com, in.medicalhelpdeskkolkatta@schneider-electric.com.
Escalations :
Parthe Sarkar 9831013691 partha.sarkar@emeditek.com.
Page 45
Medical Benefit Local Admin Contact Points
Sourthern Region Commercial Sales Offices :
Secundrabad Mr. Dennis Edwin
Bangalore Mr. Palani G.
Chennai Mr. Unni Krishnan
Eastern Region Commercial Sales Offices :
Kolkata Ms. Shampa Dutta
J amshedpur Mr. Amit Deshpande
Plants :
Hyderabad Plant Mr. Ravindra Adavadkar
Nasik Plant Mr. Rajendersinh Bhandari
Vadodara Plant Ms. Swati Mehta
Ambattur Plant Ms. Renuka Devi /
Mr.Sukhesh Gopalan
Conzerv Ms. Anju Mathew (HRBP)
Meher Mr. Arun Shetty
Western Region Commercial Sales offices :
Mumbai Mr. Antony Raj
Pune Mr. Pankaj J ain
Vadodara Mr. Rajesh Thakore
Ahmedabad Mr. Haresh Patel
Northern Region Commercial Sales offices :
Gurgaon Ms. Manisha Kala
Mr. Sachin Chauhan
Ludhiana Mr. Mohit Khurana
Chandigarh Mr. Shahab Naqvi
J aipur Mr. Om Pandey
Lucknow Mr. Rahul Srivastava
GTCI & GSC :
Bangalore Office Mr. J ayaram Govindaiah
Administration of the insurance related benefits will be handled by Administration department.
Location specific admin SPOC points are given below:
Local Helpdesk / Impant are also provided across major
locations : Gurgaon , Bangalaore , Mumbai , Kolkatta ,
Hyderabad , Nashik and Baroda. The contact details of person
and schedule will be separately circulated on regional basis
Page 46
Medical Benefit Central Contact Point
Schneider SPOC:
Providers
Ms Manisha Kala Phone: +91 858885693
E Meditek:
www.emeditek.co.in
Marsh:
www.marsh.com
Escalation
Mr. Shatrunjay Misra Phone: +91 9958793092
Email: smishra@emeditek.com
Mr. Rajiv Joshi Phone: +91 8588835007
Email: rajiv.joshi@marsh.com
Mr Surendra Bisht Phone: +91 9711157768
Availing Insurance Benefits
1. Medical Insurance
2. Accident Insurance
3. Life Insurance
4. Critical Illness Insurance
Page 48 48
02 J uly 2013
GPA Claims Process
Claimant / Nominee notifies HR,
who in turn would intimate
Insurer and submit required
claim documents within 30 Days
of the event
On obtaining all relevant
documents, Insurance Co. will
begin processing the claims
Claim Investigation and
Review of submission of all the
required documents
Is claim
payable?
Cheque is sent to Employer (HR),
from where it is given to the
Claimant/ Assignee
Insurer provides a valid reason for
the rejection to HR (death) no
death (Claimant)
No
Yes
Page 49
GPA Claims Document Checklist
Weekly Benefit Claims
1. Completed Claim form
2. Doctor's Report
3. Disability Certificate from
the Doctor, if any
4. Investigation/ Lab
reports (x-ray etc.)
5. Original
Admission/discharge
card, if hospitalized
6. Employers Leave
Certificate & Details of
salary
Death Claims
1. Completed claim form
2. Attending Doctor's report
3. Death Certificate
4. Post Mortem/ Coroner's
report
5. FIR ( First Information
Report)
6. Police Inquest report,
wherever applicable
Dismemberment/ Disablement
Claims
1. Completed claim form
2. Doctor's Report
3. Disability Certificate from
the Doctor
4. Investigation/ Lab reports
(x-ray etc.)
5. Original Admission/
discharge card, if
hospitalized.
6. Police Inquest report,
wherever applicable
Click here for
GPA Claim
Form
Page 50 50
02 J uly 2013
GPA Contact Details
Providers: Tata AIG General Insurance Company
Claims Intimation /
Registration
Claim Intimation mail should go to
General.claims@tata-aig.com,
A&H.delhi@tata-aig.com;
Ankur.jain@tata-aig.com
With a cc to :
Respective HRBP and
Manisha.Kala@schneider-electric.com
Claims can also registered directly on
Toll free no:
18002267780 / 1800119966 with policy no.
Contact Person
Name : Ankur Jain
Mobile:+91 999931608
Email : Ankur.jain@tata-aig.com
Availing Insurance Benefits
1. Medical Insurance
2. Accident Insurance
3. Life Insurance
4. Critical Illness Insurance
Page 52 52
02 J uly 2013
GTL Claims Process
Claimant / Assignee notifies HR,
who in turn would intimate Insurer
and submit required claim
documents within <<3 days>> of
the event
On obtaining all relevant
documents, Insurance Co. will
begin processing the claims
Claim Investigation and Review
within <<7 Days>>of submission
of all the required documents
Is claim
payable?
Cheque sent to Employer (HR)
within <<10 working days>, from
where it is given to the Claimant/
Assignee
Insurer provides a valid reason for the
rejection to HR/Claimant/ Assignee
No
Yes
Page 53
Claim form with authorized signature & stamp of client (as per Annexure A)
Active Employment Letter
Original Death Certificate
Proof of age of the life insured
Last attending doctor's death certificate
Guardian details for minor beneficiary
Driving license (Accidental claim)
First information report (Accidental & dismemberment claim or any police case in natural
death)
Post mortem report (Accidental or any police case in natural death)
Police case closure report (Accidental or any police case in natural death)
Viscera Report (Accidental or any police case in natural death, if applicable)
Nomination Declaration from policyholder (as per Annexure B)
Nominee bank details & ID proof
Cause of death certificate
GTL Document Checklist
Page 54 54
02 J uly 2013
GTL Contact Details
Providers: Kotak Life Insurance Company
Claims Intimation Claim Intimation mail should go to
chaturvedi.akansha@kotak.com
Charu.gosain@kotak.com
With a cc to :
Respective HRBP and
Manisha.Kala@schneider-electric.com
Contact Person Name : Charu Gosain
Mobile:+91 9818335173
Email : Charu.gosain@kotak.com
Availing Insurance Benefits
1. Medical Insurance
2. Accident Insurance
3. Life Insurance
4. Critical Illness Insurance
Page 56 56
02 J uly 2013
Critical Illness Claims Process
Notification of Claim
All critical Illness claims must be submitted in
writing to KLI within 30 days from the claim
event date along with the primary documents
Submission of diagnosis reports /medical
reports
Employee should submit complete treatment
papers from diagnosis till date of discharge
along with medical questionnaire
Claim Investigation and Review within <<7 -10
Days>>of submission of all the required
documents
Is claim
payable?
Insurer provides a valid
reason for the rejection to
HR/Claimant/ Assignee
No
Cheque sent to Employer
(HR)/ employee within
<<10-12 working days.
Yes
Critical illness claim is payable only when a doctor prescribes a claimant to be critically ill as
per diseases mentioned and a claimant is able to survive for the next 30 days. The claimant
also needs to produce sufficient documents to avail this claim.
Click here for
Critical Illness -
Documents
checklist
Page 57 57
02 J uly 2013
For Critical Illness Contact
Providers: Kotak Life Insurance Company
Claims Intimation /
Submission
All Claims should should be submitted to
chaturvedi.akansha@kotak.com
Charu.gosain@kotak.com
With a cc to :
Respective HRBP and
Manisha.Kala@schneider-electric.com
Contact Person Name : Charu Gosain
Mobile:+91 9818335173
Email : Charu.gosain@kotak.com
Retiree Policy
1. Coverage Details
2. Retiree Policy Process
3. Contact Details
Page 59
Retiree Policy Coverage Details
Policy Parameter
Insurer United India Insurance Company (UIIC)
Third Party Administrator To be decided by United Insurance
Sum Insured INR 450,000 if desired
Family Definition Self & Spouse
Benefits / Extensions Coverage
Standard Hospitalization Yes
Copayment Copay of 20% would applicable as per retail policy.
Pre existing diseases
PED coverage subject to stipulated claim free years, this is subjected to certificate
from the TPA as per the format .There is a waiting period of 4 years under normal
individual cover. If you have had 4 claims free years and this is being certified by the
TPA then PE would be covered from day one.
Pre & Post Hospitalization
Covered for 30 & 60 days for Hospitalization on disease / illness / injury subject to
maximum of 10 % of Sum Insured.
Room Rent Capping 1 % of Sum Insured per day for normal and 2 % of Sum Insured per day for ICU.
Maternity benefits Not Applicable
Cataract Capped at 10% of SI subject to maximum of INR.25,000
Hernia Capped at 15% of the SI subject to maximum of INR.30,000
Hysterectomy Capped at 20% of the SI subject to maximum of INR.50,000
Page 60
Benefits / Extensions Coverage
Major Surgeries related to Cancer Surgery
/ Cardiac surgery / Brain Tumor surgeries /
Pacemaker Implantation / Knee J oint / For
sick, sinus syndrome / Hip replacement
Capped at 70% of the SI subject to maximum of INR4 Lac
First 2 year exclusion clause
During the first two years of the operation of the policy, the expenses on
treatment of diseases such as Cataract, Benign Prostatic Hypertrophy,
Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital
internal disease, Fistula in anus, piles, Sinusitis and related disorders, Gall
Bladder Stone removal, Gout & Rheumatism, Calculus Diseases, J oint
Replacement due to Degenerative Condition and age-related Osteoarthritis &
Osteoporosis are not payable.
Retiree Policy Coverage Details Contd.
Policy guidelines of individual retail policies would be applicable.
All other benefits would be strictly as per retail policy.
Page 61
Conitnuity certficate from employer and photographs are talso required o be submitted for taking policy.
02 J uly 2013
Retiree Policy Process
Step 1:- The concerned employee should have four claim free years under mediclaim policy.
Step 2:- The intimation to this effect (Date of exit) should come a month before to Schneider Admin/ Manisha Kala to
register this with UNITED Insurance Company
Step 3:- UNITED Insurance Company would ask TPA to provide claims and policy details for concerned employee in
attached TPA certificate format
Step 5:- The concerned employee would submit this proposal form duly completed in all respects and contact the
designated office which will be issuing an Individual Mediclaim policy by charging the applicable premium as per the retail
policy.
Step 4:- Basis the details provided in TPA certificate UNITED insurance company would issue a proposal form to
concerned employee.
Page 62
Provider : United India Insurance Company
Admin SPOC Schneider
Electric
Name : Ms Manisha Kala
Phone: +91 858885693
Email : manisha.kala@schneider-electric.com
Contact Person United
Insurance
Name : Mr. Manjeet Singh
Phone : 011-23414357 / 011-23415322
Mobile : 9810074632
Email : manjeetsingh@uiic.co.in
Office Address : United India Insurance Co. Ltd.,
Branch Office,K 31,Connaught Place,
New Delhi-110001
For Retiree Policy Contact details
63
02 J uly 2013
How to make most of your benefits?
Make an informed choice of hospitals, when the hospitalization is planned and non
critical in nature.
In case of any planned hospitalization, approach the TPA sufficiently in advance (at
least 48 hrs) and request pre authorization this enables TPA to facilitate smooth
hospitalization admission & discharge process and negotiate better prices /
package rates / room rent.
Try to negotiate discounts with the hospital if opting for reimbursement as the bill is
settled directly you.
Please ensure to crosscheck the final bill sent to the TPA for the following:
You are Billed only for the services utilized for e.g. category of room, diagnostics
undergone, medicines consumed
Total bill amount
Ask WHY & WHAT is billed to you (as a consumer, you have the right to know)
We Care!