Professional Documents
Culture Documents
Version 1.3
November 1, 2017
Wipro – For Internal Circulation only
Compensation & Benefits team
Expenses for hospitalization are payable only if a 24-hour hospitalization has been taken (except
for select day care procedures, which do not require a 24-hour hospitalization). Under the
scheme, the typical expense heads covered are the following: room/boarding expenses as
provided by the hospital or nursing home; nursing expenses; surgeon, anesthetist, medical
practitioner, consultant, specialist fees; anesthesia, blood, oxygen, operation theater charges,
surgical appliance, medicines and drugs, diagnostic material and X-Ray; dialysis, chemotherapy,
radiotherapy, cost of pace maker, artificial limbs and cost of organs and similar expenses.
2. Coverage
All India based employees and long-term assignees (on India payroll) of Technologies, India BU
and WC are covered under the policy.
3. Salient Features
There are two plans called as ‘Base’ and ‘Top-up’. The Floater Sum Insured available under the
plans are given below. Wipro will offer all employees the base sum insured based on their
respective bands.
Table 1
Grade BASE Sum Insured (INR)
B3 and below 200,000
C1, C2 300,000
D1, D2 400,000
E 500,000
Table 2
Additional TOP-UP Sum Insured Options (INR)
200,000
400,000
600,000
800,000
1,000,000
Table 4
Policy Benefits
Benefits Base Plan Top-up Plan
Standard Hospitalization Covered
Pre & Post Hospitalization Relevant expenses Covered (30 days & 60 days respectively) Refer
expenses maternity benefit for maternity related pre and post limits
Pre-existing diseases (including
internal and external congenital Covered
diseases)
Waiting periods (First 30-days,
First Year, First Two Years and Waived off
First Four Years)
Up to INR 2,000 per claim for Up to INR 3,000 per claim for
Ambulance services
emergencies only emergencies only
Normal & Caesarian Delivery (first 2 Normal & Caesarian Delivery (first 2
Maternity instances of live birth for the instances of live birth for the
mother): INR 40,000. Pre-& Post mother): INR 50,000. Pre-& Post
Note: Procedures/treatments usually done in outpatient department are not payable under the
policy even if converted as an in-patient in the hospital for more than 24 hours or carried out in
Day Care Centers.
A. Room, Boarding and Nursing expenses as provided by the Hospital/Nursing Home. This
also includes nursing care, RMO charges, IV Fluids/Blood transfusion/injection
administration charges and similar expenses.
C. Anesthetic, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines &
Drugs, Dialysis, Chemotherapy, Radiotherapy, Cost of Artificial Limbs, Cost of prosthetic
devices implanted during surgical procedure like pacemaker, orthopedic implants, infra
cardiac valve replacements, vascular stents, relevant laboratory/ diagnostic tests, X Ray
and other medical expenses related to the treatment.
Note: No payment shall be made under 4.1B other than as part of the hospitalization bill.
4.2 DOMICILIARY HOSPITALIZATION as defined below in clause 5.7 below for a period
exceeding three days and subject however that domiciliary hospitalization benefits shall not
cover:
i) Expenses incurred for pre and post hospital treatment and
ii) Expenses incurred for treatment for any of the following diseases: -
1) Asthma
2) Bronchitis
3) Chronic Nephritis and Nephritic Syndrome
4) Diarrhea and all type of Dysenteries including Gastroenteritis
5) Diabetes Mellitus and Insipidus
6) Epilepsy
7) Hypertension
8) Influenza, Cough and Cold
9) All Psychiatric or Psychosomatic Disorders
10) Pyrexia of unknown Origin for less than 10 days
11) Tonsillitis and Upper Respiratory Tract infection including Laryngitis and pharyngitis
12) Arthritis, Gout and Rheumatism
Liability of the company under this clause is restricted as stated in the Schedule attached
hereto.
4.3 Expenses on Hospitalization upon written advice of a Medical Practitioner, for minimum
period of 24 consecutive hours are admissible. However, this time limit is not applied to
specific treatments as mentioned below:
Table 5
1 Hemo dialysis 8 Surgical treatment of anal fistulas
2 Parenteral Chemotherapy 9 Dilation and Curettage (D&C)
This condition will also not apply in case of stay in hospital of less than 24 hours provided
a. The treatment is undertaken under General or Local Anesthesia in a hospital/day care
center in less than 24 hours because of technological advancement and
b. Which would have otherwise required a hospitalization of more than 24 hours.
Note: Procedures/treatments usually done in out-patient department are not payable under
the policy even if converted as an in-patient in the hospital for more than 24 hours or carried
out in Day Care Centers.
4.4 For Ayurvedic Treatment, hospitalization expenses are admissible only when the
treatment has undergone in a Government Hospital or in any Institute recognized by the
Government and/or accredited by Quality Council of India/National Accreditation Board of
Health.
(N.B: Company’s Liability in respect of all claims admitted during the period of insurance shall
not exceed the Sum Insured per person as mentioned in the schedule)
4.5 The following ailments are capped with the below mentioned sub-limits (specific to A-
type & B-type city). These sub-limits are inclusive of all hospitalization and implant charges,
irrespective of the room category. (All Wipro office locations are considered as Class A and
rest of the locations are considered as Class B.)
Note: The below sub-limits are inclusive of pre and post-hospitalization expenses
Table 6
4.6 The following ailments are capped with the below mentioned sub-limits in the Top-up plan.
These sub limits are inclusive of all hospitalization and implant charges, irrespective of the room
category. The A and B type city classification does not apply to these limits.
Table 7
Capped Ailment limits as per the Top-up Top-up limits(INR)
selected 200,000 400,000 600,000 800,000 1,000,000
Appendicectomy - laparoscopic 62,700 68,970 75,867 83,454 91,799
Appendicectomy – open 38,500 42,350 46,585 51,244 56,368
Arthroscopic surgery 113,300 124,630 137,093 150,802 165,883
Cataract 29,700 32,670 35,937 39,531 43,484
Cholecystectomy - laparoscopic 60,500 66,550 73,205 80,526 88,578
Coronary Angiogram (CT Angiogram not 22,000 24,200 26,620 29,282 32,210
payable)
Fissurectomy 27,500 30,250 33,275 36,603 40,263
Fistulectomy – High 38,500 42,350 46,585 51,244 56,368
Fistulectomy – Low 33,000 36,300 39,930 43,923 48,315
Haemorrhoidectomy 35,200 38,720 42,592 46,851 51,536
Hernia repair - laparoscopic 66,000 72,600 79,860 87,846 96,631
Hernia repair - open 38,500 42,350 46,585 51,244 56,368
Hydrocelectomy - Bilateral 38,500 42,350 46,585 51,244 56,368
Hydrocelectomy - Unilateral 27,500 30,250 33,275 36,603 40,263
Hysterectomy - Laparoscopic 66,000 72,600 79,860 87,846 96,631
Hysterectomy - Open 55,000 60,500 66,550 73,205 80,526
Thyroidectomy 55,000 60,500 66,550 73,205 80,526
Tonsillectomy 31,900 35,090 38,599 42,459 46,705
a) A history of typical clinical symptoms consistent with the diagnosis of Acute Myocardial
Infarction (for example: typical chest pain)
b) New characteristic electrocardiogram changes
c) Elevation of infarction specific enzymes, Troponins or other specific biochemical
markers.
Excluded are:
A. Angioplasty and/or any other intra-arterial procedures
B. Any key-hole or laser surgery.
Exclusions:
A. Catheter based techniques including but not limited to, balloon
valvotomy/valvuloplasty are excluded.
Exclusions:
A. The condition should be confirmed by a specialist medical practitioner. Coma resulting
directly from alcohol or drug abuse is excluded.
Exclusions:
1. Other causes of neurological damage such as SLE and HIV are excluded.
PROVISIONS
1) The Company shall compensate the Insured person only once in respect of any one or
more of the covered diseases under the policy.
2) Should a benefit be paid in terms of this policy on behalf of an Insured Person the
coverage for that person terminates under this policy and such person shall not be
entitled to be covered by this policy or its renewal thereof.
4.11 Premium deduction conditions if both employee and spouse are employed with Wipro
a. Premium will be deducted from employee at a higher band, if both employee and spouse
are part of this policy
b. Premium will be deducted from either one of the employees, if both employee and
spouse are part of this policy and are in the same band.
c. If one employee is in BPS and the spouse in WT/WI, at the same/different band, premium
will be deducted from the employee in WT.
c. New incumbents - spouse and child details need to be added within the 30 days of date
of marriage or date of birth, respectively.
Remember to declare your marital status and family members at myWipro > My Data at the
time of a life changing event like marriage, child birth etc. The same applies for intercompany
transfers also.
4.16 The Policy will carry a 10% co-pay from the employee for admissible claim amount.
Complete Information on claims process is available at MyWipro > Finance > My medical claim
> Medical Insurance Claim > Plan details > Guidelines_for_Cashless_and_Reimbursement
For any claims, please use the claim form available in myWipro > Finance > My Medical claim >
Medical Insurance Claim > Medibuddy > Claims > Submit a claim. Attach check leaf as a soft
copy. You will need to fill the claim form and drop the supporting documents in HRSS Drop box.
Please write to wipro@mediassistindia.com for claims processing or for any clarification. Please
refer the portal for the detailed checklist ailment wise at www.mediassistindia.com
Claims will take up to 60 days to be processed once all the requisite documents are received by
MediAssist.
Member / Hospital
Member gets admitted
applies for pre- TPA verifies applicability
in hospital in case of
authorization to TPA of the claim and issues
emergency bu showing
within 24 hrs of pre-authorization
medical E-card / ID
admission
If TPA does not give pre-authorization, employee pays her/himself to the hospital and claims
reimbursement from insurer, through TPA
a) For any claims, please use the claim form available in myWipro > Finance > My
Medical claim > Medical Insurance Claim > Medibuddy > Claims > Submit a claim.
Attach check leaf as a soft copy.
b) All relevant documents along with the claim form need to be dropped in the nearest
Wividus drop box.
c) Documents must be submitted within 30 days of completion of hospitalization. Any
late submission shall not be considered.
d) MediAssist will process and settle the claim within 60 days of receipt of complete
documents.
e) Claims will take up to 60 days to be processed once all the requisite documents are
received by MediAssist.
6. Contribution
Wipro pays the annual premium on behalf of the employees; the contribution from the
employees towards this premium is collected monthly, by way of deduction through salary. The
contribution would be based on Marital Status of the employee.
Base plan premium will be deducted monthly from the employee’s payroll. Top-up premium is a
one-time premium deducted in 1/2/3 instalments, based on the employee’s selection during the
enrolment window.
Table 9
Base Plan Premiums
Table 10
Top-up Plan Premiums
Annual Premium
Top-up sum insured (INR)
Single Married
All premiums mentioned above are including taxes and are subject to change based on the
policy plan, performance and other criteria.
7. Definitions
7.1 A Hospital means any institution established for in-patient care and day care treatment
of illness and/or injuries and which has been registered as a Hospital with the local
authorities under the Clinical establishments (Registration and Regulation) Act, 2010 or
under the enactments specified under the Schedule of Section 56(1) of the said Act OR
complies with all minimum criteria as under:
a) Has qualified nursing staff under its employment round the clock.
b) Has at least 10 in-patient beds in towns having a population of less than 10 lacs and at least
15 inpatients beds in all other places;
c) Has qualified medical practitioner(s) in charge round the clock;
d) Has a fully equipped Operation Theatre of its own where surgical procedures are carried out;
e) Maintains daily records of patients and makes these accessible to the insurance company’s
authorized personnel.
7.3 Any one illness will be deemed to mean continuous period of illness and it includes
relapse within 45 days from the date of last consultation with the Hospital / Nursing Home
where treatment has been taken.
7.4 Cashless facility means a facility extended by the insurer to the insured where the
payments, of the costs of treatment undergone by the insured in accordance with the policy
terms and conditions, are directly made to the network provider by the insurer to the
extent pre-authorization approved.
Please note that employee will not be able to avail ‘cashless’ facility till the enrollment
details of the employee, spouse and/or child/children is shared with TPA (Medi Assist India
TPA Pvt. Ltd)- which normally takes of 45 to 60 days from the date of enrollment to be
updated.
7.5 Day Care center means any institution established for day care treatment of illness
and/or injuries or a medical set- up within a hospital and which has been registered with
the local authorities, wherever applicable, and is under the supervision of a registered
and qualified medical practitioner AND must comply with all minimum criteria as under:
a) Has qualified nursing staff under its employment
b) Has qualified Medical Practitioner(s) in charge
c) Has a fully equipped operation theatre of its own where surgical procedures are
carried out
d) Maintains daily records of patients and will make these accessible to the Insurance
Company’s authorized personnel
7.6 Day Care treatment means the medical treatment and/or surgical procedure which is:
a) Undertaken under General or Local Anesthesia in a hospital/day care center in less
than 24 hrs. because of technological advancements and
b) Which would have otherwise required a hospitalization of more than 24 hours.
Treatment normally taken on an out-patient basis is not included in the scope of this definition.
7.8 ID card / E-card means the identity card issued to the insured person by the TPA to avail
cashless facility in network hospitals.
7.9 Medically Necessary treatment is defined as any treatment, tests, medication, or stay in
hospital or part of a stay in hospital which
a) Is required for the medical management of the illness or injury suffered by the
insured;
b) Must not exceed the level of care necessary to provide safe, adequate and
appropriate medical care in scope, duration or intensity;
c) Must have been prescribed by a Medical Practitioner;
d) Must conform to the professional standards widely accepted in international
medical practice or by the medical community in India.
7.10 A Medical Practitioner is a person who holds a valid registration from the Medical Council
of any State of India or Medical Council of India or Council for Indian Medicine or for Homeopathy
set up by the Government of India or a State Government and is thereby entitled to practice
medicine within its jurisdiction; and is acting within the scope and jurisdiction of license.
The term Medical Practitioner would include Physician, Specialist and Surgeon. (The Registered
Practitioner should not be the insured or close family members such as parents, in-laws, spouse
and children).
7.11 Network Provider means the hospital/nursing home or health care providers enlisted by
an insurer or by a TPA and insurer together to provide medical services to an insured on
payment by a cashless facility. The list of Network Hospitals is maintained by and available with
the TPA and the same is subject to amendment from time to time.
Preferred Provider Network means a network of hospitals which have agreed to a cashless
packaged pricing for certain procedures for the insured person. The list is available with the
company/TPA and subject to amendment from time to time. Reimbursement of expenses
incurred in PPN for the procedures (as listed under PPN package) shall be subject to the rates
applicable to PPN package pricing.
Complete list of network hospitals is available at myWipro > Finance > My Medical Claim >
Medical Insurance Claim >Proceed to Medibuddy portal > Search network hospitals.
7.13 Pre-existing disease - Any condition, ailment or injury or relation condition(s) for which
you had signs or symptoms, and/or were diagnosed, and/or received medical
advice/treatment within 48 months to prior to the first policy issued by the insurer.
7.15 Post hospitalization medical expenses - Relevant medical expenses incurred immediately
60 days after the Insured person is discharged from the hospital provided that:
a) Such Medical expenses are incurred for the same condition for which the Insured
7.16 Qualified Nurse means a person who holds a valid registration from the Nursing Council of
India or the Nursing Council of any State in India.
7.17 Reasonable and Customary charges mean the charges for services or supplies, which are
the standard charges for the specific provider and consistent with the prevailing charges in the
geographical area for identical or similar services, considering the nature of illness/injury
involved.
7.19 Delisted Hospitals are hospitals which are not covered under the policy due to various
reasons. The treatments covered in these hospitals will not be covered by the insurer. List of
these hospitals is available at myWipro > Finance > My Medical Claim > Medical Insurance Claim
> Proceed to medibuddy portal > Plan details > Delisted hospitals
10.Contacts
For registering and resolving any issues related to the policy, please raise a helpline ticket with
HRSS.
Table 12
Primary mail ID for all
wipro@mediassistindia.com Operating from Wipro Wividus office
queries
Dedicated Toll-free line 1800-419-1164 24 / 7 * 365 days Call support
11.Amendment History
Version Amendment date Author Approved by Nature of change
1.0 Nov 1, 2015 C&B C&B Head Original version
1.1 Nov 1, 2016 C&B C&B Head Policy renewal
1.2 Nov 1, 2017 C&B C&B Head Policy renewal
1.3 Apr 10, 2018 C&B C&B Head Change in 45-day window to 30 days for new
hires/members enrolment;