Group Insurance Policy

Policy No. Version : HR/2014-15

Group Insurance Policy

Policy Effective : As per the

currently applicable policy period
Approved by : HR Director /
Finance Director
Prepared by : HR Manager

Preamble:
As part of the Hospitalization Insurance benefit, all employees and their named
dependents (Spouse and 2 children) are eligible for Medical Insurance cover. The Group
Personal Accident Program covers employees against the financial risk of death / injury
sustained due to an accident caused by violent, visible and external means. The Group
Term Life Insurance covers employees and ensures to reimburse sum Insured to the
nominee of the deceased in case of natural or accidental death. The major
features/benefits under the three policies for employees and their covered dependents
are outlined here.
Applicability
This policy is applicable to all permanent employees on the rolls of Baxter (India) Pvt.
Ltd and any other Baxter managed operation(s) in India (i.e. Commercial,
Manufacturing, Regional, Integrated Delivery Center (IDC), Global Process Center(GPC)
etc.)
Duration of the policy
The Hospitalization and Personal accident policy will be effective for one year from the
date of inception of policy. The current policy is with Bharti Axa General Insurance Co
Ltd. is valid from 1st April 2014 to 31st March 2015.
The Group term Life Insurance policy is with Future Generali India Life Insurance Co
Ltd. and is valid from 1st Nov 13 to 30th Oct 14.
Group Medical (Mediclaim) Policy
The Group Medical policy covers expenses incurred by the insured person on account of
hospitalization due to sickness or an accident. The policy covers expenses incurred on

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Room rent, medicines, surgery etc. Expenses for hospitalization

Payable only if a 24 hour hospitalization has been taken (Except for named day
care procedures, which do not require a 24 hour hospitalization).
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.
Definitions
Third Party Administrator (TPA) is an agency appointed by the insurance company to
take care of claim settlements in health insurance. Medi Assist India TPA Pvt Ltd is the
TPA for Baxter India.
Floater policyis a single policy that takes care of the hospitalization expenses of ones
entire family, declared at the time of taking the policy. Any member of the family or all
put together can claim up to the maximum sum insured.
Sum Insured is the maximum amount that can be claimed under the policy. This is
the limit for the policy period.
Enrollment procedure
The employee must enroll in order to obtain coverage for himself and his eligible
dependents. Please contact HR and provide relevant enrollment data (viz. name, date of
birth, gender). The enrollment data must reach the Insurer within 21 days of joining the
company.
HR must be notified each time the employee acquires a new dependent i.e. when his/her
family status changes because of marriage, birth or adoption of a child. The addition of a
new spouse must be declared within 21 days of the marriage. Similarly, information
about new-born child has to be declared immediately after the first discharge after the
child-birth.
If an employee fails to enroll within the defined timelines, the next enrollment can be
done only at next renewal.

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Policy Benefits

All Employees including New Joiners Covered from Day 1:

Family Floater Sum Insured as per Entitlement: The Family Floater Sum Insured
can be utilized by any member in the family unit, making the sum Insured
common one for entire policy.
Family Members Eligible for coverage: Employee, Spouse and first 2 Living
Dependent children upto 25 years of age.
Mid Term Additions: Midterm inclusion of dependent will be possible only in
case of: a) spouse (on account of marriage during the policy term)b) children
(childbirth during the policy term provided declared within 30 days of the event.
Pre and Post hospitalization for 30 & 60 days respectively: For a period upto 30
days prior to hospitalization and upto 60 days post hospitalization, relevant
medical expenses incurred will be considered as part of the claim and therefore
settled.
Pre Existing Disease Cover: Members are covered for any ailment that they may
be having even on the date of joining the policy.
Maternity Benefit: INR 35,000/- for Normal Delivery and INR 50,000/- for
Caesarean. Maternity Claims are covered from Day 1.
Baby Cover: Baby is covered from the date of birth within the Family Floater Sum
Insured (in case of complications) subject to information being sent to HR within
30 days of birth.
Ambulance Charges: Covered upto INR 1,000 per event.
Room Rental Capping: Room Rent is restricted to 1.5% of Sum Insured in case of
Normal Room and 3% of the Sum Insured in case of an ICU. The exceeded

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amount has to be borne by the employee in the same proportion as in the Final
Hospital Bill.
Claim must be filed with Medi Assist TPA within 25 days from the date of
discharge from the Hospital / completion of treatment. However, the Company
may at its absolute discretion consider waiver, of this Condition in extreme cases
of hardship where it is proved to the satisfaction of the Company that under the
circumstances in which the insured was placed it was not possible for him or any
other person to give such notice or file claim within the prescribed time-limit.
Reimbursement Claim to be intimated to the TPA within 24 Hours of admission.
Details can be shared on mail with the TPA SPOC.

The above Coverage is subject to the overall policy conditions and exclusions.
Policy Exclusions
The following are deducted / Not Paid under a standard Health insurance policy:
1. Administration charges,Admission / Registration fees, File / Records
Management charges
2. Service / Surcharges. Bed booking / Reserving charges
3. Patients Attendant charges, Special Nurse / Attendant charges, FIR / MLC
charges
4. Telephone / Photocopy / Courier / Insurance Processing Fees, etc.
5. Others (non-insurance, items not related to treatment)
6. Lasik treatment is not covered.
7. Infertility and Male Sterility are not covered.
8. Septoplasty is Excluded from the scope of the policy.
9. Treatment on trial/experimental basis are not covered under the scope of the
policy.
10. Voluntary medical termination of pregnancy during the first 12 weeks from the
date of conception is not covered.
11. Expenses related to a device contributing/replacing function of an organ and
expenses on prosthesis are excluded.
*For complete information refer policy wordings/Benefits PPT uploaded on the link
www.askbaxhr.in.
Diseases Where 24 Hours Hospitalization Is Not Required:

Dialysis, Chemotherapy, Radiotherapy, Eye Surgery ( Cataract), Dental Surgery, (

arising out of an Accident), Lithotripsy (Kidney stone removal), Tonsillectomy ,D &
C taken in the Hospital/Nursing Home. Etc.

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Capping/ Co-Payments in Certain Diseases:

Cyberknife treatment / Stem Cell Transplantation:- 50% Co Pay shall be applicable as

per Entitlement.

Claims Procedure
a. Cashless Process

Dos and Donts for Cashless Facility:

1. Kindly ensure that the Pre-Authorisation form is completely filled and signed by
the Insured and the Treating Doctor.
2. Kindly ensure to mention the mobile number on the Pre-Authorisation form
3. In case of planned hospitalisation, please send the Pre-Authorisation form in
advance (not before 15 days of admission date) to Medi Assist TPA.
4. In case of emergency hospitalisation, please send the Pre-Authorisation form
within 24 hours from the time of hospitalisation

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5. Non-payable items to be borne by the Insured

6. In case of cashless denial, Insured to pay hospitalisation expenses.
7. Do not refer the network list of any other service provider. Medi Assists Hospital
List is available on the Intranet.
8. Do not wait until the discharge time to raise the enhancement request.
b. Reimbursement Process
Reimbursement of the hospitalization expenses can be claimed where Cashless
Hospitalization facility is not availed or treatment is availed in a Non-network Hospital.
The employee will have to settle the hospital bill, collect all original hospitalization
documents and submit the documents to our office for their scrutinizing the same in
terms of the policy and check the admissibility or otherwise of the claim/expenses.
Reimbursement claims may be filed in the following circumstances:
a. Hospitalization at a non-network hospital
b. Post-hospitalization and pre-hospitalization expenses
c. Denial of preauthorization on application for cashless facility at a network hospital
One of the very basic requirements of insurance is Claim Intimation. It simply means
intimating us or the Insurance Company / TPA about the hospitalization. The same
needs to be done within a time frame of 24 hours from the date of admission.

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The documents that employee needs to submit for a hospitalization reimbursement

claim:
1.
2.
3.
4.
5.
6.

Duly filled Claim form (signed by the Insured and the Treating Doctor)
Discharge summary (with details of complaints and the treatment availed)
Final Hospital Bill (detailed break-up) along with interim bills
Payment Receipts.
Doctors consultation papers
All investigation reports (E.g. Original Blood report, X-ray, Sonography, CT Scan,
MRI, etc.)
7. All pharmacy bills supported by doctor prescriptions
8. Implant sticker / invoice, if used (E.g. lens details in cataract case, stent details in
angioplasty)
9. Medico Legal Certificate (MLC) and / or FIR for all accident cases
10. For miscellaneous charges - detailed bills with supporting prescription of the
Treating Doctor
11. Photocopy of MAID Health card
12. Cancelled cheque of the Employee for NEFT Transfer of Funds.
All documents should be in Original.
* This is not an exhaustive list; any other document could be required post assessment
of the case.
Dos and Donts for Availing Reimbursements:
1. Always keep a photocopy of the claim documents submitted to Medi Assist TPA.
2. Kindly ensure that the Claim form is completely filled and signed by the Insured
and the Treating Doctor.
3. Kindly ensure to mention the mobile number on the Claim form.
4. Mention correct and complete communication address with the pin code on the
claim form.
5. All claim documents are to be submitted in original within 25 days from the date
of discharge.

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Group Personal Accident Policy

The Group Personal Accident Program covers employees against the financial risk of
death / injury sustained due to an accident caused by violent, visible and external
means.
Definitions
"Accident" means a sudden, unforeseen and unexpected physical event
beyond the control of the Insured/Insured Person resulting in bodily injury,
caused by external, visible and violent means.
"Bodily Injury" means any accidental physical bodily harm solely and directly
caused by external, violent and visible means which is verified and certified by
a Physician but does not include any sickness or disease.
Accidental Death is death due to an accident.
Temporary Total Disability (TTD) is if an employee is temporarily disabled and cannot
engage in any employment or occupation.
Permanent Partial Disability is if an employee is partially disabled wherein the result
is irrecoverable loss of use or actual loss by physical separation of body part.
Permanent Total disability is if an employee is permanently and totally disabled
wherein the employee cannot engage in employment or occupation.
Sum Insured is the maximum amount that can be claimed under the policy. This is
the limit for the policy period.

Policy Benefits
Accidental Death is covered upto 100% of Capital Sum Insured (CSI).
Permanent Total Disablement (PTD) is covered upto 150% of Capital Sum Insured
(CSI)
Permanent Partial Disablement (PPD) is covered % of CSI (As per the chart)

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Temporary Total disability (TTD) : Temporary Total Disability is restricted to 1% of

the sum insured or actual wages or Rs 10,000/-, whichever is less, per week, for 100
weeks
Medical Reimbursement is covered for INR 15,000 or actual whichever is less, under
the basic cover (Death +PTD+PPD+TTD)
Expenses for Carriage of Mortal Remains incurred for transportation of Insured
persons dead body (death due to accident) from the place of accident to the place of
residence subject to lesser of 2% of Sum Insured or INR 5,000.
Funeral Expenses - 1% of Sum Insured or Rs. 5000 or actual expenses, whichever is
less
Educational Grant - In case of Death or PTD of the insured, for one dependent child
below 23 years of age, Rs. 10000 and in case of two dependent children below the age of
23 years, Rs. 20000.
Terrorism is covered; however terrorism activity arising out of Nuclear, Biological
and/or Chemical means is excluded from the scope of this policy
Policy Exclusions
Participation in actual or attempted felony, riot, civil commotion, crime misdemeanor
Committing any breach of law of land with criminal intent.
Death or disablement resulting from Pregnancy or childbirth
Perils of the sea are excluded from the scope of the policy
Professional sports team in respect of specific benefit for inability to perform
Participation in any kind of motor sport contest, while engaged in aviation, or whilst
mounting or dismounting from or travelling in any aircraft for events like sky diving
etc
Radioactivity, Nuclear risks, ionizing radiation

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Claims Procedure

Documents to be provided
Documents for weekly Benefits Claims

Completed claim form

Doctors Medical and Fitness Certificate
Disability certificate from the doctor, if any
Investigation /lab reports( X- ray etc)
Original admission/discharge card, if hospitalized.
Employers leave certificate & details of salary.

Documents for Death Claims

Completed claim form

Death Certificate
FIR Copy
Police Inquest report, wherever applicable

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Group Term Life Insurance

The Group Term Life Insurance covers employees and ensures to reimburse sum
Insured to the nominee of the deceased in case of natural or accidental death.
Definitions
"Natural Death" means death that occurs from natural causes, as disease or old age,
rather than from violence or an accident.
Accidental Death is death due to an accident.
Policy Benefits

Basic Death Benefit - 2 Times of Annual Base Salary. Pays the Sum Assured in case of
a natural /accidental death to the Nominee.
Critical Illness Benefit Pays the Sum Assured in case an employee develops a critical
illness like Heart Disease, Cancer, stroke etc. This is over and above the Basic Life
Sum Insured. Same as Death Benefit subject to a maximum of INR 10 Lacs.
Terminal Illness BenefitProvides an accelerated benefit whereby a percentage of
death benefit is paid in advance on diagnosis of a terminal disease. Same as Death
Benefit subject to a maximum of INR 50 Lacs.
(Terminal Illness is any condition from which an insured member is diagnosed to
be suffering from a disease which in the opinion of two Registered Medical
Practitioner specializing in the relevant field of medicine, is likely to lead to death
of the life insured within six months from the date of such diagnosis. The insured
member must no longer be receiving treatment other than that for symptomatic
relief.

Claims Procedure

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Documents to be provided
Documents to claim accidental death

Duly Filled Claim form by the Employer

FIR copy
Post mortem copy
Death Certificate issued by Municipal Corporation

Documents to claim natural death

Duly Filled Claim form by the Employer

Death Certificate issued by Municipal Corporation

Interpretation & Clarifications

Any Interpretations/ clarifications to this policy will be issued by HR and Finance
director.
Policy approved by:
Ongmu Gombu,
HR Director
Date
Policy checked by:
Priyank Parakh
National HR Manager
Date
Policy Prepared by:
Vaishali Srivastava,
HR Manager
Date

Sandeep Devgon
Finance Director
Date

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Annexure
Contact Points
HR Baxter India Pvt Ltd
Ashima Raju
Assistant Manager, HR
Contact No: 0124-4500242
Email ID: ashima_raju@baxter.com
Insurer Bharti Axa General Insurance Co Ltd
Shivalee Sharma
Relationship Manager
Contact Number: 9810507763
Email ID: Shivalee.Sharma@bharti-axagi.co.in
TPA Medi Assist India TPA Pvt Ltd
1. Rahul Kumar (SPOC For BAXTER Employees)
Contact Number: 09310981166
Email ID:- Rahul.Kumar@Mediassistindia.Com
2. Sarika Bhatia (SPOC For BAXTER Employees)
Contact Number: 08130591191
Email ID:- Sarika.Bhatia@Mediassistindia.Com

For Reimbursement claim:Intimation must be given within 24 hours from admission or prior to Date of Discharge
at rahul.kumar@mediassistindia.com
To submit re-imbursement claims after discharge within 25 days, please send it to this
address:Kind Attention - Mr. RAHUL KUMAR
Medi Assist India TPA P Ltd
B-20, Sector-2, Near Noida Sector-15,
Metro Station. Opp HCL Comnet,
Noida U.P-201301
Ph# 0120 4628200/4628201 ; Fax # 0120-4628250

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Please follow the below mentioned steps to download the insurance cards for you and
your family:

LOGON TO WWW.MEDIASSISTINDIA.COM
In the homepage under the "LOGIN" tab click on "Corporate Employee "
User ID would be your "EMP-ID@BAXTER"
Password would be "BAXTER"
Please change the password after your first login. Once you enter you will be able
to view the list of members covered.
Click on the link e cards where you can download & save it.
Claims status can also be viewed similarly.

Please enter the username and password as mentioned below

Username : Employee ID@baxter
Password : baxter
You can also login at www.mediassistindia.com anytime to access the following
information:a) Claim Forms
b) Pre-authorization request note (for cashless hospitalization)
c) Status of any pending claims submitted with the TPA
d) Updated list of networked Hospitals which provides cashless treatment based on preauthorization.