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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

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.
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)
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

Please contact HR and provide relevant enrollment data (viz.  Typical expense heads covered are the following: room/boarding expenses as provided by the hospital or nursing home. This is the limit for the policy period. surgeon. name. The enrollment data must reach the Insurer within 21 days of joining the company. diagnostic material and X-Ray. gender). the next enrollment can be done only at next renewal. Similarly. radiotherapy.Group Insurance Policy  Room rent. Any member of the family or all put together can claim up to the maximum sum insured. medicines. date of birth. dialysis. surgery etc. when his/her family status changes because of marriage. Definitions “Third Party Administrator (TPA)” is an agency appointed by the insurance company to take care of claim settlements in health insurance. The addition of a new spouse must be declared within 21 days of the marriage. oxygen. cost of pace maker.e. . If an employee fails to enroll within the defined timelines. Enrollment procedure The employee must enroll in order to obtain coverage for himself and his eligible dependents. Medi Assist India TPA Pvt Ltd is the TPA for Baxter India. nursing expenses . “Floater policy”is a single policy that takes care of the hospitalization expenses of one’s entire family. information about new-born child has to be declared immediately after the first discharge after the child-birth. blood. medical practitioner. surgical appliance. declared at the time of taking the policy. chemotherapy. specialist fees. medicines and drugs. artificial limbs and cost of organs and similar expenses. consultant . HR must be notified each time the employee acquires a new dependent i. anesthesia. birth or adoption of a child. which do not require a 24 hour hospitalization). operation theater charges. Expenses for hospitalization  Payable only if a 24 hour hospitalization has been taken (Except for named day care procedures. “Sum Insured” is the maximum amount that can be claimed under the policy. anesthetist .

The exceeded .000 per event. Maternity Benefit: INR 35. 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. Spouse and first 2 Living Dependent children upto 25 years of age.Group Insurance Policy 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. Maternity Claims are covered from Day 1.for Caesarean. Family Members Eligible for coverage: Employee.000/.for Normal Delivery and INR 50. Room Rental Capping: Room Rent is restricted to 1. Pre and Post hospitalization for 30 & 60 days respectively: For a period upto 30 days prior to hospitalization and upto 60 days post hospitalization. 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. making the sum Insured common one for entire policy. Pre Existing Disease Cover: Members are covered for any ailment that they may be having even on the date of joining the policy. Ambulance Charges: Covered upto INR 1.5% of Sum Insured in case of Normal Room and 3% of the Sum Insured in case of an ICU. relevant medical expenses incurred will be considered as part of the claim and therefore settled.000/.

Special Nurse / Attendant charges.D & C taken in the Hospital/Nursing Home. Details can be shared on mail with the TPA SPOC. Eye Surgery ( Cataract).Admission / Registration fees. Telephone / Photocopy / Courier / Insurance Processing Fees. 9. Treatment on trial/experimental basis are not covered under the scope of the policy. 8. 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. the Company may at its absolute discretion consider waiver. Diseases Where 24 Hours Hospitalization Is Not Required:  Dialysis. Voluntary medical termination of pregnancy during the first 12 weeks from the date of conception is not covered. However. 7. Claim must be filed with Medi Assist TPA within 25 days from the date of discharge from the Hospital / completion of treatment. Septoplasty is Excluded from the scope of the policy. FIR / MLC charges 4. Patient’s Attendant charges. Radiotherapy. Chemotherapy. 11. Policy Exclusions The following are deducted / Not Paid under a standard Health insurance policy: 1. Bed booking / Reserving charges 3. Tonsillectomy . Reimbursement Claim to be intimated to the TPA within 24 Hours of admission. 10. Expenses related to a device contributing/replacing function of an organ and expenses on prosthesis are excluded. Lithotripsy (Kidney stone removal). Administration charges. Infertility and Male Sterility are not covered. The above Coverage is subject to the overall policy conditions and exclusions. File / Records Management charges 2. etc. 5. *For complete information refer policy wordings/Benefits PPT uploaded on the link www. Dental Surgery. . ( arising out of an Accident).in. Others (non-insurance. items not related to treatment) 6.askbaxhr. Service / Surcharges. Lasik treatment is not covered.Group Insurance Policy   amount has to be borne by the employee in the same proportion as in the Final Hospital Bill. Etc.

Kindly ensure that the Pre-Authorisation form is completely filled and signed by the Insured and the Treating Doctor. Kindly ensure to mention the mobile number on the Pre-Authorisation form 3. 2.Group Insurance Policy Capping/ Co-Payments in Certain Diseases:  Cyberknife treatment / Stem Cell Transplantation:. In case of planned hospitalisation. please send the Pre-Authorisation form in advance (not before 15 days of admission date) to Medi Assist TPA. In case of emergency hospitalisation. 4. Claims Procedure a. please send the Pre-Authorisation form within 24 hours from the time of hospitalisation . Cashless Process Dos and Don’ts for Cashless Facility: 1.50% Co Pay shall be applicable as per Entitlement.

Hospitalization at a non-network hospital b. b. Non-payable items to be borne by the Insured 6. Insured to pay hospitalisation expenses. 7. 8.Group Insurance Policy 5. 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. Post-hospitalization and pre-hospitalization expenses c. Do not wait until the discharge time to raise the enhancement request. The employee will have to settle the hospital bill. It simply means intimating us or the Insurance Company / TPA about the hospitalization. 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. Medi Assist’s Hospital List is available on the Intranet. Do not refer the network list of any other service provider. Reimbursement claims may be filed in the following circumstances: a. Denial of preauthorization on application for cashless facility at a network hospital One of the very basic requirements of insurance is ‘Claim Intimation’. . In case of cashless denial. The same needs to be done within a time frame of 24 hours from the date of admission.

Cancelled cheque of the Employee for NEFT Transfer of Funds. lens details in cataract case. Doctor’s consultation papers All investigation reports (E. 3. 4.g. Mention correct and complete communication address with the pin code on the claim form.detailed bills with supporting prescription of the Treating Doctor 11. Medico Legal Certificate (MLC) and / or FIR for all accident cases 10. All documents should be in Original. 2. 6. 4. any other document could be required post assessment of the case. Kindly ensure to mention the mobile number on the Claim form. etc. 5. Original Blood report.Group Insurance Policy The documents that employee needs to submit for a hospitalization reimbursement claim: 1. * This is not an exhaustive list. Kindly ensure that the Claim form is completely filled and signed by the Insured and the Treating Doctor. Sonography. X-ray. if used (E. 3. Photocopy of MAID Health card 12. For miscellaneous charges . Implant sticker / invoice. Always keep a photocopy of the claim documents submitted to Medi Assist TPA. Dos and Don’ts for Availing Reimbursements: 1. 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. . 5. 2. CT Scan.) 7. stent details in angioplasty) 9.g. All pharmacy bills supported by doctor prescriptions 8. All claim documents are to be submitted in original within 25 days from the date of discharge. MRI.

This is the limit for the policy period.Group Insurance Policy 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. violent and visible means which is verified and certified by a Physician but does not include any sickness or disease. Policy Benefits • Accidental Death is covered upto 100% of Capital Sum Insured (CSI). visible and violent means. visible and external means. “Permanent Total disability” is if an employee is permanently and totally disabled wherein the employee cannot engage in employment or occupation. “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. Definitions "Accident" means a sudden. caused by external. “Accidental Death” is death due to an accident. “Sum Insured” is the maximum amount that can be claimed under the policy. "Bodily Injury" means any accidental physical bodily harm solely and directly caused by external. unforeseen and unexpected physical event beyond the control of the Insured/Insured Person resulting in bodily injury. • 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) .

20000. ionizing radiation . under the basic cover (Death +PTD+PPD+TTD) • Expenses for Carriage of Mortal Remains incurred for transportation of Insured person’s 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. whichever is less.000 or actual whichever is less. per week. while engaged in aviation. 5000 or actual expenses.In case of Death or PTD of the insured. • Funeral Expenses . for 100 weeks • Medical Reimbursement is covered for INR 15. 10000 and in case of two dependent children below the age of 23 years. whichever is less • Educational Grant .1% of Sum Insured or Rs.000. Rs. civil commotion.Group Insurance Policy • Temporary Total disability (TTD) : Temporary Total Disability is restricted to 1% of the sum insured or actual wages or Rs 10. however terrorism activity arising out of Nuclear. riot. • Terrorism is covered. • 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. Biological and/or Chemical means is excluded from the scope of this policy Policy Exclusions • Participation in actual or attempted felony.000/-. Rs. Nuclear risks. crime misdemeanor • Committing any breach of law of land with criminal intent. for one dependent child below 23 years of age. or whilst mounting or dismounting from or travelling in any aircraft for events like sky diving etc • Radioactivity.

if hospitalized. Documents for Death Claims • • • • Completed claim form Death Certificate FIR Copy Police Inquest report. wherever applicable . if any Investigation /lab reports( X.Group Insurance Policy Claims Procedure Documents to be provided Documents for weekly Benefits Claims • • • • • • Completed claim form Doctors Medical and Fitness Certificate Disability certificate from the doctor. Employers leave certificate & details of salary.ray etc) Original admission/discharge card.

Same as Death Benefit subject to a maximum of INR 50 Lacs. Claims Procedure . Cancer.Group Insurance Policy 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. This is over and above the Basic Life Sum Insured. Terminal Illness Benefit–Provides an accelerated benefit whereby a percentage of death benefit is paid in advance on diagnosis of a terminal disease. The insured member must no longer be receiving treatment other than that for symptomatic relief. stroke etc. Policy Benefits    Basic Death Benefit . Pays the Sum Assured in case of a natural /accidental death to the Nominee. “Accidental Death” is death due to an accident. Critical Illness Benefit –Pays the Sum Assured in case an employee develops a critical illness like Heart Disease. is likely to lead to death of the life insured within six months from the date of such diagnosis. (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. as disease or old age. Definitions "Natural Death" means death that occurs from natural causes. rather than from violence or an accident.2 Times of Annual Base Salary. Same as Death Benefit subject to a maximum of INR 10 Lacs.

Group Insurance Policy 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. 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 . Policy approved by: Ongmu Gombu.

P-201301 Ph# 0120 4628200/4628201 .Com For Reimbursement claim:Intimation must be given within 24 hours from admission or prior to Date of Discharge at rahul.kumar@mediassistindia.Com 2. Metro Station. HR Contact No: 0124-4500242 Email ID: Insurer – Bharti Axa General Insurance Co Ltd Shivalee Sharma Relationship Manager Contact Number: 9810507763 Email ID: Shivalee.Mr. Rahul Kumar (SPOC For BAXTER Employees) Contact Number: 09310981166 Email ID:. Noida To submit re-imbursement claims after discharge within 25 Opp HCL TPA – Medi Assist India TPA Pvt Ltd 1. Sarika Bhatia (SPOC For BAXTER Employees) Contact Number: 08130591191 Email ID:.Bhatia@Mediassistindia. Near Noida Sector-15. Sector-2. please send it to this address:Kind Attention .Sharma@bharti-axagi. Fax # 0120-4628250 . RAHUL KUMAR Medi Assist India TPA P Ltd B-20.Group Insurance Policy Annexure Contact Points HR – Baxter India Pvt Ltd Ashima Raju Assistant Manager.

Please enter the username and password as mentioned below Username : Employee ID@baxter Password : baxter You can also login at www. Click on the link e cards where you can download & save it.Group Insurance Policy Please follow the below mentioned steps to download the insurance cards for you and your family:        LOGON TO 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.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. Claims status can also be viewed similarly.