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Dear All

,

We are glad to inform you that we have renewed our Group Mediclaim, Group personal Accident & Group Term
Life Cover Policies for the year 2015-2016.

This years’ program has been developed in consultation with our new brokers Howden Insurance Brokers India
Pvt. Ltd.

Following are the details of the current year health insurance programme.

GROUP MEDICLAIM INSURANCE POLICY

Insurance Provider for GMC: United India Insurance Company .Ltd

Third Party Administrator (TPA): Family Health Plan Ltd.

Insurance Broker: Howden Insurance Brokers Pvt. Ltd will assist us on the Policy administration front.

As part of the Hospitalization Insurance benefit, you and your named dependants are eligible for Medical
Insurance cover. The major features of the Policy Benefits are as under:

TERMS OF COVER - GROUP MEDICLAIM

1) Family Floater
2) Family Scope: Self + Spouse + 2 Children or 2 Parents/In-Laws
3) Sum Insured Limit: INR 500000
4) 1st/2nd/4th Year exclusions waived off.
5) 30 days waiting period waived off
6) Pre/post Hospitalization for 30/60 days
7) Maternity Covered with the Sub- Limits : Normal Delivery INR 50000/- & C-Section INR 75000/-
8) Pre/post Natal expenses covered up to INR.5000/- within maternity sub limit as in patient only
9) Waiver of 9 months waiting period
10) Baby covered from Day One
 Inclusion of new born baby should be intimated within 30 days from the date of birth.
11) Room Rent is capped for 1.5% of Sum Insured for Normal & 2 % for ICU. All other related and associated
charges in accordance with room rent restrictions. In case insured person opts for room higher that the entitled
category all charges shall be limited to charges applicable to the entitled category
12) Ambulance charges are covered

Note: The above coverage’s are subject to the overall policy conditions and exclusions and all other terms and
conditions as per United India Insurance Group Mediclaim Tailor made Policy.

FHPL, the TPA will issue (ID card) to each employee and his Dependents. This ID card will identify them for
admission into the network of hospitals and to allow access to credit (cashless) facilities at preferred Hospitals
around the country. This ID card is non-transferable.
TPA Détails :

Network Hospital List for cashless hospitalisation : http://www.fhpl.net/ProviderList.asp
Details on TPA: www.fhpl.net

In the event that you have any queries or face any difficulty, please contact the following.

For hospitalization or claim related requirements: FHPL toll free no 1-800-425-4033

FHPL Contact Details & Escalation Matrix Hyderabad:

1. First Point of Contact

Name : Mr. Suresh
Mobile No : 09505011291
E-mail ID : suresh.kodicherla@fhpl.net
(Queries related to claims to be handled by Shiva)

2. Escalation (Service and Claims.):

Name : Mr. Veneet Mathur (Client Services)
Mobile No : 092461 01699
E-mail ID : veneet.mathur@fhpl.net

3. Preauthorization Dept. : - 040 23551717
4. Call Center No : - 040-23556464.
5. Toll Free Number : - 1800 4254 033

Howden Insurance brokers India Pvt. Ltd., can be accessed for any kind of assistance during the policy period on
the following contacts:

Ms. Rohini M 91-99662 00867 rohini@howdenindia.com
Mr. Subrahmanyam T 91-99662 00896 Subrahmanyam@howdenindia.com
Mr. Shine Thomas 91-99662 00969 shine.thomas@howdenindia.com
Board Number 040 – 65411422
For generic details on health insurance: http://www.howdenindia.in/group_health_insurance.html
Hospitalization Procedure:

Hospitalization Procedure

Emergency Admission Planned Admission

Network Hospital Non-network Hospital

Contact FHPL on toll free
no: 1800 4254 033 and
inform about nature of Contact Ms. Rohini @
emergency & your ID No. rohini@howdenindia.com or can call on
9966200867 to intimate the hospitalisation

Get the Admission Request Note
form filled and signed by the
treating doctor/hospital and Once discharged then please submit the
signed by you, done in advance following documents to Howden Insurance
fortnightly help desk for further processing

Network hospital will fax the
Request to FHPL on Fax no: Please submit the papers preferably within a week
or max in 30 days after discharge from the
hospital :
-Duly Filled & Signed Claim Form
-Hospital bill and Pre Numbered Payment receipt
FHPL doctors will examine the Pre-
-All Investigation Reports
Authorization Request form & decide on
-Discharge Card
cashless availability, as per the policy
-Prescriptions
guideline
-Bills of Medicines, Surgical items
-Details of Pre-hospitalization expenses if any
-IPD papers, if required.
Authorisation Letter (AL) / Denial Letter /
Addition Requirement Letter issued depending on
plan, benefit & balance sum available Papers will be sent to FHPL for further
to the hospital. processing and the final settlement can be
expected within 3 weeks.
GENERAL POLICY EXCLUSIONS FOR GMC POLICY:

1. Injury or disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign
Enemy, Warlike operation (whether war be declared or not).

2. Cost of Spectacles, Contact Lenses, Hearing Aids

3. Dental Treatment or surgery of any kind unless requiring hospitalization on account of Accidental Cases.

4.Circumcision unless necessary for treatment of the disease, Cosmetic or aesthetic treatment of any description, plastic
surgery other than as may be necessitated due to an accident or as a part of any illness.

5.Convalescence, general debility ‘Run-down' condition or test cure, congenital external disease or defects or
anomalies, Sterility (infertility), venereal disease, intentional self injury and use of intoxicating drugs/alcohol.

6. Voluntary medical termination of pregnancy during first 12 weeks from the date of conception.

7. Acquired Immune Deficiency Syndrome (AIDS)

8. Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials

9. Naturopathy treatment.

10. Medical Expenses for an Organ Donor

11. Expenses incurred for disease declared as an Epidemic by Health Authorities.

12. Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-ray or
Laboratory examinations not consistent with or incidental to the diagnosis & treatment
of the positive existence or presence of any ailment, sickness or injury, for which
Confinement is required at a Hospital/Nursing Home.

13 Lasik Surgery is excluded from the scope of the policy.

14. Septoplasty is excluded from the scope of the policy.

15. Infertility & Related ailments incl male sterility is out of the scope of the policy

These are General Policy Exclusions and the Specific Policy Exclusions applicable to the
Members as mentioned in the earlier sections stand valid.
As part of the Group Personal Accident & Group Term Life benefit, only employees are eligible for both the
Insurance cover. The major features of the Policy Benefits are as under:

GROUP PERSONAL ACCIDENT INSURANCE POLICY

 Insurance Provider for GPA: United India Insurance Co. Ltd

Coverage:
 Sum Insured: 3 times of Employee CTC
 Scope of Coverage : Only Employees
 Comprehensive Cover:

 Accidental Death
 Permanent Partial Disability
 Permanent Total Disability
 Weekly Compensation (Weekly max.104 weeks @5000/- per week)
 Education Benefit

 POLICY EXCLUSIONS FOR GPA POLICY:
 Suicide, attempted suicide or self inflicted injury or illness
 Whilst under the influence of intoxicating liquor or drugs;
 Any deliberate or intentional, unlawful or criminal act, error, or omission of the member.
 From war (whether declared or not), civil war, invasion, act of foreign enemies & Terrorism.
 Whilst engaging in aviation or ballooning, whilst mounting into, dismounting from or traveling in any
balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type
of aircraft anywhere in the world.
 Any loss suffered by the member on account of his participation as the driver, co- driver or passenger
of a motor vehicle during motor racing or trial runs.
 HIV (Human Immunodeficiency Virus) and/or any HIV related illness including AIDS (Acquired
Immune Deficiency Syndrome) and/or mutant derivatives or variations thereof however caused.
 Pregnancy, resulting child birth, miscarriage, abortion, or complication arising out of any of the foregoing.
 The Insured’s participation in any naval, military or air force operations whether in the form of military
exercises or war games or actual engagement with the enemy, whether foreign or domestic.
 Curative treatments or interventions that the insured performs or had performed on his body.

GROUP TERM LIFE INSURANCE POLICY

 Insurance Provider for GTL: Exide Life Insurance Co. Ltd

Coverage:
 Scope of Coverage : Only Employees
 Sum Insured: 3 times of Employee CTC Capped at Max.15,000,000
 Basic Life Cover ( Any Kind of Death)