Employee Policy Conditions

Group Mediclaim Insurance Policy
Version 3.0
November 1, 2019
Wipro – For Internal Circulation only

Compensation & Benefits team
Sensitivity: Internal & Restricted

1. Objective / Philosophy of the Policy
Group Mediclaim policy provides for reimbursement of hospitalization expenses for illness, disease or
injury sustained by employee, spouse and children.
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) with active line of
treatment followed by the diagnosis.
Active Line of Treatment is a continuous medical treatment provided by a medical practitioner to a

patient suffering from a specific ailment under life threating situations.
Tests and diagnostics of all kinds with or without hospitalization for less 24 hrs or more 24 hrs would
not be considered as active line of treatment.
Under this policy, 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, Deep Brain Stimulation (DBS)
Battery replacement artificial limbs and cost of organs and similar expenses.
2. Coverage
All India based employees and long-term assignees (on India payroll) of DO&P are covered under the
policy.
3. Salient Features
There are two plans called as ‘Base’ and ‘Base Plus (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)
AA 100,000
B1, B2 and B3 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
Version 3 GMC Policy 2019-20 1 Nov 2019
600,000
800,000
1,000,000
Once an employee opts for top-up, s/he will not be able to opt out from top-up / reduce the top-up
amount for three policy years, irrespective of the change in premiums.
Post completion of three years, employee can reduce the top-up amount or opt out from top-up,
provided there is no claim in the third year. However, once an employee opts for a slab in top-up,
s/he will be allowed to choose any available, higher top-up amount every year during the enrolment
window.
Employees in Band AA have the top-up options of INR 2 Lakhs, 4 Lakhs and 6 lakhs only.
Table 3
Policy Details
Policy Holder Wipro Limited
Policy Duration November 1, 2019 to October 31, 2020
Insurer United India Insurance Co. Ltd.
Third Party Administrator (TPA) MediAssist India TPA Pvt. Ltd.
Members Coverage and special conditions (if any)

Employee Covered
Spouse Covered. Incase employee’s spouse is also a full-time Wipro
employee, then employee should login to My Wipro > My Data >
Family Details > Spouse details and enter spouse’s Employee ID.
Then, an auto-generated e-mail will get triggered to the spouse

reconfirming this. To avoid premium deduction for both
employees, we will have to cover one of the employee as primary
Children and the other as spouse (secondary member).
Covered. No restriction on number of children. Children covered up
to the age of 25 or till employed or till marriage, whichever is
earlier.
In case of the unfortunate death of an employee with spouse and/or child/children, policy cover will continue
for the dependents till the end of the policy
Changes for policy year 2019-20
The below details are only indicative. For more details, please refer to the detailed clauses mentioned
in the policy below. For planned hospitalizations employees are requested to write to
wiprocoverage@mediassistindia.com to get TPA clearance on coverage, check if the diagnosis and
procedure recommended by doctor is covered as per policy or not

Applicable policy Change Description
All employee Ailment Caps have been revised Please refer to table 6 for the new ailment caps
Mediclaim plans
For limited top- Increase in room rent capping This will be limited only to 6lakhs, 8lakhs and
up plans only from INR 4k to INR 5k 10lakhs top-up plans only.
All employee Pre-intimation for all planned Additional 2% co-pay in case of lack of intimation
Mediclaim plans claims is mandatory. Additional for planned procedures. For avenues for pre-
2% co-pay in case of lack of intimation please refer E-cashless under myWipro
intimation for planned procedures -> myPolicies -> eCashless
For all top-up Legal Surrogacy will be covered The cost of Surrogacy irrespective of the member
plans only being part of the policy to be paid up to the
Maternity Sub limit. [only Legal Surrogacy to be
covered]
For all top-up Maternity Related Complications If life threatening complication arise during
plans only up to full sum insured maternity, the cost of the entire hospitalization
will not be restricted to Maternity limits.
For all top-up Pace Maker battery, DBS battery Replacement charges covered with a sublimit of
plans only replacement INR 3 lakhs per event.
For all top-up Congenital External Diseases Covered up to full Sum Insured
plans only
For all top-up Genetic Disorder coverage Covered up to full Sum Insured
plans only
All employee Root canal limits are to be revised Base policy: INR 3K to INR 5K, all top-up plans: INR
Mediclaim plans 5k to INR 7.5k
All employee Cover for existing dependents for Policy to continue for dependents in case of
Mediclaim plans employee demise cases shall employee’s demise till end of policy post which
continue until end of policy year portability can be opted to purchase retail policy
All employee Coverage queries For planned hospitalizations employees are
Mediclaim plans requested to write to
wiprocoverage@mediassistindia.com to get TPA
clearance on coverage, check if the diagnosis and
procedure recommended by doctor is covered as
per policy or not
Table 4
Policy Benefits
Benefits Base Plan Base Plus Top-up Plan
Standard Hospitalization Covered as per hospitalization benefits
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 as per hospitalization benefits
diseases)
Waiting periods (First 30-days,
Waived off
First Year and First Four Years)
Ambulance services (Shifting Up to INR 2,000 per claim for Up to INR 3,000 per claim for
patient to hospital only) emergencies only emergencies only

Normal & Caesarian Delivery (first Normal & Caesarian Delivery
2 instances of live birth for the (first 2 instances of live birth
mother): INR 40,000. Pre-& Post for the mother): INR 50,000.
Maternity Natal, OPD expenses up to INR Pre-& Post
5,000 within the maternity limit. Natal, OPD expenses up to INR
5,000 within the maternity limit.
Not applicable Covered upto full sum assured
Maternity Related complications
Not applicable Upto maternity sub limit

Surrogacy (Legal surrogacy)
Within the maternity limit for

normal new born baby expenses.
Complications which require an
admission can be processed under
New born baby cover from day 1
the balance floater sum insured
provided baby declaration is done
in My Wipro within 30 days from
date of birth.
Covered (Only selected procedures
like dialysis, chemotherapy,
radiotherapy and other such
specified treatments taken in the
Day care procedures
hospital / nursing home where the
insured member is discharged on
the same day. (Refer policy terms
and conditions for details.)
Up to INR 10,000 for surgical Up to INR 15,000 for surgical
treatment per family. Out of this, treatment per family. Out of
the sublimit for Root Canal this, the sublimit for Root
treatment is INR 5,000 per tooth Canal treatment is INR 7,500
inclusive of cost of the crown. per tooth inclusive of cost of
(Cosmetic treatment like filling, the crown. (Cosmetic
capping, polishing, dentures,
treatment like filling, capping,
scaling, cleaning and treatment of
polishing, dentures, scaling,
similar nature are not payable.
cleaning and treatment of
Dental Detailed prescription, nature of
similar nature are not payable.
treatment, procedures done,
prenumbered receipts are a must Detailed prescription, nature
for dental treatment claims. In of treatment, procedures
addition, Post RCT X-ray film is done, prenumbered receipts
mandatory for justification of are a must for dental
admissibility of claim.) treatment claims. In addition,
Post RCT X-ray film is
mandatory for justification of
admissibility of claim.)
In-vitro fertilization- Up to INR 40,000 Up to INR 50,000
Intrauterine Insemination are
covered (on day care and OPD
basis, no coverage of pre and
post). However,
Treatment related to infertility
like Hysterolaparscopy, Ovarian
drilling, Endometriosis,
Chocolate Cyst and diagnostic
D&C are not covered.
Covered for a maximum of first 10 cases throughout the year with a

limit of INR 100,000 per case in absence of multi-specialty hospital
Emergency Air Ambulance
in a radius of 50 kms for named ailments only (subject to approval
of insurer).
Covered up to INR 5,000 per employee. Expenses related to external aids

Mobility Extension used for mobility (like walker, crutches) upon the prescription of the
treating doctor and admissibility of the main claim.
Lasik Treatment Covered Covered, if required for correction of power of +/- 6.0 or above. Only
only basic surgical spherical power is admissible.
procedures are covered
(Smile, Femto, ICL & etc will
be restricted to basic Lasik
treatment cost)
Morbid obesity treatment Covered only if it is life threatening and not for cosmetic purposes
Ayurvedic hospitalization is covered for treatment taken in taken in a
Government Hospital or in any Institute recognized by the Government
Ayurveda
and/or accredited by Quality Council of India/National Accreditation Board
on Health. (Refer section 4.4 for details)
Mental Ailment The Policy covers inpatient treatment for Psychiatric or Mental Illness
where the illness is an established non-genetic disease like BPD,
Schizophrenia or such similar disease.
Genetic Disorder Not Applicable Covered upto full sum insured. Only
for in-patient treatment
Congenital External Diseases Not Applicable Covered upto full sum insured. It is
life threatening or impacting regular
life
Oral chemotherapy –
restricted to cancer Not covered Covered
treatment only
Hormone therapy /
Immunotherapy covered/ Not covered Covered

targeted therapy/adjuvant
therapy / immune
modulators / AMRD –
restricted to cancer
treatment
Covered up to default sum insured for employee, spouse and children, as
HIV
per the employee grade
Stem cell and cyber knife
Covered up to 50% of the sum insured
treatment
Limited up to the default sum insured as per the employee grade, top-up
Cochlear implant surgery
sum insured cannot be utilized for this purpose
Covered only if the recipient is a member in the policy and if the donor is a
Donor medical expenses
non-member of the policy
Up to INR 25,000 for employees only
Keratoconus treatment Not covered
Pace Maker battery, DBS Sublimit of INR. 3 lakhs per event.

Not covered
battery replacement
Room rent/ICU charge limit INR 4,000 (for 2 and 4 lakhs top-ups)
across all cities per day (No INR 2,700 INR 5,000 (for 6, 8 and 10 lakhs top-
Limit for Band E employees) up)
Nursing charges (to be billed
25% of room rent limit
separately)
No Proportionate deduction
on opting for higher room Yes (only difference in room charges need to be borne by the employee)
rent.
Co-pay on all claims 10% from the employee for admissible claim amount
Co-pay on day care 10% from the employee for admissible claim amount
procedures
Co-pay on maternity claims 10% from the employee for admissible claim amount
Additional 2% co-pay
applicable for employees
Applicable for all claims
who do not pre-intimate in
case of a planned
hospitalization
Co-pay for employees dies in
No
harness
Ailment capping Yes. Refer section 4.5 Yes. Refer section 4.6
4. Terms and Conditions applicable to both plans
4.1 Policy covers hospitalization expenses. Expenses prior to and after hospitalization are also covered.
Further details of coverage are given below:
Expenses on hospitalization for a minimum period of 24 hours are admissible. However, this time limit
is not applied to specific treatments as detailed later in the policy.

All expenses incurred in GIPSA PPN hospitals will be paid as per GIPSA rates in cashless &
reimbursement claims
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.
B. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees
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 orthopedic implants, infra cardiac valve
replacements, vascular stents, relevant laboratory/ diagnostic tests, X Ray and other
medical expenses related to the treatment.
D. Coverage for dependents in case of employee’s death to continue till the end of the policy.
E. No deductions in case of death during hospitalization
F. Admission less than 24 hours’ hospitalization without active line of treatment in life
threatening situations (only for employees, when at work)
G. If an employee opts for treatment in a hospital which is in the TPA network list of hospitals,
then the payment mode opted should be cashless. We strongly advice against selecting
reimbursement in place of cashless in a network hospital as a payment mode. In an event
for any reason whatsoever, the employee has to select reimbursement mode in a network
hospital, then there may be a charge under the header of ‘hospital discount’ which will be
deducted from your final reimbursed amount. This hospital discount value covers the
difference in agreed tariffs between the hospitals and TPA for cashless and for non-cashless
payment mode. Hence, to avoid having to pay the hospital discount out of pocket, we
advise you to opt for cashless in place of reimbursement in a network hospital as a payment
mode.
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 7.7 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
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 13 Surgical treatment of anal fistulas
2 Parenteral Chemotherapy 14 Dilation and Curettage (D&C)
3 Radiotherapy 15 Surgical treatment of hemorrhoids (piles surgery)
4 Eye surgery 16 Operation on a testicular hydrocele
5 Dental surgery 17 Treatment of a varicocele and a hydrocele
6 Lithotripsy 18 Tonsillectomy with adenoidectomy
7 Myringoplasty 19 Coronary angioplasty
8 Tonsillectomy 20 Varicose Vein Ligation
9 Tympanoplasty 21 Sclerotherapy
10 Herniotomy / Hernioplasty 22 Sinusitis
11 Paracentesis (myringotomy) 23 Hysterectomy
12 Coronary angiography 24 Fracture/dislocation excluding hairline fracture
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 caps will not apply in case there are complications. 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
A-class B-class city
Surgery
Ailments Description city limit limit (INR)
Type
(INR)
Cataract (including Clouding of vision, common in elderly 36000 28800
Eye surgery
cost of lens) people
Inflammation and infection of
Throat 37000 29600
Tonsillectomy tonsils/adenoids, glands between
surgery
mouth, nose and throat
Abnormal connection between two
General organs, generally between the rectum 42000 33600
Fistula High
surgery and vagina/rectum and urinary bladder,
resulting due to injury/surgery
General 49500 39600
Fistula Low Same as above
surgery
Repair of a fissure (a crack or a tear in
the lining of an organ), sphincterectomy
General 39500 31600
Fissurectomy is the correction of a tear on a sphincter
surgery
(muscle that helps in contraction of an
organ)
Hemorrhoidectomy Surgical removal of a hemorrhoid
General 50500 40400
(Excluding staples (protrusion of the mucous lining of
surgery
& tackers) rectum due to constipation)
Thyroidectomy - General Partial surgical removal of a thyroid
108500 86800
HEMI surgery gland (usually done when suffering from
cancer)
Thyroidectomy - General 50000
Total surgical removal of a thyroid gland 45000
TOTAL surgery
A procedure done by inserting a fiber
optic tube into the joints to study the 35000
Arthroscopy Orthopedics 30000
nature of condition causing
inflammation
Arthroscopic Done to treat cartilage tears (cartilage is 103000 82400
Orthopedics
surgery tissue lining the joints)
Removal of hydrocele (collection of fluid
Hydroceletomy – 33500 26800
Urology around testes), one side. Related to the
Unilateral
male reproductory organ
Hydroceletomy – Removal of hydrocele (collection of fluid 35000
Urology around testes), both sides. Related to 30000
bilateral

the male reproductory organ
An x-ray test done to find out the flow
Coronary
of blood into and out of one's heart 25000 20000
Angiogram Cardiology
(basically to study the nature of blood
(including dye)
vessels). CT Angiogram not payable
Hernia repair – Correction of hernia (protrusion of
General 66500 53200
Open (including internal organs through weak abdominal
surgery
mesh) muscles)
Hernia repair - General Correction of hernia (protrusion of
60000
laparoscopic surgery internal organs through weak abdominal 50000
muscles)
Appendicectomy – General Removal of appendix by cutting open the 35000
30000
open Surgery abdomen
Removal of appendix by laparoscopy
Appendicectomy
General (insertion of a laparoscope and removal 69000 55200
-
surgery of appendix bit by bit, requires just a
laparoscopic
small incision on the abdomen)
Cholecystectomy – General Removal of gall bladder upon finding
45000
open Surgery stone formation (by cutting open the 40000
abdomen)
Cholecystectomy – Removal of gall bladder upon finding
General 63000 50400
laparoscopic stone formation (by minimal invasion -
surgery
using laparoscope)
Hysterectomy – Removal of uterus due to any
96000 76800
vaginal /open Gynecology complications
(by cutting open the abdomen)
Hysterectomy – Removal of uterus due to any
91500 73200
laparoscopic Gynecology complications
(by laparoscopy)
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
Base Plus Policy - Ailment Cappings
Diseases/Ailments 2 lakhs 4 lakhs 6 lakhs 8 lakhs 10 lakhs
101,10
Appendicectomy - laparoscopic 75,900 83,500 91,900 0 111,200
Appendicectomy – open 38,500 42,400 46,600 51,300 56,400
124,70 137,10 150,90
Arthroscopic Surgery 113,300 0 0 0 165,900
Arthroscopy 38,500 42,400 46,600 51,300 56,400
Cataract 39,600 43,600 48,000 52,800 58,000
Cholecystectomy - laparoscopic 69,300 76,300 83,900 92,300 101,500
Cholecystectomy – open 49,500 54,500 59,900 65,900 72,500
Coronary Angiogram 27,500 30,300 33,300 36,700 40,300
Fissurectomy 43,500 47,800 52,600 57,900 63,700
Fistulectomy - High 46,200 50,900 56,000 61,500 67,700
Fistulectomy - Low 54,500 59,900 65,900 72,500 79,800
Haemorrhoidectomy 55,600 61,200 67,300 74,000 81,400
Hernia repair – laparoscopic 66,000 72,600 79,900 87,900 96,700
Hernia repair – open 73,200 80,500 88,600 97,400 107,100
Hydrocelectomy - Bilateral 38,500 42,400 46,600 51,300 56,400
Hydrocelectomy - Unilateral 36,900 40,600 44,600 49,100 54,000
110,80 121,80 134,00
Hysterectomy - Lap 100,700 0 0 0 147,400
116,20 127,80 140,60
Hysterectomy - Open 105,600 0 0 0 154,700
131,30 144,50 158,90
Thyroidectomy 119,400 0 0 0 174,800
Thyroidectomy – TOTAL 55,000 60,500 66,600 73,300 80,600
Tonsillectomy 40,700 44,800 49,300 54,200 59,600
4.7 TPA CLEARANCE FOR PLANNED HOSPITALIZATION

For planned hospitalizations employees are requested to write to wiprocoverage@mediassistindia.com
to get TPA clearance on coverage, check if the diagnosis and procedure recommended by doctor is
covered as per policy or not
4.8 MEDICAL EXPENSES INCURRED UNDER TWO POLICY PERIODS

If the claim event falls within two policy periods, the claims shall be paid taking into consideration
the available sum insured in the two policy periods, including the deductibles for each policy
period. Such eligible claim amount to be payable to the insured shall be reduced to the extent of
premium to be received for the renewal/due date of premium of health insurance policy, if not
received earlier.
4.9 SPECIAL CONDITIONS

In case an employee changes his/her marital status from ‘married’ to ‘widow’ then the coverage for the
spouse will cease to exist, GMC top up contributed would not be reimbursed, however any remaining
contribution will be rectified as per the no. of units. This would be applicable to GMC base monthly
contribution as well.
If employee’s marital status in myData is married at the time of inception of the policy and is changed
to separated / divorced during the top up recovery of first 3 months, in such a scenario, GMC top up
contributed would not be reimbursed. Also, since ‘family’ premium has been paid upfront to the
insurer on behalf of the employee the monthly deductions will continue as per ‘family’ premium.
4.10 CRITICAL ILLNESS COVER

The Policy covers critical Illness for a Sum Insured of INR 200,000 only for Employees.
a. The Benefit under this clause is in addition to the Floater Sum Insured applicable to the Employee.
b. The cover is not applicable to the Employee’s Spouse or Children.

c. The insured must survive at least three months after commencement date of insurance and 30
days after the diagnosis of the ailment for the cover to be become payable by the insurer.
Critical illness means any of the below listed ailments:

I. CANCER OF SPECIFIED SEVERITY
A malignant tumor characterized by the uncontrolled growth and spread of malignant cells
and with invasion of normal tissue and destruction of normal tissues. This diagnosis must
be supported by histological evidence of malignancy & confirmed by a pathologist. The
term cancer includes leukemia, lymphoma and sarcoma.
The following are excluded:
A. Tumors showing the malignant changes of carcinoma in situ & tumors which are
histologically described as pre-malignant or non-invasive, including but not limited to:
Carcinoma in situ of breasts, Cervical dysplasia CIN1, CIN -2 & CIN-3. B. Any skin cancer other
than invasive malignant melanoma.
C. All tumors of the prostate unless histologically classified as having a Gleason score
greater than 6 or having progressed to at least clinical TNM classification
T2N0M0.........
D. Papillary micro - carcinoma of the thyroid less than 1 cm in diameter
E. Chronic lymphocytic leukemia less than RAI stage 3
F. Micro carcinoma of the bladder
G. All tumors in the presence of HIV infection.
II. FIRST HEART ATTACK of specified severity

The first occurrence of an acute myocardial infarction which means the death of a portion of
the heart muscle because of inadequate blood supply to the relevant area.
The diagnosis for this will be evidenced by all the following criteria:
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.

(1) Non-ST-segment elevation myocardial infarction (NSTEMI) with elevation of Troponin
I or T;
(2) Other acute Coronary Syndromes
(3) Any type of angina pectoris
III. CORONARY ARTERY SURGERY (CABG) Open Chest CABG

The actual undergoing of open chest surgery for the correction of one or more coronary
arteries, which is/are narrowed or blocked, by coronary artery bypass graft (CABG). The
diagnosis must be supported by a coronary angiography and the realization of surgery must be
confirmed by a specialist medical practitioner.

Excluded are:
A. Angioplasty and/or any other intra-arterial procedures
B. Any key-hole or laser surgery.
IV. HEART VALVE REPLACEMENT

The actual undergoing of open-heart valve surgery to replace or repair one or more heart
valves, because of defects in, abnormalities of, or disease-affected cardiac valve(s). The
diagnosis of the valve abnormality must be supported by an echo cardiograph and the
realization of surgery should be confirmed by a specialist medical practitioner.
Exclusions:
A. Catheter based techniques including but not limited to, balloon valvotomy/valvuloplasty are
excluded.
V. COMA OF SPECIFIED SEVERITY

A state of unconsciousness with no reaction or response to external stimuli or internal
needs. This diagnosis must be supported by evidence of all the following:
(1) No response to external stimuli continuously for at least 96 hours
(2) Life support measures are necessary to sustain life and
(3) Permanent neurological deficit which must be assessed at least 30 days after the
onset of the coma.
Exclusions:
A. The condition should be confirmed by a specialist medical practitioner. Coma resulting
directly from alcohol or drug abuse is excluded.
VI. KIDNEY FAILURE

End stage renal disease presenting as chronic irreversible failure of both kidneys to function,
because of which either regular renal dialysis (hemodialysis or peritoneal dialysis) is instituted
or renal transplantation is carried out. Diagnosis must be confirmed by a specialist medical
practitioner.
VII. STROKE RESULTING IN PERMANENT SYMPTOMS
Any cerebrovascular incident producing permanent neurological sequelae. This includes

infarction of brain tissue, thrombosis in an intra-cranial vessel, hemorrhage and embolization
from an extra cranial source. Diagnosis should be confirmed by a specialist medical
practitioner and evidenced by typical clinical symptoms as well as typical findings in CT scan
or MRI of the brain.
Evidence of permanent neurological deficit lasting for at least 3 months must be produced.

1. Transient ischemic attacks (TIA)
2. Traumatic injury of the brain

3. Vascular disease affecting only the eye or optic nerve or vestibular functions.
VIII. MAJOR ORGAN / BONE MARROW TRANSPLANT
The actual undergoing of a transplant of one of the following human organs: heart, lung, liver, kidney,
pancreas, that resulted from irreversible end-stage failure of the relevant organ, or human bone
marrow using hematopoietic stem cells. The undergoing of a transplant must be confirmed by a
specialist medical practitioner.

1. Other stem-cell transplants
2. Where only islets of Langerhans are transplanted
IX. MULTIPLE SCLEROSIS

The definite occurrence of multiple sclerosis. The diagnosis must be supported by all the following:
a) Investigations including typical MRI and CSF findings, which unequivocally confirm the diagnosis to
be multiple sclerosis;
b) There must be current clinical impairment of motor or sensory function, which must have
persisted for a continuous period of at least 6 months, and
c) Well documented clinical history of exacerbations and remissions of said symptoms or
neurological deficits with at least two clinically documented episodes at least one month apart.
Exclusions:
3. Other causes of neurological damage such as SLE and HIV are excluded.
X. MOTOR NEURONE DISEASE WITH PERMANENT SYMPTOMS
Motor neuron disease diagnosed by a specialist medical practitioner as spinal muscular

atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis or primary lateral sclerosis.
There must be progressive degeneration of corticospinal tracts and anterior horn cells or
bulbar efferent neurons. There must be current significant and permanent functional
neurological impairment with objective evidence of motor dysfunction that has persisted for a
continuous period of at least 3 months.
XI. PERMANENT PARALYSIS OF LIMBS
Total and irreversible loss of use of two or more limbs because of injury or disease of the brain
or spinal cord. A specialist medical practitioner must believe the paralysis will be permanent
with no hope of recovery and must be present for more than 3 months.
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 LOSS OF PAY COVER

a) The Policy covers Loss of Pay to Employees only
b) The Benefit under this clause is in addition to the Floater Sum Insured applicable to the Employee.
c) The coverage is for illnesses / diseases only. Accidents and Maternity are excluded from this cover.
d) The cover under the clause commences from the day when, ‘Loss of Pay’ starts after exhausting all
leaves to the Employees Credit.
e) The cover ceases from the date on which the Hospital / Nursing Home / Treating Doctor Certifies
that the Employee is fit for resumption of duty or the date on which the Employee resumes duty,
whichever is earlier.
f) The Employee needs to produce a ‘LOP certificate’ from the Employer.
g) For a claim to be admissible under this clause a claim must be admissible under the hospitalization
claim.
h) The weekly compensation is payable for a maximum period of 52 Weeks.
i) The cover is not applicable to the Employee’s Spouse or Children.
j) The limits for employees of Azim Premji Foundation, Azim Premji University, Azim Premji
Educational Trust, Azim Premji Foundation for Development, Wipro Kawasaki Precision Mach
Ltd., Premji Invest or any such entity / subsidiary of the Wipro Group, shall be based on the
grades equivalent to or nearest to that of the grades of employees of Wipro Limited.
k) The weekly compensation payable is given below
Table 8
Level LoP per week (INR)
B3 ad below 5,000
C1 and above 10,000
4.12 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 DO&P and the spouse in IT Services/India BU, at the same/different band,
premium will be deducted from the employee in IT Services.
4.13 New hires / New Incumbents / Intercompany transfers / Onsite return/ Sabbatical Cases
a. New hires / intercompany transfers / Onsite return employees will have the option to choose
Top-up plans within the first 30 days of returning or FTR closure whichever is earlier. Failure to
select an option, will result in auto-enrollment into the Base plan with default band-wise sum
insured.

b. Employees who have been on long term onsite assignment for three years or more can choose
to opt out of the policy. However, the opt-out option will only be available if the employee has
had no claims in the last three years. Once the employee has opted out they cannot opt-in
while they are on-site. Hence would encourage all employees to exercise utmost restraint and
caution before they decide to opt-out. They will be covered under the India GMC policy once
they return to India within 30 days from date of return/FTR closure date whichever is latest.
c. A block of three years would be observed from the year of enrollment into the policy. New
hires can change plans (opt out of / reduce Top-up) only upon completion of three policy
years / atleast 2 renewal cycles. For example: if an employee joins in March 2015, he will have
to choose a Top-up plan within 30 days of joining. He will be able to opt out of / reduce Top-up
sum insured only after atleast two renewal cycles (based on the year the plan opens for new
enrollments). In this case, he will be part of the 2014-15 policy and 2015-16 and 2016-17 as per
choice made while joining/enrolment. He can only increase the top-up sum insured to any
higher top-up slab during the renewal cycles for 2 years. But reduction / opt out of top-up sum
insured will only be allowed post being in the plan for atleast three policy cycles. In this case,
he can reduce / opt out of top up sum insured in 2017-18 renewal cycle provided there is no
claim in the third year (2016- 17).
d. New incumbents - spouse and child details need to be added within the 30 days of date of
marriage or date of birth, respectively.
e. An employee on sabbatical leave is not covered under Wipro’s GMC policy and cannot opt for
top-up. They will be enrolled into GMC upon their return and can take top-up within 30 days of
return.
4.14 Resignation cases / Exiting employees

a. Employee who makes a claim (partial cover or full cover), and then exits in the same policy cycle,
will have to pay the premium for the remaining months in the policy year through the full and
final settlement.
b. All exiting employees must raise any pending claims before their last working date.
4.15 Adoption cases

The adopted child can be covered from the date of adoption and the claims will be honored with effect
from the adoption date. However, the adopted child should be enrolled through myWipro > My Data
within 30 days from the date of adoption to be eligible for any claim reimbursement
4.16 Long term onsite assignees opt out option

Employees who have been on long term onsite assignment for three years or more can choose to opt
out of the policy. However, the opt out option will only be available if the employee has had no claims in
the last three years.
In the above scenario, the organization will not be liable if there is an untoward incident when the
employee / his family travels on a personal trip to India.

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.
4.17 The Policy will carry a 10% co-pay from the employee for admissible claim amount.
There will be an additional 2% co-pay (in addition to the 10% co-pay) for employees who do not pre-
intimate (myWipro > My Medical Claim > Medical Insurance Claim > Proceed to Medibuddy portal)
in case of a planned procedures.
4.18 Root Canal Treatment claims

RCT (Root Canal Treatment) Flap surgery/Surgical Extraction should be claimed under insurance in the
first instance. Once insurance is settled, unpaid value can be claimed under MAS by producing the
insurance settlement letter. Co-pay amount will not be payable through MAS.
5. Process for Claim Submission

5.1 Claim documents
In the event of a claim, you would be required to furnish the following for or in support of a claim:
i. Duly completed claim form
ii. Bills, receipts and discharge certificate/card from the Hospital
iii. Bills from Chemists supported by proper prescription.
iv. Test reports and payment receipts.
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.
5.2 Claim Procedure

Depending on the need and condition of hospitalization, employee can go for 3 forms of hospitalization:
1. Planned Hospitalization: In the case of a planned admission, doctor must have been consulted
first and would in turn have advised on the probable date of hospitalization. In such a case,
employee must apply for an approval of the estimated hospital expenses directly with the TPA
at least 4-5 days prior to the date of hospitalization. Employee needs to fill ‘Pre-Authorization
form for Cashless Claim’ (Available in Forms section). This would help you get the best services,
room and rate with help of TPA. Below process can be followed for registering claim in case of a
planned hospitalization (Cashless if approved by TPA):

TPA issues TPA sends
letter of the
Hospital At the time
credit (for approval to
Intimates of
cashless) hospital
Employee TPA and discharge,
Employee with which
approaches sends Pre- hospital
calls TPA to approval for allows the
hospital Authorizatio sends final
plan partial employee to
with n Request bill and
hospitalizati amount as get
medical ID / with discharge
on per discharged
E-card approximat summary
Eligibility by paying all
e cost of the for approval
and non-medical
treatment to TPA
Coverage to expenses, if
the hospital any
2. Emergency Hospitalization: In case of emergency hospitalization, hospital will take up your

case on a fast track basis with your TPA and is likely to receive approvals within 4 hours during
any working day. For cashless treatment, it is mandatory for the hospital to have an approval
from your TPA. In case of delay in receiving the approval or when you cannot wait for receiving
the approval owing to medical urgency you can undertake the treatment by paying the
necessary cash deposit.
If you receive approval from your TPA after paying the cash deposit, you are entitled for refund of
the cash deposit (as per reimbursement process mentioned in point 3 below).
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
If TPA gives pre-

authorization, member Claim processed by TPA
Hospital sends complete
gets treated and and insurer and
set of claim documents
discharged after paying payment released to the
for processing to TPA
for all non-entitled hospital
benefits

3. Reimbursement: In case any hospital does not accept cashless facility, employee can register
the claim as reimbursement. Below mentioned documents for or in support of a claim need to
be submitted within 30 days of hospitalization:
a) Duly completed claim form

b) Bills, receipts and discharge certificate/card from the Hospital
c) Bills from Chemists supported by proper prescription.
d) Test reports and payment receipts.
Complete Information on claims process is available at MyWipro > Finance > My medical claim
> Medical Insurance Claim > Plan details > Guidelines_for_Cashless_and_Reimbursement
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 family size 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
Band Sum Annual Premium Monthly Premium

insured
(INR) Single Family Single Family
AA 100,000 1,602 3,043 134 254
B1, B2 and B3 200,000 2,881 5,204 240 434
C1, C2 300,000 3,180 8,247 265 687

D1, D2 400,000 4,012 9,017 334 751
E 500,000 4,223 11,352 352 946
Table 10
Top-up Plan Premiums
Top-up sum insured (INR) Annual Premium
Single Family
200,000 1,540 3,316

400,000 1,900 4,074
600,000 2,335 5,005
800,000 2,869 6,148
1,000,000 3,527 7,551
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.
7.2 Hospitalization means admission in a Hospital/Nursing Home for a minimum

period of 24 hours. In-patient care consecutive hours except for specified
procedures/treatments, where such admission could be for a period of less than 24
consecutive hours.

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.
7.7 Domiciliary Hospitalization means medical treatment for an illness/disease/injury which in the
normal course would require care and treatment at a hospital but is taken while confined at home under
any of the following circumstances:
a) The treatment is beyond 3 days.
b) The condition of the patient is such that he/she is not in a condition to be moved to a
hospital
c) The patient takes treatment at home because of non-availability of room in a hospital.
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.
7.12 Portability - Employees will now have an option to carry forward the health insurance
policy (with standard benefits and date of first inception being the date from which the
employee is being covered under Wipro’s Group Health Insurance Policy) even after leaving the
Company. Employees can write to policy.continuity@marsh.com to get the portability
options.
Example: In a retail policy from external market, the period during which pre-existing diseases
are not covered is referred to as the waiting period. In a normal scenario, in case an employee
leaves the Company, s/he will be treated as a new customer and will have to wait for 4 years for
getting pre-existing diseases’ coverage in case s/he buys an insurance policy. With the feature of
portability, an employee will be given an option to carry forward the Policy (with continuity
benefits) with the insurer.
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.

7.14 Pre-hospitalization medical expenses - Relevant medical expenses incurred
immediately 30 days before the Insured person is hospitalized provided that:
a) Such Medical expenses are incurred for the same condition for which the Insured
Person’s Hospitalization was required; and
b) The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company
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
Person’s Hospitalization was required; and
b) The In-patient Hospitalization claim for such Hospitalization is admissible by the Insurance
Company.
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.
7.18 TPA means a Third Party Administrator who holds a valid License from Insurance
Regulatory and Development Authority to act as a THIRD PARTY ADMINISTRATOR and is
engaged by the Company for the provision of health services as specified in the agreement
between the Company and TPA.
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
8. Exclusions under Mediclaim

The company shall not be liable to make any payment under this policy in respect of any expenses
whatsoever incurred by any Insured Person regarding or in respect of:
a) Injury / disease directly or indirectly caused by or arising from or attributable to War, invasion, Act
of Foreign enemy, War like operations (whether war be declared or not).
b) Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be
necessitated due to an accident.
c) Vaccination and inoculation of any kind unless it is post animal bite.
d) Change of life or cosmetic or aesthetic treatment of any description such as correction of eyesight,
etc. e) Cost of spectacles and contact lenses, hearing aids.

f) Dental treatment or surgery of any kind unless necessitated by accident and requiring
hospitalization.
g) Convalescence, general debility; run-down condition or rest cure, obesity treatment and its
complications including morbid obesity, Congenital external disease/ defects or anomalies is not
covered until it is life threatening or impacting regular life, treatment relating to all psychiatric and
psychosomatic disorders, infertility, sterility, Venereal disease, intentional self-injury and use of
intoxication drugs / alcohol.
h) All expenses arising out of any condition directly or indirectly caused to or associated with Human
T-Cell Lymph Tropic Virus Type III (HTLB - III) or lymphadenopathy Associated Virus (LAV) or the
Mutants Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar
kind commonly referred to as AIDS.
i) Charges incurred at Hospital or Nursing Home primarily for diagnosis x-ray or Laboratory
examinations or other diagnostic studies not consistent with or incidental to the diagnosis and
treatment of positive existence or presence of any ailment, sickness or injury, for which
confinement is required at a Hospital / Nursing Home.
j) Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified
by the attending physician.
k) Injury or disease directly or indirectly caused by or contributed to by nuclear weapon / materials
or contributed to/by or arising from ionizing radiation or contamination by radioactivity by any
nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel.
l) Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or
complications of any of these including caesarean section, except abdominal operations for extra
uterine pregnancy (Ectopic Pregnancy) which is provided by submission of Ultra Sonographic
report and certification by Gynecologist that it is life threatening one, if left untreated.
m) Naturopathy Treatment, acupressure, acupuncture, magnetic therapies, experimental and
unproven treatments/ therapies. Treatment related like Hysterolaparscopy, ovarian drilling,
endometriosis, chocolate cyst, diagnostic d and C, experimental and unproven treatments/
therapies are not covered. Treatment including drug experimental therapy, which is not based on
established medical practice in India, is treatment experimental or unproven.
n) Treatment for Age Related Macular Degeneration (ARMD), treatments such as Rotational Field
Quantum Magnetic Resonance (RFQMR), Enhanced External Counter Pulsation (EECP), etc.
o) Family planning surgeries are not covered.
p) Change of treatment from one system of medicine to another unless recommended by the
consultant/ hospital under whom the treatment is taken.
q) All non-medical expenses including convenience items for personal comfort such as charges for
telephone, television, ayah, private nursing/ barber or beauty services, diet charges, baby food,
cosmetics, tissue paper, diapers, sanitary pads, toiletry items and similar incidental expenses.
r) Any kind of Service charges, Surcharges, Admission Fees/ Registration Charges, Luxury Tax and
similar charges levied by the hospital.
s) All non-medical expenses. The list of non-medical expenses is available in the FAQs on
https://www.medibuddy.in/insuredFaqs.
9. Conditions common to all

9.1 Incontestability and Duty of Disclosure:

The policy shall be null and void and no benefit shall be payable in the event of untrue or incorrect
statements, misrepresentation, wrong description or on non-disclosure in any material in the proposal
form, personal statement, declaration and connected documents, or any material information having
been withheld, or a claim being fraudulent or any fraudulent means or devices being used by the Insured
or any one acting on his behalf to obtain any benefit under this policy.
9.2 Observance of terms and conditions:

The due observance and fulfillment of the terms, conditions and endorsement of this policy in so far as
they relate to anything to be done or complied with by the Insured, shall be a condition precedent to
any liability of the Company to make any payment under this policy.
9.3 Fraudulent claims:

If any claim is in any respect fraudulent, or if any false statement, or declaration is made or used in
support thereof, or if any fraudulent means or devices are used by the Insured or anyone acting on
his behalf to obtain any benefit under this policy, or if a claim is made and rejected and no court
action or suit is commenced within twelve months after such rejection or, in case of arbitration
taking place as provided therein, within twelve (12) calendar months after the Arbitrator or
Arbitrators have made their award, all benefits under this policy shall be forfeited.
9.4 Cause of Action/ Currency for payments:

No Claims shall be payable under this policy unless the hospitalization takes place in India. All claims
shall be payable in India in Indian Rupees (INR) only.
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 MediAssist

queries office
Dedicated Voice Support 1800-419-1164 24 / 7 * 365 days support
Dedicated number for 8152850999 24 / 7 * 365 days support

cashless and emergency
hospitalization
Mail ID for confirmation on wiprocoverage@mediassistindia.com 24 / 7 * 365 days support
coverage of procedure
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;

2.0 Nov 1, 2018 C&B C&B Head Policy Renewal for 2018-19

Version 2.0 Group Mediclaim Insurance Nov 1, 2018
Sensitivity:
Sensitivity: Internal
Internal & Restricted
& Restricted
VersionVersion
2.0 2.0 Group Mediclaim Insurance Nov 1, 2018
Sensitivity:
& Restricted
Version 2.0 Group Mediclaim Insurance Nov 1, 2018
Sensitivity:
& Restricted
Sensitivity:
Sensitivity: InternalInternal & Restricted
& Restricted
Sensitivity:
& Restricted
Sensitivity:
& Restricted

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Employee Policy Conditions

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Group Mediclaim Insurance Policy

Wipro – For Internal Circulation only

Sensitivity: Internal & Restricted

Active Line of Treatment is a continuous medical treatment provided by a medical practitioner to a

Members Coverage and special conditions (if any)

Then, an auto-generated e-mail will get triggered to the spouse

Changes for policy year 2019-20

Version 3 GMC Policy 2019-20 1 Nov 2019

Version 3 GMC Policy 2019-20 1 Nov 2019

Not applicable Upto maternity sub limit

Within the maternity limit for

Covered for a maximum of first 10 cases throughout the year with a

Covered up to INR 5,000 per employee. Expenses related to external aids

Version 3 GMC Policy 2019-20 1 Nov 2019

Pace Maker battery, DBS Sublimit of INR. 3 lakhs per event.

4. Terms and Conditions applicable to both plans

Version 3 GMC Policy 2019-20 1 Nov 2019

B. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees

Version 3 GMC Policy 2019-20 1 Nov 2019

Version 3 GMC Policy 2019-20 1 Nov 2019

Version 3 GMC Policy 2019-20 1 Nov 2019

4.7 TPA CLEARANCE FOR PLANNED HOSPITALIZATION

4.8 MEDICAL EXPENSES INCURRED UNDER TWO POLICY PERIODS

4.9 SPECIAL CONDITIONS

4.10 CRITICAL ILLNESS COVER

Version 3 GMC Policy 2019-20 1 Nov 2019

Critical illness means any of the below listed ailments:

The following are excluded:

II. FIRST HEART ATTACK of specified severity

The following are excluded:

III. CORONARY ARTERY SURGERY (CABG) Open Chest CABG

Version 3 GMC Policy 2019-20 1 Nov 2019

IV. HEART VALVE REPLACEMENT

V. COMA OF SPECIFIED SEVERITY

VI. KIDNEY FAILURE

VII. STROKE RESULTING IN PERMANENT SYMPTOMS

Any cerebrovascular incident producing permanent neurological sequelae. This includes

The following are excluded:

Version 3 GMC Policy 2019-20 1 Nov 2019

VIII. MAJOR ORGAN / BONE MARROW TRANSPLANT

The following are excluded:

IX. MULTIPLE SCLEROSIS

X. MOTOR NEURONE DISEASE WITH PERMANENT SYMPTOMS

Motor neuron disease diagnosed by a specialist medical practitioner as spinal muscular

XI. PERMANENT PARALYSIS OF LIMBS

Version 3 GMC Policy 2019-20 1 Nov 2019

4.11 LOSS OF PAY COVER

Level LoP per week (INR)

Version 3 GMC Policy 2019-20 1 Nov 2019

4.14 Resignation cases / Exiting employees

4.15 Adoption cases

4.16 Long term onsite assignees opt out option

Version 3 GMC Policy 2019-20 1 Nov 2019

4.18 Root Canal Treatment claims

5. Process for Claim Submission

5.2 Claim Procedure

Version 3 GMC Policy 2019-20 1 Nov 2019

2. Emergency Hospitalization: In case of emergency hospitalization, hospital will take up your

If TPA gives pre-

Version 3 GMC Policy 2019-20 1 Nov 2019

a) Duly completed claim form

Band Sum Annual Premium Monthly Premium

AA 100,000 1,602 3,043 134 254

B1, B2 and B3 200,000 2,881 5,204 240 434