Extended Family Health Insurance Policy Summary 2015-16 (EFHIP)

Emerging out of a strong business relationship between Infosys and National Insurance Company
Limited (NIC), a unique and exclusive plan has been designed for Extended Family of Employees.

1. Eligibility:
 Parents
 Parents-In-law
 Dependent siblings (up to age of 22 years)

Note:
 Policy can be availed only by employees whose base location is India
 Coverage under the policy is available for only those who have enrolled their dependents

during the window period.

 New Joiners/Base change Employees need to enrol their parents / in-laws / siblings within a

window period of 45 days of joining Infosys/ date of change of base to India.

2. Coverage:
 The Policy period for EFHIP will be from August 01, 2015 to July 31, 2016.

 The coverage commences from the succeeding day of enrolment and will expire on July 31,

2016.

3. Plan Details and Sum Insured Options:

Extended Family Health Insurance policy has two plans:
A. INDIVIDUAL PLAN

Under this Plan, the sum insured will be dependent specific

(Tax exemption u/s 80D is available only for Parents Premium).
Premium rates ( Amount in INR)
Age Group
Sum Insured
up to 55 56-59 60-65 66-70 above 70
50,000 3,150 3,700 4,000 4,750 5,700
1,00,000 5,050 6,350 6,850 7,900 9,500
2,00,000 9,700 12,200 12,600 14,500 17,100
3,00,000 14,400 18,000 18,500 21,500 23,750
4,00,000 17,300 21,600 22,200 25,800 28,500
*Premium inclusive of Service Tax.

 Single parent /Single parent In Law/Dependent sibling up to age of 22 year should

 necessarily be nominated under Individual plan.
 Family Discount: Employees covering 3 or more dependents under individual plan will be
eligible for family discount of 5% on total premium payable.

B. FLOATER PLAN FOR PARENTS/PARENTS-IN-LAW

Under this Plan,

Parents can be covered under one common Floater sum insured.
Parents in Laws can be covered separately under one common Floater sum insured.
Tax exemption u/s 80D is available only for Parents Premium

Premium rates (Amount in INR)

Age Group
Sum Insured
up to 55 56-59 60-65 66-70 above 70
1,00,000 6,700 8,400 9,100 10,500 12,600
2,00,000 12,900 16,100 16,700 19,300 22,300
3,00,000 19,000 23,900 24,600 28,500 31,500
4,00,000 21,900 27,500 28,300 32,800 36,200
5,00,000 24,700 31,100 32,000 37,100 40,900
*Premium inclusive of Service Tax.
*The premium for the plan will be applicable based on the Eldest person’s age.
Note on Eligibility:
 New Entrants (existing employees who have not taken policy in previous year) into this policy
can choose a plan up to a maximum of Rs 2lacs only ( in either of the plans)
 New joinees joining on or after 1st June 2015 can choose a plan up to a maximum of Rs 3 lacs.
 Newly Introduced plans of Rs 4lacs (Individual/Floater) & Rs 5lacs (Floater) is available only to
those employees who had taken a Sum Insured of either 2lacs or 3lacs respectively in the last
year.
 Under 3lacs Plan, any one illness/Hospitalization/Procedure will be limited to Rs 2 Lacs.
 Under 4lacs Plan, any one illness/Hospitalization/Procedure will be limited to Rs 2.75 Lacs.
 Under 5lacs Plan, any one illness/Hospitalization/Procedure will be limited to Rs 3.5 Lacs.
 All the employees who have taken the policy last year are eligible for a loyalty bonus of 10% in
premium for renewal of this policy in current year irrespective of the status of the claim
experience (With or without claim)
4. No Claim Discount

Employees renewing the policy are eligible for no claim discount as per the table below.

To avail No Claim bonus,

 Policy should have completed a minimum period of 12 Months.

 No Claim should have been made in the completed coverage period

Renewal Year Eligible Bonus Completed coverage

st
1 Year 5% 12 months

2nd Year 10% 24 months

3rd Year 20% 36 months

48 months
4th Year 25%

Examples of NCB Computation:

1) If the employee had nominated his/her dependents during Window period for 2014-15 policy
and if no claim is made under the policy for entire year, NCB would be 5% for 2015-16.
2) If the employee had nominated his/her dependents during Window period for 2014-15, 2013-14
and 2012-13 policies and if no claim is made under the policy for all three years, NCB would be
20% for 2015-16.
If claim made in 2012-13 and no claims in subsequent years, NCB would be 10%
If claim made in 2013-14 and no claims made in 2012-13 and 2014-15 then NCB would be 5%.

5. Scope / Special features of the Extended Family Health Insurance policy:

 Loyalty bonus of 10% in premium for renewal of the policy in current year irrespective of the
status of the claim experience (With or without claim).
 Employees covering 3 or more dependents will be eligible for family discount of 5% on total
premium payable.
 Pre-existing diseases are covered from day one.
 No waiting periods.
 No Room Rent Caps.
 No Age barrier for Entry.
 No Medical Checkups.
 Online submission of nominations in Harmony and no documentation involved.
 Option of premium payment in 2 Installments if premium amount >Rs 10000.
 Covers only Inpatient treatment. (Hospitalization for more than 24 consecutive hours).
 Expenses of Hospitalization for minimum period of 24 hours are admissible subject to terms
and conditions of the policy.
  However this time limit of 24 hours is not applied to certain specific treatments (Please refer
list of Day care procedures).
 Hospitalizations in India will only be covered under policy.
 The hospital where treatment is undertaken must be with a minimum capacity of 15 beds in
India.
 Maternity benefit is not covered under this plan.
 Hospitalizations for evaluation or diagnosis are not covered under the policy.
 For further details on coverage and exclusions, please refer complete policy conditions of
Extended Family Health Insurance policy in the portal.
 Scope of the cover for certain illnesses is capped to a limit (Defined Benefits Listed below)

6. Other Points:
 Issuance of this Policy is subject to the employment with Infosys and subject to
recovery/payment of full premium.
 Its employee’s responsibility to ensure that the premium gets cleared within 2 months from
the date of enrolment failing which the Policy will be terminated.
 Once the policy is activated, it will be in force and valid till expiry of the Policy even if the
employee quits Infosys.
 On expiry, such cases can be renewed as per, terms and conditions of NIC Market plan and
the premium chart applicable as defined for the sum Assured and the age of the insured.
However NIC will extend the continuity of benefits like waiver of waiting period and pre-
existing coverage etc. based on Insurance history.
 For Continued Benefits you can write to National Insurance Company (NIC@infosys.com)
before expiry of the Policy.

7. Co – Payment / Deductibles:

 Dependents covered under any of the above plans would be required to make a co-payment
per incident as per the details below including 30 days of Pre / post hospitalization expenses.
 Copayment applicable is 10% of admissible claim amount subject ta minimum of Rs 2500.
 No Co Payment is applicable on Defined benefits.

8. Pre and Post Hospitalisation expenses:

 Relevant hospital expenses incurred during the period up to 30 days prior to hospitalisation
can be claimed
 Relevant Medical expensed incurred up to 30 days after hospitalisation can be claimed

9. Defined Benefits:

 The policy is subject to defined benefits clause as under:

 The maximum amount claimable for below defined ailments will be restricted to the sum
insured or amount capped as in the list below whichever is lower. These are annual limits for
the entire policy period.
 Both joint replacements in a single surgery will be treated as single ailment and capped as
 per eligibility mentioned in “note on eligibility” above

S.N
4lacs
o Procedure 1lac 2 Lac & 3 Lacs 5lacs
1 2 2 2
1 Cataract (single eye) 5,000 0,000 2,500 5,000
1 2 2 2
2 Coronary angiography 5,000 0,000 2,500 5,000
9 1,5 1,7 2,0
3 Angioplasty (including stent) 0,000 0,000 5,000 0,000
9 1,5 2,0 2,5
4 Coronary Artery Bypass Graft 0,000 0,000 0,000 0,000
4 4 5 5
5 Hernia repair 0,000 5,000 0,000 5,000
2 2 3 4
6 Appendicectomy 0,000 5,000 2,500 0,000
3 3 4 5
7 Cholecystectomy 0,000 5,000 2,500 0,000
3 4 5 6
8 Hysterectomy 5,000 0,000 0,000 0,000
Transurethral Resection of Prostate 4 5 5 6
9 (TURP) 5,000 0,000 5,000 0,000
2 2 3 3
10 Septoplasty 5,000 7,500 0,000 5,000
2 2 3 3
11 FESS 5,000 7,500 0,000 5,000
9 1,5 1,7 2,0
12 Joint replacement – knee / hip (per
joint including implant) 0,000 0,000 5,000 0,000
2 2 3 3
13 Haemorrhoidectomy 5,000 7,500 0,000 5,000
2 2 3 3
14 Lithotripsy 5,000 7,500 0,000 5,000

* For 50,000 sum insured the defined benefits will be same as that of 1 lakh or Rs.50,000 whichever is
lower.

 Employees need to submit the cash receipt to substantiate the co-payment made to the
hospital. In the absence of the same, there will be a deduction of 10% of the total bill, when
the payment is made to the hospital.

10. Contact details for Policy Related Query/Policy Portability:

 NIC Helpdesk.
Electronic City,
Bangalore.
Extn. No. 2772(080-39802772)
NIC@infosys.com
Contact Details for Claims Related Queries
 Email ID: mediassist@infosys.com
 Dedicated landline: 080-3980 2774 (9.00 a.m. to 5.00 p.m. - weekdays)
 Dedicated Toll Free No: 1800 425 9596
 Toll Free Call Center: 1800 425 9449
 Toll Free Fax: 1800 425 9559/1800 102 5254
 Fax: 080–49313636 (5 lines)/011-41624844 (4 Lines)/022-66376933 (7 lines)