Employee Insurance Benefit Guide 2021 V7 5 April 2021

Employee Insurance Benefit Guide - 2021
About this Employee Benefits Guide
This Employee Benefits Guide is a reference document about the benefits provided by Capgemini India.
This Benefits Guide covers the below:
A. Program Details: Company provides the following insurance benefits
1) Group Medical Policy

1) Enrollment Process
2) Hospitalization and Reimbursement Procedure
2) Group Personal Accident Policy
3) Group Term Life Policy
B. Point of Contacts and Escalation Matrix

C. Frequently Asked Questions
Note: Confidential Document

The information contained here is only a summary of the employee benefit insurance policy documents which are kept by the employer. If there is a conflict
in interpretation then the terms & conditions of the applicable policy document will prevail.
Group Mediclaim Policy
Employee Insurance Benefit Guide| Compensation and Benefits | January 1, 2021 © Capgemini 2021. All rights reserved | 3
Group Medical Policy
The Group Medical policy covers expenses by the insured persons on account of hospitalization
due to sickness or accident. The policy covers expenses incurred on room rent, medicines,
surgery etc.
A. Program Details
• Plan Information
• Benefit Details
• Enrollment Procedure
• General Exclusion
• Claims Process
Plan Information - Group Medical Policy
Plan Name Group Medical Plan
Insurance Company The New India Assurance Company Limited
Medi-Assist Medi Assist India Pvt. Ltd
Inception Date 01st Jan 2021
Expiry Date 31st Dec 2021
Inclusions:
• Capgemini Full Time Employees
Policy Coverage Details • Employees on Secondment for less than or equal to 1 year
Exclusions:
• Employees on Secondment for more than 1 year
Age 18 to 30 years - INR 200,000

Age 31 to 40 years - INR 300,000
Age 41 and above - INR 400,000
Sum Insured Limits
Sum insured will be based on the completed age of employee as on 31st Dec 2020. Enhancement in sum insured
due to change of age will be applicable from subsequent renewal
• Employee
• Spouse / Partner**
Members Covered • Dependent Children (Upto the age 25)
Coverage will be for dependents as declared on system as on 31st December, 2020
Geographical Limits Within India
Mid-Term Enrollment Only allowed for newborn baby, Adoption and newly wed spouse
**Please refer to page 15 to understand the coverage of Partner under Group Medical Plan
Benefit Details - Group Medical Policy
Policy Benefits Policy Benefits
Standard Hospitalization Covered Covered subject to hospitalization in Government
hospitals only.
Pre & Post Hospitalization Homeopathic and Ayurvedic
Covered Crosspathy treatment (homeopathic / ayurvedic
Expenses Treatments
treatment provided along with allopathic
Maternity Benefits Covered treatment) is not covered under the policy.
Pre & Post Natal Expenses Covered Covered within and upto Maternity sublimit, if
performed legally & under medical advice within
first 20 weeks on confirmation of substantial risk
New Born Baby cover day 1 Yes that if the child were born, it would suffer from
Abortion
such physical or mental abnormalities as to be
Pre-existing Diseases Covered seriously handicapped. 20 weeks to be extended
as per amendment in MTP Act, 1971 in due
First 30-days Waiting Period Waived Off course of time
First Year Waiting Period Waived Off Ambulance Services Maximum upto INR 2,500 per hospitalization
1% sum insured sub to min of INR

3,000 for Normal room & no limit for ICU
(If the employee opt for higher room
Room Rent Capping
over & above the eligibility then
proportionate deduction will be applicable
on total hospital bill excluding medicines)
Infertility Treatment Coverage upto INR 10,000 per employee
Employees will be eligible for corporate

buffer under this scheme. Please note
Corporate Buffer Note :The above are only snapshots of the benefits provided under your group
that this will be as per organization’s
discretion. medical plan
Benefit Details - Group Medical Policy
Additional Benefits
Capgemini medical plan do cover advance medical treatment cost for below procedure / treatment:
Psychiatric Treatment with Eye-sight correction

Cyber Knife Gender change surgery**
cap of INR 50,000 beyond +/-7
Age related Macula Morbid Obesity Treatment Internal and External

Stem Cell Treatment
Disorder (non-cosmetic) Congenital Disease
Functional Endoscopic
Robotic Surgery Cochlear Implant -
Sinus Surgery
**Admissibility of claim will be decided basis of medical requirement of such surgery.
Note :The above are only snapshots of the benefits provided under your group medical plan.
Other Benefits - Group Medical Policy
Policy Benefit Definition Covered/Not Covered
Any Pre-Existing Condition or related condition for which care, treatment or advice
was recommended by or received from a Doctor or which was first manifested prior
Pre-existing Diseases to the commencement date of the Insured Person’s first Health Insurance policy Covered
with the Insurer
Any disease contracted by the Insured Person (except for the “First Year diseases”
listed below) during the first 30 days from commencement date of the Policy is not
covered. This exclusion shall not apply if in the opinion of Panel of Medical
Practitioners constituted by the Company for the purpose, the Insured person
First 30 day waiting period Waived
could not have known of the existence of the Disease or any symptoms or
complaints thereof at the timer of making the proposal for insurance to the
Company
During the first year of the operation of the policy, the expenses on treatment of
diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for
Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Diseases,
First year Waiting Period Fistula in anus, Piles, Sinusitis and related disorders are not payable. If these Waived
diseases are pre-existing at the time of proposal, they will not be covered even
during subsequent period or renewal
Any expenses related to treatment for ear, dental and eye will be covered only if it
is resultant of accident. If otherwise the same will not be covered under the policy.
Hearing, Dental & Vision Not Covered
The accident occurrence date has to be with in the policy period
Standalone diagnostic expenses are not payable under the policy. If the diagnosis is
Diagnostic Expenses followed by treatment the diagnostic expenses can be claimed as pre hospitalization Not Covered
expense
Standard Hospitalization - Group Medical Policy
If any Insured Person suffers an Illness or Accident during the Policy Period that requires that Insured Person’s
hospitalization as an inpatient, then the insurer will reimburse reasonable and customary expenses towards the below
mentioned hospitalization under your group medical plan.
• Inpatient Treatment
• Room rent and boarding expenses
• Doctors fees (who needs to be a medical practitioner)
• Intensive Care Unit
• Nursing expenses, Anesthesia, blood, oxygen, operation theatre charges, surgical appliances
• Medicines, drugs and consumables (Dressing, ordinary splints and plaster casts)
• Diagnostic procedures (such as laboratory, x-ray, diagnostic tests)
• Costs of prosthetic devices if implanted internally during a surgical procedure
• Organ transplantation including the treatment costs of the donor but excluding the costs of the organ
The expenses shall be reimbursed provided they are incurred in India and are within the policy period. Expenses will
be reimbursed to the covered member depending on the level of cover that he/she is entitled to. Expenses that are of
a diagnostic nature only or are incurred from a preventive perspective with no active line of treatment and do not
warrant a hospitalisation admission are not covered under the plan.
Pre & Post Hospitalization Expenses- Group Medical Policy
Pre-hospitalization expenses Post-hospitalization Expenses
If the Insurer accepts a claim under

If the Insured member is diagnosed with an hospitalization and immediately following the
Illness which results in his / her hospitalization Insured Member’s discharge, further medical
Hospitalization and for which the Insurer accepts a claim, the treatment directly related to the same
Expenses Insurer will also reimburse the Insured Member’s condition for which the Insured Member was
Pre-hospitalization expenses for up to 30 days hospitalized is required; the Insurer will
prior to the date of their Hospitalization reimburse the Insured member’s Post-
hospitalization expenses up to 60 days
Duration 30 days 60 days
Such Medical Expenses must be incurred for the Such costs are incurred in respect of the same
Restrictions same condition for which the Insured Person’s condition for which the Insured Person’s
subsequent hospitalization was required earlier hospitalization was required
Please note that although you are covered for post hospitalization claims for 60 days from the date of discharge, you
are expected to file a reimbursement claim with the Medi-Assist within 30 days of incurring the expense
Maternity Benefits - Group Medical Policy
The maternity benefit is provided under your group medical plan
Maximum Benefit INR 50,000 for Normal & INR 65,000 for C – Section (applicable for Employee / Spouse)
9-months waiting period Waived Off
Pre-Post Natal expenses OPD cover upto INR 5,000 & IPD within Maternity limit
New born baby covered

Yes
from day 1
No. of maternity claims Not restricted

Important:
• These benefits are admissible only if the expenses are incurred in Hospital/Nursing Home as in-patients in India
• Expenses incurred in connection with voluntary medical termination of pregnancy during the first 12 weeks from the date
of conception are not covered. Sterilization expenses excluded
• Maternity claim submission timeline for Female employees is 180 days (as an exception) & Male employees is 30 days
from the date of discharge
• Please ensure you update your new born baby details on HR system immediately maximum within 30 calendar
days from the birth of the child with relevant enrollment data (name, date of birth & gender).
• Well baby care charges - In case, new born baby doesn’t require separate hospitalisation/no complication seen in baby
and if hospital has included Baby Wellness / Wellborn / Well Being or any other related charges separately or in mother’s
bill are not covered in the policy
General Exclusions - Group Medical Policy
• Injury or 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) or by nuclear weapons / materials
• Circumcision (unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to any
accident), vaccination, inoculation or change of life or cosmetic or of aesthetic treatment of any description, plastic surgery
other than as may be necessitated due to an accident or as a part of any illness
• Cost of spectacles, contact lenses, hearing aids etc., Surgery for correction of eye sight, power upto + / - 7
• Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including
wear and tear etc. unless arising from disease or injury and which requires hospitalization for treatment
• Convalescence, general debility, “run down” condition or rest cure, sterility, any sub-fertility or assisted conception
procedure, venereal diseases, intentional self-injury / suicide and diseases / accident due to and or use, misuse or abuse of
drugs / alcohol or use of intoxicating substances or such abuse or addiction etc.
• All expenses arising out of any condition directly or indirectly caused by, or associated with Human T-cell Lymphotropic Virus
Type III (HTLD - III) or Lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or Variations Deficiency
Syndrome or any Syndrome or condition of similar kind commonly referred to as AIDS, HIV and its complications including
sexually transmitted diseases
• Expenses incurred at Hospital or Nursing Home primarily for evaluation / diagnostic purposes which is not followed by active
treatment for the ailment during the hospitalized period
• Expenses on vitamins and tonics etc. unless forming part of treatment for injury or disease as certified by the attending
physician
• Any Treatment arising from or traceable to pregnancy, miscarriage, or complications of any of these including changes in
chronic condition as a result of pregnancy except wherever covered under the maternity section of benefits
• Naturopathy treatment, unproven procedure or treatment, experimental or alternative medicine and related treatment
including acupressure, acupuncture, magnetic and such other therapies etc.
General Exclusions - Group Medical Policy (continued)
• Expenses incurred for investigation or treatment irrelevant to the diseases diagnosed during hospitalization or primary
reasons for admission. Private nursing charges, Referral fee to family doctors, Out station consultants / Surgeon’s fees etc.
• External and/or durable Medical/Non-medical equipment of any kind used for diagnosis and/or treatment including CPAP,
CAPD, Infusion pump etc.; Ambulatory devices i.e., Walker, Crutches, Belts, Collars, Caps, Splints, Slings, Braces, Stockings
etc. of any kind; Diabetic footwear; Glucometer/Thermometer and similar related items; also, any medical equipment which
is subsequently used at home
• All non-medical expenses including personal comfort and convenience items or services such as telephone, television, aya/
barber or beauty services, diet charges, baby food, cosmetics, napkins, toiletry items etc., guest services and similar
incidental expenses or services etc.
• Change of treatment from one path to other path unless being agreed/allowed and recommended by the consultant under
whom the treatment is taken
• Treatment of obesity or condition arising therefrom (excluding morbid obesity and life threatening) and any other weight
control program, services or supplies etc.
• Any treatment required arising from Insured’s participation in any hazardous activity including but not limited to scuba
diving, motor racing, parachuting, hang gliding, rock or mountain climbing etc., unless specifically agreed by the Insurance
Company
• Any treatment received in convalescent home, convalescent hospital, health hydro, nature care clinic or similar
establishments
• Any stay in the hospital for any domestic reason or where no active regular treatment is given by the specialist
• Out-patient Diagnostic, Medical or Surgical procedures or treatments, non-prescribed drugs and medical supplies
• Massages, Steam bathing, Shirodhara and alike treatment.
• Any kind of Service charges, Surcharges, Admission fees/Registration charges etc., levied by the hospital
• Doctor’s home visit charges, Attendant/Nursing charges during pre- and post-hospitalization period
• Treatment which is continued before hospitalization and continued even after discharge for an ailment/disease/injury
different from the one for which hospitalization was necessary
Enrollment Process
Enrollment Procedure - Group Medical Policy
1. New Joiner: You need to update your dependent data within 30 days of joining the organization
2. Mid-term Inclusions: New Spouse/Partner & New-born child must be declared within 30 days of marriage or birth respectively
A. Partner enrollment:
Partner Definition: Two individuals (18 years of age and above) of the same gender who are in a relationship as a couple. For the
purpose of this policy, individually they shall be referred to as ‘Partner’.
Insurance Benefits: Insurance benefit refers to only medical insurance for partners (only).
Enrollment Conditions:
1. Employee may enroll their partner as defined by and under conditions allowed by Capgemini
2. Employee & their Partner must satisfy the definition of Partners above
3. Employee’s Partner must be 18 years of age or older
4. The relationship between the employee and their Partner shall not be in violation to any law in India
5. Your enrollment must be completed within 30 days of your joining the company/addition of partner
6. In case of revocation or modification of the self-declaration, the employee in their sole responsibility should raise a ticket on
MyConnect
3. Please ensure to validate and update your dependent information on MyConnect
Path : Talent India >> Access All >> Human Resources >> MyConnect >> Access your personal data (Employee Self Service) >> Personal
Information >> Personal Profile >> View/Update Family dependent information
4. If you fail to enroll within the defined timelines, enrollment may only be done at the next annual renewal
5. On receipt of your Medi-assist id (MAID) please validate to ensure that all your dependents are included, and their information is correct. Incase of
any discrepancies, please raise a ticket on MyConnect. Click here to understand the process to raise Ticket
Hospitalization Procedure - Group Medical Policy
Cashless Hospitalization - Group Medical Policy
Cashless hospitalization means the Administrator may authorize (upon an Insured person’s request) for direct settlement
of eligible services and the corresponding charges between a Network Hospital and the Administrator. In such case, the
Administrator will directly settle all eligible amounts with the Network Hospital and the Insured Person may not have to
pay any deposits at the commencement of the treatment or bills after the end of treatment to the extent these services
are covered under the Policy.
List of hospitals in the Medi-Assist’s network eligible for cashless hospitalization

Hospital Network List
1. Click on Website –
https://www.medibuddy.in/networkHospitals For Assistance : capgemini@mediassist.in
2. Click on Network Hospital Lists
3. You may save this excel file on your workstation, preferred
to view online as it is updated regularly
Contact Call center at 24 X 7 Customer Service Center - Fax Number
9036 00 1656 022 - 6631 4781
Cashless Hospitalization Process
Always keep the Ecard & Govt ID proof of the patient who is getting
admitted handy.
For planned hospitalization, approach the hospital minimum 48 hours
prior to admission, present the E-card and complete the pre-
authorization formalities.
Approach the hospital insurance desk and request for a cashless form.
Fill the form & submit it at the hospital insurance desk.
For any delays/issues, please reach member Insurance SPOC.
Cashless Process
Step 1 : Pre-authorization by Medi Assist for Cashless Claims
Member intimates Medi Assist
of the planned hospitalization
Medi Assist authorizes
in a specified If the claim is registered Yes cashless as per SLA for Pre-Authorization
pre-authorization format by Medi Assist on the
planned hospitalization Completed
at-least 48 hours in advance. same day
(via MediBuddy app or to the hospital
Webpage)
*All non-emergency hospitalization

instances must be pre-authorized by Medi The member can follow
Assist. This is done to ensure that the If the claim is not
registered by Medi
No non-cashless process
best healthcare possible, is obtained, and and submit a
the patient/employee is not Assist on the same day reimbursement claim
inconvenienced when taking admission post discharge
into a Network Hospital.
Step 2 : Admission, Treatment & discharge
After the hospitalization has

been pre-authorized, member
needs to secure admission at
the hospital. Member produces ID Member gets treated and Hospital sends complete Medi Assist starts
A letter of credit will be issued card at the network discharged after paying all set of claims documents processing the claims and
by Medi Assist to the hospital. hospital and gets non entitled benefits like for processing to Medi proceeds to settlement
The member is not required to admitted refreshments, etc. Assist with the insurer
pay the hospitalization bill in
case of a network hospital.
Emergency Hospitalization Process
STEP 1 STEP 2 STEP 3
Relatives of admitted member should After member hospitalization

In cases of emergency, the
inform the call center within 24 has been pre-authorized the
member should get admitted in
hours about the hospitalization & seek employee is not required to pay
the nearest network hospital by
pre-authorization. The pre- the hospitalization bill in case
showing their ID card.
authorization letter would be directly of a network hospital. The bill
given to the hospital. In case of denial will be sent directly to, and
member would be informed directly settled by Medi Assist
Member/Hospital
Member gets admitted applies for pre- Medi Assist verifies
in the hospital in case Member logs in to authorization with Medi applicability of the claim Pre-authorization given
of emergency by portal.medibuddy.in Assist within 24 hrs of to be registered and by Medi Assist
showing his ID Card admission issue pre-authorization
Yes
No
Member gets treated and Hospital sends complete

Non cashless
discharged after paying all set of claims documents
Hospitalization
non-medical expenses like for processing to the
Process
refreshments, etc. Medi Assist
Non-Cashless Hospitalization Process
Admission Procedure Discharge Process Submission of Hospitalization Claim
In case the member chooses a non-network hospital, In case of non network hospital, member will be Member must submit the final claim with all relevant
they will have to liaise directly with the hospital for required to clear the bills and submit the claim to Medi documents within 60 days from the date of discharge
admission Assist for reimbursement from the insurer. from the hospital.
It is advised and recommended to follow the pre- Please ensure that member collects all necessary
authorization procedure to ensure eligibility for documents such as – discharge summary,
reimbursement of hospitalization expenses from the investigation reports etc. for submitting member claim.
insurer.
Non-Cashless Claim Process
Member intimates Medi
Claim registered by Insured admitted as Insured sends relevant
Assist before or as soon as
Medi Assist after per hospital norms. All documents to Medi
hospitalization occurs not A
receipt of claim payments made by Assist office within 45
later than 15 days from
intimation member days of discharge
date of admission
Yes If the document is • Insured will create the summary of Bills (2

Medi Assist performs
If claim is payable medical scrutiny of the received within 60 copies) and attach it with the bills
documents Yes days of discharge
• The envelope should contain clearly the
No Employee ID & Employee e-mail
No
Claim Rejected
Medi Assist checks for If documentation complete Claims processing Payment to be made to
document sufficiency as required Yes done as per SLA employee.
No
Send mail about

deficiency and A
document requirement
Document Checklist for Speedy Reimbursement
For a claim to be processed and approved, it is critical to have all paperwork in order.
A claim will often get rejected if there are missing documents or if the submitted paperwork lacks necessary details.
Here’s a list of documents member need to furnish to put member reimbursement on the fast-track and to make the
process hassle-free:
Original filled & duly signed claim form Download claim form here.
Detailed schedule of expense, calculating amount of all bills submitted
Original Discharge Card/ Summary
Original final hospital bills with bill no., and detailed bill summary/break up
Original numbered receipts for payments made to the hospital /Doctor
All bills for investigations done with the respective reports
All bills for medicines supported by relevant prescriptions
Employee details /ID card copy and any Government ID proof copy
Any Government ID proof copy of the patient
MLC /FIR, in case of road traffic accidents
Online Claim Submission Process 1/3
Steps for Reimbursement Claim Document uploading
Step 1 Step 2 Step 3

Member logs in to www.portal.medibuddy.in Once logged in, member clicks on the Menu Member then fills in the required user details
with the username and password provided tab and selects Submit Hospitalization claim as shown in the screen below
Step 4 Step 5 Step 6

Upon completing the hospitalization details,
If the member has not entered their account The member to proceed to filling the
the member will then proceed to a
details, they can do so before submitting the hospitalization details. On adding the details
comprehensive checklist where they can
claim details member can click on save and next
check all necessary documents that need to
be uploaded
Step 7
Once the member has all documents ready,
they can then proceed towards uploading the
documents and submitting the same post
checking the declaration
Note:
While our comprehensive technology helps
enable members to submit claims online, it is
mandatory to submit all original physical claim
documents as uploaded online.
Claims submission pending for the period
January 1, 2020 – December 31, 2020 (IMPORTANT)
• Any hospitalization with date of admission on or before December 31, 2020 will fall under the purview of 2020 policy
• Claim documents submitted post January 31, 2021 will not be processed by the Insurer
• The hardcopy of the admissible claim documents of 2020 to reach the insurer before January 31, 2021 at the below
mentioned address. Helpdesk at CG offices will NOT be available
Medi-Assist India TPA Private Ltd.,

4th Floor, Aarpee Chambers
Shagbaug, Off Andheri-Kurla Road
Next To Times Square, Marol,
Andheri East, Mumbai - 400059
Group Personal
Accident Policy
Group Personal Accident Policy (GPA)
Program Details
• Benefit Details
• Claim Procedure
• Document Checklist
• Exclusions
The Group Personal Accident Program covers Capgemini employees against the financial
risk of death / injury sustained due to an accident caused by violent, visible and external
means.
Benefit Details - Group Personal Accident Policy
Basic Policy Details
Insurance Co. ICICI Lombard Insurance Co Ltd
Policy Name Group Personal Accident Inception date 01st Jan 2021
Policy Details Type Accident Cover Expiry 31st Dec 2021
Sum Insured Multiple of salary
Policy Coverage Details
Inclusions:
• Employees on Secondment for less than or equal to 1 year
Exclusions:
• In case of Accidental injury; following which an employee works from home without utilising the leave will not qualify as loss of pay as
per policy terms
Benefit Details - Group Personal Accident Policy
Benefit Coverage
Cover Details
Accidental Death (AD)

36 times of Monthly Total Fixed Compensation, capped at INR 50,000,000
Permanent Total Disablement (PTD)
Permanent Partial Disability (PPD) Covered as per the scale of benefits (refer next slide for details)
• 1% of the Sum Insured or INR 5,000 per week or gross weekly salary which ever is less
limited upto 100 weeks
Temporary Total Disability (TTD)
• Employees on Leave arising out of any injury covered under GPA will be granted benefit of
loss of pay
Upto INR 10,000 or as per actual, whichever is lower on submission of Doctors certificate and
Emergency Medical Expenses
medical bills
Transportation of Family Members/
Upto INR 10,000/- or as per actual, whichever is lower
Repatriation of Remains
This will be considered either in PTD or in PPD and accordingly the limit will be followed. Sum
Coma Benefit
Insured (SI) will depend upon case to case basis
Animal Attack Benefit 100% in case of death else medical allowance limit will be followed
Modification allowance benefit upto INR The expenses incurred for modification of house and/or vehicle necessitated due to disability
50,000/- resulting from an accident.
Geographical Limits Worldwide
Terrorism Covered
Scale of Benefits -Permanent Partial Disability (PPD)
% of Sum % of Sum
Losses covered Losses covered
insured insured
Loss of toes – all 20% Loss of middle finger - three phalanges 6%
Great both phalanges 5% 8 two phalanges 4%

1
Great - one phalanx 2% one phalanx 2%
Other than great if more than one toe
1% Loss of ring finger - three phalanges 5%
lost each
2 loss of hearing- both ears 75% 9 two phalanges 4%
3 loss of hearing- one ear 30% one phalanx 2%

Loss of four fingers and thumb of one
4 40% Loss of little finger - three phalanges 4%
hand
5 Loss of four fingers 35% 10 two phalanges 3%
Loss of thumb - both phalanges 25% one phalanx 2%

6
one phalanx 10% Loss of metacarpus:
3%
first or second (additional)
Loss of Index finger - three phalanges 10% 11
Loss of metacarpus:
2%
7 two phalanges 8% third, fourth or fifth (additional)
% as assessed by
one phalanx 4% 12 Any other permanent partial disablement
the Doctor
Claim Procedure - Group Personal Accident Policy
Employee / Beneficiary
notifies HR, who in turn would
intimate Insurer and submit required
claims documents within 30 days of
the occurrence of the event
Claim Investigation and Review post

On obtaining all relevant documents,
submission of all the required
Insurer begins processing the claims
documents
Yes Is claim No
approved?
On approval, eligible claim amount

will be remitted to Employee / On rejection of the claim, Insurer
Beneficiary as per the bank account would provide a valid reason for the
details provided along with claim rejection to HR / Employee /
documents. Beneficiary
Document Checklist-Group Personal Accident Policy
Weekly Benefit Claims Death Claims Dismemberment / Disablement Claims
1 Completed Claim form 1 Completed claim form 1 Completed Claim form
2 Doctor's Report 2 Doctor's Report

2 Attending Doctor's report
Disability Certificate from the
3 Disability Certificate from the Doctor, if
Doctor, if any 3 Death Certificate 3 any (Authorized Disability certificate
Fitness Certificate from treating from Govt hospital-Civil Surgeon)
4 doctor mentioning From & To rest
days along with fitness date 4 Post Mortem/ Coroner's report
4 Investigation/ Lab reports (x-ray etc.)
Investigation/ Lab reports
5
(x-ray etc.) and
5 FIR ( First Information Report) Original Admission/discharge card, if
Original Admission/discharge card, 5
6 hospitalized
if hospitalized
Police Inquest report, wherever Police Inquest report, wherever
Employers Leave Certificate & 6 6
7 applicable applicable
Details of salary
If admitted the Admission history &
If RTA Case, Need FIR and MLC 7 7 If RTA Case, Need FIR and MLC Copy
8 other medical papers
Copy
NEFT Mandate Form along with NOC NEFT Mandate Form along with NOC If NEFT Mandate Form along with NOC If
9 8 8
If payable to injured payable to injured payable to injured
Cancelled Cheque (with insured 9 Cancelled Cheque 9 Cancelled Cheque (with insured name)
10
name)
Exclusions - Group Personal Accident Policy
 Suicide, attempted suicide (whether sane or insane) or intentionally self-inflicted injury or illness, or sexually
transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency
Syndrome (AIDS), Human Immune-deficiency Virus (HIV) infection; or
 Being under the influence of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a
Physician and taken as prescribed; or
 Participation in an actual or attempted felony, riot, crime, misdemeanor (excluding traffic violations) or civil
commotion; or
 Operating or learning to operate any aircraft, or performing duties as a member of the crew on any aircraft; or
Scheduled Aircraft.; or
 Self exposure to needless peril (except in an attempt to save human life); or
 Loss due to childbirth or pregnancy
Group Term Life Policy
Group Term Life Policy (GTL)
Program Details
• Benefit Details
• Claim Procedure
• Document Checklist
Group Term Life Insurance Scheme is meant to provide life insurance protection to Capgemini
employees. The Policy provides for payment of a lump sum to the nominated beneficiary in the
unfortunate event of the employee’s death.
Benefit Details - Group Term Life Policy
Basic Policy Details
Insurance Co PNB MetLife India Insurance Company Limited
Policy Name Group Term Life Inception date 01st Jan 2021
Policy Details Type Life Cover Expiry 31st Dec 2021
Sum Insured Multiple of salary
Policy Coverage Details
Inclusions:
• Employees on Secondment for less than or equal to 1 year
Exclusions:
Benefit Coverage
Cover Details
Death: In the event of death of a member from any cause (natural / accidental), provided that this shall occur while the insurance of such
member is in force, an amount determined at the time of policy inception in accordance with the Policy Schedule shall be paid
Sum Insured Limits
24 times of Monthly Total Fixed Compensation (MTFC) limited to Min 9 Lakh and Max up to 1 Crore
Claims Procedure - Group Term Life Policy
Employee / Beneficiary / Relative / Colleague notifies
Anviti /HR team, who in turn would intimate insurer
and will submit required claims documents within 15
days of the event to Anviti team. In case of death of
employee, family member can contact HR team.
Colleague / Beneficiary informs the Supervisor /
BUHR on the demise
On obtaining all relevant Claim Investigation and Review

documents, Insurer begins within 10 days of submission of
processing the claims all the required documents
Yes Is claim No
approved
within 10
days
On approval, eligible claim amount will be

On rejection of the claim, Insurer would
remitted to Employee / Beneficiary as per the
provide a valid reason for the rejection to
bank account details provided along with claim
Capgemini.
documents.
Document Checklist - Group Term Life Policy
Type of Claim Requirement
1. Claim Forms
Part I: Application Form for Death Claim (Claimant’s Statement) #
Part II: Physician’s Statement, relevant Hospital records and report from the concerned
medical specialist giving nature of disability and illness (for Terminal Illness claims)
2. Death Certificate issued by a local government body like Municipal Corporation/Village
Panchayat #
3. Medical Cause of Death Certificate issued by attending physician/hospital #

Death (all causes of death #)
Terminal Illness 4. Attested True Copies of Indoor case Papers of the hospital(s)
And Disability 5. Post-mortem Report (Autopsy Report) & Chemical Viscera Report – if performed #
6. The Beneficiary :
- Photo ID with DOB with relationship to the insured
- Proof of legal title to the claim proceeds (e.g. legal succession papers, assignment deed etc.)
7. Employer’s Certificate (wherever required)
8. Leave Record of Employee (wherever required)
All Police Reports / First Information & Final Investigation Report

If Death due to Accident
Proof of Accident – Panchnama / Inquest Report
(submit in addition to the above)
Newspaper cutting / Photographs of the accident – if available
Points of Contact and Escalation Matrix
MediBuddy App/ Webpage
Please visit web portal/ App. Medibuddy that gives you anytime-anywhere access to your health insurance policy.
You can use Medibuddy for knowing more about your
1. Policy
2. Claim submission- tracking claims etc
3. Pre-Authorization
4. Download E-Cards
5. Network Hospitals
Mobile App Download Process :

1. Give a missed call on 1800 5729 792
2. You will get SMS to download link to your smartphone
3. Available on Google Play Store and Apple App Store
Web Access :
1. Single Signon via Talent Page:
• Click on URL: https://talent.capgemini.com/in
• India >> Featured Links >>Medibuddy
2. Medibuddy Webpage: For any assistance with login please

Click on URL: https://portal.medibuddy.in • Call - 9036001656 or
Username: Capgemini email id
• Write to capgemini@mediassistindia.com.
Password: DDMMYYYY (DOB of employee)
Capgemini Query Resolution
For any HR queries related to insurance, please follow the below steps:
1. Login to My Connect
2. Under “Forms to manage your HR admin queries”, click on “Your Benefits”
3. Click on “Medical Insurance”
4. Detail your query and upload documents (if applicable)
5. Click on “Submit”
Escalation Matrix for Medi-claim (Medi-Assist)
Location SPOC Contact # Email Id Location
Praveen Patel 9686981395 Bangalore
Nethaji E N 7338744544 Chennai
Ankit Verma 9513362286 Delhi
Nethaji E N 7338744544 Hyderabad
capgemini@mediassist.in
Sufia Kalim 9742383311 Kolkata
Akash Upadhyay 9742385577 Mumbai – Vikhroli
Harishankar Rajjak 9742386600 Navi Mumbai – Airoli
Bhagyashree Jambhale 9606272303 Pune
Level Name Contact No Email ID

Contact Centre Dedicated Contact no. +91 903 600 1656 capgemini@mediassit.in
As per location wise Contact

Level 1 Helpdesk Personal capgemini@mediassit.in
matrix
Level 2 Ashrafali Shaikh +91 97423 74400 ashrafali.barkatali@mediassist.in

Level 3 Raj Kartar +91 91481 99757 rajesh.kartar@mediassist.in
For further support on your query, please reach out to Anviti team members as per your respective entity:
Name Capgemini Entity Email ID Contact No Level

Albert Fernandes Non-FS-BSv capgemini.mumbai@anviti.in +91 8104998331 Level 1
Pradeep Jaiswal BPO capgemini.bangalore@anviti.in +91 7676846885 Level 1
Namann Sahhani FS capgemini.pune@anviti.in +91 9860995622 Level 1
Gautam Gokhale All entities Gautam.Gokhale@anviti.in +91 9967981281 Level 2
Escalation Matrix for Accident and Life Plan
Level Name Capgemini Entity Email ID Contact No
Level 1 Albert Fernandes Non-FS-BSv albert.fernandes@anviti.in +91 81049 98331
Level 1 Sujesh J BPO sujesh.jayachandran@anviti.in +91 78299 44112
Level 1 Namann Sahhani FS namann.sahhani@anviti.in +91 98609 95622
Level 2 Gautam Gokhale All entities gautam.gokhale@anviti.in +91 99679 81281
Frequently Asked Questions
Important FAQs - Group Medical Policy
• What other expenses are excluded apart from those mentioned under general exclusion?
Expenses like Registration Fees, File opening fees, Telephone, Internet charges , Food and refreshments supplied to
visitors and attendants, Television charges, service fees, any expenses not related to treatment of illness are non-
medical expenses and not covered under the plan.
• How do I cover my spouse or my newborn child?

You will have to enroll your spouse/partner/newborn baby within 30 days of the life event via MyConnect.
• What is a Medi-Assist ID (MAID)/E-Card?

It is an identification card issued by Medi-Assist. Once validated by Medi-Assist, it will entitle you to credit towards
hospitalization and any other negotiated benefits at hospitals on the Medi-Assist panel upon pre-authorization.
Information on this is available with the Medi-Assist customer service helpline. Please remember the ID card is not a
credit card. The card does not entitle you to credit. To avoid any misuse of your card, the hospitals may ask you to
furnish some photo identification for the member (e.g. Voter ID, PAN Card, Driving License etc).
Once your details have been forwarded by HR to the Insurer, the Insurer will make additional endorsements and give
details of the same to Medi-Assist. Medi-Assist will issue the card on the basis of complete information received on the
employee and dependents. It normally takes 14 working days to issue the ID card. In case you lose your ID card,
please inform HR immediately.
• What if the hospital does not accept my Medi-Assist ID card?

Please make sure that the hospital is on the Medi-Assist / New India network list. This can be verified by accessing the
website (https://portal.medibuddy.in/Home.aspx) of the Medi-Assist or call the Medi-Assist customer service
helpline for assistance. If it is a network hospital and you are not accepted, please report the refusal to Medi-Assist
making note of the name of the hospital staff.
• What are network hospitals? What should I do when I reach the hospital?
These are hospitals where Medi-Assist has a tie up for cashless hospitalization. Once you reach the hospital, please
show your ID card for identification. Please complete the pre-authorization procedure listed earlier. Medi-Assist will
send a letter of credit (upon pre-authorization) to the hospital making sure they extend the credit facility to you.
If pre-authorization is not done, you must collect all reports and discharge card when you get discharged. Please make
sure you sign the hospital bill before leaving the hospital. You will then submit the claim along with all necessary
supporting documents to Medi-Assist for reimbursement . Please complete the Claim Form, attach all relevant
documents as per the reimbursement process mentioned
• What are claim reimbursements?

In the event where cashless hospitalization is not availed, you will need to submit all original bills along with the Claim
Form to the Medi-Assist. Upon approval, the hospitalization expenses will be reimbursed to you.
• How can I claim my pre & post hospitalization expenses?

The group policy covers pre-hospitalization expenses made prior to 30 days of hospitalization and incurred towards the
same illness/ disease due to which hospitalization happens. It also covers all medical expenses up to 60 days post
discharge as advised by the Medical Practitioner. All bills with summary to be sent to Medi-Assist for reimbursement.
• How can I make a claim if a claim is made partly under my name and my spouse’s insurance plans?
Claims can be settled under multiple policies on reimbursement basis. First, submit the claim to the first insurer /
Medi-Assist. Request for the original documents to be returned by the Medi-Assist. This will only be done if a part claim
is submitted and the Medi-Assist will mark the claim as settled up to the limit. The balance of expenses can be
submitted to the second insurer / Medi-Assist for settlement
What are the key reasons why a claim under the medical policy could be completely rejected under the plan?
The following are some common reasons for rejection, though NOT the only reasons for which a claim could be rejected.
1) Treatment taken after leaving the organization
2) Treatment that should have been taken on out-patient basis (unnecessary inpatient admission and /or no active line of
treatment in the hospital) or where hospitalization has been done primarily for preventive reasons
3) Treatment taken that is not covered as per policy conditions or excluded under the policy. Please go through the list of
standard exclusions listed earlier
E.g. Ailment because of alcohol abuse is a standard exclusion. Cosmetic treatments or treatments for external conditions
such as squint correction etc. are not covered. Hospitalization taken in a hospital which is not covered as per policy
conditions (E.g. less than 10 bed hospitals). Admission before/after the policy period or details of member not updated on
the insurer’s list of covered members.
4) In case original documents are not submitted as per the claim submission protocol, the claim may stand rejected
Kindly refer to the following document to understand the detailed inclusions and exclusions of (but not
limited to) treatments: Exclusion & Inclusion Document
About Capgemini
A global leader in consulting, technology services and digital transformation,
Capgemini is at the forefront of innovation to address the entire breadth of clients’
opportunities in the evolving world of cloud, digital and platforms. Building on its
strong 50-year heritage and deep industry-specific expertise, Capgemini enables
organizations to realize their business ambitions through an array of services from
strategy to operations. Capgemini is driven by the conviction that the business
value of technology comes from and through people. It is a multicultural company
of 200,000 team members in over 40 countries. The Group reported 2016 global
revenues of EUR 12.5 billion.
Learn more about us at

People matter, results count. www.capgemini.com
This message contains information that may be privileged or confidential and is

the property of the Capgemini Group.
Copyright © 2017 Capgemini. All rights reserved.

Employee Insurance Benefit Guide 2021 V7 5 April 2021

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Employee Insurance Benefit Guide 2021 V7 5 April 2021

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Employee Insurance Benefit Guide - 2021

About this Employee Benefits Guide

A. Program Details: Company provides the following insurance benefits

1) Group Medical Policy

B. Point of Contacts and Escalation Matrix

Note: Confidential Document

Age 18 to 30 years - INR 200,000

1% sum insured sub to min of INR

Infertility Treatment Coverage upto INR 10,000 per employee

Employees will be eligible for corporate

Psychiatric Treatment with Eye-sight correction

Age related Macula Morbid Obesity Treatment Internal and External

**Admissibility of claim will be decided basis of medical requirement of such surgery.

Pre-hospitalization expenses Post-hospitalization Expenses

If the Insurer accepts a claim under

9-months waiting period Waived Off

New born baby covered

No. of maternity claims Not restricted

List of hospitals in the Medi-Assist’s network eligible for cashless hospitalization

For planned hospitalization, approach the hospital minimum 48 hours

prior to admission, present the E-card and complete the pre-

Fill the form & submit it at the hospital insurance desk.

For any delays/issues, please reach member Insurance SPOC.

*All non-emergency hospitalization

Step 2 : Admission, Treatment & discharge

After the hospitalization has

Relatives of admitted member should After member hospitalization

Member gets treated and Hospital sends complete

Admission Procedure Discharge Process Submission of Hospitalization Claim

Yes If the document is • Insured will create the summary of Bills (2

Send mail about

Detailed schedule of expense, calculating amount of all bills submitted

Original Discharge Card/ Summary

Original numbered receipts for payments made to the hospital /Doctor

All bills for investigations done with the respective reports

All bills for medicines supported by relevant prescriptions

Any Government ID proof copy of the patient

MLC /FIR, in case of road traffic accidents

Steps for Reimbursement Claim Document uploading

Step 1 Step 2 Step 3

Steps for Reimbursement Claim Document uploading

Step 4 Step 5 Step 6

Steps for Reimbursement Claim Document uploading

Medi-Assist India TPA Private Ltd.,

Insurance Co. ICICI Lombard Insurance Co Ltd

Policy Details Type Accident Cover Expiry 31st Dec 2021

Sum Insured Multiple of salary

Policy Coverage Details

Accidental Death (AD)

Great both phalanges 5% 8 two phalanges 4%

3 loss of hearing- one ear 30% one phalanx 2%

Loss of thumb - both phalanges 25% one phalanx 2%

Claim Investigation and Review post

On approval, eligible claim amount

Weekly Benefit Claims Death Claims Dismemberment / Disablement Claims

1 Completed Claim form 1 Completed claim form 1 Completed Claim form

2 Doctor's Report 2 Doctor's Report

 Self exposure to needless peril (except in an attempt to save human life); or

 Loss due to childbirth or pregnancy

Policy Coverage Details

Sum Insured Limits

On obtaining all relevant Claim Investigation and Review

On approval, eligible claim amount will be