Employees GMC Benefit Manual

Air India Express Limited

2023-2024

TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LIMITED

 Employee
Benefits-GMC

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 Group Medical Benefit

1 Coverage Details

2 Enrollment in the program

3 Cashless Process

4 Non-Cashless

5 Claims Process

6 Claims Document List

7 Benefits Extensions – Definitions

8 General Exclusions

9 GMC Contact Details

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 Medical Benefit – Coverage Details - Air India Express
Policy Parameter
Insurer The Oriental Insurance Co Ltd
TPA MD India Health Insurance TPA Pvt. Ltd
Policy Start Date 15th.May’23
Policy End Date 14th.May’24
Coverage Type Family Floater
Self + Spouse + 3 Dependent Child + 2 Parents or Parents In-Law ( Cross Selection
Dependent Coverage
Allowed )
IPD Sum Insured INR 7,50,000 Per Family Per Year
OPD Sum Insured INR 10,000 Per Family Per Year

Benefits / Extensions Coverage Benefits / Extensions Coverage

Standard Hospitalization Yes Dental Yes
Pre-existing diseases Yes Pre-Post Hospitalization Exp. Yes
Waiver on 1st year exclusion Yes Baby cover day 1 Yes
Waiver on 1st 30 days excl. Yes Ambulance Services Yes
Maternity benefits Yes
Co pay on claims No
Pre & Post Natal Expenses Yes
Covid Home Care Benefit Yes
Day Care Yes
Disease Wise capping Yes
OPD Yes
Domiciliary Yes Ayush Yes

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 Dependent Coverage
Maximum No. of Members insured in a family
Employee Yes

Spouse Yes (Married, Live in partner)

Children Yes (3 children) up to the age of 25 years

Parents Yes (set of parent (Parent / In –Law) Cross selection is

allowed. Parents once declared cannot be changed for 3
year until demise
Siblings No

Others Allowed (special child, Children from single parent,

LGBTQ)
Disallowed
Mid Term enrollment of existing Dependents

Mid Term enrollment of New Joiners (New employees + their

Allowed (Within 30 days from DOJ)
Dependents)
Mid term enrollment of new dependents (Spouse/Children)
Allowed (Within 30 days from date of event)

Termination date
End date of policy or last date in organization

*No age bar for differently abled child and Widowed daughter
** Special child is covered with no age limit until employment
*** No change in the declaration in the middle of the policy for Live in Partner
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 Definitions

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 Extensions – Definitions
Benefits Definition

Any Pre-Existing ailments such as diabetes, hypertension, etc. or related ailments for which care,
Pre-existing
treatment or advice was recommended by or received from a Doctor or which was first manifested
diseases
prior to the commencement date of the Insured Person’s first Health Insurance policy with the Insurer
Any Illness diagnosed or diagnosable within 30 days of the effective date of the Policy Period if this is
First 30-day waiting the first Health Policy taken by the Policyholder with the Insurer. If the Policyholder renews the Health
period Policy with the Insurer and increases the Limit of Indemnity, then this exclusion shall apply in relation to
the amount by which the Limit of Indemnity has been increased
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,
First Year Waiting
Hydrocele, Congenital Internal Diseases, Fistula in anus, Piles, Sinusitis and related disorders are not
period
payable. If these diseases are pre- existing at the time of proposal, they will not be covered even
during subsequent period or renewal too
Expenses incurred in respect of newborn baby would be covered from day one subject to the insurers
being intimated about the birth of the child within 15 days of birth. If the baby has to be hospitalised for
Baby Cover Day 1 any illness , disease or injury for eg. If the baby has jaundice or some other medical problem, then the
family floater limit of would apply. Normal baby expense at the time of birth is covered with the family
floater SI.
The Company shall compensate the Insured, subject to the balance Sum Insured, during the Period of
Insurance, for the amount incurred up to a maximum of INR.7500 for necessary transportation of the
Insured to the nearest Hospital, for treatment of an Illness or Bodily Injury which is admissible and
Ambulance payable under the policy. In case of life-threatening emergency condition or Accident, subject to
certification by the Medical Practitioner of such life-threatening emergency hospitalisation directly to
cardiac Ambulance charges will be paid as per actual. Air Ambulance covered in case of life-
threatening condition within 250 km radius.

Day Care Procedure means the course of medical treatment, or a surgical procedure listed in the
Day Care Schedule which is undertaken under general or local anesthesia in a Hospital by a Doctor in not less Day Care List
than 2 hours and not more than 24 hours. List attached - Click on the PDF to access the list

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 Additional– Coverage Extension
Benefits Terms

Internal & External Congenital Anomaly refers to a condition(s) which is present since birth, and which is abnormal with
Congenital reference to form, structure or position. Both Internal and external Congenital is covered.

Any Outpatient treatment that does not require hospitalization is covered up to the limit of INR
OPD 10,000 per family. This includes Dental / Vision / Diagnostic / Vaccination. Any expenses which are
Cosmetic in nature are not covered
Cost of Donor expenses will be covered with no sub limit up to SI. Cost of organ excluded.
Organ Donor Hospitalization and screening expenses for both the patient and donor will be payable only once in
policy period at the time of hospitalization.

Chemotherapy Oral Chemotherapy drug and Adjuvant chemotherapy is also covered

Psychological
Treatment of mental illness and neurodegenerative disorder is covered with family sub limit
Disorder

Ayurveda, Yoga, Unani, Siddha, Homeopathy treatment covered up to full SI with reimbursement of
AYUSH
hospitalization bills if treatment taken in Government recognized / approved AYUSH hospitals

Bariatric Treatment Covered only for employees if BMI greater than 32 with co morbidity

Payable under the Policy if prescribed by the doctor & all the bills & payment proof from
Physiotherapy Physiotherapist are provided.

Robotic/ Cyber
Covered up to full SI limit
Knife

HIV/AIDS Covered up to full SI limit

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 Additional– Coverage Extension
Benefits Terms

Artificial limbs fitted following any surgical

Covered up to full SI limit
procedure

Genetic diseases or disorders Covered up to full SI limit

Age Related Macular Degeneration (ARMD) Covered up to full SI limit

Cochlear Implant Covered up to full SI limit

Keratoconus treatment Covered up to full SI limit

Biological / hormonal and adjuvant therapies Covered up to full SI limit

Immuno modulators Covered up to full SI limit

EECP-Enhanced External counter pulsation Covered up to full SI limit

Critical illness (Cancer etc.) Covered up to full SI limit

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 Additional– Coverage Extension
Benefits Terms

Sleep apnea Covered up to full SI limit

Stem cell implantation/ surgery for bone marrow

Covered up to full SI limit
transplantation

Drug-eluting stents, Bio Degradable Stents, all

types of pacemakers, ICDs, foreign made Covered up to full SI limit
implants

Comatose / Vegetative States Covered up to full SI limit

Renal Failure Covered up to full SI limit

Cholecystectomy Covered up to full SI limit

Outside Doctor/Surgeon/ Assistant

Covered up to full SI limit
Surgeon/Consultant visiting charges

Drug Therapy Covered up to full SI limit

Angiography Covered up to full SI limit

Impairment of Persons’ intellectual

Covered up to full SI limit
Faculties

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 Disease Sublimit
Disease Limit
Cataract Covered up to 10% of basic Sum Insured ( INR, 75,000) per eye
Total Knee/HIP replacement Knee and HIP replacement is capped at INR 200,000 per knee / hip
Hernia/Hydrocele Covered with sub limit of INR 100,000
Fess/Nasal Sinusitis Covered with sub limit of INR 75,000
Tonsil Surgery Covered with sub limit of INR 50,000

Appendicitis Covered with sub limit of INR 100,000

Hysterectomy Covered with sub limit of INR 125,000

Infertility Covered under Maternity C Sec Sub limit limit under IPD only
Covered up to INR 20,000 per claims under IPD limit even if taken on
Fracture
OPD basis
Gall Stone Removal Covered with sub limit of INR 75,000
Uterine Artery Embolization and HIFU Covered up to 20% of Sum Insured, max of INR 200,000
Balloon Sinusplasty Covered up to 50% of Sum Insured, max INR 350,000

Deep Brain stimulation Covered up to 70% of Sum Insured, max INR 525,000

Stereotactic radio surgeries Covered up to 50% of Sum Insured, max INR 350,000
Bronchial Thermoplasty Covered up to 30% of Sum Insured, max of INR 300,000
Vaporization of the prostrate Covered up to 30% of Sum Insured, max of INR 200,000
IONM Covered up to 15% of Sum Insured, max of INR 100,000
Note: Corporate Buffer will not be applicable to any capped ailments and maternity / Treatments under the policy
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 Room Rent–Coverage
Covers expenses related to:

• Room and boarding - 1% of SI for Normal and no limit for ICU LIST OF NON PAYABLE
ITEMS
• Doctors fees
• Intensive Care Unit
• Nursing expenses
• Surgical fees, operating theatre, anesthesia and oxygen and their administration
• Physical therapy
• Drugs and medicines consumed on the premises
• Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)
• Dressing, ordinary splints and plaster casts
• Costs of prosthetic devices if implanted during a surgical procedure
• Radiotherapy and chemotherapy

A. The expenses are payable provided they are incurred in India and within the policy period. Expenses will be
reimbursed to the covered member depending on the SI limit available.

B. Expenses on Hospitalization for minimum period of 24 hours are admissible.. However, this time limit will not apply for
specific treatments i.e., Dialysis, Chemotherapy, Radiotherapy, Cataract, Dental Surgery, Lithotripsy (kidney stone
removal), Tonsillectomy, D & C taken in the Hospital/Nursing home and the insured is discharged on the same day of
the treatment will be taken under Hospitalization Benefit. * Refer Day Care List

C. A security deposit can be collected by the empaneled hospitals to adjust the non admissible expenses.

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 Maternity Benefits
Benefit Details
Benefit Amount • INR 75,000 within the Sum Insured for Normal & INR 100,000 C-Sec
Restriction on no of children • Maximum of 3 children ( Extended up to 4th child in case of Twin at third
delivery & sudden demise of the child)
9 Months waiting period • Not applicable
Baby expenses • Covered within the maternity limit
New born baby covered from Day 1 •Baby day one within Sum Insured
(1) Incase of Specific illness of new born baby expenses towards the same will
be covered from normal sum insured
( 2) New born babies: are covered right from the time of birth

Benefit Details-Pre-Post Natal Expenses

Definition Pre post natal expenses stands out to be those treatment that a pregnant
woman undergoes during 9 months of Maternity. This includes Gynecologist
OPD consultation, Medication, and Investigation as per doctor advice.
Vaccinations given to the new born baby after birth are not covered and hence
not payable
Covered Within maternity limit
Duration Pre and post natal expenses are restricted to 9 month and 2 Months
respectively. ( means 60 days post childbirth)
• These benefits are admissible in case of hospitalization in India.
• Covers first 3 children only. Those who already have 3 or more living children will not be eligible for this benefit.
• Expenses incurred in connection with voluntary medical termination of pregnancy during the first 12 weeks from the date of
conception are not covered.
•In case of life-threatening situation during delivery for Mother or baby Family SI would be applicable.
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 Pre & Post Hospitalization Expenses
Pre-hospitalization Expenses

If the Insured member is diagnosed with an Illness which results in his / her
Hospitalization and for which the Insurer accepts a claim, the Insurer will also
reimburse the Insured Member’s Pre-hospitalization Expenses for up to 30 days
Definition prior to his / her Hospitalization.

Covered
Yes

Duration
30 Days

Post-hospitalization Expenses

If the Insurer accepts a claim under Hospitalization and immediately following

the Insured Member’s discharge, further medical treatment directly related to the
same condition for which the Insured Member was Hospitalized is required, the
Definition Insurer will reimburse the Insured member’s Post-hospitalization Expenses for
up to 60 day period.

Covered Yes

Duration 60 Days

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 COVID Home Care Treatment
Benefit Details Definition
Benefit Amount INR 15,000 per family

Home Care Treatment Covid 19 home care treatment expenses covered up to INR 15000 per family
Home Care Treatment means Treatment availed by the Insured Person at home for
Covid-19 on positive diagnosis of Covid-19 in a Government authorized diagnostic
Centre, which in normal course would require care and treatment at a hospital but is
actually taken at home maximum up to 14 days per incident provided that::-

Ø The Medical Practitioner advises the Insured Person to undergo treatment at home
Ø There is a continuous active line of treatment with monitoring of the health status by a
medical
practitioner for each day through the duration of the home care treatment
Ø Daily monitoring chart including records of treatment administered duly signed by the
treating
doctor is maintained
Ø Insured shall be permitted to avail the services as prescribed by the Medical
Practitioner
Cashless facility shall be offered under home care expenses if the treatment is through a
network
provider
Ø The Home Care treatment shall include the following, if prescribed by the treating
Medical
Practitioner and is related to treatment of COVID:
i. Diagnostic tests undergone at home or at diagnostics center
ii. Medicines prescribed in writing
iii. Consultation charges of the medical practitioner
iv. Nursing charges related to medical staff
v. Medical procedures limited to parenteral administration of medicines
vi. Cost of Pulse Oximeter, Oxygen cylinder and Nebulizer (only rental cost)

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 Voluntary Top Up Insurance Option
Top Up Decide on top up insurance at the time of enrolment
Premium Premium
Sum
(Excl. GST) (Incl. GST) •Lock in period –2 years, upside in top up insurance
Insured
possible but reduction or opting out will not be possible.
INR 250,000 INR 5,635 INR 6,649
•Definition of parent/in-laws –one opted for the top up
INR 500,000 INR 7,350 INR 8,673 insurance, the parent definition cannot be changed for 3
year, except in cases of death.
INR 750,000 INR 9,800 INR 11,564
•Top Up limit will not be applicable to
INR 1,000,000 INR 14,350 INR 16,933
a) Capped Ailment
INR 1,500,000 INR 18,899 INR 22,302 b) Maternity / Infertility
c) OPD / domiciliary
INR 2,000,000 INR 25,200 INR 29,736 d) Room rent limit

• Top Up Options mirror the same benefits as provided in the base cover by Air India Express
• Flexibility to chose any sum insured as desired basis the above table.
• Premium will be deducted form Salary in 6 EMI

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 Benefits of GMC Top up

Hassle Free Additional Cover Benefits

No documentation required for Policy Flexible Options – choose between 6 Out of pocket expenses can be taken
Issuance Top Up options care of

No pre policy medical check-up’s Tax benefit under Sec 80D (as per IT
All covers as per base GMC Policy
required law under old tax regime)

Waiting period waived Customized Product for AI employees Family Care at an affordable price

Different plans available in the market

Heavily discounted top up Premium would range between INR 20000 –
Pricing Benefit
for Flexible Sum insured options 1,00,000 for the Sum insured amount
ranging from INR 2 Lakhs-20 Lakhs

Through the same TPA – As the AI Better control on processes and less
Claims Handling
base policy delays

No age Limit for Parents Unlike Cost efficient top up premium for
Parents ( Age Limit )
individual retail plans family including parents

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Claim & Enrolment
Process

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 Enrolment
• Existing employees are covered under the policy from 15th May 2023. However, you must enroll your dependents
within 30 days of start date. If you fail to enroll, the next enrolment can be done only at next year.
• All New joiners must enroll their dependents within 30 days of joining the company.
• In case of change of status due to marriage or birth of child , enrolment must be done within 30 days of such event.

Sample Workflow

For addition of The page will display employee

HR will send the Tata Team will get it dependents details. Employee has to update
Employee data to the uploaded this data Employee has to his/her mobile number
Tata Team through TPA login with credential mandatorily before moving to
shared in mail next page

Key in the details of the

Select Top Up dependants you want to Add Dependent
Click on the disclaimers add and then click on the
to complete the add button. The added
enrollment in the policy dependant will be shown on
the web page Error in data Send mail to HR with
printed on details
card

Employee
E-card (ID) can be verifies
downloaded through details on
same employee login the ID card Use card for cashless
hospitalization
ID Card Ok

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 Cashless Process
• Cashless means the Administrator may authorize upon a Policyholder’s request for direct settlement of eligible services
and it’s according to 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/may not have to pay any
deposits at the commencement of the treatment or bills after the end of treatment to the extent as these services are
covered under the Policy.

List of hospitals in the MD India network eligible for cashless process

Please visit the below given web link to check the updated list of
Email-id-authorisation@mdindia.com
Hospitals https://mdindiaonline.com/licnew/ProviderList.aspx

Note : Patients seeking treatment under cashless hospitalization are eligible to make claims under pre and post hospitalization expenses.
For all such expenses the bills and other required documents needs to submitted separately as part of the claims reimbursement.

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 Emergency Hospitalization & Process
Step 1
Get Admitted
In cases of emergency, the
member should get admitted in
the nearest network hospital by
showing their ID card.

Member gets admitted Pre- No Non cashless

in the hospital in case of authorizatio
Step 2 Hospitalization
emergency by showing n given by
Pre-Authorization by hospital Process
his ID Card the TPA

Relatives of admitted member P

R Yes
should inform the call centre
within 24 hours about the O
hospitalization & Seek pre C Member/Hospital
authorization. The E Member gets treated
applies for pre-
preauthorization letter would be and discharged after
S authorization to the TPA
directly given to the hospital. In paying all non medical
S within 24 hrs of
case of denial member would expenses like
admission
be informed directly refreshments, etc.

Step 3 TPA verifies applicability Hospital sends complete

Treatment & Discharge of the claim to be set of claims documents
registered and issue pre- for processing to the
After your hospitalization has authorization TPA
been pre-authorized the
employee is not required to pay
the hospitalization bill in case
of a network hospital. The bill
will be sent directly to, and
settled by TPA

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 Non-Cashless - IPD Reimbursement
Admission procedure

• In case you choose a non-network hospital you will have to liaise directly with the hospital for admission.
• However, you are advised to follow the preauthorization procedure to ensure eligibility for reimbursement of
hospitalization expenses from the insurer.

Discharge procedure

• In case of non network hospital, you will be required to clear the bills and hands over the claim to TPA Helpdesk for
reimbursement from the insurer. Please ensure that you collect all necessary documents such as – discharge summary,
investigation reports etc. for submitting your claim.

Submission of hospitalization claim

• You must submit the final claim with all relevant original documents within 30 days from the date of discharge from the
hospital.

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 Non-Cashless Claims Process
Member intimates Insured admitted as per Insured hands over
Claim registered by
Tata/TPA SPOC before hospital norms. All relevant documents to
TPA after receipt of A
or as soon as payments made by TPA within 30 days of
claim intimation
hospitalization occurs member discharge

Is
TPA performs medical document
Is claim received •Insured will create the
scrutiny of the
Yes payable? within 30 summary of Bills (2
documents
Yes days from copies) and attach it
No discharge with the bills
•The envelope should
contain clearly the
No
Claim Rejected Employee ID &
Employee e-mail

Is
document
TPA checks document ation Payment to be made
Claims processing
sufficiency complete Yes vide transfer.
as
required

No
Send mail about
deficiency and A
document requirement

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 OPD Claims - Reimbursement Process

• Employees can continue to avail OPD treatment with their preferred Network hospital/ diagnostic Centre or buy

medicines from a local pharmacy / medical shop and then Claims can be lodged with TPA for reimbursement.

• Employees need to fill in the claim form and along with original documents i.e. prescription/ Bills / Reports the same

need to be submitted to TPA Helpdesk at AI Express Help desk locations (Kochi, Trivandrum, New Delhi and Mumbai)

• For Medicine bills above INR 500 prescription will be mandatory, validity of prescription will be 6 months.

• For long term treatments self attested prescription will be accepted

• All remaining documents i.e. Medicine bills, Payment receipts, diagnostic reports, prescription etc. will be required in

original.

• Employee can submit bills once in every quarter or as per treatment availed basis.

• OPD bills to be submitted within 3 months from date of treatment or INR 500 which ever is earlier.

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 Claims Document List
Completed Claim form with Signature Claims Form
Hospital bills in original (with bill no; signed and stamped by
the hospital) with all charges itemized and the original receipts

Discharge Report (original)

Claim forms
Attending doctors’ bills and receipts and certificate regarding and check list
diagnosis (if separate from hospital bill)

Original reports or attested copies of Bills and Receipts for

Medicines, Investigations along with Doctors prescription in
Original and Laboratory, Stickers in case of Implants E.g.:
Lens (Cataract), Stents (Heart Surgery) etc.

Follow-up advice or letter for line of treatment after discharge
from hospital, from Doctor.
Provide Break up details including Pharmacy items, Materials,
Investigations even though it is there in the main bill
Claim forms Can be shared with the regional
Helpdesk OR courier directly to below Address.
Address for sending claim documents:-

In case the hospital is not registered, please get a letter on the ATTN: Samadhan Bhosale
Hospital letterhead mentioning the number of beds and MD India Health Insurance TPA Pvt. Ltd.
availability of doctors and nurses round the clock. S. No. 46/1, E-space, A-2 Building, 3rd floor,
Pune Nagar Road, Vadgaonsheri,
In non- network hospital, you may have to get the hospital Pune 411014.
and doctor’s registration number in Hospital letterhead and get
the same signed and stamped by the hospital, if required.

For NEFT transfer for claim reimbursement . A signed copy of *Please retain photocopies of all
cancelled chq with the claimants name mentioned on the chq documents submitted
needs to be attached to the above form. Aadhaar card of
patients to be submitted.

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 General Exclusions
• Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations

• Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.

• Venereal diseases

• Injury or disease caused directly or indirectly by nuclear weapons

• Naturopathy

• Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges,
telephone charges, Surcharge, etc.

• Cost of hearing aids

• Any cosmetic or plastic surgery except for correction of injury

• Hospitalization for diagnostic tests only

• Vitamins and tonics unless used for treatment of injury or disease

• Voluntary termination of pregnancy during first 12 weeks (MTP)

** This is indicative list. Insurer Exclusion list will prevail.

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 Contact Details

Helpdesk Details

Employee Name Phone Number Location Days Email I.D Timings

Ms. Sharanya 7410008063 Kochi - mediclaim.aiexpress@mdindia.com -

Tuesday and 10:00 AM to

Mr. Praveen V 9388620100 Trivandrum mediclaim.aiexpress@mdindia.com
Thursday 5:00 PM
Mr. Abhishekh Tuesday and 02:00 PM to
9209031158 Mumbai mediclaim.aiexpress@mdindia.com
Mahindrakar Thursday 6:00 PM

Insurance Support Matrix

1st Level Contact 2nd Level Contact 3rd Level Contact
Toll Free 18002106869
authorisation@mdindia.com
For Cashless

Ms. Sneha Kamble – Asst. Managrt Ms. Reempa Sarkar – Div. Manager Mr. Jimsen Thomas - AGM
MD India Mobile-7249291781 Mobile- 7391059777 Mobile- 7709189632
TPA
Email I.D- Email I.D- reempas@mdindia.com Email I.D-
mediclaim.aiexpress@mdindia.com jthomas@mdindia.com
snehak@mdindia.com

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 Disclaimer:

This manual is intended to be general summary of the benefits offered by your company & should be
regarded as a guide only. While TMIBASL shall make every reasonable effort to ensure the accuracy and
validity of the information provided here in this document. TMIBASL accepts no liability or responsibility for
any errors or omissions in the content or for any loss or damages arising out of your reliance on information
provided here. If there is a conflict in interpretation or benefit applicability, then the terms & conditions of the
policy will prevail.

Prepared by

Tata Motors Insurance Broking And Advisory Services Ltd

1st Floor,AfL House,Lok Bharti Complex
Marol Maroshi Road,Andheri East,
Mumbai-400059

Tel: +91 22 66207943

Fax:+91 22 29200135

Copyright © 2018. All rights reserved. No part of this publication may be reproduced, stored in
the retrieval system, or be transmitted in any form or by any means, electronic or mechanical,
photocopying, recording or otherwise, without the prior written permission of TMIBASL.

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 THANK YOU!

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