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Employee Insurance Guide ClientKUONI INDIA RemarkBenefit Manual Proceed Click HereKUONI Circulation Copy.

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Presentation on theme: "Employee Insurance Guide ClientKUONI INDIA RemarkBenefit Manual Proceed Click HereKUONI Circulation Copy."— Presentation transcript:

1 Employee Insurance Guide ClientKUONI INDIA RemarkBenefit Manual Proceed Click HereKUONI Circulation Copy

2 2 KUONI Prepared by Marsh India Private Limited 902 Peninsula Corporate Park Lower Parel Mumbai 400 013 Tel: +91 22 66512900 Fax:+91 22 66512901 Copyright © 2005. 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 the publishers. Disclaimer: This benefit summary will serve as a guide to the benefits provided by KUONI. The information contained here is only a summary of the policy documents which are kept by the company. If there is a conflict in interpretation, terms & conditions of the policy will prevail. A copy of the policy is available with Human Resource department. Proceed Click Here

3 3 KUONI Marsh India Private Limited is an affiliate of Marsh Inc., which has been the world's largest risk and insurance services firm for well over a century now. Since its formation in 1871, Marsh has grown into an enterprise with annual revenues of US $5.9 billion, over 400 owned-and-operated offices and 36,000 colleagues, who serve clients in more than 100 countries. Marsh Inc. is the Flagship Company of Marsh & McLennan Companies, Inc. (MMC). MMC is a global professional services, Fortune 500 Company providing analysis, advice and transactional capabilities to clients in the domains of Risk & Insurance, Investment Management, and Consulting. Today, Marsh offers comprehensive solutions to its clients surpassing traditional insurance services. This includes providing new and non-conventional alternatives designed specifically to treat complex and ever-changing financial, operational and strategic exposures. In providing consistent, high quality service to clients’ worldwide, Marsh stays focused on one goal: Helping clients to be more successful. In India, Marsh and Mercer work together in a collaborative effort to operate the Employee Benefits business. This collaborative effort can offer clients the best of both worlds: The comprehensive resources and best thinking of the leading consulting firm and the personal focus of a local team with services structured to exactly meet your needs and budgets. Our experts consult on the full range of group benefits, including medical, life, accident, disability, flexible benefits, e- benefits, and work life programs. We also provide bidding, evaluation, rate negotiation, plan accounting, and reporting services to help you achieve the best service delivery at the lowest achievable price. The benefits you offer play an important role in shaping your relationship with your employees. You need benefits that fit your employees' needs while allowing you to stay competitive in the marketplace. Marsh India has initiated the first of its kind benefits survey that will assist clients understand the industry trend and current state of benefits market For more information on this study, please contact your Marsh Client Manager Jihan Menezes Manager – Employee Benefits Email – jihan.menezes@marsh.com Tel: +91 22 66512900 Fax:+91 22 66512901 About Marsh Proceed Click Here

4 4 KUONI Program Details Click Here Main Menu Exit Click Here

5 5 KUONI 1. Group Mediclaim Click Here 2. Group Personal Accident Click Here Main Menu Exit Click Here 3. Group Term Life Click Here Back This insurance scheme is to provide adequate insurance coverage of employees for expenses related to hospitalization due to illness, disease or injury The Group Personal Accident Program covers employees against the financial risk of injury sustained due to an accident caused by violent, visible and external means Group Term Life Insurance Scheme is meant to provide life insurance protection to employees. The Policy provides for payment of a lump sum to the nominated beneficiary in the unfortunate event of the employee’s death.

6 6 KUONI 1. Group Mediclaim 1.1 Benefit Details Click Here 1.2 Enrollment in the program Click Here 1.3 Cashless Hospitalization Click Here 1.4 Non - Cashless Hospitalization Click Here Exit Click Here Back Contacts Click Here

7 7 KUONI 1.1 Benefit Details Policy Parameter InsurerNew India Assurance Co. Ltd. Service ProviderMediassist Policy Start Date1 st January 2011 Policy End Date31 st December 2011 (midnight) Coverage TypeFamily Floater INR 1.5, 2 & 4 lac Dependent Coverage1 + 5 - Self + spouse and / or max 2 Dependant Siblings (upto 25 yrs) and / or max 2 Dependant children (upto 25 yrs) and / or max 2 Dependant parents (upto 80 yrs) or Dependant parent in laws (upto 80 yrs) Sum InsuredFamily Floater cover Back Click Here General Exclusions Benefits covered Standard HospitalizationYes Pre-existing diseasesYes Waiver on 1 st year exclusionYes Waiver on 1 st 30 days excl.Yes Maternity benefitsYes Baby cover day 1Yes Pre-Post Hospitalization Exp.Yes Baby Expense during MaternityYes Corporate Buffer (Critical Illness)Yes Benefits covered Ambulance ServicesYes Domiciliary HospitalizationNo Day CareYes DentalRestricted VisionRestricted DiagnosticsNo Room RentRestricted TerrorismYes Terrorism BufferYes Click Here

8 8 KUONI Applicable Members Total No of people Insured1+ 5 EmployeeYes SpouseYes ChildrenYes (max 2 children up to age 25 years) ParentsYes Parents in LawYes SiblingsYes (max 2 up to age 25 years) OthersNo Mid Term enrollment of DependentsDisallowed New Joinees (New employees + Dependents)Allowed Acquisition of new dependents (Spouse/ Children)Allowed Back

9 9 KUONI Policy Period Existing Employees + Dependents Commencement Date1 st January 2011 Termination Date31 st December 2011 (midnight) or Date of Leaving the Organization whichever is earlier New Joinees + Dependents Commencement DateDate of joining Termination Date31 st December 2011 (midnight) or Date of Leaving the Organization whichever is earlier New Dependent (Marriage/Birth) Commencement DateDate of such event Termination Date31 st December 2011 (midnight) or Date of Leaving the Organization whichever is earlier Back

10 10 KUONI Coverage Levels Sum Insured - Family FloaterFamily Floater EmployeeGraded Family Floater INR 1.5 lacs / 2 lacs / 4 lacs Dependents1 + 5 - Self + spouse and / or max 2 Dependant Siblings (upto 25 yrs) and / or max 2 Dependant children (upto 25 yrs) and / or max 2 Dependant parents (upto 80 yrs) or Dependant parent in laws (upto 80 yrs) Restrictions Employee + DependentsNO CO-PAY Upto INR 10,000 (excepting parental claims). For all claims above INR 10,000, following co-pay is applicable: 10% co-pay for employee/ spouse/ siblings/ children 20% co-pay for parents/ parents-in -law 50% co-pay for 1st six months of New Joiners & their dependents Back Expenses will be reimbursed to the covered member depending on the level of cover that he/she is entitled to.

11 11 KUONI Standard Hospitalization Room and boarding restricted to 1.5% of Basic Sum Insured for Normal room and ICU charges - 2% of Basic Sum Insured 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 Organ transplantation including the treatment costs of the donor but excluding the costs of the organ Internal Congenital diseases Reimbursement of expenses related to Back A) Expenses on Hospitalisation for minimum period of 24 hours are admissible that they are incurred in India and within the policy period. However this time limit will not apply for specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye surgery, 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 considered to be taken under Hospitalisation Benefit. B) Helpdesk conducted every Monday and Thursday by Mediassist C) A minimum amount of 7,000 will be charged by network hospitals as security deposit during cashless treatment

12 12 KUONI Maternity Benefits The maximum benefit allowable will be INR Normal 35,000/ C Section 50,000, max up to 2 children. There are special conditions applicable to the Maternity Expenses Benefits as below: These benefits are admissible only if the expenses are incurred in Hospital/Nursing Home as in-patients in India. Claim in respect of delivery for only first two children and/or operations associated therewith will be considered in respect of any one Insured Person covered under the Policy or any renewal thereof. Those Insured Persons who already have two 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. Benefit Details Maximum Benefit allowableLimit INR 35,000 for Normal/ INR 50,000 for C Section Restriction on no of childrenMaximum of 2 children 9 Months waiting periodNot Applicable (waived off) Pre-Post Natal ExpensesApplicable, within Maternity during hospitalisation Baby ExpenseApplicable – Limit INR 5000 within Maternity during hospitalisation Back √ Applicable

13 13 KUONI Post-hospitalisation Expenses DefinitionIf the Insurer accepts a claim under a) above and, immediately following the Insured Person’s discharge, he requires further medical treatment directly related to the same condition for which the Insured Person was Hospitalized, the Insurer will reimburse the Insured Person’s Post-hospitalisation Expenses ApplicableYes Duration60 Days Pre-hospitalisation Expenses DefinitionIf the Insured Person is diagnosed with an Illness which results in his Hospitalisation and for which the Insurer accepts a claim under a) above, the Insurer will reimburse the Insured Person’s Pre- hospitalisation Expenses for up to 30 days prior to his Hospitalisation as long as the 30 day period commences and ends within the Policy Period. ApplicableYes Duration30 Days Pre & Post Hospitalization expenses Back √ Applicable

14 14 KUONI Pre existing diseases DefinitionAny 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 to the commencement date of the Insured Person’s first Health Insurance policy with the Insurer First 30 day waiting period DefinitionAny Illness diagnosed or diagnosable within 30 days of the effective date of the Policy Period if this is the first Health Policy taken by the Policyholder with the Insurer. If the Policyholder renews the Health 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 First Year Waiting period Definition During the first year of the operation of the policy the expenses on treatment of diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhegia or Fibromyoma, Hernia, Hydroceie, Congenital Internal Diseases, Fistula in anus, Piles, Sinusitis and related disorders are not payable. If these diseases are pre- existing at the time of proposal they will not be covered even during subsequent period or renewal too √ Covered Waived √ Baby Cover Day 1 DefinitionIn consideration of additional premium, this policy is extended to cover the new born child of an employee covered under the Policy from the time of birth till 90 days. Not withstanding this extension, the Insured shall be required to cover the newly born children after 90 days as additional member as mentioned elsewhere under this Policy. √ Applicable Back Customized Benefits √

15 15 KUONI Ambulance services Back Ambulance Services DefinitionThe Insurer will pay for Emergency ambulance road transportation by a licensed ambulance service to the nearest Hospital where Emergency Health Services can be rendered. Coverage is only provided in the event of an Emergency. Amount restrictionINR 3,500/- per emergency hospitalization √ Applicable

16 16 KUONI Buffer Back Corporate BufferCorporate Buffer INR 25 lacs (applicable to listed Critical Illness as attached) Disbursement Limit - Equivalent to Sum Insured, restricted upto a maximum of INR 1.5 lacs per family (whichever is lower). All members eligible. Maternity not eligible Terrorism BufferTerrorism Buffer Cover of INR 1 cr. Disbursement to a maximum limit of INR 3.5 lac per family √ Applicable

17 17 KUONI Domiciliary Hospitalization DefinitionDOMICILIARY HOSPITALISATION BENEFIT means Medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a hospital/ nursing home but actually taken whilst confined at home in India under any of the following circumstances, namely: –The condition of the patient is such that he/she cannot be removed to the hospital/nursing home or –The patient cannot be removed to the hospital/nursing home for lack of accommodation therein Benefits not coveredexpenses incurred for pre and post hospital treatment, and expenses incurred for the treatment for any of the following diseases: –Asthma –Bronchitis –Chronic Nephritis and Nephritic Syndrome –Diarrhea and all types of dysentries including Gastroenteritis –Diabetes Mellitus and Insipidus –Epilepsy –Hypertension –Influenza, Cough, and Cold –All Psychiatric or Psychosomatic disorders –Pyrexia of unknown origin for less than 10 days –Tonsillitis and upper respiratory tract infection including Laryngitis and Pharyngitis –Arthritis, Gout and Rheumatism Note: When treatment such as Dialysis, Chemotherapy, Radiotherapy is taken in the Hospital/Nursing Home/Clinic and the insured is discharged the same day the treatment will be considered to be taken under Hospitalisation Benefit section. Back X Not Applicable

18 18 KUONI Customized Benefits Day Care DefinitionDay Care Procedure means the course of medical treatment or a surgical procedure listed in the Schedule which is undertaken under general or local anesthesia in a Hospital by a Doctor in not less than 2 hours and not more than 24 hours. Dental Treatment DefinitionAny dental treatment or surgery of a corrective, cosmetic or aesthetic nature unless it requires Hospitalisation; is carried out under general anesthesia and is necessitated by Illness or Accidental Bodily Injury. Vision & Hearing aid DefinitionThe cost of spectacles and contact lenses hearing aids. Covered if it requires Hospitalisation; is carried out under general anesthesia and is necessitated by Illness or Accidental Bodily Injury. Back √ Applicable Restricted √ √

19 19 KUONI Diagnostic Expenses Back Not Applicable Diagnostics Expenses Definition Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-Ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of the positive existence of presence of any ailment, sickness or injury for which confinement is required at a Hospital/Nursing Home or at home under Domiciliary Hospitalization as defined X Stand Alone Diagnostics will not be covered under the policy However if diagnostic tests are in line with hospitalization/ line of treatment, it will be paid for.

20 20 KUONI General Exclusions Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations Circumcision unless necessary for treatment of disease Dental treatment of any kind unless requiring hospitalisation Congenital external diseases or defects/anomalies HIV and AIDS Hospitalisation 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, etc Cost of spectacles, contact lenses, hearing aids Any cosmetic or plastic surgery except for correction of injury Hospitalisation for diagnostic tests only Vitamins and tonics unless used for treatment of injury or disease Infertility treatment Voluntary termination of pregnancy during first 12 weeks (MTP) Back

21 21 KUONI 1.2 Enrollment in the program Back You must enroll in order to obtain coverage for yourselves and your eligible dependants. HR will provide you with enrolment data format. Please notify HR each time you acquire a new dependent i.e. when your family status changes because of marriage, birth or adoption of a child within 10 days of the occurrence of such an event. If you fail to enroll within 10 days, the next enrolment can be done only next year at renewal. Provide required details of yourself and your dependents to the HR Hr/Controller sends the data to the insurer for endorsements (Monthly) Insurer updates their data, endorses member and sends the detail to the TPA -10 days (14 days at policy start ) TPA updates the active member database and prints the cards E card details to be mailed to the HR/Employee (4 Days) E card to be printed by employee Employee verifies details on the ID card Send mail to TPA with revised details and mailing address for corrections Error in data printed on card Use card for cashless hospitalization E Card Ok

22 22 KUONI 1.3 Cashless Hospitalization Cashless hospitalization means the Administrator may authorizes upon a Policyholder’s request for direct settlement of eligible services and it’s according 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 as these services are covered under the Policy. Planned Hospitalization Click Here Emergency Hospitalization Click Here Back List of hospitals in the TPA’s network eligible for cashless hospitalization Third Party Administrator – MEDIASSIST INDIA http://www.mediassistindia.com/ Hospital Network List - Link Contact Call centre at 24 X 7 Customer Service Center - Toll Free Number - 1 800 425 9449 ; Prime Number :080-26537870 Emergency hospitalisation - +91 9322424061 - (Please mention your company name "Kuoni" when enquiring) General Enquiry Lines - 022 30843800/ 01/ 02/ 03; 080 26537870; 1800 4259 449 *Toll free numbers are accessible only from BSNL / MTNL lines. Others can call in our board numbers or Call center Prime Number. For any other enquiries please send an email on the relevant email id given below. FOR GENERAL AND CLAIMS RELATED INFORMATION insurance@kuoniindia.com

23 23 KUONI Planned Hospitalization Step 1 Pre-Authorization Step 2 Admission, Treatment & discharge All non-emergency hospitalisation instances must be pre-authorized with the Help Desk, as per the procedure detailed below. This is done to ensure that the best healthcare possible, is obtained, and the patient/employee is not inconvenienced when taking admission into a Preferred Network Hospital. After your hospitalisation has been pre-authorized, you need to secure admission to a hospital. A letter of credit will be issued by TPA to the hospital. Kindly present your ID card at the Hospital admission desk. The employee is not required to pay the hospitalisation bill in case of a network hospital. The bill will be sent HR directly to, and settled by, insurer. 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 non cashless claims. Process Click Here Process Click Here Back

24 24 KUONI Pre-Authorization Member intimates TPA of the planned hospitalization in a specified pre- authorization format 48 hours prior to hospitalization Claim Registere d by TPA on same day Follow non cashless process No TPA issues letter of credit within 3 hours for planned hospitalization to the hospital Yes Pre-Authorization Completed Back On enclosed Pre - Authorisation Form please ensure to add employee id followed by KUONI (eg 4383 KUONI) and carry a photo-id until medi-cards are prepared and delivered.

25 25 KUONI Admission, Treatment & Discharge Member produces E card at the network hospital and gets admitted Member gets treated and discharged after paying all non entitled benefits like refreshments, etc. Hospital sends complete set of claims documents for processing to the TPA Claims Processing by TPARelease of payments to the hospital Back

26 26 KUONI Emergency Hospitalization Step 1 Get Admitted Step 2 Pre-Authorization by hospital Step 3 Treatment & Discharge In cases of emergency, the member should get admitted in the nearest network hospital by showing their ID card. Relatives of admitted member should inform the call centre within 24 hours about the hospitalization & Seek pre authorization. The preauthorization letter would be directly given to the hospital. In case of denial member would be informed directly After your hospitalisation has been pre-authorized the employee is not required to pay the hospitalisation bill in case of a network hospital. The bill will be sent directly to, and settled by, TPA Process Click Here Back

27 27 KUONI Member get admitted in the hospital in case of emergency by showing his E Card Member/Hospital applies for pre-authorization to the TPA within 24 hrs of admission TPA verifies applicability of the claim to be registered and issue pre-authorization within 3 hrs Pre- authorizat ion given by the TPA Follow non cashless process No Member gets treated and discharged after paying all non entitled benefits like refreshments, etc. Hospital sends complete set of claims documents for processing to the TPA Claims Processing by TPA Release of payments to the hospital Emergency Hospitalization Process Back Yes On enclosed Pre - Authorisation Form please ensure to add employee id followed by KUONI (eg 4383 KUONI) and carry a photo-id until medi-cards are prepared and delivered.

28 28 KUONI 1.4 Non-Cashless Hospitalization Admission procedure In case you choose a non-network hospital you will have to liaise directly for admission. However you are advised to follow the pre authorization procedure to ensure eligibility for reimbursement of hospitalisation expenses from the insurer. Discharge procedure In case of non network hospital, you will be required to clear the bill and submit a claim to Bajaj Allianz 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 hospitalisation claim 1. After the hospitalisation is complete and the patient has been discharged from the hospital, you must submit the final claim within 30 days from the date of discharge from the hospital. (Applicable in case of Non Network hospital) 2. Under hospitalisation claims you are also permitted to claim for treatment expenses 30 days prior to hospitalisation and 60 days after the date of discharge. This is applicable for both network and non-network hospitalisation. For claims related to pre-post hospitalization expenses, submission of documents within 7 days of last event. Process Click Here Claim Docs Click Here Back

29 29 KUONI Non cashless Hospitalization Process Member sends the claim to Kuoni Mumbai within 15 days of discharge Claim registered by TPA after receipt of claim Insured will create the summary of Bills (2 copies) and attach it with the bills The envelope should contain clearly the Employee ID & Employee e-mail Is document received within 15 days from discharge Claim Rejected No TPA performs medical scrutiny of the documents Is claim liable (coverage/ applicabili ty) Yes TPA checks document sufficiency No Yes Is document - -ation complete as required Claims processing done within 15-20 days Send mail about deficiency and document requirement. 3 reminders every 15 days A A Payment to be directly made to HR in the name of the employee. The same will be disbursed to claimant. Yes No Back

30 30 KUONI Claims Document List Signed Claim form Main Hospital bills in original (with bill no; signed and stamped by the hospital) with all charges itemized and the original receipts Discharge Card (original) Attending doctors’ bills and receipts and certificate regarding 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 Follow-up advice or letter for line of treatment after discharge from hospital, from Doctor. Break up with details of Pharmacy items, Materials, Investigations even though it is there in the main bill In case the hospital is not registered, please get a letter on the Hospital letterhead mentioning the number of beds and availability of doctors and nurses round the clock. In non- network hospitalisation, please get the hospital and doctor’s registration number in Hospital letterhead and get the same signed and stamped by the hospital. Back Claims Form AT web http://newindia.co.in/d ownloads.asp

31 31 KUONI Contact Details – Mediclaim & Personal Accident Back Insurance Company Group Mediclaim Policy Mediassist (TPA) Mediclaim Servicing Marsh Servicing Team Consultants 1 st Level Contact Deepesh Dhingra Medi Assist India TPA Pvt Ltd Mobile : 09320470731 deepeshd@mediassistindia.com 2nd Level Contact Rashmin Suvarna Medi Assist India TPA Pvt Ltd Mobile : 09320403547 rashmiss@mediassistindia.com 1 st Level Contact Jihan Menezes Marsh India Insurance Brokers Mobile:022 66512924 Email: jihan.menezes@marsh.com 2nd Level Contact Awantika Dhar Mgr. Servicing Marsh India Insurance Brokers Mobile:022 66512967 Email: awantika.dhar@marsh.com 1 st Level Contact Mukund Mishra New India Assurance Tel: 09833783543 Email: mukund.mishra@newindia.co.inmukund.mishra@newindia.co.in 2nd Level Contact Jeyachandran N New India Assurance Tel:+91 9820258610 Email: jeyachandran.n@newindia.co.injeyachandran.n@newindia.co.in

32 32 KUONI 2. Group Personal Accident 2.1 Benefit Details Click Here 2.2 Enrollment in the program Click Here Exit Click Here 2.3 Claims Procedure Click Here 2.4 Document Check list Click Here Back Contacts Click Here

33 33 KUONI 2.1 Benefit Details All employees are being provided with a Personal Accident insurance policy. This insurance provides compensation / payment up to a financial limit as assigned by the company, to the insured person or his / her nominated beneficiary, if the insured person suffers unfortunate death or disablement due to an accident. The cover is worldwide but payment of claim can only be made in India and in Indian Rupees. Policy Parameter HDFC General Insurance Co. Ltd. New India Policy Start Date1 st January 2011 Policy End Date31 st December 2011 (midnight) Capital Sum InsuredINR 10 lacs Cover Details Accidental DeathYes (100% of Capital Sum Insured) Permanent Total DisablementYes (100% of Capital Sum Insured) Permanent Partial DisabilityYes (as per the chart referred in the policy document with HR) Temporary Total DisabilityNot Covered Geographical LimitsWorld wide Accidental Medical Expenses40% of the claimed amount or 10% of the SI (whichever is less) Natural CalamityCovered TerrorismIncluded Carriage of dead body2% of SI subject to max to 2500/- General Exclusions Click Here BACK Click Here

34 34 KUONI 2.2 Enrollment in the GPA program All existing employees are covered under the policy from 1 st January 2011 For new employees, your enrollment data must reach the Insurer within 7 days of your joining. Please contact your HR and provide enrollment data (viz. name, date of birth, gender). The policy ends on 31 st December 2011 (midnight) or Date of Leaving the Organization whichever is earlier BACK

35 35 KUONI 2.3 Claims Procedure for GPA Employee / Beneficiary notifies HR, who in turn would intimate Insurer and submit required claims documents within 14 days of the event On obtaining all relevant documents, Insurer begins processing the claims Claim Investigation and Review within 3 days of submission of all the required documents Is claim approved within 7 days On rejection of the claim, Insurer would provide a valid reason for the rejection to HR / Employee / Beneficiary NoYes On approval, the cheque is sent to HR within 3 working days, from where it is given to the Employee / Beneficiary BACK

36 36 KUONI 2.4 Document Checklist Claims Form Website: http://newindia.co.in/ downloads.asp Death Claims Completed claim form Attending Doctor's report Death Certificate Post Mortem/ Coroner's report FIR ( First Information Report) Police Inquest report, wherever applicable Dismemberment/ Disablement Claims Completed claim form Doctor's Report Disability Certificate from the Doctor Investigation/ Lab reports (x- ray etc.) Original Admission/ discharge card, if hospitalized. Police Inquest report, wherever applicable BACK Accidental Injury Claims Completed Claim form Police FIR, if accident is reported to Police Medical papers, pathology reports, X-ray reports, as applicable For Permanent Disability Claims - disability certificate from reputed surgeon or Municipal Hospital For Temporary Total Disability Claims-sick leave certificate from Employer Attending Physician's statement

37 37 KUONI Policy Period Existing Employees + Dependents Commencement Date1 st January 2011 Termination Date31 st December 2011 (midnight) or Date of Leaving the Organization whichever is earlier New Joinees Commencement DateDate of joining Termination Date31 st December 2011 (midnight) or Date of Leaving the Organization whichever is earlier Back

38 38 KUONI Exclusions 1. 1.Service on duty with any armed force 2. 2.Intentional self injury, suicide or attempted suicide 3. 3.Insanity 4. 4.Venereal disease 5. 5.AIDS 6. 6.Influence of intoxicating drink or drugs 7. 7.Aviation other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft any where in the world 8. 8.Nuclear radiation or nuclear weapons material 9. 9.Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, mutiny, military, or usurped power, seizure, capture, arrest,, restraint, detainment’s of all kings, princes, and people of whatever nation, conditions and qualities so ever 10. 10.Childbirth, pregnancy or other physical causes peculiar to the female sex 11. 11.While committing any breach of law with criminal intent BACK

39 39 KUONI PPD Chart BACK

40 40 KUONI 3. Group Term Life Policy 3.1 Benefit Details Click Here 3.2 Enrollment in the program Click Here 3.3 Claims Procedure Click Here 3.4 Document Checklist Click Here EXIT Click Here BACK Contact Details Click Here

41 41 KUONI 3.1 Benefit Details Policy Parameter InsurerFuture Generali India Life Insurance Company Limited Policy Start Date1st January 2011 Policy End Date31st December 2011 (midnight) Sum InsuredGraded Cover Senior Vice President, Vice President - INR 30,00,000 Management - INR 20,00,000 Professional - INR 10,00,000 CoverDetails 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 in accordance with the Policy Schedule shall be paid 100% Sum Insured Suicide Cover Restriction waived off Click Here Back

42 42 KUONI Policy Period Existing Employees Commencement Date1 st January 2011 Termination Date31 st December 2011 (midnight) or Date of Leaving the Organization whichever is earlier New Joiners Commencement DateDate of joining Termination Date31 st December 2011 (midnight) or Date of Leaving the Organization whichever is earlier Back

43 43 KUONI 3.2 Enrollment in the program All existing employees are covered under the policy from 1 st January 2011 The policy ends on 31 st December 2011 (midnight) or Date of Leaving the Organization whichever is earlier Eligibility criteria: Having attained between 18 years and 60 years of age All regular full-time permanent employees Any new employees, whose enrollment data reaches the Insurer within 7 days of your joining Kuoni. Please contact your HR and provide enrollment data (viz. name, date of birth, gender). Back

44 44 KUONI 3.3 Claims Procedure Beneficiary notifies HR, who in turn would intimate Insurer and submit required claims documents within 30 days of the event On obtaining all relevant documents, Insurer begins processing the claims Claim Investigation and Review within 3 days of submission of all the required documents Is claim approved within 7 days On approval, the cheque is sent to HR within 3 working days, from where it is given to the Employee / Beneficiary On rejection of the claim, Insurer would provide a valid reason for the rejection to HR / Employee / Beneficiary NoYes Back

45 45 KUONI 3.4 Document Checklist   Claim form (completely filled)   Death Certificate (original or attested)   Attendance record & Salary Slips (last 2 months)   Identification of deceased (photo ID with DOB)   Active Service Declaration from employer   Hospitalization Documents ( Discharge summary, all investigation reports) if Life assured has taken treatment for illness leading to death   Medical certificate for cause of death.   In case of Unnatural Death the following additional documents are required:   First Information Report (FIR)   Final Investigation Report   Panchanama   Police Inquest Report   Post Mortem Report   All the above mentioned documents to be attested by the police officials. Future Generali reserves the right to call for any additional documents that it deems necessary depending upon the facts and circumstances of each claim. Link for Claims Procedure: http://www.futuregenerali.in/Life_Insurance/Claims/Claim_Procedure.aspxhttp://www.futuregenerali.in/Life_Insurance/Claims/Claim_Procedure.aspx For any help or information regarding Claims on your policy, please call us on: Tel No. : +91 22 40976699 Mail: care@futuregenerali.in with “CLAIMS-LIFE” as subject linecare@futuregenerali.in Back

46 46 KUONI Contact Details Group Term Insurance Contact Future Generali India Life Insurance Company Limited Back First Level Contact Name: Chetan Trivedi e-mail: Chetan.Trivedi2@futuregenerali.in tel: +91 9820638447


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