1. Future Generali Health Health Insurance Orientation Module

2. Future Generali Health Future Generali is an insurance joint venture between the Italy-based Generali Group and the India-based Future Group. Future Generali operates Life and Non-Life insurance businesses through ‘Future Generali India Life Insurance Co. Ltd.’ and ‘Future Generali India Insurance Co. Ltd.’ Future Group holds 74% each in both the companies. Future Generali received license from the Insurance Regulatory Development Authority (IRDA) in Sept 2007 and launched operations from Nov 2007. Introduction

3. Future Generali Health Introducing For your Health Needs

4. Future Generali Health How we are different: Future Generali Health (FGH) is an internal unit of Future Generali India Insurance.Future Generali Health (FGH) is an internal unit of Future Generali India Insurance. No Third Party Administrator (TPA) involved between the insurer and FGH.No Third Party Administrator (TPA) involved between the insurer and FGH. Claim settlement is faster due to single point clearance – no exchange of claim documents between insurer and TPA.Claim settlement is faster due to single point clearance – no exchange of claim documents between insurer and TPA. Preferred services extended as FGH provides service only to clients insured by Future Generali.Preferred services extended as FGH provides service only to clients insured by Future Generali.

5. Future Generali Health Call Centre24 X 7 Helpline to cater to customer queries Cashless Management24 X 7 services with 2 hours Turn Around Time (TAT)** Claims ProcessingAverage TAT of 14 working days** Provider Management1800 hospitals and 200 diagnostic centers network Research and AnalysisAnalysis, Feedback & monitoring Pre PolicyFor retail medical underwriting UnderwritingCentralized Group / Retail Underwriting at hubs Future Generali Health An In-house Health Management Team of Future Generali India Insurance Co. Ltd. Internal units of (FGH) Future Generali Health Team EnrolmentFor card issuance and member data management **All TAT’s subject to availability of complete documentation

6. Future Generali Health Your New Wellness Card Your New card entitles you to a host of healthcare benefits.Your New card entitles you to a host of healthcare benefits. Photo identification is necessary whenever you use this card.Photo identification is necessary whenever you use this card. This card does not entitle you to avail cashless without pre-authorization.This card does not entitle you to avail cashless without pre-authorization. This is NOT a credit card.This is NOT a credit card.

7. Future Generali Health Member Enrolment Key Function: For card issuance and member data management  Within how many days will I get my Wellness Card? You will receive health cards via courier or e-mail within 7 days after your details are received by FGH from your organization.  What if there is an error on my Wellness Card? For any error in cards or correction required, you can immediately report to your HR.  What is the use of the Wellness Card? You will get a Wellness Card to utilize the Cashless facility at Network Hospitals. This card helps only in your identification as a Future Generali Health member. Availability of Cashless and any other benefit is subject to policy terms.

8. Future Generali Health 1.Carry your ID cards and authorization letter when you go to the hospital for admission 2.Get the Pre-authorization done in at least 7 days before hospitalization 3.Pre-authorization is done to determine whether cashless facility can be granted based on all medical information about your ailment and coverage 4.Pre-authorization forms are available at NETWORK hospitals. You can also obtain it from our call centre by e-mail or Fax 5.Your treating doctor has to fill the form and sign it 6.You will also have to sign the Pre Authorization form and provide your mobile number 7.The hospital will fax this form to our Call Centre to get an authorization Claim Process: Cashless If you are going for a Planned Hospitalization:

9. Future Generali Health 8.Our doctors will examine the form and decide on cashless availability 9.If cashless is granted, we will send an Authorization Letter to the hospital. You can also get a copy of the Authorization Letter from our Call Centre by e-mail 10.If cashless is denied, we will send a Denial Letter to the hospital and inform you 11.If cashless has been denied, you will have to pay the hospital bill and then send the claim to us Claim Process: Cashless Continued…. If you are going for Planned hospitalization:

10. Future Generali Health Customer approaches FGH Toll Free for Cashless Treatment. Future Generali coordinates with hospital for preauthorization Hospital verifies customer details and sends pre-auth by fax to FGH (Pune) FGH verifies pre-auth details with policy benefits and sends the response by Fax to Hospital Authorization Letter sent by FGH Hospital admits the patient without any deposit and provides cashless treatment Query Letter sent by FGH Denial Letter sent by FGH Hospital admits the patient as Cash Patient and patient pays the Bill QueryDenial Cashless Process Network Hospital Approved Hospital faxes the reply for queries asked by FGH doctors

11. Future Generali Health 1.What is a Network Hospital? How do I know the hospital is on the network?  FGH has tied up with specific hospitals and nursing homes to provide preferred services to its customers. These hospitals are termed as “Network” hospitals.  You can find out the details of Network hospitals in your city from our Call Centre on phone or by e-mail. The details are also available in the Health Insurance Guide sent along with your Wellness Card.  Hospitals are added and removed from the network at regular intervals. You are advised to check with our Call Centre for the updated status of any hospital. Cashless Process FAQs

12. Future Generali Health 2.How does the Hospital verify that the cardholder is genuine? Since the Card issued is not a photo id card, you are required to submit a photo id to verify the genuinity of identity at the Admission Desk of the Hospital. The photo id can be your Organization Identity Card, Driving License or any other such card which will help the hospital to establish the genuinity of the patient. 3.What is a Preauthorization Request? This is a Request for Cashless Hospitalization. The same has to be duly filled up, signed and stamped by the Hospital Authorities. Thereafter it has to be sent by fax / e-mail to FGH. The Contact details of FGH is available in the hospital. Cashless Process FAQs

13. Future Generali Health 4.Where do I procure the Preauthorization Request from? The Preauthorization Form template is available with the Network Hospitals or also enclosed with the Health Insurance Guide. It can also be obtained from FGH Call Centre on phone or by e-mail. 5.How to fill the Preauthorization form? It must be filled by the Treating Doctor. Information required are : ID No. as printed on the Card, Signs and Symptoms of the present aliment, duration of the aliment, diagnosis, pre existing conditions if any, proposed line of treatment, expected date of admission, duration of stay and estimated cost of hospitalization. Cashless Process FAQs

14. Future Generali Health 6.Where do I send the Preauthorization form? The Preauthorization Request for Cashless Hospitalization can either be faxed to 24 x 7 Toll Free Fax-line 1800 103 9998 or mailed to fgh@futuregenerali.in fgh@futuregenerali.in 7.What is an Authorization Letter ? Authorization Letter is the communication ascertaining the Admissibility or Acceptance of the Cashless Service. The same is issued by FGH subject to admissibility of the claim and availability of balance sum insured for the member. 8.Is the entire amount requested by hospital authorized by FGH? FGH would release a part or the entire amount depending on the ailment and related expenses. In case a part amount has been approved by FGH, then the hospital would ask for additional authorization when necessary. Cashless Process FAQs

15. Future Generali Health 8.How do I know whether my Claim has been approved for Cashless or not? Authorization Letter or Denial Letter shall be faxed directly to the Hospital with intimation to you. A Query letter shall be faxed to the hospital if in case FGH wants some additional information to decide upon the admissibility. Cashless Process FAQs

16. Future Generali Health 9.What are the circumstances under which a Request for Cashless Hospitalization shall be denied? 1.If the information contained in the Request is insufficient for FGH to arrive at a decision and further information is not available for whatever reasons. 2.The ailment for which hospitalization is sought is not covered under the particular insurance policy or is a part of an Exclusion under the policy guidelines. 3.The insured has already exhausted his insurance coverage for the year. Cashless Process FAQs

17. Future Generali Health Contact our call centre and inform them about the nature of emergency Contact our call centre and inform them about the nature of emergency If possible, always go to a network hospital If possible, always go to a network hospital If not, then go to the nearest hospital If not, then go to the nearest hospital In a network hospital, the patient can be admitted by showing the FGH Wellness Card only In a network hospital, the patient can be admitted by showing the FGH Wellness Card only After admission, the pre authorization has to be done After admission, the pre authorization has to be done Claim Process If there is an EMERGENCY

18. Future Generali Health Our doctors will inform you and the hospital if cashless can be given Our doctors will inform you and the hospital if cashless can be given The hospital will ask you for a deposit if we deny cashless The hospital will ask you for a deposit if we deny cashless If you have gone to a non – network hospital, keep our call centre informed If you have gone to a non – network hospital, keep our call centre informed Claim Process If there is an EMERGENCY

19. Future Generali Health Cashless facility is always subject to the broader policy guidelines and relevant terms and conditions. Important Please note that decline of a request for Cashless Hospitalization is only denial of Cashless Service and is in no way to be treated as denial of treatment or claim. The insured retains the right to get treated and submit the bills to FGH for subsequent Reimbursement. Remember

20. Future Generali Health Repudiation letter sent to client Repudiated (Not falling with policy conditions) Reimbursement Claims Process Preliminary scrutiny of claim & verification : - Policy Benefit - Date of Loss - Mandatory Documents Deficient (Some Document required For Admissibility) Approved (Admissible under policy) Subsequent reminders sent at fixed intervals Reply received along with all deficient documents Reply not received Documents not received Intimation of the Deficiency is sent to the client Claim closed without payment Payment cheque sent to client Claim documents received from Insured member

21. Future Generali Health In case of Non Cashless Claims, what would be an appropriate plan of action to ensure timely reimbursement of the claim? If cashless facility is not availed, pre-authorization is denied or treatment is availed at a non- network hospital, the insured will have to settle the bills directly with the hospital and subsequently claim reimbursement by submitting the following documents to FGH: 1.First Prescription / consultation note from the Doctor 2.The Claim Form duly signed by the claimant or family member 3.The Original Hospital Discharge Card 4.The Original Hospital Bill giving detailed break up of all expense heads mentioned in the bill Reimbursement Claim Process - FAQs

22. Future Generali Health 5.The Money Receipt duly signed with a Revenue Stamp. 6.All Original Laboratory & Diagnostic Test Reports. E.g. X-Ray, E.C.G, USG, MRI Scan, Haemogram etc 7.If you have purchased medicines in cash and if this has not been reflected in the hospital bill, please enclose a prescription from the doctor and the supporting medicine bill from the Chemist 8.If you have paid cash for Diagnostic or Radiology tests and it has not been reflected in the hospital bill, please enclose a prescription from the doctor advising the tests, the actual test reports and the bill from the diagnostic centre for the tests. Reimbursement Claim Process - FAQs

23. Future Generali Health What are the norms for Intimation on Claims ? Preliminary notice of claim with particulars relating to Name of the Insured Person / Claimant, Nature of illness / injury and Name and Address of the attending Medical Practitioner / Hospital / Nursing home should be given to FGH Intimation can be sent by e-mail or Fax to our Call Centre. Preliminary notice of claim with particulars relating to Name of the Insured Person / Claimant, Nature of illness / injury and Name and Address of the attending Medical Practitioner / Hospital / Nursing home should be given to FGH. Intimation can be sent by e-mail or Fax to our Call Centre. Reimbursement Claim Process - FAQs

24. Future Generali Health Are there any norms related to the Hospital where treatment is sought which are mandatory for admissibility of claims? Please ensure that the hospital / nursing home where you are contemplating treatment fulfills these criteria. 1.It has at least 15 inpatient beds; 2.It has a Doctor who is in attendance 24 hours per day; 3.It maintains daily medical records for each of its patients, 4.It is registered and licensed as a hospital or nursing home with the appropriate local authorities. Always instruct the hospital authority to mention the Attending Doctor’s and Hospital Registration No. in the hospital papers or demand for a separate certificate on the same 5.The hospital provides a proper discharge summary, numbered bill and receipt for hospitalization expenses at the time of discharge Reimbursement Claim Process - FAQs

25. Future Generali Health Where do I send my claim documents? You can handover claim documents at the Help Desk in your office You can handover claim documents at the Help Desk in your office All claims will be managed by the Claims Team located in Pune. All claims will be managed by the Claims Team located in Pune. Claims Team Future Generali Health 2 nd Floor, Kant Helix Tower, Bhoir Colony, Opp Tata Motors, Chinchwad, Pune – 411033 (Maharashtra) All claim payments advice shall be made within 14 working days from the date of receipt of COMPLETE documents. All claim payments advice shall be made within 14 working days from the date of receipt of COMPLETE documents. FGH may ask for the additional documents from the claimant if the submitted documents are not sufficient to decide the admissibility of the claim. FGH may ask for the additional documents from the claimant if the submitted documents are not sufficient to decide the admissibility of the claim. Reimbursement Claim Process - FAQs

26. Future Generali Health What does FGH do with my claim documents? Your claim is assessed by our expert team and doctors who verify the documents and bills Your claim is assessed by our expert team and doctors who verify the documents and bills If all requirements are complete and the claim is admissible, the claim is approved and the cheque is sent to you or your corporate If all requirements are complete and the claim is admissible, the claim is approved and the cheque is sent to you or your corporate If the claim is not admissible, then a Repudiation Letter is sent to you / corporate by e-mail / courier If the claim is not admissible, then a Repudiation Letter is sent to you / corporate by e-mail / courier If our team requires additional documents to process the claim, then a Document Recovery letter will be sent to you / corporate by e-mail / courier If our team requires additional documents to process the claim, then a Document Recovery letter will be sent to you / corporate by e-mail / courier  FGH will send one intimation and two reminders at intervals of 15 days  If additional documents are not received after the second reminder from FGH, the claim is assessed with the available documents. This could lead to part payment or no payment at all. Reimbursement Claim Process - FAQs

27. Future Generali Health For any claim related query, hospital information, grievance, feedback or appreciation, please contact us on the following: Your Contact Points Toll Free Phone No 1800 103 8889 Toll Free Fax No 1800 103 9998 Emailfgh@futuregenerali.in

28. Future Generali Health Future Generali Health Insurance 2 nd Floor, Kant Helix Tower, Bhoir Colony, Opp Tata Motors, Chinchwad, Pune – 411033 (Maharashtra)