AN INTRODUCTION TO THE EMPLOYEE BENEFIT PROGRAM FOR THE EMPLOYEES OF ITTI PVT LTD

Group Mediclaim Policy This insurance scheme is to provide adequate insurance coverage of employees and their families for expenses related to hospitalization due to Disease or Injury Group Mediclaim Policy Number :-15310334160400000018

Definitions … Hospital : means any institution established for In-patient Care and Day Care Treatment of Illness and/or Injuries and which has been registered as a Hospital with the local authorities under the Clinical Establishments Act, 2010 or under the enactments specified under the Schedule of Insured Member on which the Insured Member's cover under the Policy expires. Section 56(1) of the said Act OR complies with all minimum criteria as under 15 In-Patients Bed Has qualified Medical Practitioner(s) in charge round the clock Fully equipped operation theatre of its own where Surgical procedures are carried out Network Hospital : Hospital which has agreed to extend support on Cashless procedure & paneled by TPA/Service provider. Non-Network Hospital : Within the definition of hospital but don't avail cashless facility. Claims from non-network hospitals are processed on reimbursement basis

Definitions… Hospitalization : Minimum period of 24 hrs of admission in a hospital for a proper medical/ Surgical management. Day Care procedures are Undertaken under general or local anesthesia in a Hospital/ Day Care Centre in less than 24 hours because of technological advancement, and which would have otherwise required a Hospitalization of more than 24 hours

Group Mediclaim Policy Benefit Details Enrollment in the program Cashless Hospitalization Non - Cashless Hospitalization

Benefit Details Policy Parameter Insurer The New India Assurance Company Limited TPA Family Health Plan Insurance TPA Limited Policy Start Date 16th November 2016 Policy End Date 15th November 2017 Coverage Type Group Health Insurance Cover – Family Floater Family Definition 1+5(Self + Spouse,+2 Kids +2 Dependent Parents) Sum Insured Various Sum Insured

Coverage Details Coverage Details Waiver of 30 days,1st Yr, 2nd Yr, 3rd Yr & 4th Year Exclusions Waived Off 9 Month Waiting Period NA Maternity Coverage Rs. 25,000 for Normal & Rs.35,000 for C-section (Applicable for first 2 Children only) Baby Day 1 Cover New born baby is covered from date of birth within overall Family Sum Insured Pre and Post natal expenses in-patient basis up to the Maternity Limit Lasik surgery, Oral Chemotherapy Covered (Refractive index for Lasik is +/- 7.5) Room Rent Eligibility 2% for Normal & 4% for ICU. Room charges includes nursing, RMO charges, iv fluids transfusion

IF Admitted Higher Room Rent Particulars 4000 per day (eligibility) 6000 per day (Exceeds Room Limit) Proportionate Deduction has to paid by the Employee Room + Nursing Charges (5 days) 20000 30000 10000 Visiting Doctor Charges (5days) 3750 5000 1250 Surgery fees 25000 Lab Fees 3000 4000 1000 Medicines Non Medical Expenses 2500 Total 53250 70500 17250 If patient admitted in higher room category than proportionate deduction will be applied on all the expenses exclusive of medicine and consumables as per room proportionate

Coverage Details….. Coverage Details Pre and Post Hospitalization Expenses (Except Maternity) Pre 30 days & post 60 days respectively Day Care Procedures Yes to be covered in network & non-network hospitals, without any pre-auth. Any new medical procedure or drugs that replace less than 24 hour of hospitalization to be included as day care procedure Congenital internal covered Ayurvedic Treatment Yes. Covered in government recognized hospitals with Active line of treatments Cataract Surgery covered up to a limit of INR 30,000 per eye Co-payments & sub limits for diseases 10% Copayment applicable on all claims. No other sublimit or copayments. All ailments & diseases covered can be claimed up to the full family sum insured. No capping on Surgeon Charges, Anesthetic charges, Stent charges etc

Enrollment Process Employees must enroll in order to obtain coverage for themselves and your eligible dependants. Employee has to provide to the HR who will in turn provide relevant enrolment data to MIBL as and when there are additions or when employee family status changes because of marriage, birth or adoption of a child. Provide required details of Employees and your dependents to the HR Representative immediately Hr/Controller sends the data to the MIBL for endorsements Insurer updates their data, endorses member and includes the active member database and prints the cards MIBL sends the endorsement to HR

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. List of hospitals in the insurers network eligible for cashless hospitalization https://www.fhpl.net/NetworkHospitals/NWHospitals.aspx Contact Call centre at 1800 425 4033

Points to remember-Cashless Facility Please carry below documents :- Health Card Company identification card Any photo identity proof Identify nearby network hospitals , do not wait for an emergency Please provide full information in Pre- auth Form, check pre-auth form. And remember we just a call away to help in case of any emergency .

Planned Hospitalization 72 hours prior to hospitalization Click Here

Emergency Hospitalization Click Here 24 HRS

Possibility of Denial of Cashless - examples Admission for investigations/ observation / evaluation only. Treatment not matching with disease mentioned on pre-auth form. Any treatment which otherwise could have been taken on OPD basis. Any congenital external disease. Hospital not sending proper query reply raised by TPA on time. Active line of treatment not mentioned in the pre-auth form

Reimbursement Process Claim Form duly filled and signed by you. (Fill the claim amount in Signed Claim Form) Original Main Hospital Bill with break up.(Detailed Breakup of various heads like OT Charges, Nursing Charges and Room Rent etc) All Original Hospital Payment Receipts with serial number. (With seal and signature of the hospital if the main hospital bill does not carry bill number) Original Detailed Discharge Summary from the hospital. (Gives the summary of diagnosis, period of admission and treatment in the Hospital) Original Receipts with serial number (For Consultation/Surgeon charges if charged outside the main hospital bill) Original Investigation bills and reports (Along with prescriptions & reports for all tests done along with images) Original Pharmacy bills with original Doctors Prescriptions (On doctors letterhead mentioning duration and dosage for medicines) Copy of the ID card –Self attested (Pan Card, Ration card, Passport, Driving License-Election Card –Company ID card etc.,) Original Death Summary in case of a death claims. (In case of the death of patient during hospital stay) Police FIR/ Medico Legal Certificate (Mandatory for all road traffic accident duly attested by Police) In Case of Maternity: Letter from treating doctor with Gravida Details (G P L A; No. of Living children) Frequently asked/raised objections from the Insurance company’s Processors Ensure submission of the following supporting documents for processing the claim without raising any objection: Pre numbered Cash Paid receipt Investigation Original Reports – (Not required where the details are mentioned - in discharge summary) Prescription Break up details of Main hospital bill Detailed Discharge Summary

Claim Submission Checklist Reimbursement Claim Form Reimbursement Claims Claim Submission Checklist Form Reimbursement Claim Form Form Submit all reimbursement bills, original reports, and prescriptions along with the claim form and checklist within 15 days of the date of discharge for pre-hospitalization claims and hospitalization claims, and within 60 days of discharge for post-hospitalization claims.

General Exclusions[Not payable]… Plastic Surgery, Dental Treatment/Surgery (Cosmetic Purpose) Use of intoxicating drugs/ alcohol Sterility/Infertility/Venereal Disease/Circumcision/AIDS Intentional Self Injury, Mental disorder Congenital Diseases (External) e.g. An operation to remove a 6th finger, Skin Grafting, Convalescence / General Debility Admission for only Laboratory /Observation /Evaluation purpose. Less than 24 hours treatment,OPD treatment. Admission for more than 24 hours with no active line of treatment, Health Checks, Domiciliary Hospitalization Vitamins & Health Drinks like Horlicks, Complan etc.. and Tonic inconsistent with treatment, Special diet and extra diet for patients (unless prescribed by the Doctor) Non Medical Expenses, Telephone, Fax, Barber, Photocopy, Vaccinations, Toiletries and TV charges, Service Charges, Maintenance and Surcharges, Special Nursing, Duty Doctor Charges, Attendant Pass. Abortion done for voluntary reasons & before 12 weeks

Non Medical Expenses[Not payable] ADMINISTRATIVE EXPENSES Admission charges Registration charges Medical Records/Medico-legal charges Additional stay Gate pass / Attendant pass Overhead charges Establishment charges Tax Surcharge Incidental charge Waste disposal charges DOCUMENTATION EXPENSES Documentation charges Medical records charges Discharge summary Birth certificate Death certificate Medical certificate CONSUMABLES Antiseptic/disinfectant solutions Soap Powder (talc) Oil /Cream Cream Sanitary pads / Diapers Health Foods SERVICES Telephone charges Fax charges Food / beverages T.V. / internet charges Newspaper / magazines Stationery charges Linen / laundry charges Mortuary / coffin charges

Feel free to call us on any assistance on your Insurance Needs Escalation Matrix : Mahindra Insurance Brokers Ltd   Name of Representative Contact No Email Address Account Manager Mr. Yuvaraj G +91-9731400244 G.Yuvaraj@mahindra.com First Level Ms. Shikha Choudhary +91-9945311401 choudhary.shikha@mahindra.com Escalation Mr. Rajesh R +91-9008001004 R.Rajesh6@mahindra.com