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Medi Assist India TPA Pvt. Ltd. (Medi Assist) has been appointed as the Third Party Administrator (TPA) for
health insurance benefits management by your organization. As a privileged member of the Medi Assist
family, you are now eligible for hassle-free health insurance claims administration.
What this really means for you is that should you or any of your family members who are covered under
your insurance policy require hospitalization, we become the interface between you and your insurer. We
handle all the paperwork related to your claim; wherever possible, we give you the benefit of cashless
hospitalization; and we ensure that your claim is settled at the earliest.
Apart from hospitalization, Medi Assist also enables access to a range of wellness services at our network
hospitals and service providers – and we make these available to you online with our Medi Assist Online
Portal, and over your smartphone, with our mobile app, MediBuddy.
Please retain this booklet for quick help and future reference.
Here’s to healthy living!
India Medical Insurance - Policy Terms & Conditions
Insurance Company United India Insurance Company Ltd.
Third Party Administrator (TPA) Medi Assist India TPA (P) Ltd.
Policy Period Start Date 00:00 Hours of March 30, 2018
Policy Period End Date 00:00 Hours of March 29, 2019
Entry Age Limit 1 day to 90 years
A maximum of first two living children below 21 years, which can be extended up to 25 years only if they are
unmarried and unemployed girls, disabled children without income or are children pursuing higher studies
(subject to submission of Bonafide Certificate from the institution).
Plan B
This plan provides cover for your dependent Parents / Parents-in-law in addition to Spouse and up to two
children subject to enrolment within the window period. The premium of this plan will be borne by the
associate. Please refer to the premium table below for the same.
Plan C
This plan is designed for onsite employees only who wish to opt for health insurance coverage for any one
set of their parents / parents-in-law residing in India. The plan is opened only once in a year during the
annual enrolment period for associates located onsite. The premium of this plan will be entirely borne by the
associate, please refer to the premium table below for the same.
On their return to India, only Plan A will be given as a part of enrolment and the sum insured of Plan A and
Plan C taken earlier cannot be considered as a single sum insured. Option will be provided only if associates
have not opted for enrolment during the annual renewal window.
Premium Table
Premium Grid
Plan U1 to U3 U4 & P1 P2 & above
Type Sum Premium Sum Premium Sum Premium
Insured Amount Insured Amount Insured Amount
Plan A 2 lakhs 0 3 lakhs 0 4 lakhs 0
Plan B 1 lakhs 12650 1 lakhs 20020 2 lakhs 25640
Plan A+B
3 lakhs 12650 4 lakhs 20020 6 lakhs 25640
(Floater)
1 lakh 9500 1 lakh 9500 1 lakh 9500
Plan C 2 lakhs 17600 2 lakhs 17600 2 lakhs 17600
3 lakhs 26200 3 lakhs 26200 3 lakhs 26200
Associates with a Direct Contract officer code will be provided only self-coverage, and the coverage amount
will be as per the band.
Premium shall remain the same whether you add one or both parents.
“The premium changes would commensurate with market behavior every year.”
NOTE:
No mid-term inclusion for dependents enrolment. However, the same is excluded for newly
married Spouse within 90 days from date of marriage and New born child (first two living
children) within 90 days from the date of birth. Therefore, the Reimbursement claim
payment will be delayed due to the member addition endorsement occurring during mid-
term of the policy period. Hence, request everyone to opt for CASHLESS.
No change in the associate Plan / Coverage amount due to mid-term change in band / salary
/ designation during policy year.
Dependents enrolled under Plan B for insurance coverage will be locked for 3 Plan years and
adverse selection (Parents & Parents-in-law) will not be allowed.
Third Child Coverage - The third child may be covered ONLY in case the first or second delivery
resulting in twins. The Associate will however need to pay an additional premium.
Premium Grid
Plan U1 to U3 U4 & P1 P2 & above
Type Sum Premium Sum Premium Sum Premium
Insured Amount Insured Amount Insured Amount
Third
Child 2 lakhs 1100 3 lakhs 1670 4 lakhs 2240
(Plan A)
Third
Child 3 lakhs 2870 4 lakhs 4480 6 lakhs 5800
(Plan B)
On account of separation from the organization, the coverage for all plans under Group
Mediclaim Policy will end on the last working day at Tech Mahindra and the prorated
premium amount will be refunded with F&F Settlement in case there was no claim
reported against any of the enrolled beneficiaries.
The base plan sum insured is based on the Band of the Associate and Top-Up is an optional plan which can
be opted by paying an additional premium.
The additional premium payable for the same is as per details mentioned below:
“The premium changes would commensurate with market behavior every year.”
Maternity Expenses
Maternity is covered without any waiting period up to INR 40,000 for normal and INR 50,000 for C-
section.
Expenses incurred towards well baby care hospitalization are not admissible.
A co-payment of 10% will be applicable on the maternity limit & Neo Natal Jaundice sublimit.
All Maternity expenses traceable to pregnancy, childbirth including normal Caesarean Section will be
included within Maternity Limit. This benefit is extended up to two living children only. (Those
insured persons who are already having two or more living children will not be eligible for maternity
expenses benefit).
Claim/Coverage Criteria
A Hospital 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
(Registration and Regulation) Act, 2010 or under the enactments specified under the Schedule of
Section 56(1) of the said Act OR complies with all minimum criteria as under:
o Has qualified nursing staff under its employment round the clock.
o Have at least 10 in-patient beds in towns having a population of less than 10 lacs and at least 15
in-patient beds in all other places.
o Has qualified medical practitioner(s) in charge round the clock.
o Has a fully equipped Operation Theatre of its own where surgical procedures are carried out.
o Maintains daily records of patients and makes these accessible to the insurance company's
authorized personnel.
Please refer to the Network Hospitals information in the home page of our MediBuddy Web Portal (via EASY
Portal login https://easy.techmahindra.com)
In the event of any claim admissible under this scheme, the insurance company will pay to the hospital,
nursing home or the insured person, the amount of such expenses as would fall under different heads
mentioned below:
o Room, boarding and nursing expenses as provided by the hospital or nursing home not
exceeding 1.5% of the base plan sum insured per day or the actual amount, whichever is
less. This also includes nursing care, RMO charges, IV fluid charges, blood transfusion
charges, injection administration charges and similar expenses.
o Intensive Care Unit (ICU) expenses not exceeding 3% of the base plan sum insured per day or
actual amount, whichever is less.
o Proportionate expenses are not applicable except for room rent eligibility.
o Surgeon, anesthetist, medical practitioner, consultants, specialists’ fees. Anesthetic, blood,
oxygen, operation theatre charges, surgical appliances, medicines & drugs, dialysis,
chemotherapy, radiotherapy, cost of artificial limbs, cost of prosthetic devices implanted
during surgical procedures like pacemaker, orthopedic implants, infra-cardiac valve
replacements, vascular stents, relevant laboratory/diagnostic tests, X-rays and such similar
expenses that are medically necessary.
o Hospitalization expenses (excluding the cost of organs) incurred on the donor with respect
to organ transplant to the insured will be covered within the major surgery ailment capping
limit per hospitalisation / surgery.
o INR 1,000 is payable for ambulance services per hospitalization (AMBULANCE Payable-
Ambulance from home to hospital or inter-hospital shifts is payable/ RTA as specific
requirement is payable).
*Major surgeries include cardiac surgeries; brain tumor surgeries; pacemaker implantation; cancer
surgeries; hip, knee, joint replacement surgeries; and organ transplant. The above limits specified are
applicable per hospitalization/surgery.
Pre and post hospitalization expenses payable with respect to each hospitalization shall be the actual
expenses incurred (pre-hospitalization up to 30 days and post hospitalization up to 60 days).
Exclusions
The company shall not be liable to make any payment under this policy for any expenses whatsoever
incurred by any insured person in connection with or in respect of:
Injury / disease directly or indirectly caused by or arising from or attributable to war, invasion, act of
foreign enemy, war-like operations (whether war has been declared or not).
Claim Procedure
Cashless Hospitalization Process
Cashless hospitalization is a facility provided by the insurance company where the policyholder can get
admitted and undergo necessary treatment without paying the hospital directly for the medical expenses.
The eligible medical expenditure which is incurred is settled by the insurance company directly with the
hospital. You can avail cashless hospitalization only in the hospitals that are part of your TPA’s network.
At Medi Assist, you can avail cashless and eCashless hospitalization at our network of hospitals.
Cashless hospitalization can be availed only at a Medi Assist network hospital upon approval of your
preauthorization application. In the event of hospitalization at a network hospital for a procedure covered
under your health insurance policy:
Emergency Hospitalization: This typically happens in case of emergencies such as road traffic
accident. The hospital that the Associate/dependent was hospitalized happens to be one of our
network hospitals.
Planned Hospitalization: Where the Associate/dependent plans the admission at our network
hospital in advance. Ex: Surgery scheduled after 7 days.
The hospital may ask you to pay the following expenses at the time of discharge as they are not covered
under the policy:
Non-medical expenses.
Applicable co-pay amount.
Any expenses not payable as per insurance policy or above the limit (e.g. excess room rent,
admission charges, service charges, etc.)
Emergency hospitalization
o Visit network.medibuddy.in to find a hospital that falls within your insurer network or click the
‘Hospital’ tile on your MediBuddy (via EASY Portal login).
o The Hospital tile on MediBuddy also gives you full details for the list of hospitals including location,
specialties, packages and more
2. During admission, present your Medi Assist E-card along with any other valid Government ID. You
can click the ‘E-card’ tile on MediBuddy to view your MA ID card
3. Ensure that the hospital sends your preauthorization form to Medi Assist, your TPA.
o MediBuddy+ hospital portal: Log the request online (or)
o Email: preauthhyd@mediassistindia.com
You will receive updates on the status of your claim throughout the lifecycle of the claim.
4. Medi Assist sends the approval to the hospital. Further enhancement approvals may be issued on
request, subject to the terms and conditions of the policy.
6. In case the request cannot be approved or if the expenses are not covered by your policy, you will
have to settle the hospital bill in full and subsequently raise a reimbursement claim after
discharge. Do remember that denial of a preauthorization request must not be construed as
a denial of treatment or denial of coverage.
7. After discharge, the hospital will send all the documents related to your claim to Medi Assist for
settlement. Kindly retain the copy of the claim documents for your reference.
Do Note:
o The list of network hospitals is subject to change, with hospitals being empaneled on a regular
basis. To access the latest list of hospitals in your insurer network, visit network.medibuddy.in or
use the GPS-enabled Hospital search option on your MediBuddy portal and app.
o The hospital will ask you to pay for all the non-medical expenses in your bill.
o You will have to pay for all pre- and post-hospitalization expenses. These can be claimed only
after the settlement of the main hospitalization claim.
8. At the time of discharge, check and sign the original bills and the discharge summary. Do carry home
a copy of the signed bill, discharge summary and all your investigation reports for future reference.
Note: In case of suppression of material facts or misrepresentation of facts by the hospital or the insured,
the pre-authorization issued for the cashless facility will stand cancelled. The insured will be liable to settle
the hospital bill in full.
If the information contained in the request is insufficient for Medi Assist to arrive at a decision and
further information is not available for whatever reasons.
The ailment for which hospitalization is sought is not covered under the particular insurance policy
for reason like pre-existing conditions, specific exclusions, etc.
The insured has already exhausted the insurance coverage for the year.
If the request is received after 24 hours from the time of admission and 6 hours before the time of
discharge.
Note: Denial of a preauthorization request must not be construed as denial of treatment or denial of
coverage.
Planned Hospitalization
eCASHLESS: ( Planned hospitalization at your convenience, your choice, and your fingertips)
You can now opt for planned hospitalization using Medi Assist’s eCashless facility. eCashless is the most
hassle-free way to undergo a planned cashless hospitalization.
eCashless gives you the power to get a provisional preauthorization even before you walk into the hospital.
It also gives you full visibility into the estimated cost of treatment at any network hospital of your choice. All
you need to do is carry your ID card, provisional pre-authorization on your MediBuddy app and your Medi
Assist E-Card while getting admitted to the hospital.
Note: The eCashless facility must not be used for emergency hospitalizations/ Out-Patient appointments/
Health checks. Cashless approval is subject to your policy terms and conditions and availability of sum
insured.
• Please settle the hospital bill, collect all original hospitalisation documents and Claim documents
should be handed over to the respective location Helpdesk.
• In case of non-availability of the Helpdesk at your location, claim documents can be sent to the
nearest location Helpdesk (Please refer to the Helpdesk Scheduler for address).
The following are the mandatory documents required for availing reimbursement claims:
The above mentioned documentsk are not exhaustive, but may differ on a case to case basis; additional
documents can be called for after the medical scrutiny.
Self-Help Tools
Medi Assist Online Portal: MediBuddy
The Medi Assist MediBuddy, is more than just a corporate portal that allows you to manage your corporate
health insurance policy. MediBuddy is your personalized gateway to managing your health and reducing cost
of healthcare for your family.
Log into https://easy.techmahindra.com with your TechM username and password to begin.
Please click on “ India Medical Insurance” on EASY Portal as per below path:
• Log into MediBuddy Online and click the links in the Medical Insurance tab to understand the details
of your policy before proceeding with the enrolment.
• Go to Medical Insurance > Online Enrolment to view the details of all your beneficiaries once the
enrolment process is complete.
• Go to Medical Insurance > Download E-Card tab to generate and print out a Medi Assist ID card on
the fly.
• Go to Hospitalization > Network Hospitals to browse through our extensive list of network hospitals
across the country.
• Click Wellness to choose a package and book an appointment from the convenience of your home
or office.
Medi Assist has brought together the services from your trusted diagnostic centres on MediBuddy∞ who list
their catalogues independently. All the listed service providers give special discounts on their packages to
Medi Assist members.
You can explore MediBuddy∞ with your desktop or a mobile app. However, if you need to purchase a
service, you need to log in to MediBuddy with your credentials.
You can call us on +91- 80 67617556 or mail us at infiniti@mahs.in for any queries that you may have.
Appendix
ANNEXURE I: LIST OF DAY CARE PROCEDURES:
SNO DAY CARE PROCEDURE SNO DAY CARE PROCEDURE
1 Stapedotomy 2 Excision And Destruction Of A Lingual Tonsil
Other Operations On The Tonsils And
3 Stapedectomy 4
Adenoids
5 Revision Of A Stapedectomy 6 Incision On Bone, Septic And Aseptic
Closed Reduction On Fracture, Luxation Or
7 Other Operations On The Auditory Ossicles 8
Epiphyseolysis With Osteosynthesis
Suture And Other Operations On Tendons
9 Myringoplasty (Type -I Tympanoplasty) 10
And Tendon Sheath
Tympanoplasty (Closure Of An Eardrum
11 Perforation/Reconstruction Of The 12 Reduction Of Dislocation Under Ga
Auditory Ossicles)
13 Revision Of A Tympanoplasty 14 Arthroscopic Knee Aspiration
Other Microsurgical Operations On The
15 16 Incision Of The Breast
Middle Ear
17 Myringotomy 18 Operations On The Nipple
Incision And Excision Of Tissue In The
19 Removal Of A Tympanic Drain 20
Perianal Region
Incision Of The Mastoid Process And
21 22 Surgical Treatment Of Anal Fistulas
Middle Ear
23 Mastoidectomy 24 Surgical Treatment Of Haemorrhoids
Division Of The Anal Sphincter
25 Reconstruction Of The Middle Ear 26
(Sphincterotomy)
Other Excisions Of The Middle And Inner
27 28 Other Operations On The Anus
Ear
29 Fenestration Of The Inner Ear 30 Ultrasound Guided Aspirations
Note: The above list is indicative and not exhaustive. The exact deductions on account of the non-payables
can be ascertained once the documents are scrutinized by our medical team.
Disclaimer:
The policy conditions for Tech Mahindra incorporated in the website and web portal are extracts of the Group
Mediclaim Policy wordings of United India Insurance Company Limited. These are only for reference and clarity in
understanding. For any further clarifications, please write to us on techm@mediassistindia.com.
ntact information: