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RETAIL POLICY 2011-12

National Insurance Company Limited has designed a unique and exclusive Health Insurance Plan for parents / parents-in-law and dependent siblings (below age of 22 years) for employees of Infosys.

This product is offered exclusively for employees of Infosys, emerging out of more than a decade-strong relationship between Infosys and National Insurance Company Ltd and is in addition to the Group Health Insurance Policy (HIP) offered to employees. Eligibility for coverage under NICs Health Insurance Plan for dependents of Infoscions: 2. 3. Parents / Parents-in-law without age restriction and dependent siblings (up to age of 22 years)

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Sum Insured Options: Rs.50, 000/- ; Rs.1, 00,000/- ; Rs.2, 00,000/Period of Coverage: Infosys employees can cover their parents / parents-in-law / siblings for a period of one year starting from August 01, 2011 to July 31, 2012. New joinees need to enroll their parents / in-laws / siblings within a window period of 45 days of joining Infosys.

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The Policy for all dependents will be effective August 01, 2011 / date of enrollment whichever is later and will expire on July 31, 2012.

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Plan Details: The coverage under the Plan is identical to the Standard Plan cover under the Health Insurance Policy (HIP). This Plan will cover parents / parents in-law and dependent siblings. Maternity benefit is not available under this Plan. The defined limits are identical to Infosys HIP Standard Plan. An employee will have various options to cover his / her dependents under Retail Policy: a. Covering all the dependents under Individual Plans where the sum insured will be dependent specific

Plan A: Individual Plans All figures in INR Premium per person incl service tax Coverage up to 55 50000 100000 200000 Company Confidential 2780 4600 8800 Completed age in years 56-65 3750 6500 12000 Page 1 of 18 66-70 4720 7450 14350 above 70 6100 9880 18950 FY 2011-12

Discounts No claim Discount: 10% discount for employees whose dependents were covered for entire 12 months during the Retail Policy period 2010-11 and have not made any claim for any of the insured dependent. Family Discount: Employees covering more than 3 dependents will be eligible for family discount of 5% on total premium payable.

Plan B: Floater Plans for parents/Dependents

a) FLOATER PLAN FOR PARENTS This is a new plan where both parents (natural parents) can be covered under one limit (sum insured). Tax exemption under section 80D is available. All figures in INR Premium per person incl service tax Coverage 100000 200000 Completed age in years up to 55 4600 8800 56-65 6500 12000 66-70 7450 14350 above 70 9880 18950

Age of the oldest person is to be taken for the basic premium. Additional member at 50% of the premium shown in the age band No claim Discount: 10% discount for employees whose dependents are covered for entire 12 months during the Retail Policy period 2010-11 and have not made any claim for any of the insured dependent.

b) FLOATER PLAN FOR IN-LAWS and SIBLINGS This is a new plan where members other than parents (In-Laws and Siblings) can be covered under one limit (sum insured) All figures in INR Premium per person incl service tax Coverage 100000 200000 Completed age in years up to 55 4600 8800 56-65 6500 12000 66-70 7450 14350 above 70 9880 18950

Age of the oldest person is to be taken for the basic premium. Page 2 of 18 FY 2011-12

Company Confidential

Additional member at 50% of the premium shown in the age band No claim Discount: 10% discount for employees whose dependents are covered for entire 12 months during the Retail Policy period 2010-11 and have not made any claim for any of the insured dependent.

Please Note: Parents - in - law, siblings cannot be nominated under the parents floater. E.g: Father / Mother and Father / Mother - in - law cannot be nominated under one floater

What makes this Policy unique and special?

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No entry barrier: Eligible members can be covered without entry age restriction except for siblings.

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No medical examination prior to Insurance: Under normal Health Insurance Policies, certain Medical tests are compulsory for any proposal for persons above 45 years. These tests could cost Rs. 5,000/- approx. This cost has to be borne by the proposer. For Infoscions, mere declaration in the proposal form is adequate and would be considered as such.

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No exclusion of diseases / ailments contracted during first 30 days: Covered from day One.

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No exclusion of certain Pre-existing diseases / ailments during Ist year of Policy: Covered from day one.

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No exclusion of Pre-existing diseases /ailments:

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Easy submission of proposal form: Proposal form for this Policy can be submitted online through Harmony. In case of normal Mediclaim Policy, the proposer has to submit the proposal form in the office of insurer, with supporting documents. Easy payment of premium: Premium will be recovered from employees salary.

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Issuance of this Policy is subject to the employment with Infosys. However, once the Policy is issued, it will be in force and valid till expiry of the Policy even if the employee quit Infosys. On expiry, such cases can be renewed at rates, terms and conditions of the then prevailing retail individual mediclaim Policy but continuity benefit will be provided, if the insured approaches National Insurance Company before expiry of the Policy.

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FY 2011-12

Contact details: Smt. K.H.Devaki Assistant Manager NIC Helpdesk. Electronic City, Bangalore Extn. No. 2772(080-39802772) NIC@infosys.com Cell Phone: 98453 76936 (Mrs. Devaki)

CLAIMS PROCESS

The procedure for claim remains same as for HIP and Mediassist India Pvt. Ltd will be the TPA for this Policy. Health cards will be issued in e-card format and will be mailed to respective Infosys e-mail id.

Cashless facility is available at large number of hospitals throughout the country through our TPA M/s. Mediassist as listed in Infosys HIP. In case of other hospitals, reimbursement can be claimed as per terms and conditions of the Policy.

Details on cash-less access and claims formalities can be obtained from the Mediassist Helpdesk at Building No 10, Electronic City.

ENROLLMENT PROCESS:
1. 2. 3. Login to Harmony>>My Data>>HIP Update nominee details and save the data Click on the link Click here for Retail Policy for Parents/Relatives

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Select the Sum Insured against each of the nominees

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Click the check box for Premium recovery declaration Click on the radio button Submit to freeze the data.

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Soft copy of the Coverage Certificate can be accessed upon recovery of premium amount in same page.

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FY 2011-12

Scope of the Cover Pre-existing diseases are covered Only in-patient treatment (Hospitalization for more than 24 consecutive hours) Outpatient treatment is not covered The hospital where treatment is undertaken must be with a minimum capacity of 15beds in India. Maternity benefit is not available under this plan Scope of the cover for certain illnesses is capped to a limit (Listed below)

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Procedures with Defined Benefits Note: Co-payment shall not apply in case of procedures with defined benefits / capped limits. The maximum amount claimable for below defined ailments will be restricted to the sum insured or amount capped as in the list below whichever is lower.

Procedure Cataract (single eye) Coronary angiography Angioplasty (including stent) Coronary Artery Bypass Graft Hernia repair open Hernia repair laparoscopic Appendicectomy open Appendicectomy laparoscopic Cholecystectomy open Cholecystectomy laparoscopic Hysterectomy open Hysterectomy laparoscopic Transurethral Resection of Prostate (TURP) Septoplasty FESS Joint replacement knee / hip (per joint including implant)

Retail Policy Limit (in INR) for FY 2011-12 16,000 15,000 1,50,000 1,50,000 37,000 48,000 20,000 32,000 32,000 48,000 38,000 48,000 50,000 25,000 30,000 1,50,000

Post-hospitalization expenses - relevant medical expenses incurred up to 30 days after hospitalization.

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Pre-hospitalization expenses - relevant hospital expenses incurred during the period up to 30 days prior to hospitalization can be claimed. Employees need to submit the cash receipt to substantiate the co-payment made to the hospital. In the absence of the same, there will be a deduction of 20% of the total bill, when the payment is made to the hospital.

Co - Payment / Deductibles Employees / dependents would be required to make a co-payment of INR 2,500 or 10% / 20% of the payable amount per incident (whichever is higher), as applicable to the hospital. It also includes 30 days of Pre / post hospitalization expenses also based on the categorization of the hospital. The details on Hospitals and the Co-Pay applicable are uploaded under Network Hospitals on this Portal.

Ailment

Hospital Type

Co-pay

Non-Tertiary

Non-Tertiary

10% per Claim or Rs 2500/- whichever is higher

Non-Tertiary

Tertiary

20% per Claim or Rs 2500/- whichever is higher

Tertiary

Tertiary

10% per Claim or Rs 2500/- whichever is higher

Co-payment shall not apply in case of procedures with defined benefits / capped limits. The entire claim amount would be taken care by the insurer subject to the other terms and conditions indicated in the Policy.

Definitions of hospitals and ailments which fall under Non-tertiary / Tertiary care are made available in the Health Insurance Policy document.

Examples: a. Applicability of 10% Co-pay

If the hospitalization bill is INR 10,000, then INR 2,500 will be deducted and only INR 7,500 will be paid (as 10% of INR 10,000 (=INR 1,000) is lower than INR 2,500) in this case.

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If the hospitalization bill is INR 26,000, then INR 2,600 being 10% will be deducted and only INR 23,400 will be paid (as INR 2,500 is lower than 10 % of INR 26,000 (=INR 2,600)) in this case.

b.

Applicability of 20% Co-pay

If the hospitalization bill is INR 10,000, then INR 2,500 will be deducted and only INR 7,500 will be paid, as 20% of INR 10,000 (=INR 2,000) is lower in this case.

If the hospitalization bill is INR 26,000, then INR 5,200 being 20% will be deducted and only INR 20,800 will be paid as INR 2,500 is lower than INR 5,200 in this case.

Cashless Claims Across Development Centre locations and at Metros, cashless facility will be available only at predefined hospitals as listed in under Network Hospitals on this Portal. At all other geographic locations, cashless facility will be available at the Medi Assist network hospitals GIPSA (confirmation from NIC andInfy)

Conditions / Expenses excluded under the Policy Health Insurance Policy is meant for curative /corrective treatments only. Preventive treatment / care is outside the scope of the Policy. Injuries or diseases caused by war and war-like operations Circumcision, Vaccination, Inoculation, Cosmetic treatment, Plastic surgery Surgery for correction of eyesight cost of spectacles, contact lenses, hearing aids etc. Dental treatment or surgery-corrective, cosmetic or aesthetic procedure, filling of cavity, root canal, wear and tear unless arising due to an accident and requiring hospitalization Convalescence general debility `Run Down condition or rest cure, congenital external disease or defects or anomalies, sterility, infertility/sub fertility or assisted conception procedures, venereal disease, intentional self-injury, suicide, all psychiatric and psychosomatic disorders/diseases, accidents due to misuse or abuse of drugs/alcohol or use of intoxicating substances. All expenses arising out of any condition directly or indirectly caused due to or associated with Human T-Cell Lymphotrophic Virus Type III (HTLB-III) or Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or variations Deficiency Syndrome or any Syndrome or

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condition or a similar kind commonly referred to as AIDS, complications of AIDs and other sexually transmitted diseases (STD). Expenses incurred primarily for evaluation / diagnostic purposes not followed by active treatment during hospitalization Expenses on irrelevant investigations / treatment; private nursing charges, referral fee to family physician, outstation Doctor / Surgeon / consultants fees etc. Vitamins and Tonics unrelated to treatment Injuries or diseases caused by nuclear weapons Abortion during first three months of pregnancy Naturopathy, unproven procedure / treatment, experimental or alternative medicine / treatment including acupuncture, acupressure, magneto-therapy etc. Domiciliary treatment Genetic disorders / stem cell implantation / surgery External / durable medical / Non-medical equipments of any kind used for diagnosis / treatment including CPAP, CAPD, infusion Pump etc., ambulatory devices like walker/ crutches / belts / collars / caps / splints / slings / braces / stockings / diabetic foot-wear / glucometer / thermometer and similar related items and any medical equipment which could be used at home subsequently. Change of treatment from one pathy to another unless being agreed / allowed and recommended by the consultant under whom treatment is taken. Non-medical expenses including personal comfort/ convenience items/ services such as telephone/ television/ aya/ barber/ beauty services/ diet charges/ baby food/ cosmetics/napkins/ toiletries/ guest services etc. Treatment for obesity or condition arising there from (including morbid obesity) and any other weight control program/services/supplies. Arising from any hazardous activity including scuba diving, motor racing, parachuting, hand gliding, rock or mountain climbing etc. unless agreed by insurer. Treatment received in convalescent home/hospital, health hydro/nature care clinic and similar establishments. Stay in hospital for domestic reason where no active regular treatment is given by specialist. Out-patient diagnostic/medical/surgical procedures/treatments, non-prescribed drugs/medical supplies/hormone replacement therapy, sex change or any treatment related to this. Massages/Steambath/Surodhara and alike Ayurvedic treatment. Any kind of service charges/surcharges, admission fees/registration charges etc. levied by the hospital. Doctors home visit charges/attendant, nursing charges during pre and post hospitalization period.

Company Confidential

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Treatment which the insured was on before hospitalization and required to be on after discharge for the ailment/disease/injury different from the one for which hospitalization was necessary.

List of Non-Payable Items Admission/Registration/Token Charges Administrative charges Telephone charges Attender's/Cleaner's charges Water/Electricity/Utility/Amenity/Establishment/Overhead Charges Washing/Laundry/Linen charges Ambulance charges Conveyance/Taxi charges where no ambulance facility is available Medical Attendant /Nursing/ Special Nursing/Monitoring charges Service charges Home Visit/Nursing charges - at residence after discharge Assistant fee/Follow up charges in advance Documentation/Folder/Stationery/In Patient chart charges Sundry/Medico Legal Charges/Diabetic chart charges Thermometer/Urometer Container for Specimen/Disposable Bag charges Admission Kit Oxygen/Monitor/ Spirometer /Sponge bath/Oxygen cylinder charges External Surgical Aids: Lumbo Sacral/Collar belt /Knee cap/Knee brace/ walker/hot water bag/baby kit/urine pot / traction kit/ folding commode etc. Inhaler/Nebulizer Diet charges Canteen/food bills during hospitalization Special/protein diet/health drinks prescribed by the doctor Donations/charity/rehabilitation charges as an inclusive package of charges of the hospital Surcharges/Octroi/Taxes etc.

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MEDI ASSIST INDIA PVT. LTD SCOPE OF SERVICES Medi Assist is a licensed Third Party Administrator providing Claims Management services for Health Insurance. National Insurance Company has appointed and authorized Medi Assist to: Enable cashless hospitalization at the Medi Assist Network of Healthcare Providers Settlement of reimbursement claims Provide 24 / 7 customer service through toll free numbers

MEDI ASSIST CONTACT DETAILS CASHLESS FACILITY: Email ID: mediassist@infosys.com and copy to infosys@mediassistindia.com Dedicated landline: 080-39802774 (9.00 a.m. to 5.00 p.m weekdays) Toll Free Call Center: 1800 425 9449 Landline: 080-26537870 Toll Free Fax: 1800 425 9559 Fax- 080-2658 4812

Bangalore, Mangalore, Mysore, Kolkata, Mohali - Bhubaneshwar Help Desk @ Infosys Tel: 39802774, Cell: 9342434114

Chennai: 9380001121 Hyderabad: 9394645003

Pune: 9372959279, 937333561 Trivandrum: 9387734840

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REIMBURSEMENT FACILITY: Email ID: mediassist@infosys.com ; infosys@mediassistindia.com Toll Free Call Center: 1800 425 9449 (accessible through BSNL / MTNL lines) Landline : 080 39802774 Mediassist Helpdesk Schedule @ Infosys DCs (Blore,Pune,Hyd,Chennai,Trivandrum) Bangalore DC: Usha/Achala -Contact Number-080-39802774,.-Cell-09342434114. Monday to Friday--9 AM to 5 PM-Building#10, Opposite to transport Desk Pune DC: Contact Mr. Sudhir / Uday Kulkarni (Ph- 09372959279 ) Monday-2:30 PM to 5 PM-Tower SDB 6, Phase 2, Finance Dept,Ground Floor Thursday-2:30 PM to 5 PM-Tower SDB 6, Phase 2, Finance Dept,Ground Floor Thursday -11.30 PM to 1:30 PM, Phase one. Chennai DC: Contact Mr. Ahmed-(Ph-09380001121). Monday -10AM to 2 PM-Shollinganallur, Building#4, Near Food Court Tuesday -10AM to 2 PM-Shollinganallur, Building#4, Near Food Court Wednesday -11AM to 3 PM -M City, Building-04 Ground floor (Right Wing) behind the Transport Desk. Thursday-11AM to 3 PM -M City, Building-04 Ground floor (Right Wing) behind the Transport Desk. Hyderabad DC: Contact Venkatesh -Ph-(09394645003). Wednesday -2PM to 5 PM-Building#19,Near CAG. Friday-2PM to 5 PM-Building#19,Near CAG. Trivandrum DC: (Contact Asha- 09387734840) Company Confidential Page 12 of 18 FY 2011-12

Tuesday-8:30 AM to 2PM At STPT (Techopark Campus). Tuesday-2PMto 4:30PM at Offshore (Campus 2). Note - Other DC and Metro employees need to submit the documents to the local Finance Desk.

In Case of Escalations, Please Write To: 1st Level Escalation: Infosys@nic.co.in; Mr. Uday (udaya@mediassistindia.com) Tel: 09341699770 2nd Level Escalation: Ms. Manjula J (Manjulaj@mediassistindia.com: Tel 09342511071 3rd Level Escalation: Dr. S.R. Bhat (email: srbhat@mediassistindia.com) T.Babu Paul (TB.Paul@nic.co.in) Sr Divisional Manager, National Insurance Co. Ltd., Bangalore Division III

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WHAT IS CASHLESS HOSPITALIZATION? Cashless hospitalization can be availed only at selected hospitals situated at any Infosys DC and Metro as per the list given below. Hospitals in other places where Infosys does not have presence will be as per network of hospitals of Medi Assist. The essence of cashless hospitalization is that the insured individual need not make an upfront payment to the hospital at the time of admission. At the time of hospitalization at a network hospital, you will have to produce the Authentication Certificate as proof of being covered by a health insurance Policy. The network hospitals have a preauthorization request form available with them. The form has to be jointly filled in by you and your treating doctor. Please make sure all the details asked in the form are completely filled. This will ensure speedy processing of your request. This form is faxed to the Medi Assist toll free fax number 1800 425 9559 or 080 26584812 / 13 or any of the branch fax numbers of Medi Assist. At Medi Assist, we receive the request and process the same, subject to the terms and conditions of your health insurance Policy. In case coverage is available, Medi Assist will issue an approval to the hospital for a specified amount. This is sent by fax and email (if available). The approval is called a Preauthorization. This preauthorization entitles you to avail the treatment at the hospital without paying for the medical expenses. At the time of discharge, in case the amount authorized by Medi Assist is not sufficient to cover the hospitalization expenses, the hospital will make a second request on your behalf for sanction of outstanding amount. Medi Assist will process this request and sanction will be made subject to terms and conditions of your health insurance Policy. Once final sanction has been received by the hospital, please make sure that you check and sign the original bills and discharge summary. Please carry home a copy of the signed bill and the discharge summary and all your investigation reports. This is for your reference and will also be useful during your future healthcare needs. The Policy mandates that you have to make a co-payment as described above of your final bill to the hospital along with all non-medical expenses in your bill. You have to make this payment before discharge. Please make sure you collect a receipt for the payments made. However you will be required to pay the non-medical expenses if any. Company Confidential Page 14 of 18 FY 2011-12

In case, for whatever reason, the preauthorization request cannot be approved, a letter denying preauthorization will be sent to the hospital. In this case, you will have to settle the hospital bill in full by yourself and a reimbursement claim can be filed with Medi Assist for further consideration.

Please note that denial of a preauthorization request is in no way to be construed as denial of treatment or denial of coverage. You can go ahead with the treatment, settle the hospital bills and submit the claim for a possible reimbursement.

Circumstances under which a Request for Cashless Hospitalization can be denied If the information contained in the request is insufficient for Medi Assist to arrive at a decision and the same is not available for any reason. The ailment for which hospitalization sought is not covered under the terms and conditions of your health insurance Policy. The entire sum available for your family for the year has been exhausted in previous claims during the year Age proof Photo ID not furnished in case of Parent admission in hospital

Hospitalization can be of two types: Planned Hospitalization: o This happens when you have ample time to plan your admission to the hospital. For example, if the doctor advises surgery for hernia and says that you can undergo the surgery anytime in this month, it gives you time to plan you surgery. o In such cases, it is prudent to send the preauthorization request to Medi Assist at least 72 hours before your planned admission. This will ensure a hassle-free admission procedure for you at the hospital. Emergency Hospitalization: o This happens typically in case of emergencies such as a road traffic accident. There is no planning involved in the hospitalization. In such situations, the Authentication Certificate can be shown at the network hospital to avail cashless admission facility. The preauthorization request can be sent to Medi Assist within four hours after admission. WHAT IS REIMBURSEMENT? In case you choose to or are required to avail of hospitalization facilities at a non-network hospital, your medical expenses can still be claimed through Medi Assist. This is called Reimbursement.

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Reimbursement claims may be filed in the following circumstances (Co-pay / Deductible as indicated earlier in this document would apply): o o o Hospitalization at a non-network hospital Post-hospitalization and pre-hospitalization expenses Denial of preauthorization on application for cashless facility at a network hospital

Reimbursement claims can be submitted to nominated DCs at the respective locations The documents that you need to submit for a hospitalization reimbursement claim are: o o o o o o o Original hospital final bill Numbered Receipts for payments made to the hospital Complete breakup of the hospital bill Original discharge summary All original investigation reports All medicine bills with relevant prescriptions Original signed claim form (available at Infosys Intranet, www.mediassistindia.com , Medi Assist Branches

Post-hospitalization expenses, for up to 30 days after the date of discharge and pre-hospitalization expenses for upto 30 days before the date of admission can be claimed from Medi Assist. The documents that you need to submit for a post-hospitalization or a pre-hospitalization claim are: o o o o Copy of the discharge summary of the corresponding hospitalization All relevant doctors prescriptions for investigations and medication All bills for investigations done with the respective reports All bills for medicines supported by relevant prescriptions

Medi Assist receives the reimbursement claim and processes it. The medical team at Medi Assist will determine whether the condition requiring admission and the treatment are covered under the terms and conditions of your health insurance Policy. Please note that all non-medical expenses will not be payable.

Any request for additional information/documents (If required) will be made by email within 48 hours of receipt of the claim. The required documents should be submitted within 15 days from the receipt of the intimation.

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Based on the processing of the claim, a denial or approval is executed. In case of approval, t he claims settlement shall be made by direct transfer to the Employees account at ICICI Bank. Please furnish the Bank Account details to ensure fast and efficient settlement of claims.

In case your claim is denied, the denial letter is sent to you by email.

Notice of Claim Preliminary notice of claim with particulars relating to Policy number, name of insured beneficiary, nature of illness, treating doctor and hospital should be intimated to Medi Assist within 7 days from the date of hospitalization Claims not having post hospitalization expenses must be lodged within 10 days of discharge from the hospital. Claims having post hospitalization bills for reimbursement must be submitted within 70 days from the discharge from the hospital. No separate post hospitalization claims will be considered.

WHAT ARE NON MEDICAL EXPENSES? Your health insurance Policy pays for reasonable and necessary medical expenditure. There are several items that do not classify as medical expenses during hospitalization. These items will not be payable and expenditure towards such items will have to be borne by you. Some common examples of non-medical expenses are listed for your reference: Telephone expenses Food for patient attendant Toiletries such as soap, razor, shaving cream, comb, etc. Double occupancy two hospital beds occupied for one patient Rehabilitative aids such as crutches, slings, orthopedic belts, etc. Water bed Registration charges Documentation charges Administrative expenses Admission fee

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WHAT AILMENTS / PROCEDURES ARE NOT COVERED BY THE HEALTH INSURANCE POLICY There are some procedures / ailments that are not covered by your health insurance Policy. Please note that this list in indicative and not exhaustive. LASIK surgery, contact lens, spectacles, hearing aids Dental treatment Voluntary Medical termination of pregnancy Sterilization procedures Plastic and cosmetic surgery External congenital disease Intentional self injury / suicide attempt Direct and indirect effects of the use of alcohol / intoxicating drugs AIDS and related syndromes Technical admission Expenses on vitamins or general tonics Naturopathy treatment

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