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Health Insurance Scheme

May 28, 2017 TCS Internal


Agenda
Purpose
Eligibility
Definitions
Entitlements
Benefits
Cashless Hospitalization
Exclusions
Premium
System Interface
Claiming procedure
Latest Updates
Contact No. of Mediassist Representative
References

May 28, 2017


Purpose
To provide hassle free access to medical facilities to employees and their
families

Tie up with the New India Assurance Company (NIACO) to offer a Health
Insurance Scheme (HIS).

NIACO has in turn appointed MEDIASSIST INDIA PVT. LTD. (Mediassist) as a


Third Party Administrator (TPA) of the scheme

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Eligibility
All employees of TCS India including Trainees and probationers till the time they
are in the services of the company

The policy does not apply to


Employee of TCS overseas, TCS subsidiary/Local company
Project Trainees
Temporary employees
Employees whose salary have been stopped
HIS benefits will continue for the employees on LWP, for the current financial year, if
the applicable premium is already paid

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Few Definitions
Family denotes- self & dependants

Dependants will include


Spouse of the employee
Spouse is legally married to the employee
Spouse if employed, first recover his/her expenses from that company
Double coverage will not be possible if both employee & the spouse are working in TCS
Children of the employee, including legally adopted children
Unmarried
Not employed
Covered on ALL or NONE basis
No minimum age for coverage
Dependant Parents
Covered subject to payment of full premium
Not employed
Married woman can cover their Parents or Parents in law.
Brothers and sisters are not covered under the definition of Dependants.

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Inclusion of dependants
Necessary information about dependants should be entered through Ultimatix in
the notified period for coverage to commence w.e.f. 1st Apr

Necessary information name, DOB, relationship

Additions may also be made during financial year


Full premium will be applicable
Coverage starts from the date of enrollment

New born baby


Coverage w.e.f.DOB, if enrolled within 3 months of the birth of the child

New joinees
Dependents coverage w.e.f. the DOJ, if enrollment within 2 months of 1st payroll

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Deleting Dependants
Dependents can be deleted , in the notified period for deletion to be effective
from first day of the policy year.
No premium will be recovered

No deletion is allowed during the policy.


Any deletion will be taken up in the next policy period

New joinees
Dependents coverage is discontinued w.e.f. the DOJ, if deletion within 2 months of 1 st
payroll
All deletion beyond that will be effective after the current financial year

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Entitlements

Category Coverage/ben Coverage/bene Remarks


efit (For fit (For SP
Non-SP grade)
grade)
Domiciliary Rs.5,000/- Rs.11,000/- Per insured, per
annum
Basic Rs.45,000/- Rs.1,39,000/- Per insured, per
Hospitalisation annum
Higher Rs.5,00,000/- Rs.7,50,000/- Per family, per annum
Hospitalisation
Umbrella Cover Rs.2,00,000/- Rs.2,00,000/- Per family, per annum
Personal Accident Rs.15,00,000/- Rs.50,00,000/- Only for employee
Insurance

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Benefits
Domiciliary & Dental Treatment
Only when the treatment is taken at a dispensary or hospital, as an outpatient
Include all the medical related expenses, which do not involve hospitalization.
For e.g. expenses related to pathology tests, doctors visits, prescription
medicines, etc.
Expenses for extraction, tooth filling, medicines, consultant fees, x-rays are covered

Hospitalization
The insured person is admitted or deemed to have been admitted for min. 24 hrs
Claim would cover one month prior to admission to hospital, during hospitalization & one
moth from the date of discharge

Umbrella Cover
Umbrella cover provides additional cover of Rs.2 lakhs to the insured family
For treatment of tertiary ailment and subject to availability of buffer fund.
Overall cap of Rs. 2 crores p.a. for all employees of TCS & their families

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Benefits
Personal Accident Insurance
In case of death, permanent total disablement, permanent partial disablement
Coverage applicable to employee
Not applicable to dependents & retired employees
If an employee sustains any bodily injury from accident, then insurance company will
pay sum insured to his heirs/personal representative

Cumulative Bonus
In case an employee and family dont enter a claim under HIS during the financial year,
the cover for such family increases by 5% under Higher Hospitalization cover in the
next financial year.
Can be increase to a maximum of Rs. 6.5 lacs if a similar scenario is repeated in
subsequent years.

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Benefits
Naturopathy
Expenses incurred on naturopathy are also reimbursed
Expenses for medicines are reimbursed. No reimbursement for cost towards special
diet

Continuous Period of Illness


Covered under this scheme

Treatment outside India


Medical expenses incurred outside India locations will be covered upto a
maximum of Rs.45,000/- (for SP grade, it is Rs.1,39,000) only after
exhausting the benefits under overseas medical policy
Domiciliary expenses incurred outside India location are not covered
The claims to be submitted in INR only

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Cashless Hospitalization Scheme
Enables employee to receive treatment from designated hospitals without
having to pay any charges up to the eligibility limit

Types of Cashless Hospitalization


Emergency Cashless Hospitalization
Planned Cashless Hospitalization

Emergency Cashless Hospitalization


List of hospitals is available at www.Mediassistindia.com
Insured person can approach casualty desk\ reception at networked hospital and fill
cashless requisition form mentioning TCS Employee Number
Duly filled form will be faxed to Mediassist by hospital authorities within 3 hrs of
admission.
Mediassist will provide necessary approvals to Hospital within 6 hrs after verifying the
details.

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Cashless Hospitalization Scheme
Planned Cashless Hospitalization
Obtain an authority letter from Mediassist
To obtain authority letter, fill request for cashless hospitalisation form & fax it to
Mediassist atleast before 72 hrs of planned admission
Mediassist will scrutinize the form & send the authority/rejection lettre direct to the
hospital
Authority letter will indicate an amount upto which Mediassist will settle the bill
Steps to be followed at the hospital
Contact admission desk with a copy of the TCS id card
Hospital will validate the identity of the employee
At the time of discharge, the hospital would require the employee to sign a claim form to
ensure that the charges are correctly stated
Mediassist will pay to the hospital on receipt of complete document

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Exclusions
Expenses towards cost of spectacles, contact lens, any foreign body, beauty
treatment like hair loss etc, normal health check-up, congenital defects,
anaemia, vaccination etc. are not covered by this policy

Treatment arising out of infertility, sterility, family planning.

Self Injury, Suicide, Attempted suicide whilst under the influence of intoxicating
liquor, drugs insanity, war and allied perils, Ionizing radiation, flying of an aircraft
etc. are excluded under policy.

Health Routine check-up

Maternity related expenses beyond two births

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Premium

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For employees in non-SP grades Basic
Coverage
Covered under TCS HIS Total Premium per Premium Borne by TCS Premium recoverable
year per member* (Rs.) from the employee
(Rs.). + Service tax (Rs.)

Employee/Spouse/First two children 1400 1400 Nil

Remaining dependant children 1,400 Nil 1400 plus service tax


Dependant parents/ parent-in-laws 3,500 Nil 3500 plus service tax

Retired Employees/ spouse/dependant 1400 Nil 1400 plus service tax


parents, upto the age of 65 years/
dependant children

Retired Employees/ spouse/dependant 3000 Nil 3000 plus service tax


parents, aged between 65 to 70 years

Retired Employees/ spouse/dependant 3500 Nil 3500 plus service tax


parents, above 70 years

* Subject to revision by the insurance company

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For employees in SP grades Basic Coverage
Covered under TCS Total Premium per Premium Borne by Premium recoverable from
HIS year per member* TCS (Rs.) the employee (Rs.)
(Rs.). + Service tax
Employee/Spouse/F 5500 5500 Nil
irst two children
Remaining 5500 Nil 5500 plus service tax
Children/
dependant parents
Retired 5500 Nil 5500 plus service tax
Employees/Spouse/
Dependant parents/
Dependant children

* Subject to revision by the insurance company

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Higher Hospitalization Cover
Additional insurance premium charged at concessional group rate at Rs 3200
p.a. plus service tax for the family
Fully borne by the employee
Uniform irrespective of age or grade of the employee

For employees joining during financial year, applicable premium


Date of Joining Premium (Excluding S. Tax)

April to June Rs. 3,200/-

July to September Rs. 2,500/-

October to December Rs. 1,750/-

January to March Rs. 1,000/-

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Other premium related provisions
Premium paid by the employee will qualify for deduction from income under
section 80D of the IT Act

Premium for employees on LWP will be same as regular employee

If the employee resigns during the FY, the applicable premium will be deducted
at the time of FFS

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System Interface
HIS Policy in Ultimatix
Ultimatix > HR India > India Associates > Policy and updates > Revised Health
Insurance Scheme

To Add\Delete and view HIS dependant Details:


Ultimatix -> HR Management -> TCS Employee Self Service -> HIS Dependent
Coverage

To apply for HIS Domiciliary and Hospitalization Claim Forms:


All the claims to be made within one month of date of completion of treatment
Ultimatix -> Employee Self Services -> HIS -> Domiciliary \ Hospitalization Claim Form

To View Claim Settlement Details:


Ultimatix -> Employee Self Services -> HIS Home -> Settlement Details

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Claiming procedure
Employee

Enter the claim in Ultimatix & submit the


documents to BMR at each location
MR at Branch (BMR) TCS Branch Finance
Receive & verify the claim documents, enter in a
register, send to MR(A) at Vikhroli with a hard copy of
the statement. Also, a copy to TCS Branch FInance

MR (A) at Vikhroli Receive the claim form from BMR, verify the
documents & collate the claims & forward to TCS
Corporate Finance

TCS Corporate Finance


TCS Corporate Finance will generate Lot no. & Claim no. centrally

MR (B) at Vikhroli

Process the claim & give the cheque & statement to TCS
accounts
TCS Corporate Finance

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Work Scenarios
Query regarding HIS cards
Regarding premium deduction
Query from male associates for the coverage of their in-laws
Query regarding Cashless Hospitalization
Query regarding exclusions from the policy
Query regarding the process to claim the domiciliary/hospitalization expenses.

May 28, 2017


Latest Updates
For FY 08-09, HIS premium recovery will be done as per the schedule below

Premium category Premium for non-SP Premium for SP Premium recovery


grade employees grade employees schedule
(Service Tax @ (Service Tax @
12.36 extra) 12.36 extra)
Higher Rs. 3,200 Rs. 3,200 8-Apr-08
Hospitalization
Father/ Father-in-law Rs. 3,500 Rs. 5,500 8-Jun-08
(Coverage optional)
Mother/ Mother-in- Rs. 3,500 Rs 5,500 8-Jul-08
law (Coverage
optional)
Additional children Rs. 1,400 Rs. 5,500 8-Aug-08
(other than first two
children)

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Latest Updates
Premium for the new joinees
Recovered in the subsequent month of their joining
For employees joining in the month of March 2009, it will be recovered in the same
month.

The link for addition/ deletion of dependants (viz. spouse, children, parents) for
Health Insurance Scheme (HIS) coverage was available from May 6, 2008 to
May 15, 2008.

Addition/deletions to dependant details done till May 15, 2008 was be


considered as effective from April 1, 2008.

Dependant deletions done after May 15, 2008 will be effected only after March
31, 2009 and the premium for FY 2008-09 shall be applicable (if any).

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Contact No. of Mediassisst representative
Delhi
Naresh -9313101330
Faisal 9312475495
Chennai
Chandrashekhar 9380109338
Shiva Kumar - 9884423768 & 9380109338
Alex - 9444032085
Kolkata
None
Hyderabad
Komali 040-32409004
040-27806004

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References

Policy Document
FAQs
List of Hospitals

Micros oft Word Micros oft Excel


Adobe Acrobat Works heet
Document Document

May 28, 2017


THANK YOU

May 28, 2017