Workmen Compensation

1. Workmen Compensation Group health Insurance for GMS Alumni members.

2. CONCEPT OF HEALTH INSURANCE CONCEPT OF HEALTH INSURANCE Reimbursement Pre hospitalization expenses Post hospitalization expenses 30 days 60 days Hospitalization of 24 hrs Other than daycare procedures Cashless Pre and post hospitalization expenses Medicines,Diagnostic tests,Doctors fees

3. Workmen Compensation Product Liability Product Liability What Does Hospitalization cover? If the Insured Person sustains injury or contracts any disease and upon advice of Medical Practitioner, he/she has to incur Hospitalization Expenses then following in Hospitalization Expenses are payable: • Room, Boarding Expenses as provided by the Hospital/Nursing Home. • Nursing Expenses. • Medical Practitioner/ Anesthetist, Consultant fees. • Expense on Anesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of pacemaker, Artificial Limbs, Cost of organs and similar expenses.

4. Workmen Compensation Product Liability Product Liability Coverage

5. Coverage Contd. Coverage contd.

6. Coverage Contd. Coverage contd.

7. Workmen Compensation Product Liability Product Liability ADDITION & DELETION • New members with family can be added to the policy with respect to Date of Joining of preceding month or current month only subjected to the availabilty of CD balance/ Premium. Midterm inclusion of dependents will be possible only in case of:- Spouse ( on account of marriage during the policy term) Children subject to not more than three children being covered under the policy. Parents can be added with new joiners only.

8. Workmen Compensation Product Liability Product Liability CLAIMS ASSISTANCE

9. BAJAJ CAPITAL - CLAIMS CENTRE For Claims Intimation & Process giclaims@bajajcapital.com +9111 61111111 EXTN.225 giclaigiclaims@bajajcapital.com ms@bajajcapital.com

10. CLAIM PROCESS Claims can be broadly defined as : Reimbursement and Cashless Claims This can be further broken into: Planned hospitalization - Customer should intimate TPA/broker at least 48 hours before hospitalization Emergency- Where the customer meets with an accident or suffers from any illness that requires immediate admission to the hospital. Customer should intimate TPA/Broker the hospitalisation at least 24 hours after hospitalization

11. Contd..... Claims are entertained at both network as well as non-network hospitals Network hospitals – Hospitals which are on the tied up list - Where service provider has a relationship Non-network hospitals – which do not form part of the list Types of Claims: Cashless Reimbursement

12. HOW TO AVAIL CASHLESS FACILITY IN NETWORK Checkwhether the hospital is in network of the TPA or not from the TPA’s website or TOLL Free No. In case of any PLANNED hospitalization approval to be sought 48 hrs prior to the date of admission. For anEMERGENCY Hospitalization, intimation to be sent within 24 Hrs. of admission to the TPA. Once you reach hospital, FAX the cashless request form to the TPA for cashless approval TPA will issue an Authorization Letter (AL) post verification of your documents as per policy terms and Conditions OR may raise any query which needs to be timely replied upon Where prior approval takenInsured are requested to approach the Admission / Reception Counter of the hospital on the day of admission with the Authorization Letter and your Medi Card. For additional / final amount, kindly arrange to fax the request with the final bill and discharge summary or Other documents if asked by the TPA before getting discharged from the Hospital Kindly note that constant follow up with the TPA is must during the hospitalization to avail cashless facility. TPA does not provide approval for the total hospitalization expenses in one go since they validate each and every bill raised and release the approval in batches Cashless denialdoes not in any way prevent you from seeking necessary medical attention or hospitalization. Claimant can submit the claim documents to the TPA for reimbursement subject to admissibility of the claim as per terms and conditions of the policy“within 15 days”post discharge from the hospital.

13. SUBMISSION OF CLAIM DOCUMENTS The Insured should submit all the following documents and reports in original 30 days from date of Discharge Duly Signed Claim Form in Original Mention TPA Medi card number and TPA claim intimation number Original Hospital Bill / detailed breakup of the final bill / Payment Receipt Original Discharge Summary / Card All original investigation reports / X-rays films / Scans, ECG etc. Original Bills and receipts for investigations along with Doctors prescriptions Original Bill of Pharmacy, Laboratories along with corresponding original prescription In case of Surgeons/ Consultants bill, kindly insist on a stamped, preferably Numbered receipt Hospital Registration Number / no. of beds / OT facility / Doctor and Nursing staff detail Your telephone No / Mobile No / Email I.D. for future correspondence.

14. Thank you