The FAQ section is Splitted in to below mentioned 4 catergories for easy understanding FAQ General FAQ Coverage FAQ

AQ Policy Condition FAQ Process & Documentation

Frequently Asked Questions: - General
1. Who is APOLLO MUNICH INSURANCE CO? APOLLO MUNICH INSURANCE CO is the insurer for the Group Hospitalization Policy of IBM India for the calendar year 2. Who is TTK Healthcare Services Private Limited? We are the service provider who facilitates administration of IBM India Limited Group Mediclaim Policy (GMC) and assists you by providing quality health care. It is not an insurance company; it acts as a liaison between IBM and the insurance company. 3. What are the services available to me through TTK Healthcare Services Private Limited? Online Enrollment System: For self and dependants Electronic id-cards: For self and dependants Network Hospital: The largest network of hospitals in the country Preferred Network Hospital : Discounted package rates on treatments Cashless hospitalization facility: For treatment at network hospitals for ailments covered under the Group Mediclaim Policy Claims administration services: Registration of each claim with the insurer Assessment of each claim for eligibility under the plan Submission of claim to the insurer and follow up for speedy reimbursement Dedicated Helpline - Both Voice and mail based services - write to ibmcare@ttkhealthcareservices.com or call in the IBM dedicated no 080-40539789 Help desks at designated places - This help desk facility is an attempt to help the employees in putting forward any queries that they may have regarding the health benefits and the policy provided by IBM

4. What is the Help Line Number? For IBM employees, the exclusive help line number (working 24/7) is 080-40539789. 5. Can I email my queries to TTK Healthcare Services Private Limited? Yes, there is a dedicated email id for IBM. Please send your queries to ibmcare@ttkhealthcareservices.com 6. What is the escalation matrix followed in TTK? Below mentioned are the contact numbers and mail ids for any Queries. 1. Please contact IBM Priority number - 40539789.

2. Please write to ibmcare@ttkhealthcareservices.com on any unanswered Queries by call centre for more than 2 working days 3. Please write to the TEAM LEADER at escalation_1@ttkhealthcareservices.com on any unanswered Queries by IBM care for more than 2 working days. You may also mark the copy of the mail to Harini Lakshmi (harinlak@in.ibm.com) We request you to follow the below mentioned escalation matrix ONLY if your queries are not replied by above mentioned contact points Escalation Level 1 Sandeep Kumar (Manager) - Escalation Level 1 Email : sandeep.ks@ttkhealthcareservices.com Turn-around Time: 2 working days Mark a copy to Amar K Basle (amar.basle@in.ibm.com) Escalation Level 2 Please write to IBM@apollomunichinsurance.com You would get a revert from Apollo Munich within 4 days. Escalation Level 3 Please write to rakesh_ranjan@in.ibm.com Note Please write to each escalation level separately according to the timelines. Do not mark a combined mail to all the escalation points.

Frequently Asked Questions: - COVERAGE

1. What is a family floater (Base coverage of 3 lacs) * This is the basic cover of 3 lacs Suminsured for all the members of ESC (employee, spouse and children) for the entire policy year (from 1-Jan- to 31-Dec-) * Any of the family member can claim up to 3 lacs in the policy year. There is no individual restrictions. * The employee has to pay the premium of Rs 1250 for taking this coverage of 3 lacs. Kindly refer the mail sent by IBM on 18-Jan-2012 1A) Who can be covered in the policy In the floater cover, the below mentioned persons can be covered 1. Employee 2. Spouse 3. 4 children The male child can be covered in the policy upto 21 years and unmarried female child can be covered in the policy upto 24 years.

In the non floater cover of parents, Dependent parents (up to the age 90) is covered. The employee bears the premium for the non floater coverage. Note : Any information provided by an employee is found to be incorrect or false would result in BCG Violation 1B) What is the Suminsured band of non floater cover Employees can choose to cover their dependent parents each for amounts ranging from INR 50,000 to INR 500,000 The premium, TPA charges and the service tax would have to be borne by yourself. Premium chart is available on the site https://weblogin.ttkhealthcareservices.com in your login page. Kindly refer to the same. 2) What is meant by Opting out of the policy If the employee does not want to Pay Rs 1250 premium for the coverage of 3 lacs, they can get opted out of the policy. To get opted out, pls follow the following procedure within 45 days from 1-Jan-2012 (Renewal employees) OR DOJ (New employees) 1. Login to https://weblogin.ttkhealthcareservices.com using your login id and password. Please refer to the login procedure in our home page. 2. Please check the checkbox under the additional coverage option 3. Say OK to the POPUP message 4. Click the submit button. Note: If you check the check box of opt out, you (Employee, spouse and children will not be eligible for the hospitalization benefits in the current policy year. But you can get your parents covered. If you resign from IBM, the parents coverage get cancelled automatically from the date of the resignation 2A. Can I Opt in after getting opted out? You can get opted in again by logging in to our website but you need to do this within cut off date (45 days from 1-Jan-2012 (Renewal employees) OR DOJ (New employees)) After cut off date, you are not allowed to do any changes as the data gets freezed. If you are having claims / preauth for your parents, you will not allowed to get opted out of the ESC policy. In this case, please send a mail to ibmcare@ttkhealthcareservices.com within cut off date so that we can do the needful and intimate you.

2B) Can I Opt out after having claims and preauth?

The employee is not authorized to get opted out within 45days since he has utilized the policy benefits. 3) what is Additional coverage?

If you wish to enhance the coverage beyond the family floater of INR 300,000, you can enhance it from 4 lacs to 10 lacs in total. This is called as additional coverage. The extra premium and the service tax would have to be borne by yourself for the coverage for more than 3 lacs Premium chart is available on the site https://weblogin.ttkhealthcareservices.com in your login page. Kindly refer to the same. 4 ) Can the above mentioned coverage used outside India? No, the coverage is only limited to any hospitalization inside India 5) Employees having problem in addition of dependents / Increase in Suminsured 5A ) If the problem is for SI increase, If the employee has crossed the cut off date, of (45days from DOJ) , the SI cannot be increased after the cut off date of 45days If the employee has not crossed the cut off date, of (45days) pls send the below mentioned info to ibmcare@ttkhealthcareservices.com with a copy to Harini (harinlak@in.ibm.com) and Sandeep (Sandeep.ks@ttkhealthcareservices.com) Note : If there is already a claim / preauth for the person for whom you want to increase the SI in current year, then the increased SI cannot be extended or used for the existing ailments or its complications 1. 2. 3. 4. 5. Empno DOJ For whom the SI is to be increased What is the amount Declaration : I agree to the policy condition that the increased SI cannot be extended or used for the existing ailments or its complications.

5B )Problem in Additions of Dependents If the employee has crossed the cut off date, of (45days from DOJ) , the dependents cannot be increased after the cut off date of 45days

If the employee has not crossed the cut off date, of (45days from DOJ)

pls send the below mentioned info to ibmcare@ttkhealthcareservices.com with a copy to Harini (harinlak@in.ibm.com) and Sandeep (Sandeep.ks@ttkhealthcareservices.com) In case of ESC 1. 2. 3. 4. 5. Name Gender DOB Relationship Additional SI if any

In case of Parent 1. 2. 3. 4. 5. Name Gender DOB Relationship SI of each parent

5C) In case of Name change and Age change, The name change has to be first done in IBM HRMS. Once it is done (or it if it is correct in HRMS), please send a mail to Harini (harinlak@in.ibm.com) with the proof. 5d) In case of Queries on MTI (Mid term inclusion) Mid term inclusion is possible only for new born babies and newly married spouse. This should be done with 45days of DOB of the child or DOM of the spouse The adopted child shall be covered from date of legal adoption Mid term inclusion of parents are not allowed. NOTE: PLEASE ASK THE EMPLOYEE TO REFER W3 PAGE FOR MTI DETAILS. THE EXECUTIVES NEED NOT INFORM THE ABOVE MENTIONED PROCESS. THIS IS FOR ONLY REFERENCE

6) How does the coverage take place for a new joiner? Your coverage will begin from the Date of Joining in IBM. But for the addition of your dependants, you need to visit the website https://weblogin.ttkhealthcareservices.com and complete your online enrollment procedure by submitting your dependants' details within 45 days from the date of your joining. LOGIN PROCEDURE Step 1: You need to log on to https://weblogin.ttkhealthcareservices.com. Dont login through ttkhealthcareservices.com Step 2: Choose Corporate Login Step 3: Type IBM (not case sensitive) as 'User Name'

Step 4: Press Tab & wait for 30 Secs Step 5: Please allow the value ( IBM (I310-01) ) to be auto-populated in the 'Select branch' field Step 6: Type your 6 Digit IBM Employee Number as 'ID' Step 7: Type your 6 Digit IBM Employee Number as 'Password' NOTE: We strongly advise you to change the password immediately after you log in. Step 8: Click on 'Login' button Step 9: Click on 'Add/modify dependant information/address If the employee does not want to Pay Rs 1250 premium for the coverage of 3 lacs, they can get opted out of the policy To get opted out, pls follow the following procedure within 45 days from 1-Jan-2012 (Renewal employees) OR DOJ (New employees) 1 2 3 4 Login to https://weblogin.ttkhealthcareservices.com using your login id and password. Please refer to the login procedure in our home page. Please check the checkbox under the additional coverage option Say OK to the POPUP message Click the submit button.

Note: If you check the check box of opt out, you (Employee, spouse and children will not be eligible for the hospitalization benefits in the current policy year. But you can get your parents covered. If you resign from IBM, the parents coverage get cancelled automatically from the date of the resignation

7) Addition of Dependants of the existing employees 1. Existing employees spouse and children record will get carried forward from last year. You can add the parents details/ modify the ESC dependants details at the time of renewal of the insurance policy within 45 days. They have to log on to the TTK website ( https://weblogin.ttkhealthcareservices.com )and add dependant details. Coverage will be effective from the starting date of the new policy. Follow the enrolment process 2. Newly married employees can add spouse details by logging on to the TTK website (https://weblogin.ttkhealthcareservices.com) within 45 days of the date of marriage. Coverage will be effective for the spouse from the date of marriage. 3. Employees who have a new born child can add him/her within 45 days of the date of birth by logging on to the TTK website (https://weblogin.ttkhealthcareservices.com). Coverage will be effective for the new born child from the date of birth. 4. Employees who have adopted a child can add him/her within 45 days of the date of legal adoption by logging on to the TTK website (https://weblogin.ttkhealthcareservices.com). Coverage wil be effective from the date of adoption

7) Can I remove my Dependants who are covered in the policy Only Divorced spouse & Expired dependent can be removed during the policy year. The supporting proof has to be sent to harinlak@in.ibm.com

8) What is an electronic ID card? All employees and the insured members, under this plan, are entitled for an e - ID card. This ID card will identify them for admission into the network hospitals and to allow access to credit facilities at preferred hospitals around the country. This e- ID card is non-transferable. Note: The e - ID card is the sole property of TTK Healthcare TPA Private Limited and must be returned upon request or in the event of separation from the Company's services. 9) How do I get an electronic ID card? You can and need to print the electronic ID card online. Follow the below mentioned steps to print the ID card: Complete the online enrollment process by adding self and dependant details by visiting https://weblogin.ttkhealthcareservices.com (Refer to steps under question 8 for online enrollment). It is advisable to take a print of the ID cards after completing the enrollment. These ID cards will be useful at the time of hospitalization. Step: 1 Log on to https://weblogin.ttkhealthcareservices.com Step: 2 Choose Corporate Login Step: 3 Click on 'Go' Step: 4 User name: IBM (not case sensitive) Step: 5 Press Tab & wait for 30 seconds Step: 6 Please ignore the field 'Select branch name' and allow the auto-select of the value in this field Step: 7 ID: Type your Employee ID Ex: 123456 (your 6 digit employee no.) Step: 8 Password: Type your password NOTE: We advise you to change the password after you log in. Step: 9 Click on E - Card. Step: 10 Click on "view E - Card" Step: 11 Print the pdf document Note : If you have opted out of the policy, the e-card wont get downloaded for the Opted out employees. In case parents are covered, e-cards will get downloaded only for parents 10) What happens if I lose a ID card? If you lose a ID card, you may print another copy of the card online. Follow the above mentioned 10 steps under question no. 10 to print copies of the ID Card. 11) Will I be insured in the policy even If I have not got my electronic id card?

You and your nominated dependants will be insured from the day you join IBM/date of renewal of policy, whichever is later, only if you complete the online enrollment through weblogin within the specified timeline. 12) What do I do in case of a hospitalization in my family? In case of planned hospitalization, call on the helpline numbers of TTK Healthcare Services Private Limited to inform them when you or your nominated dependant needs hospitalization. This should be done at least 48 hours prior to the date of admission. Fill the Pre-Authorization form, available with the Network Hospitals upon showing the TTK ID card or by mentioning your IBM employee id. This can also be obtained from the TTKHCS helpline or can be downloaded from the TTKHCS website. Submit/Fax the Pre-Authorization Form to our toll free fax numbers at Bangalore 48 hours in advance. The advance intimation to TTKHCS will help you to avoid payment of advance amount to some hospitals. Sign the relevant documents including discharge summary before leaving the hospital/getting discharged. If your hospitalization is authorized, then ensure you pay for non-medical expenses and co-payment charges for the dependants and parents, if enrolled. For a non-network hospital, employee has to arrange to fax the complete pre-authorization to TTK. TTK will be able to extend credit (in Network hospital) for the hospitalization only after the preauthorization is complete and eligibility is determined. TTK will then send an authorization letter to the hospital. Emergency Cashless Hospitalization: When you have an emergency hospitalization and get admitted into a network hospital, please inform your family member/relative/friend to contact the billing dept in the hospital with TTK ID or IBM employee id to send Pre-authorization form to TTK. If your hospitalization is authorized, then ensure you pay for non-medical expenses and co-payment charges for the dependents and parents, if enrolled. Kindly sign the relevant documents before leaving the hospital/getting discharged. 13) Is there any minimum time limit for stay in the hospital? Yes. Stay in the hospital should be for minimum of 24 hours. However, there are a few specific ailments specified in the policy which can be covered even though the period of hospitalization is less than 24 hours. 1. Dialysis 2. Chemotherapy 3. Radiotherapy 4. Eye Surgery 5. Lithotripsy (Kidney stone removal) 6. D&C

7.Tonsillectomy Note :Even if the stay is more than 24 hrs, and there is no active line of treatment (only investigations,tests, diagnosis is done), the claim is not admissible under the policy

Frequently Asked Questions: - POLICY CONDITIONS

All hospitalization claims under the Medical Insurance Policy pertaining to employees will be borne by the insurer and employee on an 95%: 5% basis. All hospitalization claims under the Medical Insurance Policy pertaining to dependants (spouse, children and parents) will be borne by the insurer and employee on an 80%: 20% basis. Hospitalization Expenses 1. preexisting All pre-existing diseases are covered except the standard exclusions mentioned down Hospitalization for convalescence, general debility, run down condition or rest cure Hospitalization for intentional self-injury, use of intoxicating drugs/ alcohol Injury or disease directly or indirectly caused by or arising from or attributable to war or war-like situations Circumcision unless necessary for treatment of diseases Dental treatment / surgery is not covered unless requiring hospitalization due to accident. Injury or disease caused directly or indirectly by nuclear weapons Naturopathy Cost of spectacles, contact lenses, hearing aids Any cosmetic or plastic surgery except for correction of injury Hospitalization for diagnostic tests only even if it is prescribed by a physician Vitamins and tonics unless used for treatment of injury or diseases Infertility treatment Voluntary termination of pregnancy during first 12 weeks (MTP) Sterility and Venereal diseases Charges incurred at hospital or nursing home primarily for diagnosis X Ray or laboratory examination or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence of presence of any ailment,sickness or injury , for which confinement is required at a hospital/nursing home or at home under domiciliary hospitalization as defined. HIV / AIDS# Vaccination / Immunization Genetic disorders

2. Maternity * No waiting period for Maternity sublimit of maternity coverage is Rs 50000 * Hospitalisation for maternity benefit can be availed up to 4 children

* The copay of 20% will be applied on the delivery of first 3 children in case the delivery is for spouse and 50% copay for the 4th event. * The copay of 5% will be applied on the delivery of first 3 children in case the delivery is for spouse and 50% copay for the 4th event * Pre natal and post natal expenses are covered up to Rs 10000 or actual whichever is lower as a sublimit of maternity benefit of Rs 50000. * If the maternity is paid up to Rs 50000 already, the prenatal and postnatal expenses will not be payable. * Pre natal expenses means the expenses which are incurred from the date of pregnancy till the date of delivery. Post natal expenses means the expenses incurred within 60 days of date of delivery. * No cashless facility for pre and post natal. * All pre natal and post natal claims should be submitted only with / after the main hospitalization claim. If the bills are submitted before the delivery the claim will be rejected by TTK as per the policy conditions. * The reasonable new born babys expenses can be covered in maternity limit of Rs 50000. * In case of any active treatment given to the new born baby, the expenses will be treated as child expenses separately. The baby has to be covered within 45days of birth to avail the benefit. * Immunization expenses of baby are not payable as per policy conditions. 3) Lasik surgery for refractive error correction * The lasik surgery for correction of eye sight is payable if the refractive error is more than 7.5 - If the procedure is performed only to get rid of contact lens / spectacle (Cosmetic purpose), it is not payable - In case it is performed for therapeutic reasons like erosions, non healing ulcers, recurrent cornsel, nebular opacities it is payable 4) Dental treatment is covered only in case of necessity of hospitalization 5) Congenital Internal diseases are payable 6) Congenital external diseases are payable for the children whose age is less than or equal to 1 year. 7) Oral Chemeotherapy is payable. 8) Orthopedic appliances up to 5% Payable up to a maximum of 5% of the total eligible claim amount or actual expense of the appliance whichever is lower These include but are not restricted to braces, splints, crutches, wheel-chairs, artificial limb etc

9) The treatment for ARMD (Age related Macular Degeneration) with Injections like Avastin / Lucentis / Macugen are not payable

10) Treatment for Seronegative spondyloarthritis (ie- Anchylosing spondylitis) by using biological agents / remicade injections like infliximab are not payable 11) Expenses for the INTERNAL cochlear implant and surgery is payable. The external implant / device is not payable 12) Stemcell Therapy/replacement is not payable. 13) Quantum Magnetic Resonance Therapy for treatment of osteoarthritis is not payable. 14) The treatment of Seronegative Spondyloarthritis by Remicade injections / Medications are not payable. 15) Ayurvedic treatment is payable only when there is 24 hours hospitalization and not payable which can be managed under OPD even there is 24 hours hospitalization. This can be paid only as member reimbursement and not as cashless 16) Ambulance Expenses

The ambulance expenses for all emergency hospitalizations are payable only from the place of incidence/home of the patient to the hospital and not the return trip. The limit for the ambulance charge is INR 1,500.

17) Domiciliary expenses on out-patient care Payable for self spouse and dependent children and not for parents Payable only up to a maximum of INR 10,000 (i.e., actual cost maximum of INR 20,000 at 50% co-pay) per annum is admissible. (ie - will be borne by the insurer and employee on a 50%: 50% basis) Routine health checkups do not fall under the category of domiciliary benefit This benefit would be available only for specialist consultations and investigations prescribed by a specialist and not for the treatment taken The balance cannot be carried forward to subsequent year(s). No minimum amount for claim Charges towards specialist consultation and investigations prescribed by the specialist are covered. A specialist is defined as a Physician (M.B.B.S.) whose practice is limited to a particular branch of medicine or surgery, especially one who is certified by a board of physicians and should hold an additional degree of MD or MS. Some common specialists include o Cardiologist o ENT Specialist o Neurologist o Oncologist o Gastroenterologist o Pediatrician o Gynecologist & obstetrics o Orthopedics o Nephrologists o Urologist o Psychiatrist

o Ophthalmologist o Endocrinologist Any investigation prescribed by a specialist would be admissible under the Domiciliary Plan. i.e. routine blood work, x-ray, ECG, MRI, CT scans etc.

18) Domiciliary Hospitalisation Benefit Domiciliary Hospitalization refers to: Domiciliary Hospitalization refers to medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a hospital/nursing home but actually taken whilst confined at home in India under any of the following circumstances namely: The condition of the patient is such that he/she cannot be moved to the Hospital/Nursing Home, or Patient cannot be moved to the Hospital/Nursing Home for lack of accommodation therein.

However, the Domiciliary Hospitalization benefits shall NOT cover: Expenses incurred for pre- and post- hospitalization treatment. Expenses incurred for the treatment of any of the following diseases: o Asthma o Bronchitis o Chronic Nephritis and Nephritic Syndrome o Diarrhea and all types of Dysenteries including Gastroenteritis o Diabetes Mellitus and Insidious o Epilepsy o Hypertension o Influenza, Cough, and Cold o All Psychiatric and Psychosomatic disorders o Pyrexia of unknown origins for less than ten days o Tonsillitis and Upper Respiratory Tract infections including Laryngitis o Pharyngitis o Arthritis, Gout, and Rheumatism

19) Critical Illness Buffer:

Buffer is an additional cover of INR 700,000 per policy year offered by IBM The Critical Illness Buffer can only be used once the family floater amount and the additional coverage if any taken by the employee have been exhausted The cover is only for the treatment of the following illnesses 1. Blindness 2. Cancer

3. Coronary artery surgery 4. Heart valve replacement 5. Kidney failure 6. Major organ transplant 7. Multiple sclerosis Payable only if there is a admission and not payable only if injection is given 8. Myocardial infarction 9. Paralysis 10. Stroke 11. Surgery of Aorta 12. HIV / AIDS is covered only under critical illness this is not covered under family floater cover. For availing critical illness buffer for treatment of HIV/AIDS, you may ask TTK to directly seek approval from India Total Compensation Director.

Apart from the above diseases, the buffer is payable for the treatment of any injury arising out of road accidents to employees

The critical illness is linked with the additional coverage taken by the employee. The eligibility for critical illness buffer will be determined as per the table below. Additional coverage opted by the employee 5 lakhs to 7 lakhs 3 lakhs to 4 lakhs 1 lakh to 2 lakhs No additional coverage Buffer can be utilized only with the approval from the compensation head. Co-pay % 0% 10% 20% 30%

For availing critical illness buffer excepting for HIV/AIDS, you need to send in a mail request with details to (harinlak@in.ibm.com) along with your manager's approval. The request would then be reviewed and sent for approval to India Total Compensation Director. If approved, TTK would be advised to process the approved buffer amount. NOTE: PLEASE ASK THE EMPLOYEE TO REFER W3 PAGE FOR THE BUFFER DETAILS. THE EXECUTIVES NEED NOT INFORM THE ABOVE MENTIONED PROCESS. THIS IS FOR ONLY REFERENCE

20. What are considered Non-Medical Expenses? Following are few of examples of Non-Medical expenses: ADMINISTRATIVE EXPENSES Admission charges Registration charges Medical Records/Medico-legal charges Attendant stay charges Relative stay charges Additional stay Gate pass / Attendant pass Overhead charges Establishment charges Tax Surcharge Incidental charge Waste disposal charges APPLIANCES Water bed / Air cushion Alpha bed Hot water bag Bed pan / Kidney tray / Sputum cup Crutches / Walker Braces / Cervical collar Slings / Splints Knee caps Abdominal belt / LS belt Nebuliser / Steam inhaler / Humidifier Thermometer Chest binder Spirometer Spacer Glasses / lenses / goggles / Frames Dentures/dental braces/tooth implants Hearing aids Glucometer B.P. Monitoring device Other monitoring devices Feeding Bottle Cradle charges Nipple shield / Breast reliever Baby ID band

DOCUMENTATION EXPENSES Documentation charges Discharge summary Medical records charges Birth certificate Death certificate Medical certificate

SERVICES Private nurse charges Telephone charges Fax charges Food / beverages Diet Electricity charges Water charges T.V. / internet charges Newspaper / magazines A/c charges Stationery charges Linen / laundry charges Mortuary / coffin charges Ambulance charges

CONSUMABLES Antiseptic/disinfectant solutions Soap Powder (talc) Oil /Cream Cream Sanitary pads / Diapers Cassette / CD / Film charges Oxygen cylinder Health Foods

Note : The above mentioned points from 1 20 are the important points & is not the only/ final list.

Frequently Asked Questions: - PROCESS AND DOCUMENTATION 1. What is Pre-Authorization? * The employees who wants to get the cashless treatment through our network hospitals shall get the prior approval atleast 48 hours before the admission. The prior approval is known as preauthorisation. * The forms for the same can be obtained by calling TTK's Telephone Help Lines or downloaded directly from the TTK web site https://weblogin.ttkhealthcareservices.com (Home Page). * The form needs to be filled with the help of the treating doctor. This form contains details like details of treating physician and hospital*, details of diagnosis*, treatment proposed*, past history, estimate expenses*, signature of the treating physician*, etc. TTK's medical team will then evaluate the same based on medical and policy grounds. * If complete details are not provided in the form, then credit (in the case of a network hospital) or claim eligibility (in the case of an out-of-network hospital) can not be provided.

2. What is an Authorization letter? * On approval of pre-authorization, an authorization letter will be sent to the NETWORK hospital. * The letter authorizes the hospital to extend credit for all medical expenses during hospitalization. NOTE : Therefore to use TTK cashless hospitalization service it is very important for you to follow the pre-authorization process. 3. What is the procedure to be followed for cashless? Step 1: TTK will provide the list of network hospitals offering cashless facility for treatment. Step 2: The claimant needs to produce the TTK E- card at the hospital. Step 3: Hospital sends Pre-authorization Request with the treatment details; past history and clinical notes along with estimate of hospitalization expense to TTK local office. Step 4: TTK issues a letter authorizing treatment to the Hospital the approved amount upto the Sum Insured limits (after deducting the non medical & co-pay) Note : 1. Please write your employee id, mobile no in the preauth form 3. My Pre-Authorization request has been rejected. What could be the reasons? Pre authorization may be declined under the following circumstances 1) Information provided was inadequate 2) Disease is not covered by policy 3) Sum insured is exhausted

4. What is a Claim Form? * A claim form is an important document which is essential for claim assessment.

* This form is provided on request by TTKHCS help desk or can be downloaded from https://weblogin.ttkhealthcareservices.com This form is to be signed by the member and submitted with the claim NOTE: We will not be able to assess your claim (credit or non-credit) without a signed claim form. 5. What are the documents to be submitted with claims? DESCRIPTION OF THE DOCUMENT REQUIRED FOR CLAIM PROCESSING A) If the employee opts for cashless treatment, the main bill will be paid directly to the hospital by TTK. The customer can claim only pre and post hospitalization bills. Note: Pre and Post hospitalization claims will be processed only after the settlement of the Main Hospitalization Claim B) Please note that it is mandatory to submit the Claim Form along with other relevant documents for claiming reimbursement. Please ensure that Employee ID, TTK ID, email ID and contact umber is mentioned on the Claim Form. C) All Pre and Post hospitalization claims (including maternity claims) should be submitted only after the main hospitalization claim. Pre hospitalization bills has to be submitted within 30 days of discharge along with main bill or separately (*pre hospitalization period is 30 days before admission) Post hospitalization bills have to be submitted within 67 days of discharge. (*Post hospitalization period is 60 days from the date of discharge) D) Incase of Injury/Accidents, the following details should be provided: Circumstances of Injury should be mentioned by the Doctor Pre-operative Reports FIR / MLC copy incase of Road Traffic Accident.

E) Incase of Polycystic Ovaries / Ovarian Cyst / Chocolate Cyst / Hysteroscopy / Laparoscopy: Employees need to get the details of Marital/ Obstetric history from the treating Doctor. F) Please update the new born childs details in TTK site within 45 days. Incase of hospitalization immediately after the birth of the child the details should be updated in the site prior to sending the pre-authorization request. Note: On a case to case basis, additional documentation may be required post medical review by Doctors for processing the claims.

IMPORTANT INFORMATIONS TO EMPLOYEES

Claims submitted for dependents whose name has not been enrolled in the website will not be processed by the TPA. The claim will not be paid if such claim be in any manner is fraudulent or supported by any fraudulent means or devise whether by the insured person or by any other person acting on his behalf. When the Suminsured is increased, Any ailment diagnosed / treated during coverage/enrollment period under the lower sum insured will continue to have the lower sum insured (The suminsured opted before the increase in Suminsured). This applies for any related ailment and its complications too Please log in to the TTK site and ensure that email id, address and Mobile numbers are always updated to ensure smooth claim processing and dispatch of cheque to the write location. Please ensure that Employee name, DOB, Date of Marriage and Gender appearing in site are correct. Incase of any discrepancy, you may send a mail to Harini for making necessary corrections.

6. How do TTK assess the claim? TTK will assess the validity of the claim based on the documents submitted, validate the policy, validate the treatment undergone and settle the claim within the claim settlement parameters. In case of claim is not adhering with parameters, the case would be rejected. TTK will correspond with you within 7 days of Claim receipt o If Document Shortfall, request for the shortfall documents o If Claim rejected, Rejection Letter will be sent Note: If any bills and receipts are not supported by valid documents the claimed amount of that bill would be disallowed.

7. What is a Network Provider and how do I identify them? Based on TTK experience and expertise they have tied up with hospitals across the country so that their members can avail of cashless hospitalization facility. The list of TTK Network Hospitals is available on their website. You may access the same with your User ID and Password at https://weblogin.ttkhealthcareservices.com Note : Please visit our website before the hospitalization to know the current empanelment status of the hospital 8. Does it mean that I cannot get treated in a hospital of my choice? You can get treated in any hospital within the country but the cashless facility will be available only at the network hospitals. Moreover, the collection of bills and related documents in case of a network hospital will be done by TTK, whereas in case of a hospital outside of network, you will have to collect all the documents at the time of discharge and send it to TTK along with a signed claim form. Important - Please note that any hospital/nursing home you choose has to be registered and satisfy the following conditions.

Definition of a Hospital/Nursing Home Hospital/Nursing home means any institution in India established for indoor care and treatment of sickness and injuries and which a. has been registered as a Hospital or Nursing Home with the local authorities and is under the supervision of a registered and qualified medical practitioner b. Should comply with minimum criteria as under 1. It should have at least 15 inpatient beds 2. Fully equipped operation theatre of its own wherever surgical operations are carried out 3. Fully qualified Nursing staff under its employment round the clock 4. Fully Qualified doctors should be in charge round the clock. N.B In class C towns, condition of number of beds be reduced to 10 inpatient beds 9. Will I be covered for pre hospitalization and post hospitalization expenses? Yes, you will be covered for pre hospitalization expenses incurred 30 days prior to hospitalization and post hospitalization expenses incurred up to 60 days after hospitalization relating to the illness for which you have been hospitalized; provided that the ailment is covered under the policy. Reimbursement of these expenses is possible only on production of complete and detailed bills and documents relating to the same along with a signed claim form. Consultation charges, prescribed medicines and prescribed investigations are payable under this.

Note : Please refer detailed claim documentation points 10. . Do I need to pay any money at the time of discharge? In case of Non Network Hospitals - You will have to make all payments yourself and then forward the claim (all the hospital documents and signed claim form in original) to TTK Healthcare Services in order to get claim reimbursed from Insurance Company. In case of Network Hospitals - Depending upon eligibility, TTK will extend credit for all the medical expenses billed by the Network hospital for the treatment of your illness only. * All non-medical expenses (described above) and any amount exceeding the credit limit will have to be paid by you to the hospital at the time of discharge. * In case if the patient admitted is a dependant, 80% of the medical expenses will be paid for and you will have to pay the balance 20% along with all the non-medical expenses * Any amount exceeding the credit limit will have to be paid by you to the hospital at the time of discharge. The advance intimation to TTKHCS will help you to avoid payment of advance amount to some hospitals. 11. In how many days are claims to be submitted to TTK? Claim papers are to be submitted to TTK Help desk representative or couriered to TTK within 30 days from the date of discharge. 12. What if the cost exceeds the level of hospitalization insurance cover? In such a situation you will be liable to pay the differential amount. We will inform the hospital about your eligible amount and they will recover the amount over and above the credit amount from you directly.

13. In a year how many times can I avail treatment in a hospital? There is no limit on the number of times one can take treatment, however insurance company will reimburse claims up to the sum insured. And subject to policy terms. 14. Can I submit the claim before my last working day? You need to inform and submit the claim (if any )to TTK before your Last working day. This is very important because once you are deleted from the policy you will not be eligible to claim reimbursement for any expenses incurred after the last working day even the admission is before the last working day. In case, there is no claim made by you for self and nuclear family , prorata premium paid for additional coverage will be refunded back to you for the period the coverage cease to exist. In case of any claim is made for any one/all of the insured person, there will not be any refund of premium . In case, there is no claim made for the parent , prorata premium paid for the concerned parent will be refunded back to you for the period the coverage cease to exist. In case of any claim is made, there will not be any refund of premium . 15. What is Medical 2nd opinion? Medical 2nd opinion is a Free Online Opinion by top medical experts from CMC Vellore, Wockhardt Hospital and by in-house TTK doctors through their website. With this service, you can get An alternative viewpoint from a specialist in the field Reassurance that the treatment recommended is the one that is best Advice to help prevent unnecessary or inappropriate medical management Advice as to when, if at all, you should optimally undergo treatment Advice in case of complex medical conditions

16. How do you obtain Medical 2nd opinion? Go to https://weblogin.ttkhealthcareservices.com Go to medical enquiry section Click on Specialist opinion Fill in all fields including TTK card no. Attach all supporting medical reports Send Response will be sent back to email id given by customer within 3 working days

However, the above are the views of the Medical Team and not binding on the patient/ insured. IBM provides equal opportunity to all its employees without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability or age.