HOSPITALIZATION

COVERAGE
2015-2016

CSC Proprietary and Confidential

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Agenda

What is hospitalization coverage?

Who can be covered under the hospitalization plan?

Enrollment of Parent(s)/In-law(s)

Premium details

Features of the hospitalization coverage plan

Third party administrator details

Important Timelines

Cashless benefit and reimbursement of hospitalization expenses

Claims Submission Required Documentation

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What is hospitalization
coverage?

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What is hospitalization coverage?

CSC Proprietary and Confidential

CSC provides hospitalization benefits to all employees

through a third-party administrator to cover
hospitalization expenses incurred by you, your spouse,
and children (up to two). You may also choose to cover
your parents or parents-in-law.

United India Insurance Company Limited is our insurer.

Paramount Health Services administers the
hospitalization plan for all MSS group India employees.

Hospitalization coverage includes in-patient

hospitalization treatment for employees and their
dependants as covered during the annual enrollment
period.

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Who can be covered under the

hospitalization plan?

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Who can be covered under the hospitalization

plan?

All regular employees of CSC India are eligible for hospitalization coverage.

Employee with title up to and including Advisor / Manager / Associate Partner / Practice Partner will
be provided an increased insurance coverage of INR 3 lacs, instead of INR 2 lacs offered until
FY15.
Employee may pay additional premium and enhance this coverage to INR 5 lacs under the
base policy. The applicable terms and conditions will remain same as summarized further.
Employee who has elected a coverage of INR 5 lacs in the base policy, may opt for an additional
top-up cover of INR 2 lacs. This will be available for utilization in the event base coverage of
INR 5 lacs is exhausted. Terms and conditions of the base policy will apply, with an
exception of maternity claims, which will NOT be permitted in the top-up policy.
Employee with title Principal / Senior Manager / Associate Director / Partner / Managing Partner
and above will be provided an increased insurance coverage of INR 5 lacs, instead of INR 4 lacs
offered until FY15.
Employee may opt for an additional top-up cover of INR 2 lacs. This will be available for
utilization in the event base coverage of INR 5 lacs is exhausted. Terms and conditions of
the base policy will apply, with an exception of maternity claims, which will NOT be
permitted in the top-up policy

The coverage scheme allows employees to cover a maximum of 1(self) + 5 dependants on a

family floater basis.

If you wish to cover your parents or parents in-law under the hospitalization coverage plan,
kindly note the following:

CSC Proprietary and Confidential

You can only cover either your parents or your parents in-law. Coverage combinations
mentioned below are not permitted under the hospitalization plan.

Father and Mother-in-law

Mother and Father-in-law

Mother and Mother-in-law

Father and Father-in-law

Please note that dependant family members need not be financially dependent on the
employee.
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Inclusion of spouse/new born after the annual

enrollment period
Post the annual enrollment period, in the event of interim addition to the
family, spouse or new born child will qualify immediately for medical cover
from the
day of marriage or birth respectively, subject to completion of
the following steps:
Employee updates the detail of the new member via "Personal Information"
page available in Workday.
Employee includes the new member in the hospitalization plan within 30
days from the occurrence of the event (marriage / birth of child) via
"Benefits" page available in Workday.
Health checkup camps will be organized at all CSC locations, along with
health talks, the details of which will be circulated prior to the event(s).
Any other inclusions/exclusions of dependants in the hospitalization
plan can be done ONLY during the annual enrollment process.

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Enrollment of Parent(s)/In-law(s)
- Additional Conditions

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Enrollment of Parent(s)/In-law(s)
- Additional Conditions
Effective FY14, following conditions were introduced w.r.t. enrolment of
parent(s)/in-law(s):
Once nominated in the medical insurance plan, the selection of parent(s)/in-law(s)
will be valid for next 2 cycles and parent(s)/in-law(s) cannot be added/changed
during this period.
The employee can opt out the enrolled parent(s)/in-law(s) in the subsequent 2
cycles, if would like to. However, if both the parent(s)/in-law(s) have been opted out,
the other set of in-law(s)/parent(s) cannot be enrolled in lieu.
In the unfortunate event of demise of the nominated parent(s)/in-law(s), employee
may nominate the other surviving parent(s)/in-law(s) in the subsequent enrolment
cycle. Please note, only one set of parents/in-laws may be enrolled. Combination of
parent and in-law is not permitted.
If an employee (who was single at the time of enrolling parents) gets married, s/he
may choose to nominate the in-law(s) in the subsequent annual enrolment cycle
post wedding, however the above stated rules apply for future changes.
Parent(s) / In-law(s) nominated in FY14 / FY15
The nomination of parent(s)/in-law(s) submitted in FY14 will be valid until FY16 and
in FY15 until FY17.
During the FY16 enrolment cycle, employee may only remove an enrolled
parent(s)/in-law(s) in case would like to. S/he cannot add the other parent/in-law or
change the set of parent(s)/in-law(s), unless meets the conditions listed earlier.
None of the Parent(s) / In-law(s) nominated in FY14 / FY15
Employees who had not enrolled any parent(s)/in-law(s) in FY14 / FY15, may enrol
them in FY16. Such a selection will be valid until next 2 cycles, i.e. till FY18. Addition
/ change in set of parent(s) or in-law(s) will only be permitted in FY19 cycle.

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Premium Details

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Premium Amounts

Levels

6 & below

7 & above

Premium
Contribution

Coverage
Amount

INR 3,00,000

INR 5,00,000

Contributed by
CSC

Coverage
Option

Employee + upto a maximum of 3 Employee + upto a maximum of 3

Dependants (Spouse and 2
Dependants (Spouse and 2
children)
children)

Contributed by
CSC

If you wish to cover your parents or parents in-law under the hospitalization coverage plan or increase
/top up the hospitalization coverage for your family from 3 lakhs to 5 lakhs per annum or 7 lakhs top up
you will be required to pay an additional premium and Click here to know the additional premium
amounts.

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Features of the hospitalization

coverage plan

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Features of the hospitalization coverage plan

Hospitalization expenses incurred as a result of treatment of pre

existing diseases will be covered.

Pre hospitalization expenses for 30 days prior to admission will be

covered.

Post hospitalization expenses for 60 days from date of discharge will be

covered.

There is no waiting period for maternity coverage.

New born children qualify for cover from the date of birth, provided their
details are updated via Workday within 30 days from the date of
occurrence of the event.

Actual expenses (up to the sum insured) incurred towards fees payable
to surgeon, specialist, anesthetist, attending doctors, nurses and
paramedical staff along with cost of medicines, injections, diagnostic
tests, oxygen, blood, OT charges will be covered.

Woman employees can avail maternity benefits only for her first 2
children.

A minimum of 24 hours hospitalization will be required for submitting a

claim.

Some exceptions to the above rule are, Dialysis, Chemotherapy,

Radiotherapy, Eye surgery, Lithotripsy, Tonsillectomy, Dilation,
Any admission due to accidental injury, and Cataract

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Features of the hospitalization coverage plan

Contd

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Features of the hospitalization coverage plan

Contd.

Hospitalization claim sharing by employee (Copayment)

Hospitalization expenses
incurred for self,
spouse/children

10% of the admissible claim

amount, subject to the
availability of the sum
insured should be borne by
the employee

20% of the admissible claim

Hospitalization expenses
amount, subject to the
incurred for parents/parentsavailability of the sum
in-law
insured should be borne by
the employee

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Hospitalization coverage
- Exclusions

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Hospitalization coverage - Exclusions

Following charges are not reimbursable and are to be borne by the employee:

Registration/Admission charges

Attendant/Visitor pass charges

Ambulance charges

Resident Medical Officer/Duty Medical Officer Charges (RMO/DMO)

Special nursing charges not authorized by the attending doctor

Service charges not forming a part of the room rent

Charges for extra bed for attendant etc.

Bed retaining charges

Charges for TV, Laundry etc.

Telephone/Fax charges

Food and Beverages for attendants and visitors

Toiletries

Purchase of Medicines not related to the treatment

Pre/post natal hospitalization

Stationery, Xerox or certifying charges

Expenses on vitamins/tonics, unless forming part of treatment for injury or disease, as certified by
the treating physician

Injury or disease directly or indirectly caused by or contributed by nuclear radiation/ weapons/

materials

Any cosmetic or plastic surgery except for correction of injury

Naturopathy, accupressure, accupuncture, magnetic therapy, experimental and unproven

treatment/therapies

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Hospitalization coverage Exclusions

Contd.

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Injury on diseases directly or indirectly caused by or arising

from or attributable to war, invasion, act of foreign enemy,
warlike operations (whether the war is declared or not)

Circumcision unless necessary for treatment of a disease not

excluded hereunder or as may be necessitated due to an
accident; vaccination or inoculation or change of life or cosmetic
or aesthetic treatment of any description, plastic surgery other
than as may be necessitated due to an accident or as a part of
any illness

Any dental treatment or surgery of a corrective, cosmetic or

aesthetic nature is not covered, unless necessitated by accident
that requires hospitalization.

Cost of spectacles and contact lenses, hearing aids. Dental

treatment or surgery of any kind unless requiring hospitalization

Convalescence, general debility, 'Run-down' condition or rest

cure, congenital external disease or defects or anomalies,
sterility, venereal disease, intentional self-injury and use of
intoxicating drugs/alcohol

All expenses arising out of or any condition directly or indirectly

caused by or associated with Human T-cell lymphotropic Virus
Type III (HTLB-III) or Lymphadinopathy Associated Virus (LAV)
or the Mutants Derivative or variations Deficiency Syndrome or
any Syndrome or condition of a similar kind commonly referred
to as AIDS
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Hospitalization coverage Exclusions

Contd.

Charges incurred at hospital or nursing home primarily for

diagnostic, X-ray or laboratory examinations not consistent with
or incidental to the diagnosis and treatment of the positive
existence or 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

External and/or durable medical/non-medical equipment of any

kind used for diagnosis and/ or treatment including CPAP,
CAPD, infusion pump, ambulatory devices such as walkers,
crutches, belts, collars, caps, splints, slings, braces, stockings
of any kind, diabetic footwear, glucometer, thermometer and
similar/related items and any equipment subsequently used at
home, etc.

Voluntary medical termination during first 12 weeks from the

date of conception

Naturopathy or other alternative medicine treatment

Hospitalization charges incurred for Ayurvedic / Homeopathic

treatments undertaken in hospitals other than
Government/Private hospitals affiliated to Medical Colleges

Routine vaccination/Pediatrician charges etc.

Domiciliary hospitalization
Please note that this is not an exhaustive list of exclusions, and the terms and conditions of the
Insurance policy in force will continue to prevail.
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Our Third party Administrator

(TPA) - Paramount Health

Services Pvt. Ltd.

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Third party Administrator (TPA) - Paramount

Health Services Pvt. Ltd.

Website

https://www.paramounttpa.com/cscil

Toll free No.

Dedicated support lines

Email ID:

1800-22-6655 (24 hours)

+91 22 6662 0808 and +91 44 4343 5959
(Between : 9.30am to 6.30pm)
csc.ci@paramounttpa.com

Click here to access the TPA SPOCs availability schedule at CSC India locations.
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Important Timelines

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 Intimation Timelines
You are required to intimate the TPA within 48 hours from the time of admission to the hospital.
This is applicable for:

- availing cashless facility or for reimbursement claims

- both planned and unplanned/emergency hospitalization
- hospitalization in network hospital or in a hospital not included in the network
If by chance the employee is hospitalized, it is not mandatory to intimate the TPA within 48
hours from the time of hospitalization.

Submission of Claim Documents

All necessary documents pertaining to the hospitalization claim must be submitted within 30
calendar days from the date of discharge from the hospital, to the TPA SPOC.

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Cashless benefit and

reimbursement of
hospitalization expenses

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Cashless Benefit/Reimbursement of hospitalization

expenses

Cashless treatment can be availed in 3,191 (approximate) network

hospitals all over India.

Employees & their dependents can avail cashless hospitalization

benefit using e-cards available in the Third Party Administrator (TPA)
portal.

You are required to intimate the TPA within 48 hours from the time of
admission to the hospital. This is applicable for :

For availing cashless facility/the reimbursement claims

For both planned and emergency/unplanned hospitalization and
If hospitalized in a network hospital or in a hospital not included in the
network.

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How do I intimate the TPA?

If you wish to avail cashless or reimbursement facility for hospitalization
coverage, it is mandatory that you intimate the TPA via e-mail at
csc.ci@paramounttpa.com specifying the details mentioned below.

Ensure that the above detailed timelines are adhered to.

Your 7-digit CSC employee number

Paramount Health Services ID
Name of the patient
Name of the hospital and location
Nature of ailment

In case of emergencies, you can contact the TPA SPOC via the
Paramount toll free helpline number1-800-22-6655.
Click here to view the SPOC details.

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Reimbursement of hospitalization expenses

CSC Proprietary and Confidential

Hospitalization expenses incurred as a result of treatment

undergone in a non network hospital can be reimbursed by
submitting necessary claim bills to the TPA.

Expenses incurred as a result of treatment undergone in a network

hospital can also be reimbursed by submitting necessary claim
bills to the TPA., provided the cashless benefit has not been
availed.

Original discharge summary, detailed final bill, pharmacy bills

supported with doctors prescription, Investigation & lab reports, Xrays etc., should be attached along with the reimbursement claim
form and submitted to TPA SPOCs within 30 days from the date of
discharge.

Any claim request submitted after 30 days from the date of

discharge will not be considered for reimbursement.

Once the claim request is approved by the insurer, The payment

would be done through National Electronic Fund Transfer (NEFT)
to the bank account number given by the employee.

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Claims Submission Required Documentation

Claim form signed by the employee

Original hospitalization bills/receipts appropriately authorized with hospital; All charges should be
clearly itemized and bill number should be clearly mentioned in the bill

Original discharge card/summary

Bills/receipts/certificate regarding diagnosis from an authorized physician (If not included as part of the
hospital bill/receipt)

Original laboratory reports/attested copies of bills for medicines, investigations, if any, with details
clearly itemized

An authorized physicians prescription in original

Follow-up advice or letter for line of treatment after discharge from hospital from an authorized
physician

In case of hospitalization in a hospital not part of the network hospitals list in the TPA portal, you are
required to obtain the hospitals and doctors registration number in an authorized document (hospital
letterhead with stamp/seal)

In case of hospitalization in a hospital that has not been legally registered, obtain a document from the
hospital in an authorized document (hospital letterhead with stamp/seal) clearly mentioning the number
of beds, availability and schedule of doctors, nurses & other hospital staff

Kindly ensure that you would take a photo copy of all the documents submitted to the TPA for future
reference.

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THANK YOU

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