Group Mediclaim Policy

17-Jul-09
 Proposed Mediclaim Policy
Objective

To provide financial assistance to an employee & his/her family in case of illness.

Applicability

All on roll employees, not covered under ESI Act.

Key Features

Coverage Limit

Coverage Entitlement

Coverage Terms

Premium

SLAs

17-Jul-09
 Coverage Terms

Family Floater Self + 5 (spouse /2 children/Parents)

Coverage of Pre-Existing Diseases

Waiver of First 30 days exclusion (day one coverage)

Waiver of first year exclusion (diseases like cataract, hernia etc.)

Instant Maternity up to Rs. 50,000/- ( N and C)

Day one Child Cover

Corporate Floater of Rs. 30 Lacs

Parent age- 80yrs

Room rent ( 2% of SI & 4%- ICU)

Ambulance charges Rs. 2000/ (Max)

17-Jul-09
 SLA & Deliverables

Actual Delivery Target

Activity 100% SLA 70% 15% 10% 5%

Cashless more than 10

4 Hours 4 Hours 6 Hours 10 Hours
Approvals Hours

Cashless Query more than 4

1 Hour 1 Hour 2 Hour 4 Hour
Resolution Hour

Cashless more than 4

1 Hour 1 Hour 2 Hour 4 Hour
Enhancements Hour

Claim Re- 10-15 working 15-20 working more than 25

10-15 working days 25 working days
imbursements days days working days

Shortfall / Query 3-5 working days ( 3-5 working more than 10

7 working days 10 working days
Intimation for reimbursement) days working days

17-Jul-09
 Thank you

17-Jul-09