know your insurance benefits-sei & infra

8/10/2019 Know Your Insurance Benefits-SEI & Infra

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KYR – Know Your Benefits

Employee Insurance Program

Quick Guide to 2013 -14 Insurance Benefits

Healthy Bytes



Page 1

Content

Insurance Benefits @SEI – Snapshot

– Enhancements Summarized

Enrollment to Insurance Benefits

Annexure

– Insurance Benefits @SEI - Detailed

• Medical Insurance

• Accident Insurance

• Life Insurance

• Critical Illness Insurance

– Enrollment to Insurance Benefits

– Availing Insurance Benefits

• Medical Insurance• Accident Insurance

• Life Insurance

• Critical Illness Insurance

– Retiree Policy

– How to make most of your benefits?

Click on the relevant section for direct navigation



Insurance Benefits @SEI -

Snapshot



Page 3

What are the Insurance Benefits available to me in Schneider ?

The benefits are renewed with Insurer on annual basisCoverage period for 2013-2014: 1st July 2013 till 30th June 2014

Fresh Enrollment / Validation of Enrollment, along with choice of Top-up Options needs to

be made by all employees by 12th July 2013 to avail the benefitsMid-term enrolment changes are not allowed except in case of Marriage or Child birth

Schneider Electric offers

four Insurance Benefits toemployees !

Provides insurance coverageto employees against the risk

of death / injury sustaineddue to an accident

Provides life insuranceprotection to employees

1. Medical Insurance(along with Top-up Option)

2. Accident Insurance 3. Life Insurance(along with Top-up Option)

4. Critical Illness

Provides financial support toemployees in case of

Critical Illness

Provides insurance coverageto employees and their family

for expenses related tohospitalization due to illness,

disease or injury



Page 4

Wellness Enhancements under Healthy Bytes- Summarized

Medical Insurance

Coverage increased from 4L – 4.5L / family

Enhancement continued from 2012

Option to include 3rd child in base cover

Top-up Options to extend Hospitalization coverage by 4L or 6L

Extension of benefit to Retiring employees at better than Market discounts

Extension of Insurance to HIV cases

Acc ident Insurance

Previous cover:JM: INR 15 Lac

MM: INR 20 LacSM: INR 45 Lac

Grade 10 onwards 2*FC (enhanced in 2012)

New Cover in 20132*Fixed Compensation fo r all, such that

minimum of previous benefit applicable

for Grade is retained

Enhancement in 2013

Life Insurance

Previous cover:JM: INR 5 Lac

MM: INR 10 LacSM: INR 15 Lac

Grade 10 onwards 2*FC (enhanced in 2012)

New Cover in 20132*Fixed Compensation fo r all, such that

minimum of previous benefit applicable

for Grade is retained

Enhancement in 2013

Top-up Options to extend Life Insurance Cover Enhancement continued from 2012Other Wellness Benefits

Health Check up benefit @2500/employee being introduced for all employees Enhancement in 2013(detailed in separate presentation)Deals & Discounts (OPD, IPD and Health check up) in Health care facili ties

Launch of Health Camps - Thyroid, Cardiac, Bone Density, Eye Care, Nutrition, Blood

Sugar, Yoga, Lung Function, Physiotherapy consultation Enhancement continued from 2012

Weekly Health Tips / Communication



Insurance Benefits Landscape 2013 – Snapshot

Health Benefits => Insurance Benefits Overview



Enrollment to Insurance Benefits



702 July 2013

Make Sure Your Dependents Are Covered

• You can enrol your spouse, dependant children and dependant parents /

parents-in-law (any one set of parents)

• Make sure you add and / or edit current dependent details online at

following website within the enrolment period, failing which you will not be

able to cover them till next year

• Policy period: 1st July 2013 till 30th June 2014

URL www.emeditek.comSelect “ E-Enrolment” > “ Schneider Electric” option to login

Login credentials User ID : Employee Code (8 digit starting with “00”) Bridge ID

Password : Employee Code (8 digit starting with “00”) Bridge ID

Annual Enrollment 1st July to 12th July 2012. (Please validate the dependants data within the timelines

else last year details would be considered. Insurance Companies strictly do not allow

mid-term modifications.)



Home Page – www.emeditek.com

http://www.emeditek.com/

http://www.emeditek.com/



Login Page

Select your Company name



Login Page

Enter Employee ID & Password



Dependent Addition Page

Update Dependent details

Available details willappear here



1202 July 2013

How To Enroll?URL www.emeditek.com | Select “ E-Enrolment” > “ Schneider Electric” option to login

Login credentials User ID : Employee Code (8 digit starting with “00”)

Password : Employee Code (8 digit starting with “00”)

Validatepersonal details

Select Top-upPlans

ValidateDependent Details

Check BankDetails

UpdateNominee details Click Save & Sign-off to

save details



Updated Employee Profile



Annexure – Insurance Benefits Detai led

1402 July 2013



Insurance Benefits - Detailed

1. Medical Insurance (along with Top-up Option)2. Accident Insurance3. Life Insurance (along with Top-up Option)4. Critical Illness Insurance



Page 16

Medical Insurance Benefit – Coverage Details

Policy Parameter

Insurer United India Insurance Company (UIIC)

Third Party Administrator E Meditek

Sum Insured 4,50,000 INR per family

Coverage Type Family Floater

Dependent Coverage

Employee + Spouse + Children (max 2 children) + 2 Parents / Parents in Laws

(One set of parents)

• If there are less than 5 dependents then 3rd child can also be covered for free else

3rd child can be covered at additional premium of Rs. 1,124 per year.

Note: Enrolments for family needs be done through Emeditek Gateway.

Top-up Plans

Top-up plans allow you to enhance coverage / benefit limits upon payment of

additional premium, at highly discounted prices as compared to Market.

Two options are available in Medical insurance:

Enhance cover by Rs. 400,000 for an annual premium of Rs. 3,000

Enhance cover by Rs. 600,000 for an annual premium of Rs. 3,600

Note: Enrolments for Top up can be done through Emeditek Gateway by selecting from the drop down. After your

authorization, the payments for applicable premium for Top-up plans will be routed through payroll deduction.

Co-pay on Claims

Applicable for Parent claims only @ 20%

Example: If admissible claim value is Rs. 10,000 then insurance plan will pay

Rs. 8,000 and remaining Rs. 2,000 has to be paid by you.



Page 17

Medical Benefit – Coverage Details Contd.

Benefits / Extensions Coverage

Standard Hospitalization • Yes

TPA services • Yes

Pre existing diseases • Yes

Waiver on 1st year exclusion • Yes

Waiver on 1st 30 days excl. • Yes

Maternity benefits

Yes. INR 50,000 for

both Normal &

C-section

Pre & Post Natal ExpensesYes only for

hospitalization.

Baby cover day 1 • Yes


Day Care • Yes

HIV / AIDS • Yes

Room RentYes. Up to Rs. 6000

per day

Day care Procedures •Yes

Pre-Post Hospitalization Exp. Yes. 30 & 60 days

Ambulance ServicesYes. INR 1500 per

incident

B fit E t i D fi iti



Page 18

Benefits Definition

Pre existing

diseases

Any Pre-Existing ailments such as diabetes, hypertension, etc or related ailments for which care, treatment or advicewas recommended by or received from a Doctor or which was first manifested prior to the commencement date of the

Insured Person’s first Health Insurance policy with the Insurer

First 30 day waiting

period

Any Illness diagnosed or diagnosable within 30 days of the effective date of the Policy Period if this is the first Health

Policy taken by the Policyholder with the Insurer. If the Policyholder renews the Health Policy with the Insurer and

increases the Limit of Indemnity, then this exclusion shall apply in relation to the amount by which the Limit of

Indemnity has been increased

First Year Waiting

period

During the first year of the operation of the policy the expenses on treatment of diseases such as Cataract, Benign

Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal

Diseases, Fistula in anus, Piles, Sinusitis and related disorders are not payable. If these diseases are pre- existing atthe time of proposal they will not be covered even during subsequent period or renewal too

Baby Cover Day 1In consideration of additional premium, this policy is extended to cover the new born child of an employee coveredunder the Policy from the time of birth till 90 days. Not withstanding this extension, the Insured shall be required to

cover the newly born children after 90 days as additional member as mentioned elsewhere under this Policy.

Pre HospitalizationIf the Insured member is diagnosed with an Illness which results in his / her Hospitalization and for which the Insurer

accepts a claim, the Insurer will also reimburse the Insured Member’s Pre-hospitalization Expenses for up to 30 days

prior to his / her Hospitalization.

Post Hospitalization If the Insurer accepts a claim under Hospitalization and immediately following the Insured Member’s discharge, further medical treatment directly related to the same condition for which the Insured Member was Hospitalized is required,

the Insurer will reimburse the Insured member’s Post-hospitalization Expenses for up to 60 day period.

Day Care

Day Care Procedure means the course of medical treatment or a surgical procedure listed in the Schedule which is

undertaken under general or local anesthesia in a Hospital by a Doctor in not less than 2 hours and not more than 24

hours. Generally 8 aliments (i.e. Dialysis, Chemotherapy, Radiotherapy, Eye surgery, Dental Surgery, Lithotripsy(kidney stone removal), Tonsillectomy, D & C)

Benefit Extensions – Definitions



Page 19

Medical Benefit – General Exclusions

• Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria…

• Cost of spectacles, contact lenses, hearing aids

• Any cosmetic or plastic surgery except for correction of injury

• Hospitalization for diagnostic tests only.

• Vitamins and tonics unless used for treatment of injury or disease

• Infertility treatment

• Voluntary termination of pregnancy during first 12 weeks (MTP)

• Dental treatment.

• Incidence occurred while under the Influence of intoxicating drink or drugs.

• 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 disease

• Congenital external diseases or defects/anomalies

• Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.

• Venereal diseases .

• Injury or disease caused directly or indirectly by nuclear weapons (Nuclear radiation or nuclear weapons material) Naturopathy.

• Aviation other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft any where in the world.

• Incidence arising out of any breach of law with criminal intent.• Insanity



Insurance Benefits - Detailed1. Medical Insurance (along with Top-up Option)2. Accident Insurance3. Life Insurance (along with Top-up Option)4. Critical Illness Insurance

G P l A id (GPA) B fi D il



Page 21

Group Personal Accident (GPA) – Benefit Details

This insurance provides compensation/payment up to a financial limit as assigned by the company, to the insured

person or his legal personal representative, if the insured person suffers death or disablement due to an accident.

The cover is worldwide but payment of claim can only be made in India and in Indian Rupees.

Policy Parameter

Insurer Tata AIG General Insurance Company

Policy Start Date 01st July 2013

Policy End Date 30th June 2014

Sum Insured 2 times of Fixed compensation (*Enhanced this year)

Coverage Details

Accidental Death Yes (100% of Capital Sum Insured)

Loss of both eyes OR 2 limbs OR 1 limb and 1 eye Yes (100% of Capital Sum Insured)

Loss of one eye OR 1 limb Yes (50% of Capital Sum Insured)

Permanent Total Disablement from injuries otherthan those named above

Yes (100% of Capital Sum Insured)



Page 22

GPA – Benefit Details

Coverage Details

Permanent Partial Disability Yes as per benefit chart

Temporary Total Disability (Weekly Benefit- 1% of Sum Insured subject to a

maximum of INR 5,000 for 100 weeks)

Geographical Limits World wide

Terrorism Covered

Disappearance Yes, Covered

Education benefit* ( Payable in case of Accidental

death of an employee )

Yes @ 10% of sum insured

(Max. Rs. 1 Lac) per child for two children up to age of 4

years is payable.

Medical Extension ( Payable towards medical

expenses for treatment of accidental injury - OPD)*

Up to INR 7500

Note: If accident requires hospital admission then your

medical insurance can be utilized. Above expenses are

available for immediate medical attention

GPA D t il f V i Di bil it Cl



Page 23

GPA – Details for Various Disabil ity Clauses

* Indicative list, Please refer to poli cy document



Insurance Benefits - Detailed1. Medical Insurance (along with Top-up Option)2. Accident Insurance

3. Life Insurance (along with Top-up Option)

4. Critical Illness Insurance

G T Lif (GTL) B fit D t il



Page 25

Group Term Life (GTL) – Benefit Details

Policy Parameter

Insurer Kotak Mahindra Old Mutual Life Insurance

Company

Policy Start Date 01st July 2013

Policy End Date 30th June 2014

Sum Insured 2 times of Fixed compensation (*Enhanced this

year)

Coverage Details

Death

In the event of death of a member from any cause

(natural/accidental), provided that this shall occur while

the assurance in respect of such member shall be in

force, an amount determined in accordance with the

Policy Schedule shall be paid

Yes



Page 26 2602 July 2013

What is a GTL Top up Cover ?

Top up cover is an additional life cover offered to all employees over and above the cover under

the company sponsored GTL policy .It is on a pure voluntary basis and the premium for the top-

up shall be paid by the individual employee.

Features of GTL Top up Cover :

It is very quick and hassle free

The premium rates under the Top-up plan are substantially lower an individual term plan .Thus

top up provides an additional Life cover at a very low cost. It provides tax benefit under Section 80 C of the Income Tax Act, 1961.

The premium amount is deducted from employee’s payroll.



Page 27 2702 July 2013

Life Insurance (Top-up Option)

A top up plan on Life insurance is a flexible option that increases your total sum insured at a

discounted premium as compared to retail / individual insurance plan available in the market.

You may select the top up option on the enrolment portal and the premium will be calculatedas per the following age band grid.

Note: The above values are rounded off.Refer to enrollment portal for actual amount as per your selectionBase + Top-up should not be more than 10 x GC. IF it is contact your Admin before selecting

Age Band Vs.

Options

JM MM SM

500,000 1,000,000 1,000,000 2,000,000 1,500,000 3,000,000

18-30 483 966 966 1933 1449 2899

30-35 517 1034 1034 2067 1551 3101

36-40 674 1348 1348 2697 2022 4045

41-45 944 1888 1888 3775 2831 5663

46-50 1472 2944 2944 5888 4416 8831

51-55 2275 4551 4551 9101 6826 13652

56-60 3382 6764 6764 13528 10146 20292

GTL Top-Up Selection Process



• Suicide is not covered under Voluntary Top up.

• Top up is not available by just authorizing in the portal. Once the medical underwriting is completed and insurers

have accepted the case, member will be covered under voluntary top up.

• In case of any claim arisen during medical underwriting requirement process Top Up Sum insured will no t be paid

02 July 2013

GTL Top-Up Selection Process

Step 1:- Go to emeditek

enrolment portal

Step 2:- Select your Agebracket and Top up Sum Insured

Step 3:- Answer the 4 questionsthat will appear on the portal

under the Voluntary Top up SumInsured

• As asked by the insurereither you need to providethe medical details to theDoctor who would call you

from and do the tele-underwriting.

• Or else, need to undergomedical tests andquestionnaire ,as per theunderwriting guidelines atmedical centers prescribedby Kotak. (Medical expenseswill be borne by Kotak).

If No, then your cover would commence afterreceiving approval from Kotak Life .

The applicable premium would be deducted fromyour payroll.

If answer to any of thesequestions is Yes then you need to

undergo medical underwriting :



Page 29

GTL – Exclusions

• Service on duty with any armed force

• Insanity

• Venereal disease

• Influence of intoxicating drink or drugs

• Aviation other than as a passenger (fare paying or otherwise) in any duly licensed

standard type of aircraft any where in the world

• Nuclear radiation or nuclear weapons material

• Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be

declared or not), civil war, rebellion, revolution, insurrection, mutiny, military, or

usurped power, seizure, capture, arrest,, restraint, detainment’s of all kings, princes,

and people of whatever nation, conditions and qualities so ever

• Childbirth, pregnancy or other physical causes peculiar to the female sex

• While committing any breach of law with criminal intent .



Insurance Benefits - Detailed1. Medical Insurance (along with Top-up Option)2. Accident Insurance3. Life Insurance (along with Top-up Option)


Crit ical Illness Cover



Page 31 3102 July 2013

Crit ical Illness Cover

Benefit:

2L for JM

3L for MM and SM

Diseases covered under Crit ical Illness:

• Major Heart Attack (MI)

• Cancer

• Stroke• Coronary Artery By-Pass Graft Surgery (CABG)

• Kidney failure

• Major organ transplant

• Paralysis

• Loss of limbs

• Aorta surgery

• Major burns

• Heart valve surgery

• Blindness

Click here for

Critical IllnessBenefit Details

http://intranet.in.schneider-electric.com/pdf/Insurance%20Renewal%202013/Critical%20Illness%20%20Benefit%20Details.pdf






Availing Insurance Benefits

1. Medical Insurance2. Accident Insurance3. Life Insurance4. Critical Illness Insurance

C hl / R i b t hi h t h



Page 33

Cashless / Reimbursement – which one to choose

Cashless claims process is more easier than Reimbursement:

No out of pocket expenditure for employees, except non payable expenses.

No requirement for document submission.

It saves times for administrative work as TPA directly coordinates with the

hospital.

Availing Medical Benefit Cashless Process



Page 34

Availing Medical Benefit – Cashless Process

Cashless means the Emeditek may authorize upon a Policyholder’s request for direct settlement of eligible

services and it’s according charges between a Network Hospital and Emeditek. In such case Emeditek will

directly settle all eligible amounts with the Network Hospital and the Insured Person may not have to pay anydeposits at the commencement of the treatment or bills after the end of treatment to the extent as these services

are covered under the Policy.

Planned Hospitalization Emergency Hospitalization

List of hosp itals in the Emeditek network

Hospitals list

http://www.emeditek.com/NetworkServices.aspx

Website : www.emeditek.co.in

Contact Customer Service Line

1800-102-3242

+91-124-4466666 (Hotline)

[email protected]

Note : Patients seeking treatment under cashless hospitalization are eligible to make claims under pre and post hospitalization expenses. For all such

expenses the bills and other required documents needs to submitted separately as part of the claims reimbursement.

Cashless Process Flow


http://www.emeditek.co.in/

mailto:[email protected]


http://www.emeditek.co.in/




Page 3535

Emergency

Identification via Emeditek Cards. Also carry claimant ID proof

Approach Network Hospi tal . For updated l is t vis ithttp ://www.emeditek.com/NetworkServices.aspx

Planned

Pre-authorization request to Emeditek TPAfrom hospi tal TPA Helpdesk

Emeditek TPA Pvt Ltd will verify the documents

VERIFIED BY

DOCTOR

Authorization Issued Pre – Authorization Request DeniedQueries Raised forfurther Clarification

Cashless Process Flow

Planned Hospitalization



Page 36

Member intimates Emeditek of the

planned hospitalization in a

specified pre-authorization format

at-least 48 hours in advance

Claim

Registered by

the Emeditek on

same day

Follow non cashless

process

No

Emeditek authorizes

cashless for planned

hospitalization to the

hospital

Yes

Pre-Authorization

Completed

Pre – Authorization Form

www. emeditek.co.in

Click here for

Pre

Authorization

Form

Member produces ID card

at the network hospital

and gets admitted

Member gets treated and

discharged after paying

all non entitled benefits

like refreshments, etc.

Hospital sends complete

set of claims documents

for processing to E

Meditek

Claims Processing &

Settlement by Emeditek

& Insurer

Step 1Pre-Authorization

All non-emergency hospitalisation

instances must be pre-authorized

with the E Meditek, as per the

procedure detailed below. This is

done to ensure that the best

healthcare possible, is obtained,

and the patient / employee is not

inconvenienced when taking

admission into a Network Hospital.

Step 2 Admission, Treatment &

discharge

After your hospitalisation has been

pre-authorized, you need to secure

admission to a hospital. A letter of

credit will be issued by Emeditek to

the hospital. Kindly present your E-card and a photo identity card at the

Hospital admission desk. The bills

related to treatment will be sent

directly to, and settled by Emeditek

at the end of the Treatment

Emergency Hospitalization & Process

http://intranet.in.schneider-electric.com/pdf/Insurance%20Renewal%202013/Pre%20Authorization%20Form.pdf










Page 37

P

R

OC

E

S

S

Step 1Get Admitted

Step 2Pre-Authorization by hospital

Step 3Treatment & Discharge

In cases of emergency, the

member should get admitted in

the nearest network hospital by

showing their E card.

Relatives of admitted member

should inform the call centre within

24 hours about the hospitalization &

Seek pre authorization. The

preauthorization letter would be

directly given to the hospital. In case

of denial member would be informed

directly

After your hospitalisation has

been pre-authorized the

employee is not required to pay

the hospitalisation bill in case of

a network hospital. The bill will

be sent directly to, and settled by

E Meditek

Member gets admitted in

the hospital in case of

emergency by showing his

E Card

Member/Hospital applies

for pre-authorization to the

Emeditek within 24 hrs of

admission

Emeditek verifies

applicability of the claim to

be registered and issue pre-authorization

Pre-

authorization

given by the E

Meditek

No

Member gets treated and

discharged after paying all

non medical expenses like

refreshments, etc.

Hospital sends complete set

of claims documents for

processing to the E Meditek

Non cashless

Hospitalization

ProcessYes

Do’s and Don'ts



Page 38

Do s and Don ts

Cashless Claims

Produce your ID card to the hospital authorities at the time of admission.

In case of non-photo ID card, please also carry any other Photo ID Proof

with you and submit a photo copy of the same to the hospital.

Please inform TPA well in advance (at least 48 Hours before admission)

about the hospitalization (Within 24 hours of admission, in case of Emergency Hospitalization). This ensures that the authorization for

cashless is provided well before the patient reaches hospital and the

admission would be hassle free.

Make sure to fill up the mobile number in pre-authorization form

Non-payable items and co-payment charges have to be borne by the

Insured

Availing Medical Benefit



Page 39

Emergency

Approach To Non Network Hospi tal

Planned

Intimate within 72 Hrs.from time of admission or

before

Intimate within 24 Hrs.from time of admission

Emeditek TPA

Submit documents w ithin 15days from date of discharge

from the hospital

Availing Medical Benefit

– Reimbursement Process: Non Network Hospital

Reimbursement Claims



Page 40

Please intimate TPA about the hospitalization before the

admission (within 24 hours from time of admission in

case of Emergency hospitalization), even if the hospitalis not in network or you do not wish to avail cashless

facility.

Please ensure that the hospital meets the requirement

as per the definition provided in the policy.

Please collect and preserve Discharge summary,Reports, Prescriptions, Bills and receipts in Original.

Please note that All Bills, cash memos and diagnostics

should be supported by the doctors’ prescription.

Submit all the documents along with a duly filled in claim

form within 15 days from the date of discharge from

the hospital (within 60 days if the claim includes PostHospitalization expenses).

Indicative list of documents to be submitted for



Page 41

Reimbursement ProcessCompleted Claim form with Signature

Hospital bills in original (with bill no; signed and stamped

by the hospital) with all charges itemized and the original

receipts

Discharge Report (original)

Attending doctors’ bills and receipts and certificate

regarding diagnosis (if separate from hospital bill)

Original reports or attested copies of Bills and Receipts

for Medicines, Investigations along with Doctors

prescription in Original and Laboratory

Follow-up advice or letter for line of treatment afterdischarge from hospital, from Doctor.

Provide Break up details including Pharmacy items,

Materials, Investigations even though it is there in the

main bill

In case the hospital is not registered, please get a letter

on the Hospital letterhead mentioning the number of

beds and availability of doctors and nurses round the

clock.

In non- network hospital, you may have to get the

hospital and doctor’s registration number in Hospital

letterhead and get the same signed and stamped by the

hospital, if required.

Claims Form

www.emeditek.co.in

Click here

for ClaimForm

*Please retain photocopies of all documents submitted

Click here forChecklist ofDocuments

Things to remember

http://intranet.in.schneider-electric.com/pdf/Insurance%20Renewal%202013/Claim%20Form.doc



http://intranet.in.schneider-electric.com/pdf/Insurance%20Renewal%202013/Checklist%20of%20documents.pdf









Page 42

g

Always carry your TPA card with Government identity

proof while going to the hospitalMaintain all bills relating to hospitalization, including pre

and post in original

Remember to take the bills from your family / consulting

doctor

Before hospitalization, clarify whether the particular

disease is covered under your policy terms andconditions or not

Request the hospital authorities to send the necessary

papers to the TPA at the earliest, without which, claim

cannot be processed & cashless cannot be granted

Feel free to consult TPA claims team anytime for any

issues. It is advisable to store TPA helpline numbers inyour mobile phone and also give it to your family

members.

E meditek Contact Points



Page 43

Southern Region Commercial Sales Offices :

1st Point of Contact :

Shivshankar 9620552223 [email protected]

Ramesh 9845081848 [email protected].

Sundarrajan 8861005057 [email protected].

Escalations :

Vikas Anupam 8861005056 [email protected].

Dr Sujit Paul 9686957788 [email protected].

Northern Region Commercial Sales Offices :


Shatrunjay 9958793092 [email protected], [email protected]

Amit Kumar 9958086222 [email protected].

Escalations :Dr Faisal Khan 9910029560 [email protected].

E meditek Contact Points



















Page 44

Western Region Commercial Sales Offices :


Tushar Shoni 9737150883 [email protected].

Sanjay Pawar 9594083185 [email protected], [email protected].

Escalations :

Dr Kadam 9867330175 [email protected].

Nishchint Kumar 9594567878 [email protected].

Eastern Region Commercial Sales Offices :


Ayan Mitra 9830333702 [email protected], [email protected].

Escalations :

Parthe Sarkar 9831013691 [email protected].

Medical Benefit – Local Admin Contact Points















Page 45

Sourthern Region Commercial Sales Offices :

Secundrabad Mr. Dennis Edwin

Bangalore Mr. Palani G.

Chennai Mr. Unni Krishnan

Eastern Region Commercial Sales Offices :

Kolkata Ms. Shampa Dutta

Jamshedpur Mr. Amit Deshpande

Plants :

Hyderabad Plant Mr. Ravindra Adavadkar

Nasik Plant Mr. Rajendersinh Bhandari

Vadodara Plant Ms. Swati Mehta

Ambattur Plant Ms. Renuka Devi /Mr.Sukhesh Gopalan

Conzerv Ms. Anju Mathew (HRBP)

Meher Mr. Arun Shetty

Western Region Commercial Sales offices :Mumbai Mr. Antony Raj

Pune Mr. Pankaj Jain

Vadodara Mr. Rajesh Thakore

Ahmedabad Mr. Haresh Patel

Northern Region Commercial Sales offi ces :

Gurgaon Ms. Manisha Kala

Mr. Sachin ChauhanLudhiana Mr. Mohit Khurana

Chandigarh Mr. Shahab Naqvi

Jaipur Mr. Om Pandey

Lucknow Mr. Rahul Srivastava

GTCI & GSC :

Bangalore Office Mr. Jayaram Govindaiah

Administration of the insurance related benefits will be handled by Administration department.

Location specific admin SPOC points are given below:

Local Helpdesk / Impant are also p rovided across majorlocations : Gurgaon , Bangalaore , Mumbai , Kolkatta ,Hyderabad , Nashik and Baroda. The contact details of personand schedule will be separately circulated on regional basis

Medical Benefit – Central Contact Point



Page 46

Schneider SPOC:

Providers

Ms Manisha Kala Phone: +91 858885693

E Meditek:

www.emeditek.co.in

Marsh:

www.marsh.com

Escalation

Mr. Shatrunjay Misra Phone: +91 9958793092

Email: [email protected]

Mr. Rajiv Joshi Phone: +91 8588835007

Email: [email protected]

Mr Surendra Bisht Phone: +91 9711157768





Availing Insurance Benefits

1. Medical Insurance2. Accident Insurance3. Life Insurance4. Critical Illness Insurance

GPA – Claims Process



Page 48 4802 July 2013

Claimant / Nominee notifies HR,who in turn would intimate

Insurer and submit requiredclaim documents within 30 Days

of the event

On obtaining all relevantdocuments, Insurance Co. willbegin processing the claims

Claim Investigation andReview of submission of all the

required documents

Is claimpayable?

Cheque is sent to Employer (HR),from where it is given to the

Claimant/ Assignee

Insurer provides a valid reason forthe rejection to HR (death) nodeath (Claimant)

No

Yes

GPA – Claims Document Checkl ist



Page 49

Weekly Benefit Claims

1. Completed Claim form2. Doctor's Report

3. Disability Certificate from

the Doctor, if any

4. Investigation/ Lab

reports (x-ray etc.)

5. Original

Admission/dischargecard, if hospitalized

6. Employers Leave

Certificate & Details of

salary

Death Claims

1. Completed claim form2. Attending Doctor's report

3. Death Certificate

4. Post Mortem/ Coroner's

report

5. FIR ( First Information

Report)

6. Police Inquest report,wherever applicable

Dismemberment/ Disablement

Claims

1. Completed claim form2. Doctor's Report

3. Disability Certificate from

the Doctor

4. Investigation/ Lab reports

(x-ray etc.)

5. Original Admission/

discharge card, ifhospitalized.

6. Police Inquest report,

wherever applicable

Click here forGPA Claim

Form

GPA – Contact Details

http://intranet.in.schneider-electric.com/pdf/Insurance%20Renewal%202013/GPA%20Claim%20Form.doc






Page 50 5002 July 2013

Providers: Tata AIG General Insurance Company

Claims Intimation /

Registration

Claim Intimation mail should go to

[email protected],

A&H.delh [email protected];

[email protected]

With a cc to :

Respective HRBP and

[email protected]

Claims can also registered directly on

Toll free no:18002267780 / 1800119966 with pol icy no.

Contact Person

Name : Ankur Jain

Mobile:+91 999931608

Email : Ankur.jain@tata-aig .com


mailto:A&[email protected]









mailto:A&[email protected]




Availing Insurance Benefits1. Medical Insurance2. Accident Insurance

3. Life Insurance4. Critical Illness Insurance

GTL – Claims Process



Page 52 5202 July 2013

Claimant / Assignee notifies HR,who in turn would intimate Insurer

and submit required claimdocuments within <<3 days>> ofthe event

On obtaining all relevantdocuments, Insurance Co. willbegin processing the claims

Claim Investigation and Reviewwithin <<7 Days>> of submission

of all the required documents

Is claimpayable?

Cheque sent to Employer (HR)within <<10 working days>, fromwhere it is given to the Claimant/

Assignee

Insurer provides a valid reason for therejection to HR/Claimant/ Assignee

No

Yes

Claim form with authorized signature & stamp of client (as per Annexure A)

GTL – Document Checklist



Page 53

• Claim form with authorized signature & stamp of client (as per Annexure A)

• Active Employment Letter

• Original Death Certificate

• Proof of age of the life insured• Last attending doctor's death certificate

• Guardian details for minor beneficiary

• Driving license (Accidental claim)

• First information report (Accidental & dismemberment claim or any police case in natural

death)

• Post mortem report (Accidental or any police case in natural death)

• Police case closure report (Accidental or any police case in natural death)

• Viscera Report (Accidental or any police case in natural death, if applicable)

• Nomination Declaration from policyholder (as per Annexure B)

• Nominee bank details & ID proof

• Cause of death certificate

GTL – Contact Details



Page 54 5402 July 2013

Providers: Kotak Life Insurance Company

Claims Intimation Claim Intimation mail should go to

• [email protected]

• [email protected]

With a cc to :

Respective HRBP and

[email protected]

Contact Person Name : Charu Gosain

Mobile:+91 9818335173

Email : [email protected]













Availing Insurance Benefits1. Medical Insurance2. Accident Insurance3. Life Insurance


Critical Illness – Claims Process



Page 56 5602 July 2013

Notification of Claim

All critical Illness claims must be submitted in

writing to KLI within 30 days from the claimevent date along with the primary documents

Submission of diagnosis reports /medicalreports

Employee should submit complete treatmentpapers from diagnosis till date of discharge

along with medical questionnaire

Claim Investigation and Review within <<7 -10Days>> of submission of all the required

documents

Is claimpayable?

Insurer provides a validreason for the rejection toHR/Claimant/ Assignee

No

Cheque sent to Employer(HR)/ employee within<<10-12 working days.

Yes

Critical illness claim is payable only when a do ctor prescribes a claimant to be criti cally ill as

per diseases mentioned and a claimant is able to sur vive for the next 30 days. The claimant

also needs to p roduce sufficient documents to avail this cl aim.

Click here forCritical Illness -

Documentschecklist

http://intranet.in.schneider-electric.com/pdf/Insurance%20Renewal%202013/Critical%20Illness%20Document%20checklist.pdf







Retiree Policy1. Coverage Details2. Retiree Policy Process3. Contact Details

Retiree Policy – Coverage Details

Policy Parameter



Page 59

Policy Parameter

Insurer United India Insurance Company (UIIC)

Third Party Administrator To be decided by United Insurance

Sum Insured INR 450,000 if desired

Family Definition Self & Spouse


Standard Hospitalization •Yes

Copayment Copay of 20% would applicable as per retail policy.

Pre existing diseases

PED coverage subject to stipulated claim free years, this is subjected to certificate

from the TPA as per the format .There is a waiting period of 4 years under normalindividual cover. If you have had 4 claims free years and this is being certified by the

TPA then PE would be covered from day one.

Pre & Post HospitalizationCovered for 30 & 60 days for Hospitalization on disease / illness / injury subject to

maximum of 10 % of Sum Insured.

Room Rent Capping 1 % of Sum Insured per day for normal and 2 % of Sum Insured per day for ICU.

Maternity benefits Not Applicable

Cataract Capped at 10% of SI subject to maximum of INR.25,000

Hernia Capped at 15% of the SI subject to maximum of INR.30,000

Hysterectomy Capped at 20% of the SI subject to maximum of INR.50,000

Retiree Policy – Coverage Details Contd.



Page 60


Major Surgeries related to –Cancer Surgery

/ Cardiac surgery / Brain Tumor surgeries /Pacemaker Implantation / Knee Joint / For

sick, sinus syndrome / Hip replacement

Capped at 70% of the SI subject to maximum of INR4 Lac

First 2 year exclusion clause

During the first two years of the operation of the policy, the expenses on

treatment of diseases such as Cataract, Benign Prostatic Hypertrophy,

Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital

internal disease, Fistula in anus, piles, Sinusitis and related disorders, Gall

Bladder Stone removal, Gout & Rheumatism, Calculus Diseases, Joint

Replacement due to Degenerative Condition and age-related Osteoarthritis &Osteoporosis are not payable.

Policy guidelines of individual retail policies would be applicable.

All other benefits would be strictly as per retail policy.

Retiree Policy Process



Page 61

Conitnuity certficate from employer and photographs are talso required o be submitted for taking policy.

02 July 2013

Step 1:- The concerned employee should have four claim free years under mediclaim policy.

Step 2:- The intimation to this effect (Date of exit) should come a month before to Schneider Admin/ Manisha Kala toregister this with UNITED Insurance Company

Step 3:- UNITED Insurance Company would ask TPA to provide claims and policy details for concerned employee inattached TPA certificate format

Step 5:- The concerned employee would submit this proposal form duly completed in all respects and contact the

designated office which will be issuing an Individual Mediclaim policy by charging the applicable premium as per the retailpolicy.

Step 4:- Basis the details provided in TPA certificate UNITED insurance company would issue a proposal form toconcerned employee.

For Retiree Policy – Contact details



Page 62

Provider : United India Insurance Company

Admin SPOC – Schneider

Electric

Name : Ms Manisha Kala

Phone: +91 858885693


Contact Person – United

Insurance

Name : Mr. Manjeet Singh

Phone : 011-23414357 / 011-23415322Mobile : 9810074632


Office Address : United India Insurance Co. Ltd.,

Branch Office,K 31,Connaught Place,

New Delhi-110001

How to make most of your benefits?





6302 July 2013

• Make an informed choice of hospitals, when the hospitalization is planned and non

critical in nature.

• In case of any planned hospitalization, approach the TPA sufficiently in advance (at

least 48 hrs) and request pre authorization – this enables TPA to facilitate smooth

hospitalization admission & discharge process and negotiate better prices /

package rates / room rent.

• Try to negotiate discounts with the hospital if opting for reimbursement as the bill is

settled directly you.

• Please ensure to crosscheck the final bill sent to the TPA for the following:

– You are Billed only for the services utilized for e.g. category of room, diagnostics

undergone, medicines consumed…

– Total bill amount

– Ask WHY & WHAT is billed to you (as a consumer, you have the right to know)



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