Voluntary Parental Insurance Policy Version 1.0

Dec 1, 2013 Wipro – For Internal circulation only Group HR Function

Contents

OBJECTIVE .......................................................................................................................................... 3

COVERAGE .......................................................................................................................................... 3

POLICY OVERVIEW .............................................................................................................................. 3

POLICY BENEFITS ................................................................................................................................ 4

POLICY TERMS & CONDITIONS ........................................................................................................... 5

Co-payment ................................................................................................................................................. 5

Sub-limits ..................................................................................................................................................... 5

Day Care Procedures ................................................................................................................................... 7

Health Insurance Portability ....................................................................................................................... 7

Definition of hospital and nursing home ..................................................................................................... 8

Illness ........................................................................................................................................................... 8

TYPE OF COVER .................................................................................................................................. 9

Comprehensive Cover (with pre-existing illness cover) .............................................................................. 9

Standard Cover (without pre-existing illness cover) ................................................................................... 9

Coverage Exclusions: ........................................................................................................................................................ 9

CONTRIBUTION ................................................................................................................................ 10

Comprehensive Cover ................................................................................................................................ 10

Standard Cover .......................................................................................................................................... 11

PROCESS FOR RENEWAL/ CLAIM SUBMISSION ................................................................................ 12

Renewal Premium details .......................................................................................................................... 12

Employees who are overseas and who have opted out of India Salary .................................................... 13

THIRD PARTY ADMINISTRATOR (TPA) .................................................................................. 13

PROCEDURE .................................................................................................................................. 13

Claim Documents ....................................................................................................................................... 14

Procedure for Cashless hospitalization...................................................................................................... 14

Procedure for Reimbursement .................................................................................................................. 16

PART II OF THE SCHEDULE - COMMON TO ALL ................................................................................ 17

PART III OF THE SCHEDULE - Common to all ........................................................................... 22

CONTACTS ........................................................................................................................................ 26

AMENDMENT HISTORY .................................................................................................................... 26

OBJECTIVE

Voluntary Parental Insurance policy provides for reimbursement of hospitalization expenses for illness, disease or injury sustained by parents of the employees of Wipro Ltd.

Expenses for hospitalization are payable only if a 24 hour hospitalization has been taken. (Except for select day care procedures, which do not require a 24 hour hospitalization). Under the scheme, the typical expense heads covered are the following: room/boarding expenses as provided by the hospital or nursing home; nursing expenses; surgeon, anesthetist, medical practitioner, consultant, specialist fees; anesthesia, blood, oxygen, operation theater charges, surgical appliance, medicines and drugs, diagnostic material and X-Ray; dialysis, chemotherapy, radiotherapy, cost of pace maker, artificial limbs and cost of organs and similar expenses.

COVERAGE

All employees of WT, WI, WC, Eco Energy, WIN & CCLG are eligible to cover their parents under the policy. This

includes employees who are not on India payroll, however their parents are residents of India.

This is a voluntary policy whose terms and conditions get renewed every year effective 1st Dec.

For employees who had availed the previous year policy, the policy for the subsequent year will be renewed

automatically with similar terms, unless the employee chooses to opt out of the Policy on myWipro.

POLICY OVERVIEW

Policy Details

Policy Start & End Date 01st December 2013 -30th November 2014

Insurer United India Insurance Company Limited

Third Party Administrator (TPA)

Medi Assist India Pvt. Ltd.

Sum Insured Bands B2 and below: Option available for INR 1 lakhs, 1.5 lakhs , 2 lakhs, and 3 lakhs per parent Bands B3 and above: Option available for 1.5 lakhs , 2 lakhs, and 3 lakhs per parent

Options of Cover available Standard cover (pre-existing diseases not covered), Comprehensive cover (covers pre-existing diseases)

POLICY BENEFITS

Policy Benefits

Comprehensive Cover Standard Cover

(Available only for a limited period. Refer Section : Type of Cover for window period details)

(Available throughout the year)

Standard Hospitalization

Covered Covered

Pre & Post Hospitalization Expenses

Relevant expenses Covered (30 days & 60 days respectively)

Relevant expenses Covered (30 days & 60 days respectively)

Pre-existing Diseases Covered Not covered

First 30-days & First Year Waiting Period

Waived off Waiting period applicable

Internal Congenital Ailments Coverage

Covered Not covered

External Congenital Ailments coverage

Not covered Not covered

Emergency Ambulance Services

Covered (INR 1,000 per claim for Emergencies only)

Emergency hospitalization is defined as urgent treatment at hospitals that is required by an insured who is immobile due to some illness or accident and cannot take the strain of traveling in a vehicle other than ambulance. Such need has to be certified by your consulting doctor.

Covered(INR 1,000 per claim for Emergencies only)

Emergency hospitalization is defined as urgent treatment at hospitals that is required by an insured who is immobile due to some illness or accident and cannot take the strain of traveling in a vehicle other than ambulance. Such need has to be certified by your consulting doctor.

Day Care Procedures Covered (Only list of select procedures like Dialysis, chemotherapy, radiotherapy and other such specified treatments taken in the hospital/ nursing home where the insured is discharged on the same day. Refer Policy Terms & Conditions for details)

Covered (Only list of select procedures like Dialysis, chemotherapy, radiotherapy and other such specified treatments taken in the hospital/ nursing home where the insured is discharged on the same day. Refer Policy Terms & Conditions for details)

Surgical Dental treatment (subject to condition)

Covered (INR 10,000 for surgical treatment per family). Out of this, the sub limit for Root canal treatment is INR 3,000 per tooth inclusive of cost of the crown.

(Cosmetic treatment like filling, capping, scaling, polishing, dentures, cleaning & treatment of similar nature are not payable. Detailed prescription, nature of treatment, procedures done, pre-numbered receipts are a must for dental treatment claims. In addition, X-ray reports may be asked for if required for justification of admissibility of claim.)

Not covered

Room Rent Restriction Covered (Limited to INR 2,400 per day in A-Class cities & INR 1,750 in B-Class cities.

‘A’ class cities includes Metros, Bangalore, Hyderabad, Pune & Gurgaon. Rest of the cities are classified as ‘B’ class cities.

Covered (Limited to INR 2,400 per day in A-Class cities & INR 1,750 in B-Class cities.

‘A’ class cities includes Metros, Bangalore, Hyderabad, Pune & Gurgaon. Rest of the cities are classified as ‘B’ class cities.

Emergency Air Ambulance facility

Covered for a maximum of first 10 cases throughout the year with a limit of INR 100,000 per case in absence of multi-specialty hospital in a radius of 50 KM for named ailments only. (subject to approval of insurer)

Covered for a maximum of first 10 cases throughout the year with a limit of INR 100,000 per case in absence of multi-specialty hospital in a radius of 50 KM for named ailments only. (subject to approval of insurer)

Mobility Extension Covered (INR 5,000 per employee ). Expenses related to external aids used for mobility (like walker, crutches) upon the prescription of the treating doctor and admissibility of the main claim.

Not covered

Lasik Treatment Covered, if required for correction of power 7.0D and above

Covered, if required for correction of power 7.0D and above

Co-pay 10% co-pay for all claims above Rs.10,000. Except for Capped ailments as listed below.

10% co-pay for all claims above Rs.10,000. Except for Capped ailments as listed below.

Maternity Not covered Not covered

Employees have an option to cover their in-laws (instead of parents), provided their parents are already covered under any other medical insurance policy. Employees are required to produce supporting documents in that regard and write to parentalinsurance.helpdesk@wipro.com for offline enrollment of in-laws.

POLICY TERMS & CONDITIONS

Co-payment

Policy will carry a 10% of co-pay from the employee for admissible claim amount over and above Rs. 10,000 for each and every claim. The Co-pay will be applied on claims above Rs.10,000 for the portion of claim over and above Rs. 10,000. If there are multiple claims during the year by an employee, Co-pay will be applied for aggregate claims crossing Rs 10,000 for the year. Co-pay essentially means 10% of the claim amount over and above Rs. 10,000 will be borne by the employee. No Co-pay would be applicable on procedures with sub-limits (list of treatments mentioned in table below).

Sub-limits

The following ailments are capped with the below mentioned sub-limits (specific to A-type & B-type city). These sub limits are inclusive of all hospitalization and implant charges, irrespective of the room category.

Table 1.1

AILMENTS Surgery Type Description A Class cities

B Class cities

Cataract (Inclusive of Lens)

Eye Surgery Clouding of vision, common in elderly people

25000 22000

Tonsillectomy Throat Surgery

Inflammation and infection of tonsils/adenoids, glands between mouth, nose and throat

21000 17000

Fistula High General Surgery

Abnormal connection between two organs, generally between the rectum and vagina/rectum and urinary bladder, resulting due to injury/surgery

35000 30000

Fisula Low General Surgery

Same as above 30000 25000

Fissurectomy General Surgery

Repair of a fissure(a crack or a tear in the lining of an organ),sphincterectomy is the correction of a tear on a sphincter( muscle that helps in contraction of an organ)

25000 20000

Haemorrhoidectomy (Excluding staples & tackers)

General Surgery

Surgical removal of a haemorrhoid (protrusion of the mucous lining of rectum due to constipation)

32000 25000

Thyroidectomy – HEMI

General Surgery

Partial surgical removal of a thyroid gland( usually done when suffering from cancer)

40000 35000

Thyroidectomy – TOTAL

General Surgery

Total surgical removal of thyroid gland 50000 45000

Arthroscopy Orthopaedics A procedure done by inserting a fiberoptic tube into the joints to study the nature of condition causing inflammation

35000 30000

Arthroscopic Surgery Orthopaedics Done to treat cartilage tears( cartilage is the tissue lining the joints)

75000 50000

Hydroceletomy unilateral

Urology Removal of hydrocele (collection of fluid around testes), one side. Related to male reproductory organ

25000 20000

Hydroceletomy bilateral

Urology Removal of hydrocele( collection of fluid around testes), both sides.Related to male reproductory organ

35000 30000

Coronary Angiogram (Including dye)

Cardiology An x-ray test done to find out the flow of blood into and out of one's heart( basically to study the nature of blood vessels)

20000 15000

Hernia repair – open (Excluding mesh)

General Surgery

Correction of hernia( protrusion of internal organs through weak abdominal muscles)

40000 35000

Hernia repair – laparoscopic

General Surgery

Correction of hernia( protrusion of internal organs through weak abdominal muscles)

60000 50000

Appendicectomy – open

General Surgery

Removal of appendix by cutting open the abdomen

35000 30000

Appendicectomy – laparoscopic

General Surgery

Removal of appendix by laparoscopy( insertion of a laparoscope and removal of appendix by bit by bit, requires just a small incision on the abdomen)

50000 45000

Cholecystectomy – open

General Surgery

Removal of gall bladder upon finding stone formation( by cutting open the abdomen)

45000 40000

Cholecystectomy – laparoscopic

General Surgery

Removal of gall bladder upon finding stone formation( by minimal invasion - using laparoscope)

50000 45000

Hysterectomy – open Gynecology Removal of uterus due to any complications( by cutting open the abdomen)

50000 45000

Hysterectomy – laparoscopic

Gynecology Removal of uterus due to any complications( by laparoscopy)

60000 55000

Day Care Procedures

For the purpose of this definition, Day Care procedures include treatment for specific procedures where the period of hospitalization is less than 24 hours. Ailments include Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Dental Surgery, Lithotripsy (Kidney stone removal), Tonsillectomy taken in the Hospital/Nursing Home where the insured is discharged on the same day.

Health Insurance Portability

Employees will now have an option to carry forward the parental health insurance policy (with standard benefits and date of first inception being the date from which the parents are being covered under Wipro’s Parental Group Health Insurance Policy) even after leaving the Company.

Example: In a retail policy from external market, the period during which pre-existing diseases are not covered is referred to as the waiting period. In a normal scenario, in case an employee leaves the Company, s/he will be treated as a new customer and will have to wait for 4 years for getting pre-existing diseases’ coverage in case s/he buys parental insurance policy for her/his parents. With the feature of portability, an employee will be given an option to carry forward the Policy (with continuity benefits) with the insurer, subject to certain conditions. Conditions: Portability to be offered to an employee only if s/he has spent minimum 2 years in the Policy to be eligible for

portability. Benefit of portability would be offered from the period of previous policies. For comprehensive parental

policy Health Insurance Portability can be offered only after completion of two continuous policy years with United India Insurance Co. Ltd. For standard parental policy Health Insurance Portability can be offered only after completion of four continuous policy years with United India Insurance Co. Ltd.. However, in case an

employee leaves Wipro after completing three continuous years in the policy, then pre-existing coverage will be given after one year.

Example: Say Ram joined the Company on 1st Jan 2009. He had availed Group parental insurance policy for continuously 3 years. He has quit now in 2012. Ram can therefore continue with the same insurance policy for his parents, however his parents will not get pre-existing benefits for next 1 year (so that they complete 4 years of waiting period). Jan 2013 onwards, they can avail pre-existing coverage. Say, Krishna joined the Company on 1st Jan 2006. He has availed Parental Insurance policy for the past 4 years. Krishna decided to separate from the organization as of Nov 2012. Since his parents have already completed 4 years in the policy (hence waiting period of 4 years is completed), if he chooses to, he will get pre-existing benefits for his parents Nov 2012 onwards. Portable policy will be given at the retail rates approved by the Insurer. In case of opting for retail policy, parents

will have to undergo pre-policy medical tests. 50 % of Medical test expenses subject to a maximum of Rs.375/ would be borne by the insurer when the proposal accepted by the insurance company.

Portability cannot be given if the parent is suffering from any chronic illness at the time of enrollment in portable

policy. Chronic illnesses are conditions or illnesses which are prolonged or recurrent, progressive and may be irreversible i.e. cancer, organ transplant, renal failure, cardiac disease, brain, neurological conditions and etc.

Portability will be offered after the expiry of policy period of Parent i Insurance. e.g. If an employee resigns in July,

portability option will start from 1st December only i.e. after Parent’s policy of WIPRO has expired.

Definition of hospital and nursing home

Hospital & nursing home where treatment is availed means any institution in India established for indoor care and treatment of sickness and injury which is registered with the local authority having 15 inpatient beds , full equipped operation theatre , fully qualified nursing staff and doctor round the clock.(In class 'C' towns No of beds be reduced to 10). This condition can be waived in case of very small towns. The policy provides for Domiciliary Hospitalisation expenses when medical treatment is taken for a period exceeding 3 days for an illness/disease/injury (not specifically excluded) which normally would require treatment as an in -patient in a hospital/nursing home but is actually taken whilst confined at home in India under the following circumstances: Either the condition of the patient is such that he/she cannot be removed to the hospital/nursing home OR the patient cannot be moved to the hospital/nursing home for lack of accommodation therein .

Illness

Any one illness will be deemed to mean continuous period of illness and it includes relapse within 45 days from the date of last consultation. Occurrence of same illness after the lapse of 45 days will be considered as fresh illness.

TYPE OF COVER

Comprehensive Cover (with pre-existing illness cover)

Applicable to: • All employees who choose this option before 30th November 2013 • Employees joining Wipro (new hires) or returning from abroad locations who opt for parents policy before 45

days from the date of joining or returning from locations abroad

Standard Cover (without pre-existing illness cover)

Applicable to: • All employees who avail the policy after 30th November 2013. • Employees joining Wipro or returning from abroad locations who opt for parents policy after 45 days from

the date of joining or returning from locations abroad • All employees who wish to choose standard cover without additional coverage benefits on or before 30th Nov

2013. The Company shall not be liable to make any payment under this policy in respect of any expenses whatsoever

incurred by any Insured Person in connection with or in respect of:

Coverage Exclusions:

1. All diseases / injuries which are pre-existing when the cover incepts for the first time. 2. Any diseases contracted by the Insured Person during the first 30 days from the commencement date of the

policy. 3. During the first year of operation of insurance cover, the expenses on treatment of diseases such as

Cataract, Benign Prosthetic Hypertrophy, Hysterectomy for Manorrhagia or Fibromyoma, Hernia, hydrocele, Congenital Internal Disease, Fistula in anus, Piles, Sinusitis and related disorders are not payable. If these diseases other than congenital internal diseases/defect are pre-existing at the time of proposal, they will not be covered even during subsequent period of renewal too. If the Insured is aware of the existence of congenital internal diseases / defect before inception of policy, it will be treated as pre-existing.

4. Injury or Disease directly or indirectly caused by or arising from attributable to war, Invasion, Act of Foreign Enemy, War like operations (whether war be declared or not).

5. 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 esthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.

6. Cost of spectacles, contact lenses and hearing aids. 7. Any dental treatment or surgery which is a corrective, cosmetic or aesthetic procedure, including wear and

tear, unless arising from disease or injury and which requires hospitalization for treatment. 8. Convalescence, general debility, 'run - down' condition or rest cure, congenital external disease, intentional

self - injury and use of intoxicating drugs & alcohol.

9. All expenses arising out of any condition directly or indirectly caused by or associated with Human T-Cell Lymphotrophic Virus III (HTLV III) or the Mutants Derivative or any Syndrome or condition of a similar kind commonly referred to as AIDS.

10. 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.

11. Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.

12. Injury or Disease directly or indirectly caused by or contributed to by nuclear weapons / materials. 13. Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any

of these, including caesarian section 14. Naturopathy treatment. 15. Exclusion of Loss/ Damage/ Liability due to Terrorism activity.16. RFQMR Treatment

CONTRIBUTION

The premium paid by the employees towards the Policy is debited by way of deduction through salary. Employees will be required to pay prorated premium depending on the number of months the parent would be covered. The contribution would be based on type of cover chosen (Standard/ Comprehensive), sum insured and age of the parent, as given below:

Comprehensive Cover

Please note:

Those who have been in comprehensive policy for 4 continuous years, without any claims history, will have their sum assured doubled from that of the previous year sum assured, at the same premium. Rest of the terms & conditions will remain unchanged

Example: Say Ram has enrolled his father for the last 4 years and has never claimed from the policy. Sum assured was Rs 1.5lakhs.The current year being the 5th year of renewal, his sum assured will get doubled – increase in amount being Rs 1.5lakhs. In case he continues with same sum assured as last year, he pays the same premium as is applicable for 1.5lakhs but his sum assured will be Rs 3 lakhs. In case Ram chooses to increase the sum assured to Rs 2 lakhs this year, he will pay the premium applicable for Rs 2 lakhs sum assured; however the actual sum assured will Rs 3.5 lakhs (2+1.5).

A 5% discount on aggregate premium of both parents is offered if an employee opts to cover his/her both parents (or both parent-in-laws) in the comprehensive policy.

If the Second parent is not alive, then the 5% discount on premium for one parent is offered in the comprehensive policy

COMPREHENSIVE Premium Rates (For members who have not claimed last year)

Cover 36-45 yrs 46-55 yrs 56-65 yrs 66-70 yrs 71-75 yrs 76-80 yrs 81-85 Yrs 86-90 yrs

100000 4803 7493 8542 9747 10626 13863 16289 16289

150,000 5056 7887 8992 10260 11185 14593 17147 17147

200,000 6499 8342 11703 13391 14708 19519 22935 22935

300,000 7149 9177 12873 14730 16179 21471 25228 25228

COMPREHENSIVE Premium Rates (For New joinees)

Cover 36-45 yrs 46-55 yrs 56-65 yrs 66-70 yrs 71-75 yrs 76-80 yrs 81-85 Yrs 86-90 yrs

100000 6355 9913 11301 12896 14058 18341 21550 21550

150,000 6689 10435 11896 13574 14798 19306 22684 22684

200,000 8599 11037 15483 17716 19459 25823 30343 30343

300,000 9459 12140 17031 19488 21404 28406 33377 33377

COMPREHENSIVE Premium Rates (For members who have claimed last year)

Cover 36-45 yrs 46-55 yrs 56-65 yrs 66-70 yrs 71-75 yrs 76-80 yrs 81-85 Yrs 86-90 yrs

100000 9244 14422 16442 18760 20452 26682 31352 31352

150,000 9731 15181 17307 19747 21529 28087 33002 33002

200,000 12511 19709 22526 25773 28309 37568 44143 44143

300,000 13762 21680 24779 28350 31140 41325 48557 48557

Standard Cover

Those in standard policy for 4 continuous years without any claim history will automatically get their pre-existing diseases covered, from the 5th year of renewal.

Standard Premium Rates (For members who have claimed)

Cover 36-45 yrs 46-55 yrs 56-65 yrs 66-70 yrs 71-75 yrs 76-80 yrs 81-85 yrs 86-90 yrs

100,000 1969 3375 3847 4446 4819 6143 7219 7219

150,000 2072 3552 4049 4681 5073 6467 7599 7599

200,000 2664 4612 5271 6108 6670 8651 10164 10164

300,000 2931 5073 5798 6718 7337 9516 11181 11181

Standard Premium Rates (For members who have not claimed)

Cover 36-45 yrs 46-55 yrs 56-65 yrs 66-70 yrs 71-75 yrs 76-80 yrs 81-85 yrs 86-90 yrs

100,000 1822 2500 2851 3293 3570 4551 5347 5347

150,000 1919 2631 3000 3466 3758 4791 5629 5629

200,000 2467 3417 3904 4524 4941 6408 7529 7529

300,000 2714 3758 4294 4977 5435 7048 8282 8282

Standard Premium Rates (For New joinees)

Cover 36-45 yrs 46-55 yrs 56-65 yrs 66-70 yrs 71-75 yrs 76-80 yrs 81-85 yrs 86-90 yrs

100,000 1870 3206 3655 4224 4578 5836 6858 6858

150,000 1969 3374 3847 4447 4819 6144 7219 7219

200,000 2531 4381 5007 5802 6337 8218 9656 9656

300,000 2784 4820 5508 6382 6970 9040 10622 10622

(Figures above are inclusive of service tax)

PROCESS FOR RENEWAL/ CLAIM SUBMISSION

Renewal Premium details

To apply for Parental Insurance cover, please fill up the online form at the link: My Wipro> My Financial >Top

up Cover > Parental Insurance->Create. Please ensure that your forms are submitted on or before 30th Nov 2013, for the coverage to be effective 1st

Dec 2013. This is specifically applicable to Comprehensive cover. Standard cover is available throughout the year. You will have an option to pay the premium amount in maximum 3 installments through Oct, Nov & Dec

payroll recovery. This is a limited period option, available till Nov 30th 2013 as per the below terms. Applicable to employees based in India with active India payroll for coverage of parents only.

1. Option to pay the premium in upto 3 installments if opting by Oct 18th 2013. 2. Option to pay the premium in upto 2 installments if opting by Nov 18th 2013. 3. Options to pay the complete premium in one go if opting post Nov 18th 2013.

Please note that in case you have already enrolled your parents into the Policy, the terms & conditions will get automatically renewed effective 1st Dec 2013, in case of no change in options is exercised.

One time opt out option will be available only this year. Going forward opt-out option will not be available.

You will however continue to have the option to do the following during each renewal window:

Change the cover from Standard to Comprehensive (switch of cover from Comprehensive to Standard is not allowed)

Change the sum insured

Choose the number of installments in which the total premium amount will be deducted from payroll as per above guidelines

Certain formalities need to be completed for cover: 1. Fill up the online form available on myWipro>My Financials>Top UP>Parental Insurance 2. The cover for the parent will start from the 1st of next month, when the consolidated cheque is paid by

Wividus Payroll to the Insurance company. (Except during the Limited Period offer of Comprehensive Insurance) 3. The Insurance Company will issue the Mediclaim policy document for the Parent.

4. Based on whether the parent is dependent, the employee can get reimbursement under MAS by submitting the Mediclaim document which will specify the premium paid OR payroll slip showing deduction of premium.

Employees have an option to cover their in-laws (instead of parents), provided their parents are already covered under any other medical insurance policy. Employees are required to produce supporting documents in that regard and write to parentalinsurance.helpdesk@wipro.com for offline enrollment of in-laws.

Employees who are overseas and who have opted out of India Salary

For employees who have opted out of India salary, whose parents are in India, they may apply for this by following the following process:

Fill up the online form available on myWipro>My Financials>Top UP>Parental Insurance

The cheque must be prepared in favor of United India Insurance Co. Ltd.

The cheque must be couriered to United India Parents Policy Helpdesk, Wipro Technologies, EC-1 , Tower 4 , 3rd Floor , "A" Wing , Keonics Electronic City, Hosur Main Road, Bangalore -560100

Helpdesk will confirm back to the employee on completion of coverage of parents into the policy.

THIRD PARTY ADMINISTRATOR (TPA)

Administration of Mediclaim is provided through the third party Administrators – Medi Assist India Pvt. Ltd. The TPA is responsible for:

Compiling of employees/ dependents data.

Issue of non-photo Mediclaim e-cards. Valid photo-id card (driving licence, voters id, Pan card etc) to be produced along with e-card during hospitalization. Incase your parent do not have any valid photo ID proof, please contact United India Insurance Co. Ltd (sanchali@uiic.co.in, 080-22210602)

Compiling of Addition & Deletion data on monthly basis

Reporting of status of claims

Co – ordinating for submission of claims

Co – ordinating between the client & the insurance company as & when required.

Will be addressing the queries / clarifications sought from the employees from time to time.

Any other queries regarding availability of medical services/hospitals will be attended by them.

PROCEDURE

Depending on the need and condition of hospitalization, employee can go for 3 forms of hospitalization:

• Reimbursement claims wherein the insured himself settles hospital bills and subsequently prefers the

claim on Mediassist (detailed explanation given below); and

• Cashless claims wherein Mediassist pays the hospital directly on behalf of the insured. (detailed

explanation is given below)

Claim Documents

In the event of a claim, you would be required to furnish the following for or in support of a claim: a) Duly completed claim form b) Bills, receipts and discharge certificate/card from the Hospital c) Bills from Chemists supported by proper prescription. d) Test reports and payment receipts.

Procedure for Cashless hospitalization

(i) Planned Hospitalization: In the case of a planned admission, doctor must have been consulted first and

would in turn have advised on the probable date of hospitalization. In such a case, employee must apply for

an approval of the estimated hospital expenses directly with the TPA at least 4-5 days prior to the date of

hospitalization.

1. 3 days’ notice to be given to Mediassist by filling up and sending the Request for Cashless Hospitalization in

conjunction with the hospital where the treatment is to be undertaken.

Mandatory Details that are required to be filled in the form

• Proposed date of admission

• History of illness / ailment (This is basically required to ensure that the disease/ ailment is covered under the

policy)

• Type of Treatment – Medical / Surgical Management

• Approximate expenses (will be filled up by the hospital)

• Type of Ward / Ward Charges

• Approximate duration of hospitalization. (will be filled up by the hospital)

2. Minimum hospitalization required is 24 hours (Cataract, Dialysis & Radiotherapy can be day care treatment

i.e., less than 24hours).

3. The authorization/ denial letter will be sent directly by i-healthcare to the concerned hospital.

Employee needs to fill ‘Pre-Authorization form for Cashless Claim’(Available in Section 10, Forms). This would help

you get the best services, room and rate with help of TPA. Below process can be followed for registering claim incase of a

planned hospitalization (Cashless if approved by TPA) :

(ii). Emergency Hospitalization : In case of emergency hospitalization, hospital will take up your case on a fast track basis

with your TPA and is likely to receive approvals within 4 hours during any working day.

1. The Policy Holder is advised to get admitted

2. Hospital / Policy Holder to send Request for Cashless Hospitalization form duly completed to Mediassist within 24

hours from time of admission.

3. Mediassit will fax authorization/ denial letter to the hospital within 6 hours of receipt of request.

4. In the event of refusal of the Cashless request by Mediassist, the employee is required to settle the bills with the

hospital and subsequently prefer the claim on i-healthcare for a possible reimbursement.

Below process can be followed for registering claim incase of an emergency hospitalization:

General rules of Cashless hospitalization:

1. Cashless hospitalization is available only at Network Hospitals.

2. Hospital will bill Medi Assist India Pvt. Ltd. upto the amount specified in the Authority Letter.

3. Patient to fill and sign the claim form and sign the hospital bills before discharge from the hospital. ( Forms

available at administration / billing department)

4. All original documents will be picked up by i-healthcare directly from the hospital.

5. Any amount over and above the Authority Letter will need to be settled directly by the Insured.

6. If the Insured has made any payments directly to the hospital and this amount is within the Sum Insured,

the insured will need to send these bills directly to i-healthcare along with a signed claim form.

7. Any pre hospitalization and post hospitalization expenses to be submitted to i-healthcare along with a

signed claim form

8. The insured to bear co-pay as per the scheme.

Procedure for Reimbursement

Non - Network Non cashless hospitalization

1. Patient will get admitted in any registered hospital/nursing home across India for minimum of 24hours.

2. If it is not a registered hospital / Nursing Home, it should satisfy the following parameter:

Hospital and nursing home where treatment is availed means any institution in India established for indoor

care and treatment of sickness and injury which is registered with the local authority having 15 inpatient

beds , full equipped operation theatre , fully qualified nursing staff and doctor round the clock.(In class 'C'

towns No of beds be reduced to 10). This condition can be waived in case of very small towns.

3. The Insured shall notify the claim of hospitalization immediately in writing to the Company / TPA but not

later than 7 days and shall deliver to the Company / TPA, within 30 days from the date of discharge from

the hospital, a detailed statement (of pre hospitalization expenses if applicable, and hospitalization) in

writing as per the claim form together with the final hospital bill, discharge summary, medical reports,

prescriptions, all bills, vouchers and any other document particular, relevant to the making of such claim.

For post hospitalization expenses if applicable, all such documents (bills, prescriptions, vouchers, reports)

should be delivered to the Company / TPA not later than 10 days from the last day of the post

hospitalization period.

4. The claimant to provide the following original documents

i. Detailed discharge summary including name of the patient, age, date & time of admission & discharge,

history of treatment, treatment given, advice on discharge.

ii. Detailed hospital bill with break-up of every expense (viz., room rent, doctor consultation, nursing, OT

materials, laboratory, etc.,) on numbered and dated bill and not on hospital letter head with seal and

signature.

iii. All lab reports like X-ray, scan, ECG, etc.,

iv. Cash/Credit card payment receipt.

v. Original prescriptions with medical bills.

vi. Claim form to be filled and signed

vii. Blank signed discharge voucher (for speedy settlement)

viii. Please mention your email ID and contact numbers on the claim form

5. Employees should send all of the above directly to i-healthcare.

6. Any deficiency in documentation will be informed to insured by email

7. TPA will process and settle the claim within 14 working days of receipt of complete documentation.

8. All payments will be made through the TPA to the hospital / nursing home / to the insured person who

claim for re-imbursement of medical expenses.

9. In case of reimbursement all original documents, final bills etc to be submitted to the TPA within 30 days of

discharge.

PART II OF THE SCHEDULE - COMMON TO ALL

1. Definitions

For the purposes of this policy, the terms specified below shall have the meaning set forth:

(i) The term “Any One Illness” wherever appearing/specified in this policy, means a continuous period of illness

and it includes relapse within 45 days from the date of last consultation with the Hospital/Nursing Home where

treatment may have been taken. However, if the same illness recurs (whether as a relapse or not) after 45 days, it

shall not qualify as “Any One Illness” as defined hereinabove.

(ii) The term “Domiciliary Hospitalisation” wherever appearing/specified in this policy, means medical

treatment for a period exceeding three days for such illness/disease /injury which in the normal course would

require care and treatment at the Hospital/Nursing Home but actually taken whilst confined at home in India

under any of the following circumstances namely:

a) The condition of the patient is such that he/she cannot be removed to the Hospital/Nursing home or

b) The patient cannot be removed to Hospital/ Nursing Home for lack of accommodation therein

Subject however that Domiciliary Hospitalisation benefits shall not cover:

a) Expenses incurred for Pre and Post Hospitalisation treatment and

b) Expenses incurred for treatment for any of the following diseases:

(i) Asthma

(ii) Bronchitis

(iii) Chronic Nephritis and Chronic Nephritic Syndrome

(iv) Diarrhoea and all types of Dysenteries including Gastroenteritis

(v) Diabetes Mellitus and Insipidus

(vi) Epilepsy

(vii) Hypertension

(viii) Influenza, Cough and Cold

(ix) All Psychiatric or Psychosomatic Disorders

(x) Pyrexia of unknown origin for less than 10 days

(xi) Tonsillitis and Upper Respiratory Tract Infection including Laryngitis and Pharingitis

(xii) Arthritis, Gout and Rheumatism

(iii)The term “Hospitalisation” wherever appearing/specified in this policy, means admission in a

Hospital/Nursing Home upon the advice of a Medical Practitioner for a minimum period of 24 hours

except in case of Specified Treatment, where the minimum period of Hospitalisation may be less than

24 hours. For the purpose of this definition, the term “Specified Treatment” means any treatment involving

Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, Dental Surgery, Lithotripsy (Kidney stone removal),

Tonsillectomy, D & C taken in the Hospital/Nursing Home. Also the treatments as mentioned below will form a

part of “Specified Treatment”

ENT

• Myringoplasty

• Tympanoplasty

• Paracentesis (myringotomy)

FESS

• Tonsillectomy

• Tonsillectomy with adenoidectomy

EYE

• Operations for pterygium

• Operations for cataract

• Operations for Glaucoma

OPERATIONS ON THE DIGESTIVE TRACT

• Surgical treatment of anal fistulas

• Surgical treatment of haemorrhoids (piles surgery)

GENITAL SURGERY

• Operation on a testicular hydrocele

• Herniotomy / Hernioplasty

• Treatment of a varicocele and a hydrocele

• Therapeutic curettage (D & C)

OTHER OPERATIONS

• Lithotripsy / ESWL

• Coronary angiography (on recommendation by the treating physician, if stress test +ve or if active treatment

is done following angiography). Not to be encouraged if done only following chest pain, without prior cardiac work

up (echo/stress test/ thalium)

(v)The term “Medical Practitioner” wherever appearing/specified in this policy, means a person who holds a

degree/diploma of a recognized institute and is registered by Medical Council of respective States of India if so

required. The term Medical Practitioner would include Physician, Specialist, Anaesthetist and Surgeon.

(vi) The term “Maternity Expenses Benefit” wherever appearing/specified in this policy, means treatment

taken in Hospital/Nursing Home arising from or traceable to pregnancy, child birth including normal caesarean

section.

(vii)The term “Post Hospitalisation” wherever appearing/specified in this policy, means relevant medical

expenses incurred during period upto 60 days after the date of discharge from Hospitalisation on disease, illness,

injury and accident sustained .

(viii)The term “Pre Hospitalisation” wherever appearing/specified in this policy, means relevant medical

expenses incurred during a period upto 30 days prior to Hospitalisation/Domiciliary Hospitalisation for disease,

illness or injury sustained.

(ix)The term “Qualified Nurse” wherever appearing/specified in this policy, means a person who holds a

certificate of a recognised Nursing Council and who is employed on recommendations of the attending Medical

Practitioner.

(x)The term “Surgical Operation” wherever appearing/specified in this policy, means any manual and/or

operative procedures for correction of deformities and defects, repair of injuries, diagnosis and cure of diseases,

relief of suffering and prolongation of life.

2. Scope of Cover

The Company hereby agrees subject to the terms, conditions and exclusions herein contained or otherwise

expressed herein, that, if during the policy period stated in Part I of the Schedule, any Insured Person shall

contract disease or suffer from Any One Illness or sustain any bodily injury through accident, and if such disease,

illness, accident or injury shall require any such Insured Person, upon the advice of a Medical Practitioner to incur

Hospitalisation or Domiciliary Hospitalisation expenses, the Company pay to the Insured Person, the amount of

such expenses as are reasonably and necessarily incurred thereof, by or on behalf of such Insured Person not

exceeding the sum insured for the person as mentioned in the Part I of Schedule hereto, to the extent and the

manner hereinafter provided.

3. Exclusions

The Company shall not be liable to make any payment under this policy in connection with or in respect of any

expenses whatsoever incurred by any Insured Person in connection with or in respect of :

(i) Diseases, illness, accident or injuries directly or indirectly caused by or arising from or attributable to war,

invasion, act of foreign enemy, war like operations (whether war be declared or not).

(ii) Circumcision whether or not necessitated by vaccination or inoculation or change of life or cosmetic or

aesthetic treatment of any description, plastic surgery unless necessary for treatment of a disease not

excluded by the terms of the policy or as may be necessitated due to treatment of an accident.

(iii) The cost of spectacles and contact lenses, hearing aids.

(iv) Convalescence, general debility, run -down condition or rest cure, sterility, venereal disease, intentional

self-injury (whether arising from an attempt to suicide or otherwise) and use of intoxicating drugs

and/or alcohol.

(v) All expenses arising out of any condition directly or indirectly caused to or associated with Acquired

Immuno Deficiency Syndrome (AIDS) whether or not arising out of HIV, Human T -Cell Lymphotropic

Virus Type III (HTLV –III) or Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or

Variations Deficiency Syndrome or any Syndrome or condition of a similar kind.

(vi) Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-Ray or laboratory examinations or

other diagnostic studies not consistent with or incidental to the diagnosis and treatment of the positive

existence or presence of any diseases, illness or injury whether or not requiring

Hospitalisation/Domicilia y Hospitalisation.

(vii) Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by

the attending Medical Practitioner.

(viii) Diseases, illness, accident or injuries directly or indirectly caused by or contributed to by nuclear

weapons/materials or contributed to by or arising from ionising radiation or contamination by

radioactivity by any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel.

(ix) Voluntary medical termination of pregnancy.

(ix) Naturopathy treatment, pranic healing, holistic healing, unani, yogic healing etc.

4. Basis of Assessment of claims

(i) Basis of assessment of the claim shall be as under:

The benefit payable shall be such expenses reasonably and necessarily incurred by or on behalf of the Insured

Person under the following categories but not exceeding the Sum Insured in respect of such Insured person as

specified in Part I of the Schedule.

Heads of compensation payable

a) Room and Boarding Expenses as incurred at the Hospital/Nursing Home;

b) Nursing Expenses;

c) Fee paid to Medical Practitioner, Surgeon, Anaesthetics, Consultants and Specialist

d) Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & drugs,

Diagnostic Materials and X - Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker,

Artificial Limbs & Cost of Organs and similar expenses; and /or

e) Pre Hospitalisation and Post Hospitalisation expenses, wherever applicable.

f) Ambulance charges if admissible as mentioned in Part I (j).

(ii) Claim documents :

The Insured shall be required to furnish the following for or in support of a claim:

a) Duly completed claim form

b) Bills, receipts and discharge certificate/card from the Hospital

c) Bills from Chemists supported by proper prescription.

d) Test reports and payment receipts.

(iii) The procedure for lodging the claim shall be as under:

Upon the happening of any event giving rise or likely to give rise to a claim under this policy :

a) The Insured shall give immediate notice thereof in writing to the Company.

b) The Insured shall deliver to the Company, within 45 days from the date of completion of treatment or within

60 days if the treatment has taken place in a rural area where no network hospital or

United India Insurance Co. Ltd. office is present, a detailed statement in writing as per the claim form together

with bills, vouchers and any other material particular, relevant to the making of such claim.

c) The Insured shall tender to the Company all reasonable information, assistance and proofs in connection

with any claim hereunder.

5. Limitation Period

In no case whatsoever shall the Company be liable for any claim under the Policy, if the requirement of Clause

4 (iii) (b) above are not complied with, unless the claim is the subject of pending action or arbitration; it being

expressly agreed and declared that if the Company shall disclaim liability for any claim hereunder and such claim

shall not within 12 calendar months from the date of the disclaimer have been made the subject matter of a suit in

court of law then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be

recoverable hereunder.

6. Policy Related Terms and Conditions

(i) Claim must be filed within 45 days from the date of completion of treatment or within 60 days from the

date of completion of the treatment if taken in rural areas where no network hospital or United India Insurance

Co. Ltd. Office exists. However, the Company may at its absolute discretion consider waiver, of this Condition in

extreme cases of hardship where it is proved to the satisfaction of the Company that under the circumstances in

which the insured was placed it was not possible for him or any other person to give such notice or file claim

within the prescribed time -limit.

(ii) The Insured Person shall obtain and furnish the Company with all original bills, receipts and other

documents upon which a claim is based and shall also give the Company such additional information and

assistance as the Company may require in dealing with the claim.

(iii) Any medical practitioner authorised by the Company shall be allowed to examine the Insured Person in

case of any alleged diseases, illness, accident or injuries requiring Hospitalisation or Domiciliary Hospitalisation

when and so often a s the same may reasonably be required on behalf of the Company.

(iv) All medical/surgical treatment under this policy shall have to be taken in India and admissible claims

thereof shall be payable in Indian currency.

PART III OF THE SCHEDULE - Common to all

Standard terms and conditions applicable to group benefits

1. Incontestability and Duty of Disclosure

The policy shall be null and void and no benefit shall be payable in the event of untrue or incorrect

statements, misrepresentation, misdescription or on non-disclosure in any material particular in the proposal

form, personal statement, declaration and connected documents, or any material information having been

withheld, or a claim being fraudulent or any fraudulent means or devices being used by the Insured or any one

acting on his behalf to obtain any benefit under this policy.

2. Observance of terms and conditions

The due observance and fulfillment of the terms, conditions and endorsement of this policy in so far as

they relate to anything to be done or complied with by the Insured, shall be a condition precedent to any

liability of the Company to make any payment under this policy.

3. No constructive Notice

Any of the circumstances in relation to these conditions coming to the knowledge of any official of the

Company shall not be the notice to or be held to bind or prejudicially affect the Company notwithstanding

subsequent acceptance of any premium.

4. Notice of charge etc.

The Company shall not be bound to notice or be affected by any notice of any trust, charge, lien,

assignment or other dealing with or relating to this policy but the receipt of the Insured or his legal personal

representative shall in all cases be an effectual discharge to the company.

5. Special Provisions

Any special provisions subject to which this policy has been entered into and endorsed in the policy or in

any separate instrument shall be deemed to be part of this policy and shall have effect accordingly.

6. Overriding effect of Part II of the Schedule

The terms and conditions contained herein and in Part II of the Schedule shall be deemed to form part of

the policy and shall be read as if they are specifically incorporated herein; however in case of any inconsistency

of any term and condition with the scope of cover contained in Part II of the Schedule, then the term(s) and

condition(s) contained herein shall be read mutatis mutandis with the scope of cover/terms and conditions

contained in Part II of the Schedule and shall be deemed to be modified accordingly or superseded in case of

inconsistency being irreconcilable.

7. Fraudulent claims

If any claim is in any respect fraudulent, or if any false statement, or declaration is made or used in support

thereof, or if any fraudulent means or devices are used by the Insured or anyone acting on his behalf to obtain

any benefit under this policy, or if a claim is made and rejected and no court action or suit is commenced

within twelve months after such rejection or, in case of arbitration taking place as provided therein, within

twelve (12) calendar months after the Arbitrator or Arbitrators have made their award, all benefits under this

policy shall be forfeited.

8. Cancellation/termination

The Company may at any time, cancel this policy, by giving 30 days notice in writing by Registered

post/Acknowledgement Due post to the Insured at his last known address in which case the Company shall be

liable to repay on demand a rateable proportion (pro -rata) of the premium for the unexpired term from the

date of the cancellation. The Insured may also give 30 days’ notice in writing, to the Company, for the

cancellation of this policy, in which case the Company shall cancel the policy from the date of receipt of notice

and retain the premium for the period this policy has been in force at the Company’s short period scales, as

given below

Short Period Scale -

Days Upto Percentage

7 10%

30 25%

60 35%

90 50%

120 60%

180 75%

240 85%

Exceeding 240 100%

9. Cause of Action/ Currency for payments

No Claims shall be payable under this policy unless the hospitalisation takes place in India. All claims shall

be payable in India in Indian Rupees only.

10. Policy Disputes

Any dispute concerning the interpretation of the terms, conditions, limitations and/or exclusions contained

herein is understood and agreed to by both the Insured and the Company to be subject to Indian Law. Each

party agrees to submit to the exclusive jurisdiction of the High Court of Mumbai and to comply with all

requirements necessary to give such Court the jurisdiction. All matters arising hereunder shall be determined

in accordance with the law and practice of such Court.

11. Arbitration clause

If any dispute or difference shall arise as to the quantum to be paid under this policy (liability being

otherwise admitted) such difference shall independently of all other questions be referred to the decision of a

sole arbitrator to be appointed in writing by the parties to the dispute/difference or if they cannot agree upon

a single arbitrator within 30 days of any party invoking arbitration, the same shall be referred to a panel of

three arbitrators, comprising of two arbitrators, one to be appointed by each of the parties to the

dispute/difference and the third arbitrator to be appointed by such two arbitrators. Arbitration shall be

conducted under and in accordance with the provisions of the Arbitration and Conciliation Act, 1996. It is

clearly agreed and understood that no difference or dispute shall be referable to arbitration, as hereinbefore

provided, if the Company has disputed or not accepted liability under or in respect of this policy. It is hereby

expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this

policy that the award by such arbitrator/arbitrators of the amount of the loss or damage shall be first

obtained.

12. Renewal notice

The Company shall not be bound to accept any renewal premium nor give notice that such is due.

Every renewal premium (which shall be paid and accepted in respect of this policy) shall be so paid and

accepted upon the distinct understanding that no alteration has taken place in the facts contained in the

proposal or declaration herein before mentioned and that nothing is known to the Insured that may result to

enhance the risk of the company under the guarantee hereby given. No renewal receipt shall be valid unless it

is on the printed form of the Company and signed by an authorised official of the Company.

13. Notices

Any notice, direction or instruction given under this policy shall be in writing and delivered by hand, post,

or facsimile to In case of the Insured, at the address specified in Part 1 of the Schedule.

In case of the Company:

United India Insurance Co. Ltd.

Divisional Office-3, No.24

Classic Bldg., Richmond Road

Bangalore-25

Notice and instructions will be deemed served 7 days after posting or immediately upon receipt in the case of

hand delivery, facsimile or e -mail.

14. Customer Service

If at any time the Insured requires any clarification or assistance, the Insured may contact the offices of the

Company at the address specified, during normal business hours.

15. Grievances

In case the Insured is aggrieved in any way, the Insured may contact the Company at the specified address,

during normal business hours.

CONTACTS

Contact For Policy Certificate, insurance & Coverage, Health cards, TPA & Claims Related queries

For parental policy enrolment related queries:

Level 1 Helpdesk parentalinsurance.helpdesk@wipro.com Mob: 08792811136 08050281601

Level 2 Escalation 1

Ms. Sanchali Pandey sanchali@uiic.co.in Mob: 08022210602

Level 3 Escalation 2

Mr. Manoharan C M cmmanogaran@uiic.co.in Mob: 09845128349

For parental claims related queries:

Level 1 Ms. Padma T padma.t@mediassistindia.com Mob: 09342514290

Level 2 Ms. Manjula J manjulaj@mediassistindia.com Mob: 09342511071

Escalation 1 Ms. Sanchali Pandey sanchali@uiic.co.in Mob: 08022210602

IMPORTANT NOTE

The contact details for enrolment into parental insurance policy come into effect immediately. However, the

contact details for claims will come into force effective from 01/12/2013. For claims prior to 01/12/2013,

please refer the parental insurance policy under:

My Wipro> My Information Sources> People Practices>India> My Financials> Other Benefits> Parent’s Mediclaim policy 2012-13

Visit Channel W> Fit for Life to take proactive care of your health!

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AMENDMENT HISTORY

Amendment Date Policy Version Author Approved By Nature of Changes

Dec 1, 2013 1.0 C&B Team Head – C&B New Policy for year 2013-14