MEDICLAIM POLICY (REVISED)
To provide (partly) financial support to the employees for unforeseen hospitalization expenditure
and to ensure smooth interaction with the medical authorities during such emergency in terms of
quality, speed and payments.
2.1. This policy will cover all the employees’ and their family i.e. his/her spouse and up to two
2.2. Employees’ can request for coverage of other dependants example- financially
dependent parents (not in-laws’), subject to their age not exceeding 80 years and for a
third child. In these cases the employee will have to bear 100% of the premium.
2.3. This policy is mandatory.
2.4. All new joinees will be covered from the date of joining.
3. Effective Date:
This revised policy will be effective from 14th July, 2007.
Cashless Hospitalization and other benefits are detailed below and for this year our TPA is
E-Meditek. For more details you can log on to www.emeditek.com
4.1. Cashless medical service facilitation through network medical providers.
Due to Third Party Administrator’s (TPA) contractual agreement with the hospital/ nursing
home, the employee (our employee) will not have to make any direct payment to the
medical facility providers. TPA will be guaranteeing the payment and hence preventing
the hassles of cash payment at the hospital/ nursing home. TPA will render the following
Cashless medical service facilitation at TPA’s network hospitals up to the limit
authorized by Mediclaim Insurance policy.
Claims processing, claims filing, liaison with Insurance Company etc.
Interaction with hospitals/insured regarding medical diagnosis of insured.
4.2. Cash less Medical services include the following benefits, too:
Bills scrutiny before release of payment.
Medical procedure audit-elimination of unnecessary prescriptions.
Case Management & Audit of Medical bills.
4.3. Twenty four hour assistance center will provide the following:
Information source (about location of doctors/medicos/diagnostics/hospitals etc.);
Referral services to the closest and most appropriate medical provider;
Free 24 hr telephone consultation with doctor on phone;
Ambulance facility for emergency.
4.4. Pre and Post Hospitalization:
Pre-hospitalization expenses up to 30 days and post hospitalization expenses up to 60 days
are also reimbursable but in case of maternity claim these expenses are not admissible
4.5. Maternity Benefit:
Maternity coverage is upto Rs. 50000/- for both normal & cesarean cases with a
waiting period of nine months from date of joining of the employee. The waiting period
will start from the date of joining of Employee in InterGlobe and allied companies,
whether he/she is married or not.
New born child shall be covered from day one upto the age of 3 months under
maternity and after that child will be covered under para 2.1. And expenses incurred
for the treatment taken in the hospital as an impatient shall be payable subject to limit
of 50000/- available for maternity benefit extension.
5.0 Pre- Existing Diseases:
Pre- existing diseases are covered under this policy but for the new joinee’s in the
scheme there is a waiting period of 30 days for parents.
The Mediclaim coverage is for Rs.1,00,000/- per year for an employee and his/her family as
described above in Para 2.1.
However, an employee will have an option to increase his/her coverage over and above 1 lakh,
by paying extra premium. The maximum amount of coverage allowed would be Rs.5 lakhs. The
additional premium required to be paid by an employee for the additional sum assured over and
Above Rs. 1 lakh, will be initially paid by the company and later on, it will be recovered from the
employee in one installment. In case the dependent parents are covered then the additional sum
assured is not meant for the expenses under pre-existing diseases where expenses are
recurring in nature like chemotherapy, dialysis or any other such expenses. Under such
circumstances the coverage will remain the same i.e. 1 lacs only. The sum assured
enhancement will not be permissible in between the policy year for existing and the new joinees’.
Please note that only financially dependent parents can only be covered. In case, it is found that
the parents are not dependents, the claim may prejudice. .
6. Separated Employee
This facility is not extended to separated employees after the date of relieve from the
organisation and the premium paid by the employee will not be refunded.
The buffer policy will take care of any hospitalisation charges of the employee & his/her family
(as described above in Para 2.1) that exceeds Rs.1,00,000/- upto a maximum limit of 2.00 lac
per family. For consideration under this, the employee should have completed at least 1 year of
service with the company. The release of this amount will be at the sole discretion of the
The Mediclaim Policy will be treated as a part of your CTC up-to sum insured of Rs. 100000/-. If
an employee is enhancing the sum insured or cover other dependants (as described above in
Para 2.2), then the additional premium will be recovered at one go from the salary..
HR will be responsible for administration of this policy. The employees will be given a TPA card/
e- cards for self and their family members.
In case of planned hospitalization from the list of hospitals given by TPA (Network Hospital),
the employees should inform the TPA so that they have sufficient time (4-6 days) to authorize the
hospital to render cashless facility to the employee.
In case of emergency hospitalization, the employees can directly approach any hospital with
the TPA card;
a) If it is Network hospital they will be entertained but need to inform TPA within 24 hours to
avail cashless benefit.
b) If it is Non Network hospital, the employee has to pay self and get the documents filled to
HO within 20 days of the discharge from the hospital, which in turn will co-ordinate with
the TPA to get the reimbursement, if payable for the same. TPA will send the medical
bills to the insurance company signed up by company. Settlement of the bills will take
place between the TPA and the insurance company. Neither the employees nor the
company will have any role in it as long as the medical bills are within the TPA and
insurance company’s guidelines.