wipro Mediclaimpolicy

  • Upload
    umesh

  • View
    292

  • Download
    1

Embed Size (px)

Citation preview

  • 8/19/2019 wipro Mediclaimpolicy

    1/14

     

    Group Mediclaim Insurance PolicyVersion 1.0

    Oct 1, 2014

    Wipro – For Internal circulation only

    Employee Compensation & Benefits Team

  • 8/19/2019 wipro Mediclaimpolicy

    2/14

    Contents

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

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

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

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

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

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

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

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

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

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

    CONTRIBUTION  .................................................................................................................................. 8 

    EXCLUSIONS UNDER MEDICLAIM  ...................................................................................................... 9 

    PROCESS FOR CLAIM SUBMISSION  .................................................................................................... 9 

    Claim Documents....................................................................................................................................... 10

    Procedure .................................................................................................................................................. 10

    E-medical card ........................................................................................................................................... 11

    TOP COVER  ....................................................................................................................................... 12 

    Summary table of Applicable Annual Premium based on employee’s age & Scope of Cover .................. 13

    Top-Up Policy period ................................................................................................................................. 13

    Accessing Top-Up Application ................................................................................................................... 13

    CONTACTS  ........................................................................................................................................ 14 

    AMENDMENT HISTORY  .................................................................................................................... 14 

  • 8/19/2019 wipro Mediclaimpolicy

    3/14

    OBJECTIVE

    Group Mediclaim policy provides for reimbursement of hospitalization expenses for illness, disease or

    injury sustained by employee, spouse and children.

    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 India based employees of WT, WI, WC and Eco Energy, are covered under the policy.

    POLICY OVERVIEW

    Policy Details

      Policy Holder  Wipro Limited

      Policy Start & End Date 01st

     October 2014 -30th

     September 2015

      Insurer  United India Insurance Co. Ltd.

     

    Third Party Administrator

    (TPA) 

    Medi Assist India Pvt Limited

     

    Sum Insured INR 2 Lakhs per Family

    Covered Members Description Special Condition if any

      Total Members Covered per

    Family (Including Employee)

    Employee + Spouse+

    Children

    This is applicable for all employees in India

    Payroll only

      Employee Covered

      Spouse

    Covered

    Incase employee’s spouse is also working in

    Wipro as a full time employee, please write

    to [email protected]  to

    discontinue premium deduction for one of

    the member

     

    Child Covered No Restriction on number of Children

    mailto:[email protected]:[email protected]:[email protected]:[email protected]

  • 8/19/2019 wipro Mediclaimpolicy

    4/14

    POLICY BENEFITS

    Policy Benefits

     

    Standard Hospitalization  Covered

      Pre & Post Hospitalization Expenses  Relevant expenses Covered (30 days & 60 days respectively) Refer

    maternity benefit for maternity related pre and post limits

      Pre-existing & including internal

    and external congenital Diseases 

    Covered

     

    First 30-days & First Year Waiting

    Period 

    Waived off

      Ambulance Services  Covered (INR 1000 per claim for Emergencies only)

      Maternity  For Class ‘A’ cities  –  Normal Delivery: INR 40,000, Caesarian Delivery:

    INR 40,000. Other cities - Normal Delivery: INR 30,000, Caesarian

    Delivery: INR 40,000. Pre & Post Natal OPD expenses upto INR 5000

    within the Maternity Limit is covered. Maternity benefit is applicable

    for first two live births only. Any complication rising from pregnancy

    will not be covered.  New Born Baby Cover from Day 1 Within the maternity limit for the normal expenses. Complications

    which require an admission can be processed under floater.

      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). Carries 5 percent copay for all

    day care treatments

     

    Dental 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.)

     

    Invitro fertilization Covered upto INR 40,000

     

    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)

     

    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.

     

    Lasik Treatment Covered, if required for correction of power is 6.0D and above

     

    Morbid obesity Treatment for morbid obesity is covered, only if it is life threatening but

    not cosmetic purpose

      Ayurveda Ayurvedic Hospitalization is covered for treatment taken in registered

    hospital with a justified admission

      Mental ailment In-patient treatment of mental ailment. Latter should be an established

    ailment - genetic or non-genetic.

  • 8/19/2019 wipro Mediclaimpolicy

    5/14

     

    HIV HIV covered upto sum insured for self, spouse and children

     

    Stem Cell and Cyber Knife

    treatment

    Stem cell therapies and Cyber Knife treatment are covered upto 50% of

    the sum assured.

    POLICY TERMS & CONDITIONS

    Co-payment

    The Policy will carry a co-pay from the employee for admissible claim amount over and above INR 10,000

    for each and every claim. The Co-pay will be applied on claims above INR10,000 for the portion of claim

    over and above INR 10,000. If there are multiple claims during the year by an employee, Co-pay will be

    applied for aggregate claims crossing INR 10,000 for the year. Co-pay essentially means a percentage of the

    claim amount over and above INR 10,000 will be borne by the employee and the same shall not be

    reimbursed under any insurance or ancillary in-house medical scheme run by Wipro.

    No co-pay will be applicable for admissions in GIPSA PPN network hospital for specified GIPSA procedures.

    List of these procedures vary across hospitals and updated lists are available with the hospitals directly.

    The policy will carry a co-pay of 5% on all Day Care procedures except in a GIPSA Hospitals for the specifiedGIPSA procedures

    Co-Pay limits based on Room Rent categories for non-GIPSA PPN procedures requiring admission:

    Lower Room Rent Cap Upper Room Rent Cap

    Class A cities: INR 2400, Class B cities: INR 1750 Class A cities: INR 2900, Class B cities: INR 2100

      A Standard Co-pay of 10% will apply where the room rent is up to the Lower Room Rent cap.

      A co-pay of 15% will apply where the room rent is between lower room rent cap and the Upper room

    rent cap  A co-pay of 20% will apply where the room rent exceeds the upper room rent cap

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

    class cities 

    Sub-limits for Robotics Assisted Surgery

    The following ailments are capped with the below mentioned sub-limits (specific to A-type & B-type city).

    All procedures other than the ones mentioned below are excluded from the policy if performed using

    robotics.

    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

    24000 17000

    Fistula High General

    Surgery

    Abnormal connection between two

    organs, generally between the rectum and

    vagina/rectum and urinary bladder,

    35000 30000

  • 8/19/2019 wipro Mediclaimpolicy

    6/14

    resulting due to injury/surgery

    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 isthe 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(including mesh) GeneralSurgery Correction of hernia( protrusion ofinternal 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  –  Gynecology Removal of uterus due to any 60000 55000

  • 8/19/2019 wipro Mediclaimpolicy

    7/14

    laparoscopic complications( by laparoscopy)

    Day Care Procedures 

    For the purpose of this definition, 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

    o  Myringoplasty

    o  Tympanoplasty

    o  Paracentesis (myringotomy)

      FESS

    o  Tonsillectomy

    o  Tonsillectomy with adenoidectomy

      EYE

    Operations for pterygium

    o  Operations for cataract

    o  Operations for Glaucoma

      OPERATIONS ON THE DIGESTIVE TRACT

    o  Surgical treatment of anal fistulas

    o  Surgical treatment of haemorrhoids (piles surgery)

      GENITAL SURGERY

    o  Operation on a testicular hydrocele

    o  Herniotomy / Hernioplasty

    o  Treatment of a varicocele and a hydrocele

    Therapeutic curettage (D & C)  OTHER OPERATIONS

    o  Lithotripsy / ESWL

      .

    Health Insurance Portability

    Employees will now have an option to carry forward their health insurance policy (with standard benefits)

    even after leaving the Company/ retirement.

    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.

    With the feature of portability, an employee will be given an option to carry forward the Policy

    (with standard benefits) with the insurer, subject to certain conditions.

    Conditions:

    http://hrweb.wipro.com/hrweb/staticsites/ppractice/emp_com/specified_treatments.htmhttp://hrweb.wipro.com/hrweb/staticsites/ppractice/emp_com/specified_treatments.htmhttp://hrweb.wipro.com/hrweb/staticsites/ppractice/emp_com/specified_treatments.htm

  • 8/19/2019 wipro Mediclaimpolicy

    8/14

      Portability to be offered to an employee only if s/he has spent minimum 2 years in the organization to

    be eligible for portability.

    Example:

    Say Ram joined the Company on 1st

     Oct 2012. He has completed 2 years in the Group Policy. He has quit as

    of Nov 2014. Ram can therefore continue with the same policy, however he will not get pre-existing

    benefits for next 2 years (so that he completes 4 years of waiting period). Oct 2016 onwards, he can avail

    to avail pre-existing coverage.Say, Krishna joined the Company on 1

    st Jan 2011. He has completed 4 years in the organization. Krishna

    decided to separate from the organization as of April 2015. Since he has 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 April

    2015 onwards.

    Portable policy will be given at the retail rates approved by the Insurer. Employee opting for retail policy

    will have to undergo pre-policy medical tests. 50% of medical test expenses subject to a maximum of

    INR375 would be borne by the insurer when the proposal accepted by the insurance company.

    Portability cannot be given if employee is suffering from any chronic illness at the time of enrollment inportable 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.

    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 list of network hospitals is dynamic (subject to addition and deletion). It is strongly advisable to check

    with Medi Assist customer care number or Mediclaim Helpdesk to check the hospital status.

    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.

    CONTRIBUTION

    WIPRO pays the annual premium on behalf of the employees; the contribution from the employees

    towards this premium is accumulated on a monthly basis by way of deduction through salary.

    The contribution would be based on Marital Status of the employee, as given below:

    Employee Category Monthly Premium

  • 8/19/2019 wipro Mediclaimpolicy

    9/14

    Individual (Single) INR 230

    Married (Family) INR 480

    “A nominal amount is collected every month in excess of the medical insurance premium component. The excess will

    be utilized towards wellness programs and preventive healthcare interventions. Regular communication will be sent

    out on the available programs and we urge you to make the most out of them.”  

    EXCLUSIONS UNDER MEDICLAIM

      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).

      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.

     

    The cost of spectacles and contact lenses, hearing aids. 

    Convalescence, general debility, run-down condition or rest cure, sterility/family planning surgeries

    both vasectomy and tubectomy/ infertility, venereal disease, intentional self-injury (whether arising

    from an attempt to suicide or otherwise) and use of intoxicating drugs and/or alcohol.

      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.

      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/ Domiciliary Hospitalisation.

     

    Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified bythe attending Medical Practitioner.

      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.

      Termination of pregnancy within 12 weeks of the gestational period.

      Naturopathy treatment, pranic healing, holistic healing, unani, yogic healing etc.

      Treatment related like hysterolaparoscopy, ovarian drilling , endometriosis, chocolate cyst, diagnostic d

    and C are not covered

     

    IVF Pre and Post or any other infertility related treatment is not covered.

     

    Family planning surgeries are not covered.   Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of

    any of these including caesarean section, except abdominal operation for extra uterine pregnancy

    (Ectopic pregnancy), which is proved by submission of Ultra Sonographic report and Certification by

    Gynaecologist that it is life threatening one if left untreated

    PROCESS FOR CLAIM SUBMISSION

    Remember to declare your family members at the time of a life changing event like marriage, child birth etc.

  • 8/19/2019 wipro Mediclaimpolicy

    10/14

    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.

    For any claims effective 1st

     Oct 2013, please use the claim form available in myWipro My Information Source

    People Practice India Policies My Financial Mediclaim Medical Insurance Claim form. You will need to

    fill the form and drop the supporting documents in Wividus Drop box, please write to

    [email protected] for claims processing or for any clarification.

    Please refer the portal for the detailed checklist ailment wise: www.mediassistindia.com 

    Procedure

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

    For cashless treatment it is mandatory for the hospital to have an approval from your TPA. Incase of delay in

    receiving the approval or when you cannot wait for receiving the approval owing to medical urgency you can

    undertake the treatment by paying the necessary cash deposit.

    If you receive approval from your TPA after paying the cash deposit, you are entitled for refund of the cash

    deposit (as per reimbursement process mentioned in point (iii)). Below process can be followed for

    registering claim incase of an emergency hospitalization:

    Employee Approaches the

    Hospital with medical ID

    Employee to call up TPA to

    plan the hospitalization 

    Hospital Intimates TPA and sends

    Pre-Authorization Request with

    approximate cost of the

    treatment 

    TPA issues letter of

    credit (for cashless)

    with approval for partial

    amount as per Eligibility

    and Coverage to the

    hospital 

    At the time of Discharge

    hospital sends the final

    bill and the discharge

    summary for the final

    TPA send the final approval to

    hospital which allows the

    employee to get discharged by

    Sto

     

    mailto:[email protected]:[email protected]://www.mediassistindia.com/http://www.mediassistindia.com/http://www.mediassistindia.com/http://www.mediassistindia.com/mailto:[email protected]

  • 8/19/2019 wipro Mediclaimpolicy

    11/14

     

    (iii). Reimbursement: Incase any hospital does not accept cashless facility, employee can register the claim as

    reimbursement. Below mentioned documents for or in support of a claim need to be submitted within 30

    days of hospitalizatio:

    a) Duly completed claim formb) Bills, receipts and discharge certificate/card from the Hospital

    c) Bills from Chemists supported by proper prescription.

    d) Test reports and payment receipts.

    Please refer the portal for the complete document checklist on ailment wise: www.mediassistindia.com 

    a)  You would need to log the claim in myWipro under My Financials  MAS, Health Check, Medi-cards

    & Insurance claim (WISH)

    b)  All relevant documents along with the claim form need to be dropped in the nearest Wividus drop

    box.

    c) 

    Documents must be submitted within 30 days of completion of hospitalization treatment. Anylate submission shall not be considered.

    d)  Medi-Assist will process and settle the claim within 14 working days of receipt of complete

    documents.

    E-medical card

    You can print yours & your family’s e-card yourself on the link provided below:

    Member get admitted in the

    hospital in case of

    emergency by showing his

    Member / Hospital applies

    for pre-authorization to the

    TPA within 24 hrs of

    Member gets treated anddischarged after paying all

    non entitled benefits like

    TPA verifies applicability of

    the claim to be registered

    and issue pre-

     

    Pre-authoriza

     

    Hospital sends complete setof claims documents for

    processing to the TPA 

    Claims Processing by TPA &

    Insurer 

    Release of payments to the

    hospital 

    Employee will be

    him/herself to the hospital

    and claim reimbursementfrom Insurer through TPA. 

    Yes 

    No 

    Stop 

    http://www.mediassistindia.com/http://www.mediassistindia.com/http://www.mediassistindia.com/http://mywipro.wipro.com/irj/portalhttp://mywipro.wipro.com/irj/portalhttp://mywipro.wipro.com/irj/portalhttp://mywipro.wipro.com/irj/portalhttp://www.mediassistindia.com/

  • 8/19/2019 wipro Mediclaimpolicy

    12/14

    myWipro My Financials MAS, Health Check, Medi-cards & Insurance claim (WISH) Medicard.

    Do remember to print the card(s) and share with family right away as medical contingency hits unplanned

    most of the time.

    TOP COVER

    Top up Cover Policy Features

      Top Up Cover offers you an option to increase your Mediclaim Insurance for furthering your financia

    protection benefit under this plan.

      Employee can increase sum insured upto INR 100,000, INR 200,000, INR 300,000, INR 500,000, INR 700,000 OR

    INR 1,000,000 over and above the existing sum insured. A one-time premium would be deducted from payrol

    in the month this additional coverage is opted for.

    Please note that it is important to top-up your cover in case you have a chronic pre-existing ailment, failing

    which CMAP benefit may not be released by the Company.

      Employees will have option of buying a top-up cover over and above the floater cover at their own expense

    Top up is a limited period offer and available from 1st Oct to 15th Nov in 2014.

     

    Critical Illness Cover (Please note  –  it is important to top-up your cover in order to be eligible for this

    benefit): 

      Amount of cover – INR 2 lacs (over and above sum insured and top up)

      This benefit is for the employee only

    The critical illnesses covered are as below:

      Cancer of specified severity

     

    First Heart Attack

      Coronary artery surgery open chest (CABG)

      Heart valve replacement

      Coma of specified severity

      Kidney Failure

      Stroke resulting in permanent symptoms

      Major organ/Bone marrow transplant

      Multiple Sclerosis

      Motor Neuron disease with permanent symptoms

     

    Permanent paralysis of limbs 

    Loss of Pay Cover (Please note  – it is important to top-up your cover in order to be eligible for this benefit): 

      This benefit is for employees only

      Amount – INR 5000 per week

      This benefit will commence immediately on the day ‘Loss of Pay’ (due to medical exigencies) begins

    and will be paid till employee returns to work or for 52 weeks, whichever is earlier

      New Employees have to opt for top-up cover within 45 days from the date of joining or on returning from

    abroad. The premium payable calculated will be proportionate to the number of months the policy will be

    effective.

    http://mywipro.wipro.com/irj/portalhttp://mywipro.wipro.com/irj/portal

  • 8/19/2019 wipro Mediclaimpolicy

    13/14

     

    The top-up cover can be utilized only after exhausting the main cover.

     

    The Top up policy is applicable from 1st

     October 2014 to 30th

     September 2015 if applied during the window

    mentioned above.

      For new joinees/Long Term assignee return cases, top up is applicable from 1st

      of the following month in

    which you choose Top up Cover in myWipro.

      myWipro Top up Coverage application will be accessible from the 1st to the 20th of every month (only for a

    new joinee / returnee from Long term onsite assignment).

     

    To choose Top up Cover, please log onto myWipro  My Financials  Top Up Cover.

     

    Top up option, once selected on myWipro cannot be cancelled.

     

    The Top up Cover lapses in the event of Separation due to resignation / Termination from the company as in

    the case of default coverage. There will be no refund of Top up premium paid in such event.

    Summary table of Applicable Annual Premium based on employee’s age & Scope of Cover 

    Amount

    Unmarried Married

    Below 35

    Years36 - 45 Years

    Above 45

    Years

    Below 35

    Years36 - 45 Years

    Above 45

    Years

    INR 100,000 450 490 700 950 1030 1260

    INR 200,000 850 930 1320 1790 1940 2400

    INR 300,000 1110 1200 1710 2320 2520 3590

    INR 500,000 1399 1512 2155 2923 3175 4523

    INR 700,000 1678 1814 2586 3508 3810 5428

    INR 1000,000 2014 2177 3103 4209 4572 6514

    Top-Up Policy period

    The Top up policy is applicable from 1st October 2014 to 30th

     September 2015. You have an option to apply for

    Top up from 1st Oct 2014 to 15th Nov 2014 only.

    For a new joinee / returnee from Long term onsite assignment, the top up window will be open for 45 days from

    date of joining / date of return. The premium payable calculated will be proportionate to the number of months the

    policy will be effective. Top up is applicable from 1st

     of the following month in which you choose Top up Cover in

    myWipro.

    Accessing Top-Up Application

    myWipro Top Up Cover module will only be accessible from the 1st to the 20th of every month (only for a new joinee

    / returnee from Long term onsite assignment).

    http://mywipro.wipro.com/irj/portalhttp://mywipro.wipro.com/irj/portalhttp://mywipro.wipro.com/irj/portalhttp://mywipro.wipro.com/irj/portal

  • 8/19/2019 wipro Mediclaimpolicy

    14/14

    To choose Top up Cover, please log onto  myWipro   My Financials MoreTop up Cover. Please refer to the

    Editorial section for further information on how to raise a request on myWipro.

    CONTACTS

    For any further information with regards to the Policy,

    E-mail Id's Contact No. Timings

    First point of contact

    for all enquiries and

    Cashless claims:

    [email protected]

    080 32413698 Wipro Working hours

    +91 9341625893 24 / 7

    First level of

    escalation: [email protected] 

    +91 9379260825 and

    702296980324 / 7

    Final level of

    escalation:[email protected] +91 9739519191

    Working hours and for

    emergencies 24X7

    Visit myWipro My Information Sources  People Practices  India  Other Benefits  Healthcare

    services to know about the existing offers across the network of hospitals/ clinics.

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

    Top 

    AMENDMENT HISTORY

    Amendment Dat Policy Version Author Approved By Nature of Changes

    Oct 1, 2014 1.0 C&B Team Head – C&B Renewed Policy for year 2014-15

    Top

    http://mywipro.wipro.com/irj/portalhttp://mywipro.wipro.com/irj/portalhttp://mywipro.wipro.com/irj/portalmailto:[email protected]:[email protected]:[email protected]:[email protected]://mywipro.wipro.com/irj/portalhttp://mywipro.wipro.com/irj/portalhttp://channelw.wipro.com/chwhome/home/index.phphttp://channelw.wipro.com/chwhome/home/index.phphttp://channelw.wipro.com/chwhome/home/index.phphttp://wipro.chihealth.in/http://wipro.chihealth.in/http://wipro.chihealth.in/http://wipro.chihealth.in/http://channelw.wipro.com/chwhome/home/index.phphttp://mywipro.wipro.com/irj/portalmailto:[email protected]:[email protected]:[email protected]://mywipro.wipro.com/irj/portal