Health Insurance Scheme (HIS) Claim Guidelines

Important guidelines for processing of HIS Claims

Staple and number the Claim Form along with supporting documents (in case of multiple claims,

staple them separately and mention the number of documents).

Raise separate Claim requests for each illness.

Write your employee ID and HIS Claim category either Domiciliary and/ or Hospitalisation and

mention the total number of claims on the envelope containing the documents. Ensure each

supporting document has employee ID and Claim number written on it.

Retain the scanned or photo copies of all the documents to produce them if/ when required.

Submit the original documents along with the duly filled Claim Form in the drop-box at TCS office

location (address details provided later in the document).

Submit the Claim documents within 7 days from the Claim Request Generation date; else the Claim

request will be rejected.

Domiciliary Claim Domiciliary treatment covers all illnesses (subject to policy conditions) that do not require hospitalisation including treatments taken either from a physician or at the OPD in a hospital.

Following are the mandatory documents required for processing the Domiciliary Claims:

Duly filled and signed Claim Form as generated through the portal.

Doctors prescription with details of the nature and duration of illness. No payment details

should be mentioned in this document.

Original pre-numbered bills from the doctors official receipt book, with pre-printed doctors

information and receipt number. Blank document with the doctors signature and stamp will not

be considered as a receipt proof.

Note: Doctors prescriptions/ letter head bills will not be accepted by the insurance company.

Original medical bills or receipt along with prescriptions for the medicines purchased from the

pharmacy stores.

Note: The bills or receipts produced should be within the policy period.

Copies of all investigations/ labs/ test reports (wherever applicable) from hospitals or from

other lab or diagnostic centres during and before or after the hospitalisation.

Note: Prescription for the particular financial year only will be considered as valid.

Following are the mandatory documents required for dental illness coverage under Domiciliary

Claim: In addition to the above documents, following documents are mandatory for raising claim request for dental expenses:

The bills or receipts for expenses incurred for extraction, fillings, medicines, consultants fees, and X-rays. (Apart from the mentioned treatments, no other treatments are payable under Domiciliary dental coverage) Note: It is mandatory to submit the X-ray film (if any) and day-to-day case summary (day-wise treatment undergone during the entire cycle of the treatment) in case of Root Canal or other dental treatment where multiple visits or sittings are being carried out. Cash paid memo or printed bill and Letter Head bill are not accepted.

Hospitalisation Claim Hospitalisation benefits are applicable only if the insured person is admitted to a hospital continuously for a minimum of 24 hours (with exception to Day Care Procedures mentioned in the policy).

Following are the mandatory documents for processing the Hospitalisation Claims:

Duly filled and signed Claim Form as generated through the Medi Assist portal.

Original and detailed admission or discharge summary/card issued by the hospital. Detailed hospital bills along with break-up bill of all hospitalisation expenses.

Original and numbered bill/receipt/cash memo issued by the hospital.

Copies of all investigations, lab or test reports (wherever applicable) from hospitals or from any other lab or diagnostic centres during and before or after the hospitalisation.

Original medical bills or receipts with prescriptions for the medicines purchased from the pharmacy store.

Few guidelines for processing of Hospitalisation Claims are as follows:

In addition to the above mentioned documents, In case of expenses incurred outside India and the local insurers settlement is still pending, employees should raise the claim for up to Rs 95,000/- (For General grades) and Rs. 2,39,000 (For SP grades) within 90 days from the date of discharge and thereafter submit the documents once they have the bills to support the same or when the settlement is complete, relaxation of more 60 days will be given only for document submission.

Note: The claim amount should be in equivalent Indian Rupees only and a settlement will be done in equivalent Indian Rupees only. (Claim documents should be sent directly to the Mumbai address)

All hospitalisation claims should be submitted immediately after discharge.

Copy of Hospitalisation Indoor case paper (wherever applicable) may be called for processing the claim request.

In case of accidents or road traffic accident cases, submit the complete details of the accident along with the copy of First Information Report (FIR) or Medico Legal Case (MLC) from the police station or hospital.

Pre and post hospitalisation expenses will not be payable if the Hospitalization related to the aliment is not claimed through Medi Assist.

In case of Cataract claims, Intraocular Lens (IOL) sticker is mandatory.

Note: Hospitalisation claims should be submitted immediately after discharge and pre or post

hospitalisation expenses if any can be claimed subsequently.

Accessing Medi Assist Portal To log on to the Medi Assist portal, go to www.mediassistindia.net/Corporate If you are logging on for the first time use the following credentials, else you can use your existing credentials:

Login ID = emp ID@tcs (for example, 123456@tcs) Password = Date of Birth in 'dd-mm-yyyy' format (for example: 01-01-1982)

(If you have forgotten your password, click Forgot Password on the Medi Assist home page.) Note: The Medi Assist portal link should be opened only using Internet Explorer (IE) 8.0 and above.

The respective location address to send claim documents is as follows.

AHMEDABAD, VADODARA

HIS Helpdesk Tata Consultancy Services Ltd., 801-1001, Sakar-II, Off Ashram Road, Ellis Bridge, Ahmedabad- 380006 HIS Helpdesk Tata Consultancy Services, Ground, 1st, 2nd & 3rd Floor, Rameshwar Building, Om Business Park, Ellora Park, Subhanpura, Vadodara 390023 Email ID:darshitakt@mediassistindia.com

DELHI, NOIDA, GURGAON HIS Helpdesk Tata Consultancy Services Ltd., ASF Centre Plot No. 362-263, Phase IV, Udyog Vihar, Gurgaon, Haryana - 122016 HIS Helpdesk Tata Consultancy Services Ltd., Plot No. 61 A, Block A, Sector 63, Phase III, Noida, UP - 201304 Email ID: delhi.his@tcs.com

BANGALORE HIS Helpdesk Tata Consultancy Services Ltd., Dispatch section, Medi Assist Team, Unit IV, #96 EPIP Industrial Area, Abhilash, Whitefield Road, Bangalore - 560066

CHENNAI

HIS Helpdesk Tata Consultancy Services Ltd., 185/188, Lloyds Road, Chennai 600086 Email ID: chennai.his@tcs.com

HIS Helpdesk Tata Consultancy Services Ltd., Think Campus, Electronic City, Bangalore - 560066 Email ID: bangalore.his@tcs.com

KOLKATA, BHUBANESWAR, PATNA, LUCKNOW, JAMSHEDPUR, GUWAHATI HIS Helpdesk Tata Consultancy Services Ltd., 1W-16, 1st Floor, Delta Park Eden, Salt Lake Electronics Complex, Kolkata - 700091 Email ID: kolkata.his@tcs.com

HYDERABAD HIS Helpdesk Tata Consultancy Services Ltd., Deccan Park, Plot No 1, Survey No. 64/2, Software Units Layout, Serilingampally Mandal, Madhapur, Hyderabad -500034 Email ID: tcs.hyd@mediassistindia.com

MUMBAI, GOA, Overseas HIS Helpdesk (Desk No.10D-85) Tata Consultancy Services Ltd., Wellspring, Godrej & Boyce Complex, Gate No.4, Plant No.12, LBS Marg, Vikhroli (W), Mumbai - 400079 Email ID: mumbai.his@tcs.com

PUNE HIS Helpdesk Tata Consultancy Services Ltd., Sahyadri Park, Plot No. 2, 3, Rajeev Gandhi Infotech Park, Phase III, Hinjewadi, Pune - 411057 Email ID: pune.his@tcs.com

TRIVANDRUM HIS Helpdesk Tata Consultancy Services Ltd., Technopark Campus, Kariyavattom P.O. Trivandrum - 695581 Email ID: ashakj@mediassistindia.com

KOCHI HIS Helpdesk Tata Consultancy Services, TCS Centre-SEZ, Ground Floor, Infopark Special Economic Zone, Kakkanad, Kusumagiri Post, Kochi 682030 Email ID: kochi.his@tcs.com

HIS Policy Exclusions

There are certain exclusions in HIS due to which NO benefits are payable. This list of exclusions (enumerated below) is only indicative and not exhaustive.

Expenses towards Health Check-ups, correction of eye sight, cost of spectacles, contact lens, cost of braces, cost of scaling of teeth, hearing aids including Cochlear Implants, Nebulizer, beauty treatment, external congenital defects/diseases/anomalies i.e. the defects/conditions/anomalies which are visible at the time of birth; and anaemia, etc. are not covered by this policy.

Lasik/Laser surgery and advanced surface ablation surgery are not covered under the domiciliary as well as under the Hospitalisation.

Vaccination, Inoculation, Baby Check-up charges (MMR/BCG/Polio/Anti Typhoid) Circumcision (other than on medical grounds), Strictures, Change of Life (beauty treatment of any description) cosmetic or aesthetic treatment, Hair Loss/Alopecia and its treatment, Weight Loss/ Height Gain treatment, Acne/ Pimples Treatment, Removal of Warts, Plastic Surgery other than as may be necessitated due to an accidental injuries.

Depression, Convalescence (which expression shall cover also general debility run down condition and general over haul) or Rest Cure, Venereal Disease, Insanity, Intentional self-injury, Intemperance or disease or condition or accident arising out of the use of intoxicating drugs or liquors or alcohol or any disease directly or indirectly due to any one or more of them. Use of tobacco leading to cancer.

Insanity/ anxiety / mental Illness and their treatments are not payable.

Health routine check-up examination / Master Check-up unless necessary positive existence for treatment of any medical condition.

Expenses incurred at Hospital or Nursing Home primarily for evaluation / diagnostic purposes which is not followed by Active line of treatment for the ailment during the hospitalised period. Refer to the definition of Active line of treatment in the section on Hospitalization.

Weakness related treatments are generally not payable.

Extra amount paid directly by the associate to consultant / surgeon etc. over and above hospitalization expenses (wherein consultant / surgeon charges are already included in the hospital bill) will not be reimbursed.

Injury, disease or illness directly or indirectly due to or arising from ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel (solely for the purpose of this exclusion, combustion shall include any self-sustaining process of nuclear fission), War, Invasion, Act of Foreign Enemy, Hostilities or Warlike Operation (whether war be declared or not), Riot or Civil Commoti on or Breach of Law or hunting.

Bodily injury or sickness due to wilful or deliberate exposure to danger (except to save a human life) intentional self-inflicted injuries, attempted suicide and arising out of non-adherence to any medical advice or bodily injury sustained as a result of participating in any criminal act, Breach of

Law, injury sustained whilst or as a result of participating in any hazardous sports or hunting. Steeple chasing, Polo or winter sports or riding or driving in races employment in Military, Naval or Air Services or engaging in Aviation or Ballooning or entering into, travelling in or leaving any aircraft or balloon.

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

Genetic disorders like Colour Blindness, Sickle Cell anaemia, Haemophilia, Down Syndrome, etc. and stem cell implantation or surgery.

Treatment of obesity or conditions arising thereof from (including morbid obesity) and any other weight control program services or supplies etc. even if associated with thyroid problem

Instruments such as CPAP/ BiPAP for treatment of sleep apnoea, CAPD for treatment of Dialysis, external equipments or prosthetic devices , ambulatory devices like walker, crutches, Belts, collars, Caps, Splints, Slings, Stockings, diabetic foot wear etc.

Experimental and unproven treatment, not recognized by the Indian Medical Council.

Treatment of Age related Macular Degeneration (AMRD), Rotational Frequency Quantum Magnetic Resonance therapy (RFQMR), External Enhanced Counter Pulsation (EECP) therapy etc.

Robotic surgeries, Cyberknife surgeries are not payable unless there is any other alternative available.

Procedures and treatments usually done in outpatient department are not payable under the policy even if converted to day-care surgery/procedure or as in- patient in the Hospital for more than 24 hours. Example: administration of Intravitreal/intravenous injections, Remicade injections, Avastin injections, Herceptin Injections and any other preventive injections or vaccinations, etc.

Targeted therapy, hormonal therapy, biological therapy and drugs/medicines related to these therapies unless administered along with chemotherapy drugs during parental chemotherapy.

Non-Medical expenses such as Telephone, Television, Ayah, Private Nursing, diet charges, baby food, cosmetics, tissue paper, diapers, sanitary pads, toiletry items and similar expenses.

Treatment arising out of infertility, sterility, family planning unless it is an IVF procedure for infertility treatment and covered under Maternity benefits. Refer to the section on Maternity Benefits to know more details on hospitalisation coverage for IVF procedure.

Maternity and maternity related expenses are not payable for more than first two children and the Insured person who is already having two or more living children would not be eligible for any maternity benefits.

Expenses incurred towards abortion, voluntary termination of pregnancy and related complications are not payable.

Check up and diagnostic tests done during maternity period.

Diagnostic, X-ray or Laboratory examination not consistent with or incidental to the diagnosis of positive existence and treatment of any ailment, sickness or injury for which confinement at a hospital or nursing home is required is required.

This exclusion shall not apply to injury resulting from an accident to a fully licensed standard type of aircraft operated by a recognised airline on a fully regular scheduled ai r route in which the insured person is travelling as a bonafide passenger.

In case of Hospitalisation, the following services are not reimbursable:

- Registration/Admission Fees.

- Telephone charges.

- Visitors charges, attendants charges, ambulance charges.

- Service charges, surcharge and/or any other Charges like Medico Legal Charges (MLC), Medical Record Charges etc.

- Diet charges, which are not part of the administered treatment. Non-medical expenses such as Equipments, Television, Ayah, Private Nursing, baby food, cosmetics, tissue paper, diapers, sanitary pads, toiletry items and similar expenses.