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EMPLOYEE INSURANCE POLICY
(2016-17)
INTERNAL/EEL/HR-17:00001
ESSJAY ERICSSON PVT. LTD.
Registered Office: Essjay Ericsson Pvt. Ltd. , 210 F IE Patparganj Industrial Area, Delhi-110092
ESSJAY ERICSSON PVT. LTD. INTERNAL/EEL/HR-17:00001
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EMPLOYEE INSURANCE POLICY (2016-17)
This document describes the coverage & benefits extended to all EIL local employees under the Group
Insurance schemes like Group Medical Health Insurance (Mediclaim), Group Personal Accident
Insurance (GPAI) & Group Life Insurance.
Scope This Instruction is applicable to all local on-roll employees of Ericsson India Private Limited (EIL).
Group Medical Health Insurance (Mediclaim) Employees or their immediate family (spouse & dependent children) may be required to undergo
medical treatment. To cover the risk of expenses required for such medical treatment, Ericsson has
partnered with National Insurance Company Limited (NIC) to provide Medical Health Insurance and
Ericsson has selected E-Meditek (TPA – Third Party Administrator) for administering the Policy.
Coverage:
All local employees with their immediate family (spouse & dependent children), till the time they
remain employed with EIL are eligible to benefits as stated in this Instruction.
Married Children or children over 25 (twenty five) years of age are not covered under this policy.
Hospitalization should be for a minimum of 24 hours continuous duration resulting in a line of
treatment and not merely for diagnostic purposes except as those permitted by Insurance guidelines –
examples: Cataract, Medical Termination of Pregnancy (M.T.P) etc.,
Co-Pay: As per the agreed terms with NIC, 10% co-payment on each and every claim will be made by
the employee. Co-payment is applicable on sum insured or admissible claim amount whichever is less.
Co-Pay is not applicable for Cataract treatments.
Benefits:
Sum Insured: Coverage for employees is as per Family Floater, wherein, the amount of coverage is
dependent on the size of employee’s family.
Size of Family Sum Insured
Employee only 2 Lacs
Employee + Spouse 3 Lacs
Employee + Spouse + 1 Child 4 Lacs
Employee + Spouse + 2 or more children 5 Lacs
The above stated Sum Insured Amounts are on per annum per family basis.
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In case the employee and spouse are both working under Ericsson Group, both would be registered as
employees in the policy with a base sum insured of INR 2 Lacs. However, only one of them can enroll
the child / children as dependents. Both the employees cannot enroll the children as their dependents.
Top-Up: Over and above the above stated Sum Insured, employees can take additional coverage by
paying additional premium as per table below:
The premium paid by the employee can be availed as tax deduction under Section 80D up to a
maximum limit of INR 25,000/- per year as per Income Tax rules.
Pre-existing diseases covered
As per our Group Medical Health Insurance Policy, employees and/or dependents as defined above,
are covered on an As-Is basis which implies that employees and / or their dependents can avail
treatment for any pre-existing diseases.
Pre & Post Hospitalization claim:
Employees can avail expense reimbursement for treatments / medical conditions covered under the
policy, incurred 30 days prior to & 60 days subsequent to the discharge date from the hospital.
Enrollment Process:
Ericsson’s Insurance Policy is an Annual policy effective from 09th November of the year. Every year
employees must sign a declaration giving details of their dependents and whether they wish to do any
voluntary top-up to their Sum-Insured. The declaration process is electronically enabled and every
year mailers are sent to employees by Ericsson and E-Meditek. Employees must ensure to complete
this declaration on or before 08th November.
Mailers are sent to New-joiners of Ericsson for completing the above stated declarations within 21
days of their joining, on the E-Meditek enrolment website. Employees must read the Instructions given
in email carefully and complete all actions. New joiners are covered under the Insurance from the day
of their joining Ericsson.
If dependents declaration is not completed within the stipulated time period, the employee would be
covered as individual employee with Sum Insured of INR 2 Lacs for the current policy period and
addition of dependents (spouse and / or kids) will not be possible during the tenure of the policy. In
such scenarios, the employee will be able to add his / her dependents under this policy, only at the
Quantum of Top-Up Sum Insured - Over and Above Base Sum Insured with Tax 15%
Sum Insured 100000 200000 300000 400000 500000
200000 969 1818 2666 3512 4360
300000 1352 2703 4051 5402 6752
400000 1493 2983 4476 5967 7459
500000 1807 3613 5420 7225 9031
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time of next renewal due effective 9th November subsequent to the expiry of the current policy
period.
Any mid-term inclusion in the policy (marriage, child birth) needs to be updated in the TPA portal
within 30 days from the event with the Name, Date of Birth, Date of Event (marriage date, birth date),
Gender, Relationship with the employee for the additional dependent to be included in the policy
failing which, claim arising out of the hospitalization of the additional dependent, will not be
admissible under this policy.
Once a dependent has been enrolled / included in the policy, exclusion from the policy can only
happen either through a natural cause such as death of the dependent or change in the relationship
status of the employee with the spouse as for example in the event of a divorce/legal separation from
the spouse which must be duly intimated to EEL HR / COE TPY&B TEAM and should be updated in the
TPA portal.
Process of availing Benefits
As stated above, E-Meditek is appointed as Third Party Administrator to ensure smooth execution of
the Insurance Policy.
E-Meditek issues e-card for employees and their family members. This e-card is valid without
photograph of the insured (employee / spouse / kids). It is advisable to also keep a copy of the e-card
handy for use in case of an emergency hospitalization. Employees can access / print their e-cards by
following below steps:
Visit site http://emeditek.co.in/ (For future ease in usage, you may bookmark this link)
Click on User Login, Select Card Holder Login.
Input employee ID EELXXXX, Input Password which would be the employee’s DOB in
DDMMYYYY format. Password is not case sensitive.
Click on membership card / Individual Name, Click on E-card., Click on Print Button at top to
print the card.
Cashless Hospitalization: Ericsson employees can also avail of cashless hospitalization benefit,
wherein the Insurance Company makes direct payment to the Hospital for the eligible amount.
Employees wanting to avail this facility must comply with the process detailed below:
Network Hospital: E-Meditek has a tie-up with several hospitals where employees can avail of
cashless benefit. To avail cashless Hospitalization service, employee must enroll in the Network
hospital for treatment. Updated list of Network Hospital can be found on E-Meditek website or by
clicking the Link. It is advised that employees go by recommendation of the Doctor for treatment and
Hospitalization, Employees can always avail reimbursement in case the recommended Hospital by the
Doctor is a non-network hospital.
Planned Hospitalization: In case of planned hospitalization, following steps need to be completed:
Step 1: Authority letter from E-Meditek: Insured Employee should fill up a request for cashless
hospitalization and send it via email / fax at least 72 hours before the planned admission. Kindly
ensure that "part b" to be filled in by the treating doctor at the hospital and "part c" to be filled in by
the hospital / nursing home is filled completely & correctly.
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Email Id: [email protected]
Fax no 0124 – 4466677
Cashless Hospitalization Request Form
Step 2: E-Meditek will scrutinize the admissibility of the request and either approve or deny the
request. Authority letter / rejection letter will be faxed to the hospital with intimation to the insured.
Please note that rejection of a request for cashless hospitalization is only denial of cashless service and
is in no way to be treated as denial of treatment. The insured retains the right to get treated and
submit bills to E-Meditek for subsequent reimbursement (if any) as per policy terms & condition.
Step 3: Patient will contact the admission/TPA desk of the network hospital on planned admission
date with the E-Meditek identity card. Identity of the patient will be validated before admission.
Note that the initial authorization from E-MEDITEK office is on an estimated financial amount, keeping
in view the Doctor’s recommendations of the treatment.
Employee is advised to keep a track of the approx. expenditure every day & seek additional
authorization, in case the earlier authorization amount is expected to fall short.
In case of Emergency, employees are advised to get admitted to nearest Hospital for treatment. If
admission is to Network Hospital, then follow steps as listed in planned hospitalization for availing
cashless hospitalization. It would be endeavor of E-Meditek to support on ASAP basis and not as per
timelines stated for Planned Hospitalization. If the hospital is a non-network hospital then the Claim
reimbursement process as listed below will apply.
Claim Reimbursement Process:
Intimation: An employee has to inform E-Meditek about hospitalization within 48 hours of admission,
else the claim submitted later for settlement on reimbursement basis, is liable to be rejected by TPA.
Under no circumstance though, the information to the TPA for such hospitalization be sent later than
the discharge date. Information to the TPA on such hospitalization should be in written – through mail
or SMS – as far as possible.
Mode of Claim intimation:
Email to: [email protected], [email protected], & [email protected],
OR
Contact No.s
OR
Online Intimation: http://www.emeditek.co.in/OnlineIntimation.aspx
Information to be shared: Information shared through such mailers / calls or online, must have Patient
Name, E-Meditek Card Number, Hospital Name and Address, Undergoing Treatment for and
Estimated Expenditure.
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Document Submission for claim: Employee will have to settle all bills directly with the hospital and
subsequently claim reimbursement form E-Meditek, submitting the following documents in original:
Original Claim Form Duly Signed by Employee
Document Checklist
Original Hospital Bill with Bill Number & break up
Original Discharge Summary
Original Hospital Payment receipt with receipt number
Hospital Registration Number
Original Pharmacy & Investigation bills
Original Doctor prescriptions
Investigation Reports in original / attested from hospital
Police FIR / Medico Legal certificate
X-Ray / Ultrasound films
Copy of cancelled Cheque
Please ensure to retain copies of all documents submitted to E-Meditek for further reference.
Claim Submission: Employees stationed in Ericsson Forum Office can directly meet E-MEDITEK
representative who visits the office every day from 10 am to 5 pm, to submit the claim & take
acknowledgement on a photocopy of the Claim Form.
Employees stationed at other locations can either submit the claim directly to their location-based
EMEDITEK Helpdesk / drop box or alternatively can send the hard copy of claim documents to the
Emeditek office addressing it to
The SPOC Emeditek,
Emeditek TPA Pvt. Ltd, Plot # 577,
Udhyog Vihar, Phase – V,
Gurgaon 122016.
Claim Status: Employees can check the status of their claims online on E-Meditek website. Steps to be
followed for same are as below:
Click on User Login, Select Card Holder Login.
Input employee ID EELXXXX, Input Password which would be the employee’s DOB in
DDMMYYYY format. Password is not case sensitive
Click on Individual name, Click on Claims.
Details of claim will be available with current status.
Note: In case of any IR Pending or Rejection of claim on any grounds, E-MEDITEK will directly contact
the employee
Important Terms & Conditions for Claim Reimbursements:
Please ensure to retain copies of all documents submitted to E-Meditek for further reference.
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Claims for hospitalization should be submitted no later than within 30 days from the date of
discharge; else, the claim is liable to be rejected by the TPA.
For hospitalization claims to be admissible under this policy, a hospital / nursing home should comply
with minimum criteria (all inclusive) as stated below: -
Has been registered as a hospital or Nursing Home with the local authorities & is under the
supervision of a Registered and qualified Medical Practitioner
It should have at least 15 and 10 in-patient beds for Metro and Non-Metro respectively.
Should have fully equipped operation theatre of its own wherever surgical operations are
carried out.
Should have qualified nursing staff under its employment round the clock.
Term “HOSPITAL/ NURSING HOME” shall not include an establishment, which is a place of
rest, deaddiction / Rehabilitation center, wellness facility, resort or old age home, or a similar
place.
The claim amount cleared for payout by the insurance company/TPA shall be final. EIL shall
not be liable in case of a claim or part of a claim being rejected by the insurance company
Support
Please check E-Meditek website (http://emeditek.co.in/) for E-MEDITEK contact numbers.
For escalation please refer the Link
For Final escalation, Ericsson employees may write to EEL HR through following channels
89900
(Airtel/Vodafone/Reliance/BSNL/MTNL/TATA/ IDEA)
Email: [email protected]
Web Request
Important exclusions from the policy
Any injury or disease caused by war and allied perils .
Any injury or disease sustained in the process of breach of criminal law by the insured.
Routine eye examination cost of glasses and contact lenses.
Charges incurred at hospital or nursing home primarily for diagnostics, x-ray or lab tests, not
connected with positive existence of a disease requiring hospitalization.
Genetic diseases (except cancer).
Expenses on irrelevant investigations/treatment; private nursing charges, referral fee to family
physician, outstation Doctor/Surgeon/ consultants’ fees etc.
Out-patient diagnostic/medical/surgical procedures/treatments, non-prescribed
drugs/medical supplies/hormone replacement therapy, sex change or any treatment related
to this.
Unproven procedure/treatment, experimental or alternative medicine/treatment including
acupuncture, acupressure, magneto-therapy etc.
Stay in hospital for domestic reason where no active regular treatment is given by specialist.
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Dental treatment or surgery of any kind unless requiring hospitalization due to accident.
Circumcision, cosmetic treatment & plastic surgery unless necessitated by an accident.
Venereal diseases, insanity, intentional self-injury & any disease arising from use of
intoxicating drugs and liquors.
Charges incurred at hospital or nursing home primarily for diagnostics, x-ray or lab tests, not
connected with positive existence of a disease requiring hospitalization.
Expenses incurred towards vitamins & tonics unless forming part of treatment of disease as
certified by the attending doctor.
Convalescence, general debility, run-down condition or rest cure, congenital external disease
(non-life threatening only) or defects or anomalies.
Voluntary medical termination of pregnancy during the first 12 weeks from the date of
conception.
Doctor’s home visit charges/attendant, nursing charges during pre & post hospitalization
period.
Hospitalization period Hospitalization of less than 24 hours except for treatments i.e.
Dialysis, chemotherapy, radiotherapy, eye surgery, dental surgery(due to accident), lithotripsy,
D&C, Tonsillectomy etc. taken in a Registered hospital/nursing home.
Cataract treatment beyond INR 35,000/-. The eligibility for cataract treatment is for a
maximum of Rs.35, 000/- per eye per annum (including cost of lenses). There is no co-pay in
Cataract claim.
Note: Notwithstanding the above list of exclusions, all exclusions mentioned specifically in the policy
issued by NIC to Ericsson, will be the final and binding list of exclusions to govern the admissibility of
a hospitalization claim. Employees are advised to check with the TPA (E-Meditek), preferably prior to
or at least at the time of commencement of hospitalization, if a particular treatment / medical
condition is excluded under this policy. Failure on the part of the employee to check this beforehand
will not render subsequent rejection of the claim by the TPA/ Insurance Company contestable.
Important conditions as applicable for availing Maternity Benefit
Can be availed for first two instances only (Delivery & an associated surgery). Employees
already having two or more children will not be eligible for this benefit.
Expenses incurred in connection with voluntary Medical Termination of Pregnancy (M.T.P)
during the first 12 weeks from the conception are not covered.
Benefit towards Maternity expenses is limited up to Rs.75, 000 for Caesarean delivery & Rs.50,
000 for normal delivery.
Pre and post-natal expenses under IPD within the maternity limit covered.
Co-payment of 10% is applicable on maternity admissible claimed amount or sum insured
whichever is lower.
Portability:
The Group Mediclaim Policy is Portable in nature and the option to port the policy upon exit from EIL
is a voluntary option for the employee
Benefits of Portability
The extent of benefits and Pricing would be as per the Retail Policy Benefits of National
Insurance at the time of policy porting by the employee on exit from EIL.
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No health checkup would be required for employees over 45 years of age.
Continuity benefit would be given to the employee keeping in reference his/her Date of
joining in Ericsson
First 30 Days waiting Period would be waived off.
First 2 years Exclusion waiver would be given from the Date of Joining of the employee.
Diseases like Cataract, Hernia, hysterectomy, piles, stone disease etc. would be covered
Pre-Existing Diseases can be covered provided the Employee has been with Ericsson for 4
continuous years or more at the time of porting the policy.
Process of Portability
Employee to write to [email protected] stating the intent to continue with the policy on
exit from Ericsson. Employee to attach a proof of Date of Joining in Ericsson along with Mediclaim
proposal form. This intent is to be mandatorily shared 30 days before his / her last working day at
Ericsson.
Other Important Points to Note
In case a registered hospital/nursing home is not covered under the list of network hospitals,
the employee may approach the local E-MEDITEK office to have the Hospital/Nursing Home
included. This process may take few days’ time & it is advisable only in case of pre-planned
hospitalization. However, the inclusion of the hospital in the panel of the TPA is subject to
TPA’s internal criteria.
Employee can take up to a Single Bed (Deluxe) AC room in any hospital in case of a
hospitalization.
In case the E-MEDITEK card is not yet available and hospitalization is required, employee may
contact his / her location E-MEDITEK helpdesk or his / her HR Generalist who shall guide him /
her on the hospitalization procedure.
Enclosures
Claim Form
Document Submission Checklist
Link to check Cashless Hospitals
Link to Non-Payable items under the Mediclaim Policy
List of Critical Illness diseases
Group Personal Accident Insurance (GPAI) Policy In addition to Group Medical Health Insurance, Ericsson covers all its employees under a 24 hour GPAI
policy against any injury / death due to an accident of any nature at any place. This policy is taken
from National Insurance Company Ltd.
Coverage
The extent of coverage of this policy is as defined below:-
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In case an insured employee is incapacitated due to accident for a short period of time and
thus unable to resume work, the injured person can claim up to 1% of the sum insured as
indicated above in Column A, for each week of disability, subject to a maximum of 104 weeks
& a maximum amount of Rs. 40,000/- (Forty Thousand) per month or Rs. 10,000/- (Ten
Thousand) per week. This benefit is available once employee has exhausted all his/her paid
leaves in ericsson and has a loss of pay situation
Permanent Partial Disability means permanent loss of earning capacity, for example due to the
loss of one or both limbs or eye(s). The disability must be confirmed by the Disability Board /
Chief Medical Officer of a Government Hospital. The compensation is awarded by the
insurance company based on the percentage loss of earning capacity as per the Table of
Benefits for Personal Accidental Insurance policy
In case of death or permanent total disability arising out of an accident, the benefit is payable
to the nominee or employee, as per the limits stated in Column-B, in the above table.
Claim Process
o In the eventuality of an accident, information is to be sent to EEL HR within 48 hours so that the
insurance company can be intimated.
o On re-joining duty after the accident, the employee can claim reimbursement of medical & related
expenses by filling up a claim form. The documents to be attached along with Claim Form are:
o Medical Report: This is to be filled up and signed by the attending doctor who should be qualified
& a Registered medical practitioner.
o Original First Information Report (F.I.R.) lodged with Police (if any): This is required where the
accident has been Registered as a police case.
o Copy of the Leave Application duly authorized by your manager in ESS. (Please take screenshot of
the approved leave from ESS).
o Original Case History / Medicine Prescriptions / Medical, x-ray, Diagnosis Reports / Medical Bills /
Expense details / Discharge & Fitness Certificate by Medical Practitioner.
o The above documentation should be submitted to COE TPY&B
o Employees are advised to keep a copy of these documents for their records.
o After recording relevant information, COE TPY&B will forward all documents to the Insurance
Company for reimbursement.
o The reimbursement shall take up to 30 working days.
o Claims passed by insurance company shall be binding on the company & the employee. The claim
amount shall be disbursed to an employee / nominee on receipt of the amount from the
insurance company.
Temporary Total Disability
Benefit (A)
Permanent Partial / Total Disability and Loss of Life Benefits
(B)
1% of GPA Sum Insured or actual
weekly salary (whichever is
lower) subject to a maximum of
Rs.10000 per week for a
maximum of 104 weeks.
Up to 36 times of the monthly salary (i.e. Monthly Basic
Salary+HRA+Composite Allowance) of an employee, subject
to a minimum benefit of Rs.10 Lacs (Ten Lacs only).
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o COE TPY&B is responsible for all procedures & follow-up activities with Broker/Insurer.
o Note: As a standard procedure, the nominees declared during the enrolment process to the policy
will be considered for the purpose of GPAI. In case, the employee had not selected any nominee,
then nominees indicated in the PF declaration (with same percentage allocation) will be
considered for the purpose of GPAI. However, if an employee wishes to change the nomination
and/or percentage, the same may be intimated to EEL HR.
Life Insurance Cover All Ericsson employees are under a 24 hour Life Insurance Worldwide cover from Bajaj Allianz against
loss of life due to any cause (natural causes & accidents). The accident cover is over & above the GPAI
coverage
Coverage
Up to 30 times of monthly salary* of an employee, subject to a minimum amount of INR 10 Lacs (Ten
Lacs only)
(*Salary - Basic, House Rent Allowance & 100 % of Composite Allowance as payable to an employee per
month, shall constitute as components of salary for the purpose of calculation of above coverage.)
Key Features of the policy
o The Insurance amount is payable to the nominee in case of death of an employee.
o All employees shall be covered under the life insurance cover provisions till such time that
they remain in employment with Ericsson India Private Limited (EIL), i.e. the life insurance
cover, automatically ceases once an employee is not employed with EIL.
o Employees can enroll for a top-up on the term life cover provided by EIL to cover the
employee up to a maximum of 7 times of the yearly salary. (Including the 2.5 times as
mentioned above). The top-up premium amount would be INR 56/- per Lac of sum insured
plus Service Tax @ 15%
o Medical underwriting - If total sum insured opted is more than INR 2.6 Crores, employee
might be contacted by insurer/Marsh for medical underwriting where the employee is either
requested to fill a form or undergo a medical test. The cost of the medical test will be borneby
insurance company. If the employee is contacted for medical underwriting he/she will be
covered up to the free cover limit of INR 2.6 CR. Once the underwriting is successfully
completed, the employee will be covered for the full sum insured limit as applicable.
Claim Process
In the case of any eventuality (loss of life of the employee), GFHR GO COE TPY&B team must
be informed at the earliest by the employee’s manager / HR Business Partner / HR Generalist
so that the insurance company can be intimated.
GFHR GO COE TPY&B team to confirm the required documents for the Nominee from
employees’ family.
HR Business Partner / HR Generalist to arrange the required documents from the family. After
collecting relevant information & documents, GFHR GO COE TPY&B will forward the related
documents to the Broker for processing the claim.
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The claim amount shall be disbursed to the employee’s nominee/s based on approval from
GFHR GO GSSC New Delhi Legal & Compliance team on receipt of amount from the insurance
company to Ericsson.
HR Business Partner / HR Generalist is responsible for all procedures & follow-up activities
pending from employees’ Family.
GFHR GO COE TPY&B is responsible for all procedures & follow-up activities pending from
Broker & Insurer.
Note: As a standard procedure, the nominees declared during the enrolment process will be
considered for the purpose of Life cover. In case, the employee had not selected any nominee,
then nominees indicated in the PF declaration (with same percentage allocation) will be
considered for the purpose of Life cover. However, if an employee wishes to change the
nomination and/or percentage, the same may be updated on TPA portal.
Portability:
The Group Term Life Policy is Portable in nature at the volition of the employee upon exit
from EIL (Ericsson Group) i.e. when not taking internal mobility to EIL or moving out on LTA or
L2L assignments to other entities in Ericsson
Benefits of Portability
The benefits would be as per the Retail Policy Benefits of Bajaj Allianz prevailing at the time
of portability
Medical checkup would be required as per Bajaj Allianz guidelines depending on the age of
the Employee
Employee can take the portability of the policy for the Full Sum Insured (Employer offered +
Voluntary Top-up, if any)
No financial underwriting will be required if the same or less sum Insured is opted for retail
policy as opted in Group Plan. Retail rates would prevail
Rate for retail policy will be as per the Retail plan as applicable that time.
Process for Portability
The employee would be required to contact : [email protected]
The employee would be required to provide the proof of his/her DOJ in Ericsson along with
the Term Life proposal form Detailed Life Insurance Cover policy is available with GFHR GO
COE TPY&B and can be viewed, if required.
Group Medical Health Insurance (Mediclaim) for Dependent Parents or Parents-
in-laws of Local Employees Employee’s parents or parents-in-laws may be required to undergo medical treatment. To support
employees in managing expenses required for such medical treatment, Ericsson has partnered with
National Insurance Company Limited (NIC) to provide Medical Health Insurance for dependent
parents and parents-in-laws. Insurance premium for such Insurance cover is paid by employees and is
optional. NIC has tied-up with E-Meditek (TPA – Third Party Administrator) for administering the
Insurance Policy.
The policy issued by NIC summarizes the benefits available. Notwithstanding anything mentioned in
these Instructions, the details of applicability, benefits & process etc. as mentioned in the policy issued
by NIC, shall be final and binding.
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Insurance Premium The premium towards coverage of dependent parent(s) and/or parent(s)-in-law will be borne by
employees. Consolidated premium is paid by Ericsson and it is recovered from employee’s salary
processed through the immediately ensuing payroll cycles. Recovery is made in 4 equal installments
through consecutive payroll cycles
Employee has an option to cover his/her dependent parent(s) and / or parents-in-law for Sum Insured
amounts of either INR 2, 3, 4, 5, 6 or 7 Lacs as per premium amounts indicated below.
Sum Insured Premium with service tax @15%
200000 15,003
300000 18,055
400000 20,854
500000 23,093
600000 25,402
700000 27,943
An employee can choose a Sum Insured / Coverage amount from the menu of Sum Insured options at
the time of enrolling the parents and / or parents-in-law upon joining the company or at the time of
policy renewal. However,
Switching between sum insured options during the currency of the policy period is not
permissible.
Existing employees, at the time of the policy renewal, can scale up or scale down the sum
insured amount by INR 1 Lac.
Employee has to opt for the same sum insured amount for both parents and / or parents-in-
law. Example: Father: SI or INR 2 Lac and Mother: SI of INR 2 Lac is permissible per these
instructions but Father: SI of INR 2 Lac and Mother: SI of INR 3 Lac is not permissible.
Both parents and parents-in-law need to be enrolled unless either parent or parent-in-law is
deceased.
The premium paid only for Parents and not for Parents-In-Law, by the employee can be
availed as tax deduction under Section 80D up to a maximum limit of INR 25,000/-, if any of
the parent is under age of 60, else the maximum limit will increase to INR 30,000/- for the
year as per existing Income Tax rules.
An employee opting to enroll his/her parent(s) and/or parent(s)-in-law during the policy period upon
joining EIL shall have his/her parent(s) and/or parent(s)-in-law covered for the balance period i.e. till
the policy termination date, from the date of joining. Premium shall be charged on pro-rata basis for
enrolment of dependent parent(s) and/or parent(s)-in-law during the year.
Self and Spouse both working under Ericsson Group can enroll their Parents and/or Parent(s)- in-Law
only as one employee’s dependent parents and / or parent(s)-in-law and not against both.
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Benefits No pre-medical check-up required for enrolment in Mediclaim Policy.
All pre-existing diseases covered under the policy.
No age limit defined for dependent parent(s) under the policy.
Pre & post hospitalization claim: Expenses related to hospitalization for treatments / medical
conditions covered under the policy, incurred 30 days prior to & 60 days subsequent to the discharge
date from the hospital, are covered by the policy and will be settled on a reimbursement basis.
Portability: The Parental Mediclaim Policy is portable in nature and the option to port the policy upon
exit is a voluntary option for the employee. Process is defined later in the document.
Important Exclusions from the policy General Policy exclusions - Link to Non-Payable items under the Mediclaim Policy
Any injury or disease caused by war and allied perils.
Any injury or disease sustained in the process of breach of criminal law by the insured.
Routine eye examination, cost of glasses and contact lenses.
Charges incurred at hospital or nursing home primarily for diagnostics, x-ray or lab tests, not
connected with positive existence of a disease requiring hospitalization.
Genetic diseases (except cancer).
Out-patient diagnostic/medical/surgical procedures/treatments, non-prescribed
drugs/medical supplies/hormone replacement therapy, sex change or any treatment related
to this.
Unproven procedure/treatment, experimental or alternative medicine/treatment including
acupuncture, acupressure, magneto-therapy etc.
Stay in hospital for domestic reason where no active regular treatment is given by specialist.
Expenses on irrelevant investigations/treatment; private nursing charges, referral fee to family
physician, outstation Doctor/Surgeon/ consultants’ fees etc.
Dental treatment or surgery of any kind unless requiring hospitalization due to accident.
Circumcision, cosmetic treatment & plastic surgery unless necessitated by an accident.
Venereal diseases, insanity, intentional self-injury & any disease arising from use of
intoxicating drugs and liquors.
Charges incurred at hospital or nursing home primarily for diagnostics, x-ray or lab tests, not
connected with positive existence of a disease requiring hospitalization.
Expenses incurred towards vitamins & tonics unless forming part of treatment of disease as
certified by the attending doctor.
Convalescence, general debility, run-down condition or rest cure, congenital external disease
or defects or anomalies, sterility etc.
Voluntary medical termination of pregnancy during the first 12 weeks from the date of
conception..
Doctor’s home visit charges/attendant, nursing charges during pre & post hospitalization
period
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Hospitalization of less than 24 hours except for treatments i.e. Dialysis, chemotherapy,
radiotherapy, eye surgery, dental surgery(due to accident), lithotripsy, D&C, Tonsillectomy
taken in a registered hospital/nursing home.
The eligibility for cataract treatment is for a maximum of Rs.35, 000/- per eye per annum
(including cost of lenses). There is no co-pay in Cataract claim.
Note: Notwithstanding the above list of exclusions, all exclusions mentioned specifically in the policy
issued by NIC to Ericsson, will be the final and binding list of exclusions to govern the admissibility of
a hospitalization claim. Employees are advised to check with the TPA (E-Meditek), preferably prior to
or at least at the time of commencement of hospitalization, if a particular treatment / medical
condition is excluded under this policy. Failure on the part of the employee to check this beforehand
will not render subsequent rejection of the claim by the TPA/ Insurance Company contestable.
Enrollment The Dependent Parents and / or Parents-in-Law Insurance Policy is renewed every year on 09th
November and is valid for a year till 08th November next year. Every year employees are informed
about the enrolment process via emails from Ericsson & E-Meditek along with the premium amount
and any major changes in the Insurance policy.
Employees may have historically enrolled their parents and/or parents-in-law- details of which are
available on E-Meditek website during the enrolment window opening each year with the
commencement of the insurance renewal process and employees have the option to include / exclude
them. It is mandatory to signoff the renewal of Insurance every year before the beginning of the new
policy period.
For any reason, if employee does not sign off the renewal enrolment on E-Meditek portal then or
excludes the parents and / or parents-in-law already covered under the current policy period, during
the currency of the renewed policy period, parents or parents-in-laws are excluded from the coverage
and cannot avail of the benefits under this policy. In such an instance, the only option available to
employee would be to ensure he/she gets them enrolled again on the next renewal due effective 9th
November of the following year. Such re-enrolments will be subject to a first 60 days waiting period
i.e. no claims will be eligible for processing / settlement for hospitalization of parents and / or parents-
in-law during the first 60 days of the policy period.
Employees joining subsequent to the policy renewal date 9th November, may enroll their Dependent
Parent(s) and/or parents(s)-in-law under this Mediclaim Policy as per the process communicated via
email received by them within 21 days of joining from e-Meditek (Third Party Administrator – TPA).
The window for enrolment would be available for 30 days from date of joining and requests for
enrolment beyond this window will not be possible.
In case of separation of the employee, the coverage for dependent parent(s) and / or parents-in-law
will cease from the date of leaving of the employee. The premium, only where employee has made no
claim against the policy in the policy period, will be paid back to the employee on a prorated basis (for
the balance period from Date of Leaving till the policy termination date of 8th November) with the F&F
settlement.
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In case of demise of any parent/parent-in-law covered under the policy, the premium will be refunded
on pro-rata basis subject to no claim reported in the policy period.
Process of availing Benefits As stated earlier, E-Meditek has been appointed as Third Party Administrator to ensure smooth
execution of the Insurance Policy.
E-Meditek issues e-cards for insured parents &/or parents-in-law. This e-card is valid without
photograph of the insured. It is advisable to also keep a copy of the e-card handy for use in case of an
emergency hospitalization. Employees can access / print their e-cards by following below steps:
Visit site http://emeditek.co.in/ (For future ease in usage, you may bookmark this link)
Click on User Login, Select Card Holder Login.
Input employee ID EELXXXX, Input Password which would be the employee’s DOB in
DDMMYYYY format. Password is not case sensitive.
Portal would prompt for a change of password. Employees would be required to change their
passwords accordingly
Click on membership card / Individual Name, Click on E-card., Click on Print Button at top to
print the card.
Cashless hospitalization: Employees can also avail of cashless hospitalization benefit for parents
and/or parents-in-law, wherein the Insurance Company makes direct payment to the Hospital for the
eligible amount. Employees wanting to avail this facility must comply with the process detailed below:
Network Hospital: E-Meditek has a tie-up with several hospitals where employees can avail of
cashless benefit. To avail cashless hospitalization service, employee must enroll in the Network
hospital for treatment. Updated list of Network Hospital can be found on E-Meditek website or by
clicking the Link. It is advised that employees go by recommendation of the Doctor for treatment and
hospitalization, Employees can always avail reimbursement in case the recommended Hospital by the
Doctor is a non-network hospital.
Planned hospitalization: In case of planned hospitalization, following steps need to be completed:
Step 1: Authority letter from E-Meditek: Insured Employee should fill up a request for cashless
hospitalization and send it via email / fax at least 72 hours before the planned admission.
Kindly ensure that "part b" to be filled in by the treating doctor at the hospital and "part c" to
be filled in by the hospital / nursing home is filled completely & correctly.
Email Id: [email protected]
Fax no 0124 – 4466677
Cashless Hospitalization Form
Step 2: E-Meditek will scrutinize the admissibility of the request and either approve or deny
the request. Authority letter / rejection letter will be faxed to the hospital with intimation to
the insured. Please note that rejection of a request for cashless hospitalization is only denial of
cashless service and is in no way to be treated as denial of treatment. The insured retains the
right to get treated and submit bills to E-Meditek for subsequent reimbursement (if any) as
per policy terms & condition.
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Step 3: Patient will contact the admission desk of the network hospital on planned admission
date with the E-Meditek identity card basis which Identity of the patient will be validated
before admission.
Note that the authorization from E-MEDITEK office is on an estimated financial amount,
keeping in view the Doctor’s recommendations of the treatment.
Employee is advised to keep a track of the approx. expenditure every day & seek additional
authorization, in case the earlier authorization amount is expected to fall short.
In case of Emergency, employees are advised to get admitted to Hospital. In case admission
is to Network Hospital, then follow steps as listed in planned hospitalization for availing
cashless hospitalization. It would be endeavor of E-Meditek to support on ASAP basis and not
as per timelines stated for planned hospitalization.
Claim Reimbursement Process:
Intimation: An employee has to inform E-Meditek about hospitalization within 48 hours of admission,
else the claim submitted later for settlement on reimbursement basis, may be rejected by the TPA.
Under no circumstance though, the information to the TPA for such hospitalization be sent later than
the discharge date. Information to the TPA on such hospitalization should be in written – through mail
or SMS – as far as possible.
Mode of Claim intimation:
Email to: [email protected], [email protected], &
OR
Phone Call on 0124-4149765 or 0124-4466677, Toll Free 1800-102-3242
OR
Online Intimation: http://www.emeditek.co.in/OnlineIntimation.aspx
Information to be shared: Information shared through such mailers / calls or online, must
have Patient Name, E-Meditek Card Number, Hospital Name and Address, Undergoing
Treatment for and Estimated Expenditure.
Document Submission for claim: Employee will have to settle all bills directly with the
hospital and subsequently claim reimbursement form E-Meditek, submitting the following
documents in original:
Original Claim form duly signed by employee
Document Checklist
Original Hospital Bill with Bill Number & break up
Original Discharge Summary
Original Hospital Payment receipt with receipt number
Hospital Registration Number
Original Pharmacy & Investigation bills
Original Doctor prescriptions
Investigation Reports in original / attested from hospital
Police FIR / Medico Legal certificate, if any.
X-Ray / Ultrasound films
Copy of cancelled Cheque
Please ensure to retain copies of all documents submitted to E-Meditek for further reference.
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Claim Submission: Employees stationed in Ericsson Forum Office can directly meet E-MEDITEK
representative who visits the office every day from 10 am to 5 pm, to submit the claim & take
acknowledgement on a photocopy of the Claim Form.
Employees stationed at other locations can either submit the claim directly to their location-
based EMEDITEK Helpdesk / drop box or alternatively can send the hard copy of claim
documents to the Emeditek office addressing it to Vikash Avasthi, Emeditek TPA Pvt. Ltd, Plot
# 577, Udhyog Vihar, Phase – V, Gurgaon 122016.
Claim Status: Employees can check the status of their claims online on E-Meditek website. Steps to be
followed for same are as below:
Click on User Login, Select Card Holder Login.
Input employee ID EELXXXX, Input Password which would be the employee’s DOB in
DDMMYYYY format. Password is not case sensitive
Portal would prompt for a password change. Employees to change their password and
proceed with portal use
Click on Individual name, Click on Claims.
Details of claim will be available with current status.
Note: In case of any IR Pending or Rejection of claim on any grounds, E-MEDITEK will directly contact
the employee.
o Important Terms & Conditions for Claim Reimbursements:
o Please ensure to retain copies of all documents submitted to E-Meditek for further reference.
o Claims for hospitalization should be submitted no later than within 30 days from the date of
discharge; else, the claim is liable to be rejected by the TPA.
o For hospitalization claims to be admissible under this policy, a hospital / nursing home should
comply with minimum criteria (all inclusive) as stated below: -
o Has been registered as a hospital or Nursing Home with the local authorities & is under the
supervision of a registered and qualified Medical Practitioner
o It should have at least 15 and 10 in-patient beds for Metro and Non-Metro respectively.
o Should have fully equipped operation theatre of its own wherever surgical operations are
carried out.
o Should have qualified nursing staff under its employment round the clock.
o Term “HOSPITAL/ NURSING HOME” shall not include an establishment, which is a place of
rest, deaddiction / Rehabilitation center , wellness facility, resort or old age home, or a similar
place
Support Please check E- Meditek Contact No.s
For escalation please refer the Link
For Final escalation, Ericsson employees may write to EEL HR through following channels
ECN 89900
(Airtel/Vodafone/Reliance/BSNL/MTNL/TATA/ IDEA)
Email: [email protected]
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Web Request
Portability The Group Mediclaim Policy is Portable in nature and the option to port the policy upon exit from EIL
is a voluntary option for the employee
Benefits of Portability
The extent of benefits and Pricing would be as per the Retail Policy Benefits of National
Insurance at the time of policy porting by the employee on exit from EIL.
Waiver of health check-up requirement under the portability plan
First 30 Days waiting Period would be waived off.
First 2 years Exclusion waiver would be given from the date of Joining under the Ericsson
parent’s program. Diseases like Cataract, Hernia, hysterectomy, piles, stone disease etc. would
be covered
Pre-Existing Diseases can be covered provided the parents have been covered under the
Ericsson Parent’s program for 4 continuous years or more at the time of porting the policy.
Process of Portability
Employee to write to [email protected] stating the intent to continue with the policy on
exit from Ericsson. Employee to attach a proof of Date of Joining in Ericsson along with Mediclaim
proposal form. This intent is to be mandatorily shared 30 days before his / her last working day at
Ericsson.
Other Important Points to Note To avail benefits under this Instruction, Hospitalization should be for a minimum of 24 hours
continuous duration resulting in a line of treatment and not merely for diagnostic purposes
except as those permitted by Insurance guidelines example Cataract, M.T.P. etc.,
Co-Pay: As per the agreed terms with NIC, 10% co-payment on each and every claim will be
made by the employee. Co-payment is applicable on sum insured or admissible claim amount
whichever is less. Co-Pay is not applicable for Cataract treatments. However, if the employee
has enrolled parents in 2014-15 and 2015-16 without any claim history in both the policy
years, for the first claim reported in 2016-17 against parental policy a co pay of 5% will be
applicable. However, for subsequent claims in the same year 10% will be applied.
In case a registered hospital/nursing home is not covered under the list of network hospitals,
the employee may approach the local E-MEDITEK office to have the Hospital/Nursing Home
included. This process may take few days’ time & it is advisable only in case of pre-planned
hospitalization. However, the inclusion of the hospital in the panel of the TPA is subject to
TPA’s internal criteria.
Employee can take up to a Single Bed (Deluxe) AC room in any hospital in case of a
hospitalization.
In case the E-MEDITEK card is not yet available and hospitalization is required, employee may
contact his / her location E-MEDITEK helpdesk or his / her HR Generalist who shall guide him /
her on the hospitalization procedure.