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MORNINGSTAR INDIA PRIVATE LIMITED

HOSPITALIZATION BENEFIT PLAN

1. What are the broad benefits under MORNINGSTAR INDIA PRIVATE LIMITED Hospitalization
Benefit Plan?

Under MORNINGSTAR INDIA PRIVATE LIMITED Hospitalization plan, you or your eligible &
insured family members would be paid all the eligible expenses incurred due to hospitalization.
The hospitalization must fulfill following conditions:

Where the total stay in hospital is more than 24 hours (this condition is relaxed for
certain ailments which are mentioned ahead)
Where the hospitalization is for treatment of a disease or illness and the treatment
given cannot not be administered on Outpatient basis.
Where the hospital is more than 15 beds in Metro Cities OR is registered with the local
authorities (this condition is relaxed to 10 beds for Non-Metro cities)
This plan pays for various components of hospitalization expenses like Stay Charges,
Operation Charges, and Doctors fees, Nursing Charges, Investigations & Diagnostics
Charges, and Medicines etc. To summarize in short, it pays for all hospitalization
expenses, which are Medical in nature.


2. What are the additional benefits under this Plan?

In addition to getting the expenses paid for the hospitalization, you also get reimbursement of
expenses incurred for same disease/illness 30 days prior to the Date of Admission to Hospital
(Called Pre-Hospitalization Expenses). This could be the doctors fees, Preliminary investigations
& diagnostics and the medicine charges. You also get reimbursement of expenses incurred for
same disease / illness 60 days after the Date of Discharge from the hospital (Called Post-
Hospitalization Expenses). This could be follow-up consultations with doctors, Medicines, &
confirmatory diagnostics etc. These benefits are subject to the limits on the policy.



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3. What is the Family Eligibility criterion for insuring the family members?

Under floater Sum Insured, you can insure up to any THREE members of your family amongst
Spouse + any 2 Dependents among Children or Parents. Please note that you cannot insure
your dependents like brother, sister, uncle, aunt, or your grandparents etc.

4. When does the Insurance Cover start?

The Annual Insurance Policy starts on 01st April 2013 for all existing employees who have
joined on or before 01st April 2013 are already insured.

Employees who have joined post 01st April 2013, insurance cover will commence w.e.f. his/her
date of joining subject to completion of his/her online enrollment into Policy

5. When does my Insurance Cover end?

Insurance policy expires on 31st March 2014 or on any of the following event, whichever occurs
earlier would terminate your insurance cover.

Termination or expiration of insurance policy (in case of expiry, it would be renewed)
Your separation from MORNINGSTAR INDIA PRIVATE LIMITED (Last date of
employment)

As the employee insurance is extended to the dependents, the date of termination of cover for
employee is also the date of termination of cover for dependents. Your dependents cover can
also be terminated if the dependent is no longer eligible for such coverage.

6. I want to cover to my dependants in the policy. What are the next steps?

You will receive the mail from Medimanage for completing your online enrolment. Accordingly
you can login to Medimanage portal for completing your enrolment for dependents under
Group Mediclaim Policy.

7. How do I know that my dependents or I are insured?

After your enrollment, you would receive a communication from Medimanage informing the
availability of e-card (Raksha TPA ID) on the website for the members insured. The process of

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generation of e-card normally takes about 4-6 weeks. Please note that each insured family
member gets separate e-card therefore, if you dont get the e-card for one of your family
member, chances are that the member is not insured. In such events, immediately contact our
health plan coordinator, by raising tickets in my communication module on our web site
www.medimanage.com.

8. How do I avail this Hospitalization benefit?

This benefit can be availed in two forms.

i. Cashless: This insurance plan is administered by an outsourced agency called Third Party
Administrator (TPA). Our current TPA is M/s. RAKSHA TPA. They have a network of hospitals all
over India where you or your insured dependents can get hospitalized & take the treatment
without paying the eligible expenses upfront from your pocket. (Applicable for only Medical
Expenses, for Non-Medical expenses, you have to make the payment as per hospitals policy.)

Cashless hospitalization not allowed only in Preferred Provider Network (PPN) hospitals.

ii. Reimbursement: In this traditional form, after your/or your insured dependents
hospitalization is complete; you need to make the payment for these expenses & then get the
eligible amount reimbursed from the TPA.

Note:
1. Claim intimation is mandatory in case of planned hospitalization; you should
provide intimation of claim at least 3 days before the hospitalization and if it is
emergency hospitalization, then provides intimation of claim within 48 hours of
getting hospitalization. Please intimate about the hospitalization on.
2. Reimbursement claim documents should be submitted within 15 days from date of
discharge.

9. What is the process to avail cashless facility?

Please follow the steps mentioned herein:

Identify the hospital where you wish to undergo treatment & confirm whether the same
is part of Network Hospital list of Raksha TPA. You can do so by referring to the hospital
list available with your HR. You can also contact Medimanage OR get in touch with their
voice contacts as mentioned at the end of this document. (As this hospital list gets

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constantly updated, its recommended that you check on the RAKSHA TPA
empanelment with the hospital prior to admission)

Fill up the Cashless Request Form & the network hospital will fax the duly filled request
to RAKSHA TPA. The cashless formalities need to be done a week prior or at least two
days prior to the date of hospitalization in order to ensure timely approval from RAKSHA
TPA.
In cases, RAKSHA TPA requests for submission of additional documents, please do
furnish the same. In case, you do not comply with this, your cashless request would be
rejected. In such cases, please call Medimanage voice contacts to help you solve the
problem if any.
Upon scrutiny of this form, RAKSHA TPA would accept the request & send the
authorization letter to hospital stating the amount approved. This is the amount, up to
which your expenses would be paid for directly by the TPA. RAKSHA TPA could also
reject the request subject to policy terms and conditions. In such events, please call
Medimanage to understand the reason for the same.
For payment of Non-Medical expenses, you may have to pay Security Deposit to
hospital.
In case, the hospitalization expenses exceed the Authorized Limit (AL), which is initially
sanctioned by Raksha TPA, the hospital sends request for additional authorization or the
final bills, in case of discharge and the claim is further approved as per the eligible limits.
In case employee does not want to wait for the final approval and wants to be
discharged, he / she can pay the balance amount and later get the balance eligible
amount reimbursed from Raksha TPA.


10. What happens if I have to be hospitalized in emergency or in case of accident?

In case of such emergency events

Please take the patient to the hospital & start the treatment.
Let the patient stabilize
Follow the standard procedure for Cashless Authorization in case of network hospital
and Reimbursement in case of non-network hospital.





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11. How do I claim the amount if the hospitalization is in Non-network hospital?

You have to collect all the documents (As per the document checklist enclosed on Medimanage
portal) & submit it to your HR along with your e-mail details. You should get the settlement
within 21 working days from the date of submission of your claim or the date of fulfilling all the
additional documents, whichever is later. Additional documents (Deficiency documents) need
to be submitted within 45 days from the date of first intimation of the additional required
documents. Please note that you have to submit claim documents within 15 days from Date
of Discharge from hospital. In case you delay submitting the claim, the same may not be paid
for.


12. What are the exclusions of this policy?

HIV and AIDS
Intentional Self-Injury, Use of intoxicating drugs/alcohol
Venereal Diseases, Naturopathy, unproven procedure/treatment, experimental or
alternative medicine/treatment including acupuncture, acupressure, magneto-therapy
etc
All psychiatric & psychosomatic disorders
Injury or Disease caused directly or indirectly by nuclear weapons
Naturopathy
Expenses on Vitamins/Tonics unless forming part of treatment
Cost of Spectacles or Contact Lenses, Correction of eyesight, Hearing Aid etc.
Any cosmetic or plastic surgery except for correction of injury
War, Invasion, Act of foreign enemy, War like operations, Nuclear weapons, Ionising
Radiation, contamination by Radioactive material nuclear fuel or nuclear waste
Any hospitalization for Diagnostic tests only
Infertility treatment
Any hospitalization less than 24 hours except for specific treatments like Dialysis,
Chemotherapy, Radiotherapy, Cataract Surgery, Lithotripsy, Tonsillectomy etc.
Any Non Medical Expenses like Registration Fees, Admission Fees, and Charges for
Medical Records, Cafeteria Charges, Telephone Charges, and Service Charges etc.
Any dental treatment or surgery, which is corrective filling of cavity, root canal etc.
Expenses incurred for investigation or treatment or irrelevant to the diagnosed during
hospitalization, private nursing charges, referral fee to family physician, outstation
Doctor/Surgeon/ consultants fees etc.
Vaccination & Inoculation

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Genetical disorders & stem cell implantation / surgery
Change of treatment from one pathy to other pathy unless recommended by consultant
Treatment for obesity or condition arising there from (including morbid obesity) and any
other weight control program/services/supplies
Any treatment required arising from insureds participation in any hazardous activity
Any stay in the hospital for any domestic reason or no active regular treatment is given
Massages, Steam bathing, Shirodhara & alike treatment under Ayurveda
All expenses arising out of any condition directly or indirectly caused to or associated
with Human T-Cell Lymphotrophic Virus Type III (HTLB-III) or Lymphadinopathy
Associated Virus (LAV) or the Mutants Derivative or variations Deficiency Syndrome or
any Syndrome or condition or a similar kind commonly referred to as AIDS,
complications of AIDs and other sexually transmitted diseases (STD)
Treatment which is continued before & after hospitalization for an ailment / disease /
injury different from one for which hospitalization was necessary
Voluntary Termination of Pregnancy during first 12 weeks from the date of conception.
Treatment arising from or traceable to pregnancy/ childbirth including caesarean
section, miscarriage, abortion or complications thereof including changes in chronic
conditions arising out of pregnancy
Out patient Diagnostic, Medical or Surgical procedures or treatments, non-prescribed
drugs & Hormone replacement Therapy, Sex Change
Any treatment received in convalescent home, convalescent hospital, health hydro,
nature care clinic
Doctors home visit charges, Attendant/Nursing Charges during pre & post
Hospitalization
External/ durable medical/Non-medical equipments of any kind used for
diagnosis/treatment including CPAP, CAPD, infusion Pump etc., ambulatory devices like
walker/ crutches/ belts/ collars/caps/ splints/ slings/ braces/ stockings/ diabetic foot-
wear/ glucometer/ thermometer & similar related items & any medical equipment
which could be used at home subsequently.
Non-medical expenses including personal comfort/ convenience items/ services such as
telephone/ television/ aya/ barber/ beauty services/ diet charges/ baby food/
cosmetics/napkins/ toiletries/ guest services etc.
Treatment, which the insured was on before hospitalization and required to be on after
discharge for the ailment/disease/injury different from the one for which hospitalization
was necessary.



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13. I am a female employee & married recently. My name is changed after the marriage. Is
my insurance cover still valid with my new name?

Your insurance cover is still valid but getting the name change process completed is important.
As in near future, you may go for a claim, which will be lodged, under your Post-Marital name
and the claim may not be honoured due to difference in names. Please submit a requisition for
change of name along with a photocopy of your marriage certificate.

14. What happens if the details like DOB, furnished by me is incorrect.

It is important that you provide correct information. In case of discrepancy in data available
with TPA & the actual data furnished (you may have mentioned in the form your wifes age as
35 years and the claim form & hospital records have mentioned it as 45 years), your claim may
get rejected. Please get in touch with our executive about this & get the necessary & timely
changes made in the insurance records.

15. I am an existing Employee & during the enrollment exercise (i.e. before April 19 2013); I
have covered my Spouse & 1 Child. I need hospitalization for my other child later in the
month of October 2013; can I cover my child then?

All the dependent enrollments have to be done on or before 19
th
April 2013 for existing
Employees (& within fifteen days of joining the company for New Joiners). These Enrollments
cannot be amended (except for additions like Marriage & child-birth) till expiry of this policy i.e.
Up to 31
st
March 2014.

16. I have insured my spouse under the policy. Do I have to intimate insurer when my first
child is born?

Yes, New Born Child Cover from Day One. Intimation of the new born baby should be within 1
month from DOB. You add his/her details in My Members Section on www.medimanage.com
within 1 month from the date of birth of new born. You also have to intimate us and your HR
about this addition.

17. Are there any specific restrictions on my hospital expenditure?

To rationalize the expenses paid under Mediclaim, insurance company has issued sub limits,
which are as follows:


Room Rent Capping - 1% of Sum Insured

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ICU Rent Capping - 2 % of Sum Insured
Maternity - INR 50,000 for Normal and Caesarean
OPD - Rs. 5,000/- per Employee
Co-payments for dependents - 10% of Admissible claim amount
OPD claims in respect to each insured can be lodged only once during the policy period.
OPD claims would be admissible only after 90 days from inception.

18. I have insured my Spouse under the policy. My spouse was hospitalized and the total
hospital bill was 100,950. The non-medical expenses (like food, telephone bill & registration
charges etc. are INR 950. The room rent per day was Rs. 3000 only. Now, how much money I
will get once the claim is settled?
First, the admissible claim amount would be identified. As the non-medical charges are INR 950,
the total admissible claim value would be INR 100,000 (i.e. Total Bill of INR 100,950 Non-
medical charges of INR 950). Raksha will issue a cheque amounting to INR 100,000.

19. In case of any query regarding this Benefit Plan, whom should I get in touch with?

You can raise a ticket in My Communication Section by logging on to www.medimanage.com
for all issues regarding this Health Plan. You can get in touch with Medimanage for any of the
following issues.

Checking whether enrollment is done or not
Getting the TPA ID.
How to get cashless hospitalization done
In case of delay or problems in getting the Cashless
Changes in the enrollment information
Any other query regarding this Health Plan

20. Where do I check my claim status?
You can check your claim status on Medimanage Portal under My Claims section.
You can also register your claim online through this section and get regular updates on the
claims which you have already submitted.
Log-on to https://www.medimanage.com

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Homepage on Medimanage portal will be displayed
Reach the Dashboard on the homepage
Click on My Claims
21. Do I need to intimate about the hospitalization?
Claim intimation is mandatory in case of planned hospitalization; you should provide intimation
of claim at least 3 days before the hospitalization and if it is emergency hospitalization, then
provides intimation of claim within 48 hours of getting hospitalization. Please intimate about
the hospitalization on claimintimation@medimanage.com

Phone Email
Primary Contact
Raksha TPA
Call Centre no.:-
1) 0129-4289999 Faridabad
2) 022- 42009999 Mumbai
3) 011- 30881499 New Delhi
4) 080- 26789000 Bangalore
5) 033- 40061531 Kolkata
6) 044- 28350536/37 Chennai
intimationmumbai@rakshatpa.com
Secondary Contact
Medimanage Nil claimintimation@medimanage.com












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ESCALATION MATRIX


Board Line No. +91 22 67282929
Function Contact Person Contact Details
Enrollment Queries Ms. Vijayata Navale
+91 22 6728 2919
Login to the web site www.medimanage.com & Raise a ticket by logging in through
My Communication module.
Reimbursement Claims
Ms. Smita
Dhamdhere
+91 22 6728 2916
Login to the web site www.medimanage.com & Raise a ticket by logging in through
My Claims module.
Cashless
Claims
Rest of
India
Ms. Urmila +91 98200 46961 | +91 22 6728 2921 |cashless1@medimanage.com
Mr. Ganesh +91 99200 46961 | +91 22 6728 2922 |cashless2@medimanage.com
Mr. Rushikant +91 98190 46961 | +91 22 6728 2920 |cashless3@medimanage.com
Ms. Vanitha +91 97422 46961 | +91 802211 3334|cashless1.blr@medimanage.com
Chennai Mr. Vivek +91 91766 46961 | +91 44 2811 1108 |helpdesk1.che@medimanage.com
First Level Escalation (Enrollment)
Mr. Surendra Bombatkar +91 22 6728 2924 | +91 97696 78789 | surendra@medimanage.com
First Level Escalation (Claims)
Dr. Neelam Motling +91 22 6728 2957 | +91 9920 621215 | DrNeelam@medimanage.com
Final Level Escalation (Enrollment & Claims)
Ms. Nilima Lalsare +91 22 6728 2980 | +91 9820428289 | nilima@medimanage.com