MEDICLAIM SCHEME

1.0 OBJECTIVE:

1.1 To provide relief to self/family members for medical expenses incurred in India on
account of hospitalization and domiciliary treatment.

2.0 ELIGIBILITY:

2.1 All staff members are eligible to avail of the benefits. The standard entitlements for the
mediclaim are as per Benefit Plan(E/P/Q/R/S) and H&S grade applicable to them are as
below:

Plan/Grade Coverage/family (minimum)

H&S Rs.150,000
P&Q Rs.150,000
R&S Rs.300,000
Plan E Rs.50,000 (for self only excluding maternity
benefit & domiciliary hospitalization
PPs Rs.50,000 (for self only excluding maternity
benefit & domiciliary hospitalization

The above entitlement includes maternity benefit for married NIITians not exceeding Rs
35,000/- for normal delivery and Rs.50000/- for surgical delivery as inbuilt benefit only.
For Single NIITians it will be included when they get married subject to intimation of
nomination to the Insurance department immediately after marriage. Delivery
expenses are admissible only if the insured is covered for 9 months prior to the date of
delivery.

2.2 New joinees have the option to upgrade their mediclaim coverage at the time of joining
to higher limits as given below. In case no such higher option is used then limits shall be
considered by default as in 2.1

Coverage Annual premium

Rs.50,000 1,195
Rs.1,50,000 7,680
Rs.3,00,000 13,785
Rs.5,00,000 16,925
Rs.10,00,000 32,555

For NIITians opting for higher mediclaim insurance coverage & for others, the difference
in the mediclaim premium amount as shown above will be adjusted from the flexi basket
Eg Current coverage 1.5L – current annual premium – Rs.7680; revised coverage being
opted: Rs. 3 lacs; annual premium for 3 Lacs : Rs.13785/-. Adjustment from the flexi
basket = Rs. 641/- pm (i.e. Rs.13785 minus Rs.6095 = 7690/12 = Rs.641/- per month)

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2.3 All GNIIT students doing their Professional Practice with NIIT will be covered for self
only, excluding maternity benefit and domiciliary hospitalization.

2.4 The option to downgrade the current coverage is not permissible under mediclaim
policy.

3.0 SCHEME PERIOD:

3.1 The scheme is effective from 1st February 2010 to 31st January 2011.

3.2 NIIT reserves the right to modify/extend/suspend this scheme at any time.

4.0 DEFINITION OF DEPENDENTS:

4.1 The following relations can be included as a dependent under the mediclaim scheme
Spouse, Children (age >3 months), Parents (age below 80 years at joining), dependent
parents-in-law (age below 80 years at joining). Other relations such as dependent
sisters, brothers, grand-parents etc. are not covered except people covered prior to
01/02/2008.

5.0 SCHEME DETAILS:

5.1 NIIT will provide hospitalization Insurance Cover to each NIITian as per the coverage
defined and his/her 3 nominated dependants (in case of NIITians covered for 50,000/-
coverage is for self only).

5.2 Reimbursement under the scheme is provided for expenses incurred for hospitalization
expenses due to illness/disease or accident sustained.

5.3 An additional Floater coverage for self and 3 dependents for claims against critical
diseases such as heart diseases, brain hemorrhage, renal failure, lever cirrhosis, cancer,
major organ transplant, paralysis & coma etc; which will be over and above the
coverage amount and can be made use of in case of such an eventuality. The floater to
be paid up to a max of Rs. 2 Lakhs or sum insured whichever is lower, from the
Company floater as per the floater norms.

5.4 The following diseases are not covered under the mediclaim policy in the first year of
coverage.

a) Cataract
b) Benign Prostatic Hyperthrophy
c) Hysterectomy for manorrhagia or fibromyoma
d) Hernia
e) Hydrecele
f) Congenital Internal Diseases
g) Fistula in anus
h) Piles
i) Sinusitis and related disorders

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5.5 There is a capping on diseases viz cataract @10% of sum insured or Rs. 30000/-
whichever is less & Stone ,Hernia, Uterus removal @ 20% sum insured up to maximum
of 50000/-.

5.6 There would be a 10% co-payment applicable for all the nominated members other than
Self, Spouse & 2 children i.e. in case of claims processed for nominees other than Self,
Spouse & 2 children, the policy provides for reimbursement of claims up to 90% of the
approved amount only.

5.7 There would be a cap on per day hospital room charges to be applied @ 1% of sum
insured i.e. in case the NIITian having the coverage of 1.5 lacs the room charges can be
claimed maximum up to Rs.1500/- per day. This cap is applied only on room rent and
there would not by any other prorata deduction for any other expenses.

5.8 Pre hospitalization expenses for 30 days and post hospitalization expenses for 60 days
are payable (except for maternity cases).

5.9 Ambulance expenses up to Rs. 1000/ payable under the scheme.

5.10 Domiciliary treatment allowed under conditions excepting for some diseases specified in
the insurance policy. Few of the diseases not covered under domiciliary treatment are
Asthma, Bronchitis, Diabetes, Hypertension, Cough and Cold, Tonsillitis & Arthritis)

5.11 Maternity benefit is applicable to the married NIITian or to the NIITian’s spouse only if
the date of conception is after the date of coverage.

For NIITians with the coverage of 50,000/-; maternity coverage is not applicable.

Maternity expenses coverage for Rs. 35,000/- maximum for normal delivery and Rs
50,000/- maximum for surgical delivery is provided within the total sum insured
including only hospitalization expenses.

5.12 Hospitalization expenses on newborn child during the first three months after birth are
covered within the maternity limit of 35K/50K.

5.13 As per the mediclaim policy there are certain exclusions for which reimbursement
cannot be made as per the policy terms. Details are as per point 5.17.

5.14 In case of upgrade of sum insured diseases incepted /already under claims / pregnancy
incepted before the coverage change such limit upgrade will not be applicable and
coverage will be up to the last sum insured only. The revised coverage limit will be
applicable to only new diseases incepted after the date of upgrade.

5.15 Pre-existing diseases will be covered in case of continuous coverage under NIIT
mediclaim scheme for more than 3 years AND no treatment of such diseases has been
required / taken for last 3 years.

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5.16 Provision for additional dependent’s coverage beyond above at extra premium. The
Insurance premium at the rates chargeable as per Insurance Company tariff would be
recovered from the medical basket of the NIITian which is exempted from the tax as per
the income tax rules.

5.17 IMPORTANT EXCLUSIONS

Diseases pre-existing at the inception of coverage including congenital diseases

(whether or not known to insured)
Aids or diseases traceable to same
Charges incurred primarily for diagnostic/laboratory purposes without the
existence of disease/sickness
Injury/disease caused by war or warlike operations/nuclear materials
Treatment traceable to pregnancy unless insured before conception of child
Spectacles/contact lenses/hearing aids/dental surgery unless requiring
hospitalization
Convalescence/general debility/rest cure/venereal diseases/intentional self
injury/use of intoxicating drugs or alcohol
Voluntary termination of pregnancy during first 12 weeks of pregnancy not
covered.
Naturopathy treatment not covered.
Congenital external diseases
First year exclusions as per 5.4

5.13 SALIENT DEVIATIONS FROM NORMAL MEDICLAIM POLICY

Waiting period of 1 month for claim admissibility waived

Minimum 15 beds condition for nursing home/hospital for extreme hardship cases
not applicable.
Minimum 24 hrs hospitalization condition not applicable.
Domiciliary hospitalization at the option of insured under doctor’s advice allowed.
For accidental injury claims involving multiple fractures / surgery, post
hospitalization cover for two months is extendable till advised by treating doctor
limited to one year and the claims can be submitted in two lots , one immediately
after discharge and the second after completion of OPD treatment.

6.0 NOMINATION PROCEDURE

6.1 On joining, each NIITian will give the details of their nominees for Mediclaim (part of
joining report) and submit to the Location HR. The Location HR will update the
nominations which would be displayed to the NIITian on iniitian.com in ‘My Info’.
NIITians must check the nomination in their own interest.

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7.0 NOMINATION CHANGE PROCEDURE

7.1 NIITians who wish to make any changes (addition/modification) in the existing
nominations as per the policy will fill up MED- IV and submit it to Location HR. Location
HR will forward the change to the CSO-Insurance Department, who in turn will update
the nomination in the system. NIITian must verify the changes on iNIITian in their
nominations and inform Insurance department in case it is not done.

7.2 NIITians whose family status changes as a result of marriage or childbirth can nominate
their spouse or children (after three months of Date of birth) by substituting the existing
nominations or adding to the existing list with immediate effect. NIITian can make
change in the following events (provided no claim has been taken during the current
policy period in respect of the dependent whose name is being substituted). The
nominations can be changed/replaced on the following events:

NIITian gets married and wants to nominate his/her spouse in place of an existing
dependent.
NIITian wants to nominate his/her newborn child in place of an existing
dependent.
In the event of death of any dependent under the policy.
In the event of separation /divorce of the NIITian.

Note: Any delay in nomination of spouse can have implication in maternity claims as
these cases are subject to coverage before date of conception of child. All ARE
REQUESTED TO NOMINATE THE SPOUSE immediately after marriage.)

7.3 NIITians desirous to cover more dependants (spouse/children/parents only) should

fill up the Additional Nomination Proposal Form available on iNIITian and submit the
same to Mr R P Chandola-CSO-Insurance Department, NIIT, H 9, MCIA, Mathura Road,
New Delhi-110044. The updation in the nominations will be done from the succeeding
month.

8.3 CLAIM PROCEDURE

8.3 The NIITian must inform Location HR giving complete details on MED-II within 2 days of
occurrence of any event.

I. Hospitalization (including expenses of 30 days prior to Hospitalization and 60

days after the date of discharge from the Hospital subject to treatment of one
disease). Hospital / Nursing Home should be one that is registered either as a
Hospital or Nursing home with the Local authorities or has no. of beds more
than 15 and is under the supervision of a registered and qualified medical
practitioner.

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II Domiciliary Hospitalisation treatment for a period exceeding three days for
such illness/disease or injuries which in the normal course would require care
and treatment at a hospital/ nursing home but actually taken whilst confined at
home. The NIITian should attach a certificate from the attending Doctor
verifying any of the following circumstances under which domiciliary treatment
was given:

a. The condition of the patient is such that he/she cannot be removed to

the hospital/nursing home or
b. The patient cannot be removed to hospital /nursing home for lack of
accommodation therein or
c. The patient prefers to be confined at home for treatment with the
approval of the attending medical practitioner.

III Maternity includes treatment arising from or traceable to pregnancy, childbirth

including normal caesarean section.

8.2 Once the treatment is over, the claim must be filled up and submit online on iNIITian -->
customized-> Human Resources -> Online Mediclaim workflow and send the following
documents to CSO HO through CSO/LHR region within 14 days of its completion.

A) Claim form of United India Insurance Co. duly filled in

B) Original bills and money receipts for treatment taken
C) Original prescriptions/test reports/discharge card
D) Doctor’s certificate / mediclaim information sheet as per format duly filled in.
E) Leave certificate from HR in case of ‘SELF’ hospitalization.

8.3 In case of Domiciliary Hospitalization the NIITian must furnish a certificate issued by the
Doctor recommending Domiciliary treatment.

8.4 The reimbursement against the claim would be cleared by CSO on receipt of the claim
amount from the insurance company. Norms for claim settlement is 30 days from the
date of receipt of the papers by the Insurance Company. Advance payments against the
claims are not possible under any circumstances.

8.5 NIIT does not take any liability in case of rejection of any claim by the Insurance
Company for any reason whatsoever.

8.6 Test reports, x-rays and bills not paid for by the Insurance Company for whatever
reasons can be taken back from the Insurance Company on the request of the NIITian
through the CSO Region/LHR.

9.0 INTER COUNTRY TRANSFER

9.1 On the movement to overseas the Mediclaim coverage benefit in India is continued for
one year for self & nominees. In case the NIITian wants to continue the coverage even
after one year; he/she need to pay the Mediclaim premium amount for continuing the

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coverage. The intimation of the renewal will be informed to NIITian thru iNIITian
overseas mediclaim workflow.

10.0 SERVICE SEVERANCE:

10.1 In case of service severance, the Mediclaim policy of the NIITian and his/her
dependants is discontinued with effect from his/her Last Working Day.

11.0 CONTINUITY OF MEDICLAIM IN THE EVENT OF SERVICE SEVERANCE

11.1 NIITians in the event of the service severance wish to continue the Mediclaim policy
should contact R.P. Chandola (Insurance-Department-CSO-HO), email id @ t-
rpchandola@niit-tech.com to get more details and completing the formalities at least
one week before their last working day. However continuation of Mediclaim policy will
be at the sole discretion of insurance company.

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