Paramount Health Group In partnership with Iffco-Tokio General

Paramount Health Group In partnership with Iffco-Tokio General Insurance Company Ltd. Presents New Dimensions In Health Insurance

Paramount Health Group National in scope, local in focus Paramount Healthcare A TPA Providing an edge over others IRDA LICENCED- NO. 006 VALIDITY : 21/03/2011 TO 20/03/2014

Paramount Health Group PARAMOUNT AS A TPA - EFFICIENT LINK M/s. Samsung India Software Operations Pvt. Ltd. , (Insured) M/s. Iffco-Tokio (Insurer) M/s. Paramount Health (Service Provider)

Paramount Health Group Who is covered ? l l l Employee Spouse 2 Dependant Children up to the Age of 21. 2 Dependant Parents or In-laws Maximum number of family members including employee is restricted to 6. All other members excluded by the above definitions shall be deleted irrespective of coverage.

Paramount Health Group How to Include ? l Mid term coverage for dependents for new born child & newly wed spouse only. l Inclusion of new members from the date of joining provided intimation by close of every month and premium remittance.

Paramount Health Group What is Covered ? § § § § Total FSI (Floater Sum Insured) is Rs. 2. 5 lakh / Rs. 4 lakh / Rs. 5 lakhs) depending on category of employee. Domiciliary Hospitalization Covered (treatment taken at home subject to policy) Waiver of Pre-Existing Disease Exclusion Waiver of 30 Days and First Year Exclusion Maternity : Up to Rs. 50, 000/- for both LSCS & Normal Delivery Without 9 months waiting period Baby cover from day 1 within FSI Pre & Post Hospitalization expenses. NO CASHLESS BENEFIT FOR PRE & POST HOSPITALIZATION EXPENSES

Paramount Health Group Coverage of Maternity Benefit § Pre and Post Natal Expenses are not covered unless admitted in Hospital / Nursing Home and treatment is taken there. l Child cover from day one as part of family floater sum insured. § Claim in respect of Maternity of only first two children and / or operations associated therewith will be considered in respect of any one Insured Person covered under the policy. Those Insured persons who are already having two or more living children will not be eligible for this benefit.

Paramount Health Group What is not covered ? l l l l l Circumcision except for disease not excluded here or Injury. Vaccination, Inoculation, Change of Life, Cosmetic, Aesthetic treatments of any description, plastic surgery except for relating to treatment of injury or illness. Vitamins & Tonics unless it forms part of treatment. Dental treatment unless necessary due to an accidental injury which requires inpatient treatment for more than 24 hours. Convalescence, General Debility, Run Down Condition or Rest Cure. Sterility, Venereal Disease, Intentional Self Injury and use of Intoxicating Drugs / Alcohols. Personal comfort and convenience items or services. Treatment except on Allopathic are not covered under this policy. Congenital Disorders are not covered (both external and internal).

Paramount Health Group What is not covered ? l l l l Any Expense of any treatment related to Human T. Cell Lymphatropic Viruses Types III or Lymphadinaspathy Associated Viruses (LAV) OR the Mutant derivatives OR Variations Deficiency Syndrome OR any Syndrome OR a Condition of a similar kind referred to as AIDS. Expenses on Diagnostic, X-ray or Laboratory Examination, unless related to the treatment of sickness or injury falling within ambit of Hospitalization or Domiciliary Hospitalization. Voluntary Medical Termination of Pregnancy (VTP). Any Expenses on treatment of Insured person as Outpatient in the Hospital (except for pre & post hospitalization expenses). Insured’s participation in any hazardous activities. Obesity Travel costs. Use of Alcohol or Drugs

Paramount Health Group PART - 2 l l CLAIMS PROCEDUE CASHLESS & REIMBURSEMENT

Paramount Health Group PHS – Office network & penetration HO, RO’s and FO’s are connected to Central Database

Paramount Health Group PHS – Current Health Provider network l l l Hospitals & Nursing Homes No. of States covered No. of Cities covered 4094 30 372

Paramount Health Group TPA SERVICES PROVIDED TO YOU BY PHS ü Enrollment Services ü Call Center Service(24/7) ü Customer Relations. ü Cash-Less Hospitalization Service (Pre Authorization) ü Network Hospital Management Service ü Claim Processing & Settlement Service

Paramount Health Group ENROLLMENT SERVICES About Health Card It is Identity Card which will identify you as the beneficiary of Insurance Co. and will give access to our Network Hospitals. It bears Name of the Insured, DOB, Gender, PHS ID No. , Policy Validity etc. For any correspondence and queries Insured should quote PHS ID no. as mentioned on ID card. Request all to carry photo id cards along with the PHS e-cards to the hospital. As ID card carries all crucial information related to an insured so while enrolling all these details should be taken with due care.

Paramount Health Group PROCEDURE FOR CASHLESS FACILITY IN A NETWORK HOSPITAL Send the Admission request note to PHS. (Request note available on admission counter of network hospital as well as on PHS website. ) Fax : 080 41127990 / 022 - 28259743 Planned admissions : Notify Paramount 2 -3 days prior to the date of admission. On receipt of the above form, duty doctor will verify your coverage as per insurance policy and if covered an authorisation letter (AL) will be sent to hospital and copy to insured if so desire. If the coverage is not established, Intimation (Denial) will be sent to hospital and to insured. The denial of authorisation for cashless access does not mean denial of treatment and does not in any way prevent from seeking necessary medical attention or hospitalization.

Paramount Health Group WHAT TO DO IN AN EMERGENCY ? In an accidental case or in medical emergency it is advised to approach nearest Network / Non Network Hospital with PHS ID Card. If the admittance is in network hospital; hospital will send the pre-authorization form to PHS will verify the coverage and if covered issue the authorization letter to network hospital. If the admittance is in non-network hospital insured may pay the expenses and claim reimbursement based on the coverage.

Paramount Health Group IN THE HOSPITAL The network hospital will treat the insured / patient without asking for deposit or payment of bills upto the guaranteed amount, except for some tertiary care hospitals which will collect for some nominal deposit. If any medicines purchased or investigation done outside the hospital, kindly obtain prescription and investigation / lab report along with proper Cash Memo / Receipt for payment made. Charges such as Telephone / Fax, Food & Beverages, Barber, etc. , are not covered in insurance policy. If such services are obtained from the hospital insured should pay the same to directly to the hospital.

Paramount Health Group Procedure in a Non network hospital Get admitted as per the norms of the hospital. Collect all the documents from the hospital and submit it to paramount for reimbursement as below within 30 days from the date of discharge : All reimbursement documents has to be routed through HR Department. § Signed Claim Form of Iffco-Tokio General Insurance Company Ltd. § Original Discharge Summary (Not Discharge Card) § Original Final Hospital Bill along with Bill Breakup in detail & Payment Receipt § All Investigation Reports along with bills and receipts § Original Bills of medicines and surgical appliances if purchased by you along with Doctors Prescription,

Paramount Health Group HOW MUCH TIME DOES IT TAKE TO SETTLE A CLAIM If the claim file is complete in all respect PHS will settle the claim within 7 working days from the date of receipt of complete documents. PHS may settle the claim, deducting the amount pertaining to deficient document. Any deficiency in the claim documents; intimation will be sent to insured through HR within 5 working days from the date of receipt of claim documents. If the deficient documents are submitted PHS will reopen the file and pay for the same if they are payable under the policy.

Paramount Health Group Website – www. paramounttpa. com Ø Customer Education of Products & Insured Claim Status Ø Download of Pre-Authorization & Claim Forms Ø Corporate Logins for HR’s Ø Provider Network Information Ø Real Time Claim Status - Insurer, Employer and Member Ø Health Newsletter Ø Verification of Enrolment online & Card Status Ø E-card and web enrolment facility. Ø Online MIS reports to Corporate HR’s Ø Online Feedback

Paramount Health Group ESCALATIONS AT PARAMOUNT OFFICE SPOC : Mr. Prashanth Rao (Asst. Manager - CRM) Mobile : 9342575022 e-Mail : prashanth. rao@paramounttpa. com Escalations: Ms. Sreekala Raju (Manager - CRM) Mobile : 9343796729 e-Mail : sreekala. raju@paramounttpa. com Mr. Srihari K. P. (Branch Head) Mobile : 9343728900 e-Mail : srihari. kulkarni@paramounttpa. com Bangalore Mumbai (Head Office) M/s. Paramount Health Services (TPA) Pvt. Ltd. , 15, 2 nd Floor, (Above Nissan Show Room), Queen’s Road, Bangalore - 560 052. Tel. : 080 - 2237 1234 / 4113 1448 / 449 Fax. : 080 - 4112 7990 M/s. Paramount Health Services (TPA) Pvt. Ltd. , Elite House, 1 st Floor, No. 54, Sri. A. M. Vasanji Road, Off Andheri-Kurla Road, Chakala, Andheri (East), Mumbai - 400 093. Tel. : 022 - 6644 4600 Fax. : 022 - 6644 4709/775 Call Centre No. : 022 – 66620828 (24 x 7) and Toll Free No. : 1800 -22 -6655 (24 x 7)

Paramount Health Group Thank You Paramount - Your Link to Good Health