EMPLOYEE INSURANCE BENEFITS GUIDE

CORONA KAVACH POLICY

Policy period: March 21 to December 19, 2021

EMPLOYEE INSURANCE BENEFITS GUIDE

Intuit Confidential and Proprietary 2

Corona Kavach Policy

Policy Details

Enrolment Procedure

Claims Procedure

Exclusions

Contacts & Links

Overview


The Corona Kavach policy covers medical expenses incurred by the insured or family members due to treatment of COVID-19. This policy is applicable to the treatments taken within India only.

Note:

❑ Payable only if there is 24 hours of hospitalization

❑ Home care treatment expenses are covered in case a medical practitioneradvises the insured person to undergo treatment at home

❑ Typical expenses covered are room/boarding as provided by the hospital ornursing home, nursing, oxygen, medicines and drugs, positive COVID-19investigation charges (done in authorized center)

Policy Details



Policy Details

Claims Procedure

Exclusions

Contacts & Links

Enrolment Procedure

Policy details


Policy Details

Policy Holder Intuit India

Policy Period March 21, 2021 to December 19, 2021

Insurer National Insurance Company Limited

Third Party Administrator (TPA) Medi Assist India TPA Pvt. Ltd.

Sum Insured INR 300,000 per member

Eligible Members Self + spouse + 3 dependent children (maximum age limit: 25 years)+ 2 parents (maximum age limit: 80 years)



Policy Details

Claims Procedure

Exclusions

Contacts & Links

Enrolment Procedure

Hospitalization Benefit


Hospitalization Benefit

Waiting Periods 15 days

24 Hours of Hospitalization Mandatory to get the claim paid

Treatment Payable Only if• Hospitalized and treatment taken in hospital with active line treatment• Home care treatment advised by duly qualified medical practitioners covered maximum of 14

days

Pre- & Post-Hospitalization Expenses Covered (up to 15 days & 30 days respectively)

Pre-existing Diseases Not covered

Treatment Type Allopathy & AYUSH

Room Rent Normal/ICU Actuals

Pulse Oximeter, Oxygen Cylinder and Nebulizer

Payable under home care treatment expenses only if prescribed and provided by hospital as part of the treatment kit

PPE Kits/Gloves/Mask Covered, only in case of hospitalization/home care

Comorbidities Covered during COVID treatment

Ambulance Charges Covered up to INR 2,000 per hospitalization



Policy Details

Claims Procedure

Exclusions

Contacts & Links

Enrolment Procedure

Home Care Treatment


Home Care Treatment

Home care treatment means treatment availed by the insured person at home for a positive COVID-19 diagnosis in a government-authorized diagnostic centre, which in normal course would require care and treatment at a hospital but is actually taken at home for a maximum of 14 days per incident provided that:

A. The medical practitioner advises the insured person to undergo treatment at home.B. There is a continuous active line of treatment with monitoring of the health status by a medical practitioner for each day through

the duration of the home care treatment.C. A daily monitoring chart, including record of treatment administered duly signed by the treating doctor, is maintained.D. Insured shall be permitted to avail the services as prescribed by the medical practitioner. Cashless or reimbursement facility shall be

offered under home care expenses subject to claim settlement policy disclosed in the insurer website.(https://nationalinsurance.nic.co.in/en/health-insurance/corona-kavach-policy-national)

E. In case the insured intends to avail the services of non-network provider claim shall be subject to reimbursement, a prior approvalfrom the insurer needs to be taken before availing such services.

F. In this benefit, the following shall be covered if prescribed by the treating medical practitioner and is related to treatment of COVID-19:a) Diagnostic tests undergone at home or diagnostics centerb) Medicines prescribed in writingc) Consultation charges of the medical practitionerd) Nursing charges related to medical staffe) Medical procedures limited to parenteral administration of medicinesf) Cost of pulse oximeter, oxygen cylinder and nebulizer

https://nationalinsurance.nic.co.in/en/health-insurance/corona-kavach-policy-national

Enrollment Procedure



Policy Details

Claims Procedure

Exclusions

Contacts & Links

Enrolment Procedure

Corona Kavach Policy Enrolment page sample for enrolment:


Dependents covered under base policy (Group Medical

Insurance policy)

Click on Add button to add additional dependents who are not covered under Base Policy

Claims Procedure



Policy Details

Claims Procedure

Exclusions

Contacts & Links

Enrolment Procedure

Planned Hospitalization


Medi Assist issues letter of credit(for cashless) with approval forpartial / full amount as per eligibilityand coverage to the hospital

Medi Assist sends final approval to hospital, which allows the employee to get discharged by paying all non-medical/non-payable expenses

Start

Follow reimbursement process Claims processing by TPA and insurer, release of payments to the hospital

Cashless HospitalizationEmployee approaches network hospital with Corona Kavach e-card (along with valid photo ID) well in advance

Hospital contacts Medi Assist and sends pre-authorization request with approximate cost of the treatment for approval

At time of discharge, hospital sends final bill and discharge summary to Medi Assist for final approval

Medi Assist issues letter of credit (for cashless) with approval for partial/full amount as per eligibility and coverage to the hospital

Hospital sends complete set of claims documents for processing to Medi Assist

No

No

Yes

Yes



Policy Details

Claims Procedure

Exclusions

Contacts & Links

Enrolment Procedure

Emergency Hospitalization


Member gets admitted to the hospital in case of emergency by showing Corona Kavache-card (along with valid photo ID)and treatment starts

Member/hospital applies for pre-authorization to Medi Assist within 24 hours

Member gets treated and discharged after paying all non-medical/non-payable expenses

Medi Assist verifies admissibility of the claim to be registered and issues pre-authorization

Pre-authorization given by Medi

Assist

Hospital sends complete set of claims documents for processing to Medi Assist

Claims processing by TPA and insurer

Release of payments to the hospital

Follow reimbursement process

Yes

No

Cashless Hospitalization

Start



Policy Details

Claims Procedure

Exclusions

Contacts & Links

Enrolment Procedure

Hospitalization Reimbursement


Start

Claim Documents

Employee submits all the documents to Medi Assist within 30 days from discharge from the hospital along with copy of cancelled cheque

Medi Assist checks for the eligibility and admissibility of the claim as per policy terms

Is claim payable?

Medi Assist reassesses the complete claim documents for admissibility as per policy terms

Employee submits the shortfall documents to Medi Assist

Medi Assist asks for the additional/missing documents

On rejection of the claim, Medi Assist provides the reason for rejection

Medi Assist processes the claim and sends the reimbursement via EFT to employee account

Are documents

intact?Yes

No

No

Yes

Yes

No



Policy Details

Claims Procedure

Exclusions

Contacts & Links

Enrolment Procedure

Claim Documents for Hospitalization Related Reimbursement Claims


Documents GMC Claim

Cancelled cheque

Original claim form fully filled out and duly signed by you

Original main hospital bill with bill number and break-up (with detailed break-up of various expenses like room rent/OT charges/nursing charges, etc.)

Original discharge summary (gives the summary of diagnosis and treatment in hospital)

Original death summary (only in case of death of patient during hospital stay)

Original hospital payment receipt with receipt number

Hospital registration number (registration number and number of beds on hospital letterhead with signature)

Doctor’s registration number (on doctor’s letterhead with signature)

Original pharmacy and investigation bills

Original prescriptions

Investigation reports in original/attested from hospital (reports for all tests done along with images)

* This is an indicative List. If any additional documents are required, Medi Assist will revert to you.

Exclusions



Policy Details

Claims Procedure

Exclusions

Contacts & Links

Enrolment Procedure

Exclusions


• Claim arising out of detection of COVID-19 within first 15 days of/prior to policy inception

• Investigation and evaluation

• Rest cure, rehabilitation and respite care

• Dietary supplements and substances

• Unproven treatments

• Treatment other than COVID-19

• Any expenses incurred on day care treatment and OPD treatment

• Diagnosis/treatment outside the geographical limits of India

• Testing done at a diagnostic center which is not authorized by the government shall not be recognized under this policy

• All covers under this policy shall cease if the insured person travels to any country placed under travelrestriction by the government of India

Note: This is an indicative list. Please get in touch with Medi Assist for more exclusions.

Contacts & Links



Policy Details

Claims Procedure

Exclusions

Contacts & Links

Enrolment Procedure

Contact Information


Particulars Contact Mail ID

Dedicated Helpline Toll-Free Number 080-46855372 [email protected]

SPOC Mr. Suman Manjunath Contact: +91 99725 78987

[email protected]

First-Level Escalation

Mr. Y Amit Kumar Contact: +91 95138 68677 [email protected]

Final-Level EscalationMr. Kannan Gopalan

Contact: +91 77609 64280 [email protected]

Dedicated Helpline

Second-Level Escalation

Mr. Prakash KContact: +91 99725 78987 [email protected]

mailto:[email protected]







Policy Details

Claims Procedure

Exclusions

Contacts & Links

Enrolment Procedure

Links


Medi Assist Health Care website : https://medibuddy.sso.intuit.com/

All India Hospital Network: https://network.medibuddy.in/national-insurance-network-hospital.html

Pre-authorization form for cashless claim

Claims form for reimbursement claim

https://www.medibuddy.in/assets/claimForms/cashless-claim-form.pdf

https://www.medibuddy.in/assets/claimForms/reimbursement-claim-form.pdf

https://medibuddy.sso.intuit.com/

https://network.medibuddy.in/national-insurance-network-hospital.html

https://www.medibuddy.in/assets/claimForms/cashless-claim-form.pdf

https://www.medibuddy.in/assets/claimForms/reimbursement-claim-form.pdf

THANKS & STAY HEALTHY

EMPLOYEE INSURANCE BENEFITS GUIDE

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