INSURANCE

COVERAGE DOCUMENT
Insured under Master Policy no: 100001
YOUR CERTIFICATE NUMBER IS: 1139358
COMPANY NAME: Robert Bosch Engineering and Business Solutions.
PLAN TYPE: Fulhealth Japan
REGION OF COVERAGE: Region3
COUNTRY(S) BEING VISITED: Japan
START DATE OF COVERAGE: Sep 21 2014
END OF COVERAGE: Jan 1 2015
DURATION OF COVERAGE: 103 Days
POLICY STATUS: Live
INSURED(s) BEING COVERED:
NAME

PASSPORT NO.

EMP NO.

MAYFAIR ID NO. DOB

(1) Kamalakannan Arumugham

J3137184

30264295

56009959

8/29/1985

(2) Manimekalai Rajendran

J3738602

30264295

56009960

4/5/1988

(3) Mahanth Kamalakannan

L6562425

30264295

56015342

10/1/2013

COVERAGE PROVIDED (FOR A FULL & COMPLETE COVERAGE LISTING, EXCLUSIONS, CLAIMS
PROCEDURES, ETC PLEASE REFER TO YOUR SUMMARY OF COVER)
ROBERT BOSCH- FULHEALTH - REST OF THE WORLD PLAN COVERAGE
Deductibles/Limits
1) Individual / Family Deductible: NONE
2) Maximum Benefit-USD 5,000,000 per claim
3) Maximum Cover for accommodation at Hospital: Cost of a Semi Private Room
Covered Benefits (The below benefits are covered 100% unless stated otherwise)
1) Hospital Benefits (free choice)
2) Parent Accommodation
3) Physician Benefit (free choice)
4) Pre-existing Conditions
5) Ambulance Services
6) Laboratory & X-Ray Expenses
7) Wellness Care (Age 0-18) USD 700 per annum limit
8) Routine Physical Exams (Age 18+ and 65: 1 exam every 24 months; Age 65+: 1 exam every 12 months)
Other Covered Benefits (The below benefits are covered 100% unless stated otherwise).
1) Digital Rectal Exam (DRE) and Prostate Specific Antigen (PSA) Testing
2) Convalescent Facility (Skilled Nursing at home)
3) Short-Term Rehabilitation Expenses (Physical, Chiropractic, Speech & Occupational Therapy)
4) Durable Medical and Surgical Equipment
5) Emergency use of the Emergency Room
6) Legal abortions
7) Transplants
8) Oral Surgery (For treatment not excluded in exclusions)
Maternity-Covered 100%,Covers cost of pre-natal, birth & post-natal, 3 months waiting period for delivery.
The waiting period does not apply to antenatal check-ups.
A waiting period of 3 months will be imposed on all members with a travel policy start date on or after the 1st JUNE
2013.(for the above mentioned waiting period).
Expenses for Prescription Drug -Covered 100%

Page 1

Repatriation of Insured:
1) Emergency repatriation up to max per claim limit: USD 5,000,000
2) Cover costs of transporting other member(s) of the family necessarily having to accompany the Insured person
returning to the home country.
3) We cover on-going treatment for the repatriated Insured up to 12 months from the date of occurrence or until the max
limit is reached
4) Staff replacement: Actual travel costs of replacement staff up to max limit: USD 2,000
Funeral costs and/or repatriation of mortal remains:
In the event of death of an Insured Person reasonable costs for the transport of an Insured Person`s body or ashes to the
home country (the cost of burial or cremation is not included); or reasonable local funeral expenses in the country where
death occurs, up to max. limit: USD 7,000
Other Assistance Services: (Information on local medical infrastructure, support & information, assistance desk available
24 hours per day, 7 days per week). No limit.
Overseas Cover(While you are outside BASE Location)
1) Emergency Physicians visits: The Insured Person will need to pay for treatment and on his/her return, contact the
Underwriters Medical Coordinators representative for or Region 3 (rest of the world) to initiate his/her claim. The
Insured Person will need to provide received invoices, medical reports, etc as proof of his/her claim prior to
reimbursement.
2) Emergency Hospitalization: If the Insured Person is outside the Base Location & has an emergency Hospitalization,
he/she shall contact the Underwriters Medical Coordinators representative for or Region 3 (rest of the world) as soon as
possible so the Underwriter / Underwriters Medical Co-ordinator may arrange for direct payments to the treating
Hospital.
Dental Benefits
1) Preventive Services covered 100%
(Oral Examinations, X-rays, Cleaning)
2) Basic Services covered 100%
(Emergency exams and palliative care for pain relief, Oral Surgery, Amalgam, composite fillings, Extractions (routine)
Non-cast prefabricated stainless steel crowns, Repairs/adjustments of/for Partial or complete denture, periodontics,
Endodontics (root canals)).
3) Major Services covered 50%,up to max. limit of USD 5,000 per person per annum.
(crowns, in-lays and on-lays, removable or fixed bridgework, partial or complete dentures). Waiting period of 6 months
applies.
Annual Maximum: No max limit
*The validity of the policy is subject to the current coverage dates listed in the Mayfair website"
(a) For 24 Hours Emergency Medical Assistance and Cashless Service Contact Details:
Mayfair Assistance Centre:
Toll Free Numbers:
1) Canada: + 888-800-1205
2) From most countries: +800-212-12112
3) Japan: +800-100-4011
Please ensure you use the appropriate pre-fix prior to using the toll free number; for example, to dial from Germany you
must dial 00-800-212-12112
Alternatively you can all direct or make a collect call by dialing:
+ 1-905-532-6130
Email: mayfairassist@generalihealth.com
(b) For Pay and Claim or General Policy Queries
Toll Free from most landlines:
Direct Line: +1-905-532-6130 and choose the appropriate option
Alternate No: +91 80 30147200 **
Email: RBEI.INS@in.bosch.com claims can be sent via email or by Haus Post.
Postal address:
Kind Attention: Natasha Kaul (C/INR14-IN)
Robert Bosch Engineering and Business Solutions Limited
Page 2

No.123, Industrial Layout,

Hosur Road, Koramangala,
Bangalore-560095,
Karnataka
(c) Escalations and Feedback:
(1) If you need to escalate any issues please email attention to the Claims Manager: mayfair.claims@ihmsworldwide.
com
(2) If your issue is still not resolved please email attention to the Complaints Director at: info@mayfairworldwide.com
(d) Important Points to Note**
(1)* Please always note the direct-line number as the toll-free number may not work from certain connections
(2) If you receive a copy of an invoice from a Service Provider requesting payment, please forward it to mayfair.
claims@ihmsworldwide.com immediately
** Open IST (GMT +5.5) 10:00 to 18:30
Please refer to the latest version of this document available at your insured's login at
http://www.mayfairworldwide.com/asp/insuredslogin.asp

Page 3