Employee Insured Benefits Manual - 2023

Expedia Group - Employee Benefits Manual
Expedia Group – Insurance Benefits Manual - 2023

Disclaimer:
This manual is intended to be a general summary of the benefits provided by Expedia Group & should be regarded as
guide only. While HR shall make every reasonable effort to ensure the accuracy and validity of the information provided
here in this document. HR accepts no liability or responsibility for any errors or omissions in the content or for any loss or
damages arising out of your reliance on information provided here. If there is a conflict in interpretation or benefit
applicability, then the terms & conditions of the policy will prevail.
Prepared by
Marsh India Insurance Brokers Private Limited
1201-02, Tower 2, One Indiabulls Centre, Jupiter Mills Compound
841, Senapati Bapat Marg, Elphinstone Road (W),
Mumbai 400 013
Copyright © 2010. All rights reserved. No part of this publication may be reproduced, stored in the retrieval system, or be
transmitted in any form or by any means, electronic or mechanical, photocopying, recording or otherwise, without the prior
written permission of MARSH.
Brief introduction – Employee Benefits Insurance
Provides insurance coverage to the employees & their dependents for expenses
Group Medical related to hospitalization / OPD due to illnesses or injuries
Provides insurance coverage to the dependent parents or parents in law (one set
Voluntary Parental Cover of parents) for expenses related to hospitalization upto sum Insured of INR
500,000/OPD due to illnesses or injuries
Provides insurance coverage to the employees & their dependents for expenses
Voluntary Top Up related to hospitalization due to non capped ailments or injuries, over and above
the base sum Insured of INR 500,000
Tele Medicine Facility to consult a general physician within 30 minutes over the call
Provides insurance coverage against the risk of death & disability during the policy
Group Personal Accident period, sustained due to an accident caused by violent, unforeseen and external
event
Group Medical Benefits
Hospitalization cover
Out Patient Department (OPD)
Voluntary Parental Cover
Voluntary Top Up
Tele Medicine
Cashless Process
Non-Cashless/Reimbursement Process
General Exclusions
GMC Contact Details

Coverage Details For Group Medical Policy

Policy Parameter
Insurer Niva Bupa Health Insurance Co. Ltd.
Insurer Niva Bupa Health Insurance Co. Ltd. (In-house Claims Team)
Policy Start Date 01-January-2023 or from date of joining (DOJ) for new joiners
Policy End Date 31-December-2023
Coverage Type Family Floater
Sum Insured INR 5,00,000
Employee Eligible Siblings of the employee Not Eligible

Spouse/ Partner Eligible Mid Term enrollment of existing
Not allowed
Children (physical or mentally abled Dependents
Eligible for 4
are covered with no age limit) Mid Term enrollment of new joiners
Allowed
Eligible* only (New employees +their Dependents)
Parents or Parents-in-Law (either set)
when opted Mid term enrollment of new
Allowed
Cross combination of Parents & In- dependents (Spouse/Children)
Not Eligible*
laws
* Only in case Parents/in laws are opted by employees under the Voluntary Parental Policy
**No Individual should be covered as dependent of more than one employee
Covers expenses related to :

Please Note :
A) The expenses are • Room and boarding (Non ICU) : 2% of Sum Insured for Normal i.e. INR
payable provided they are 10,000 per day and 3% of Sum Insured i.e. INR 15,000 per day for
incurred in Indian territory ICU/ICCU/HDU
and within the policy period • Doctors/Medical Practitioner fees
B) Expenses would be • Intensive Care Unit

admissible if the • Nursing expenses
hospitalization is more than
24 hours, unless the • Surgical fees, operating theatre, anesthesia and oxygen and their
procedure done is a part of administration
defined “Day Care” list, • Drugs and medicines consumed on the premises
which will include Dialysis,
Chemotherapy, • Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)
Radiotherapy, Eye surgery, • Costs of prosthetic devices if implanted during a surgical procedure
Lithotripsy (kidney stone
removal), Tonsillectomy, D • Radiotherapy and chemotherapy
& C done in hospital and • Infertility coverages for male/ female which would include surgeries / IVF and
the insured is discharged IUI
on the same day of the
treatment • OPD expenses (coverage details of the cover in following slides)
• Ambulance expenses in emergency cases
• Maternity expenses (coverage details of the cover in following slides)
Coverages of time bound exclusions
Pre-Existing Diseases
A pre-existing condition is any condition for which the insured has already
Definition
received medical advice or treatment prior to enrollment in the insurance policy
Coverage in Expedia Covered from Day One for all employees and their dependents
30 days waiting period

Any claim arising (except for accidental claim) with in 30 days of the policy
Definition
inception are not covered in default policy conditions
Coverage in Expedia Waiting period of 30 days is waived off for all employees and their dependents
1st/ 2nd /3rd and 4th years waiting period

Varying waiting period are applicable on non-emergency diseases / ailments /
Definition conditions like Cataract, Diabetes mellitus, Hypertension, Stone in Gall Bladder
etc. from the inception of the insurance policy
Coverage in Expedia Waiting periods are waived off for all employees and their dependents
Pre & Post Hospitalization Expenses

Pre-Hospitalization Expenses
If the Insured member is diagnosed with an Illness which results in his/her
hospitalization and for which the Insurer accepts a claim, the Insurer will also
Definition
reimburse the Insured Member’s pre-hospitalization OPD expenses for up to 30
days prior to his / her hospitalization.
Covered in Expedia Yes
Duration 30 Days
Post-Hospitalization Expenses
If the Insurer accepts a claim under hospitalization and immediately following the
Insured Member’s discharge, further medical treatment directly related to the same
Definition condition for which the Insured Member was hospitalized is required, the Insurer
will reimburse the Insured member’s post-hospitalization expenses for up to 60 day
period.
Covered in Expedia Yes
Duration 60 Days
Maternity Benefits Expedia Group - Employee Benefits Manual
Benefit Details
Up to INR 100,000 for both Normal
Maternity coverage
delivery & C-section
Waived off, i.e., Day one cover for
9 Months waiting period
maternity
Pre and Post natal INR 5,000 within maternity limit (IPD &
expenses OPD)
10% of maternity SI; Over and above
Well Baby Expenses
the maternity limit
• These benefits are admissible in case of hospitalization in India.
• Covers first two live births only. Those who already have two or
more living children will not be eligible for this benefit.
• Expenses incurred in connection with voluntary medical
termination of pregnancy during the first 12 weeks from the date of
conception are not covered
• Well baby expenses are covered up to 10% of maternity sum
Insured which is over and above Maternity Sum Insured
• Well baby expenses will include expenses for mild jaundice (which
is considered normal for baby)
• If the baby is suffering with any covered disorder (other than mild
jaundice ), the expenses for baby’s treatment shall be considered
from the family Sum Insured . This cover is available from day 1 of
baby’s birth
Infertility and the procedures to catalyst conception

Male & Female Infertility expenses
This cover will include the treatment required to treat various kind of causes of
Definition
infertility
Coverage in Expedia Covered for INR 200,000, over & above family Sum Insured of INR 500,000
Eligibility Employee or Spouse
Treatment for infertility, which will include IPD procedure to diagnose & treat the
Treatment
cause of infertility
Procedures to catalyst
The procedures like IVF, IUI ICSI etc, which catalyst conception are also covered
conception
Ambulance / Advance treatments / Domiciliary cover

Ambulance Cover
In case a patient has to be shifted from residence to hospital for admission in
Definition Emergency Ward or ICU or from one Hospital to another Hospital by fully equipped
ambulance for better medical facilities
Coverage in Expedia Covered up to INR 10,000 per hospitalization
Advance treatment
A co-payment is a cost-sharing requirement under a health insurance policy that
Definition of Co-payment in
the insured will bear a specified percentage of the admissible claim amount. A co-
advance treatments
payment does not reduce the sum insured.
Coverage in Expedia Co-payment of 50% applicable on Cyber Knife Treatment, Stem Cell
Transplantation/Robotic Surgeries/Bio-absorbable Stent/FAMETO Laser
Surgery/Toric lens/KT Laser Prostate. This cover is not available in most of
retail Insurance policies available in India market today.
Domiciliary Hospitalization
Domiciliary Hospitalization means medical treatment for an Illness/Injury which in
the normal course would require care and treatment at a Hospital but is actually
taken while confined at home under any of the following circumstances:
Definition - The condition of the patient is such that he/she is not in a condition to be removed
to a Hospital, or
- The patient takes treatment at home on account of non-availability of room in a
Hospital.
Coverage in Expedia Not Covered
Other Salient Features

Benefits / Extensions Coverage
Internal congenital disorders are covered, these are disorders by birth

Internal Congenital Cover
and not visible by naked eyes
External congenital disorders are covered up to 6 years of age. These

External Congenital Cover
are disorders by birth and are visible externally
Cataract Surgery is capped at INR 50,000. This includes both
Cataract Capping
monofocal & multifocal lens.
Psychiatric ailment coverage Covered under both hospitalization and OPD basis
Treatment of Autism is Covered under both hospitalization and OPD

Autism Coverage
basis
No deduction in case of death of No amount would be deducted till Sum Insured value in case of the
employee/dependent death of the patient during the hospitalization
Coverage continuation for dependents till the

The family will remain covered till the expiry of the policy
policy end date in case of employee’s demise
Lasik Surgery Covered for eyesight =/-7.5 or worse
Consultation and Medicine pertaining to AYUSH services are covered

AYUSH up-to 20% of Family Sum Insured within hospitals certified by AYUSH
ministry
OPD Coverage
Terms WHAT THIS WOULD COVER
• OPD would include all • OPD expenses pertaining to Doctor Consultation, Diagnostics and
Pharmacy bills (prescription based only) will be a part of the OPD
dependents covered in the limit.
base policy • Overall per family OPD limit is INR 15,000.
• Employee can submit the • Vision claims will have a sublimit of INR 5,000 per family within the
overall family OPD limit
expenses for the entire
• Additional Dental OPD limit of INR 5,000, which is over and above
quarter in one go the family limit
• The bills of previous

Inclusions / Exclusions
quarter will not be
entertained, if are not • Vision treatment will include the prescription/tests/treatment done
submitted within 15 days of for various eye disorders, which otherwise does not need
hospitalization or day care
the end of the quarter. • Cost of specs and contact lens are not covered,
• Vaccination not covered
OPD Claim Form • Prescribed physiotherapy is covered
(Required details) • Cosmetic treatment is not covered
• Consultation of Dental and Vision will fall under the Dental and
Vision sublimit.
Covid Vaccination Coverage
WHAT THIS WOULD COVER
• The covid vaccination taken for any members who are covered under the medicalim policy
• The vaccination cost can be reimbursed for an amount of INR 1,500 per dose per person
• The reimbursement process would be same as followed for OPD or IPD reimbursement
• The cover is separate and over and above the OPD sublimit
Process Flow – Soft Copy Claim Processing

• The claimant can submit soft copies (preferably scans) of all the documents in one email but the mail size should
not be more than 8 MB or if required, the employee can send the documents in parts on subsequent trail emails
• Both claims (IPD and OPD) claims can be submitted for reimbursement
• The claimant has to write below mentioned phrase in each & every document “Submitted to Niva Bupa Health
Insurance Co. Ltd.”
• The email is to be sent on B2Bclaimbcp@nivabupa.com, with a copy to expediagroup@nivabupa.com,

Kirti.Rathi@nivabupa.com; Aparna.Malhotra@marsh.com & manish.pundhir@marsh.com
• The subject of the email should be: Reimbursement claim – Expedia – Soft Copies – “Employee Code”
“Patient Member ID” & Type of Claim i.e., IPD, OPD, Maternity etc”
• In the body of the email, the claimant has to mention the employee code, name of the patient, card no. (member
ID) and below mentioned drafted consent : "I hereby declare that the benefits paid under this claim shall not
be claimed from anywhere else in any form. Further, Niva Bupa Health Insurance Company reserves the
right to ask for original claim documents for processing of claims wherever necessary.
• Niva Bupa on receipt of the documents will process the claim and shall pay the claim amount in the account for
which the claimant has provided the cheque copy
• The turn around time for claim processing is 15 working days
• If Niva Bupa would need any further clarity or any document, they will raise the query to the employee via email
• Employee in a similar way will email the query documents to the same email ids as provided above.
Voluntary Parental Cover

• Any one set of parents can be covered within the family Sum Insured of INR 500,000
• No cross selection of parents are allowed
• Premium will be deducted in January month payroll
• Nomination for voluntary parental policy is done once a year & not in between the policy period, except for new
joiners
• Pre-existing diseases are covered from Day One with no pre health check ups to be done
• Parents up to 100 years can be covered with no restrictions.
• No capping on any diseases except for cataract which is sub limited to INR 50,000
Family Sum Insured Annual Premium (Inclusive of GST)

INR 5 lacs INR 8,000
Note :
• The new joiners can declare their parents/In laws details for the voluntary plan within 30 days from their date of
joining on Destination Benefits Portal.
• The premium for new joiners would be charged on the pro rata basis
• Post the declaration window closes, no request for enrollment shall be entertained
• The premium shall be refunded (if there is no claim reported from the parents including OPD claims) on pro-rata
basis to the employee, who decides to leave Expedia in mid of the policy year. The employee shall receive the
refund as a part of full & final
• All the terms & conditions of the base Group Medical Policy would prevail
• Employee gets a tax exemption on the premium paid under section 80D
Voluntary Top Up Plan

• Healthcare costs are rapidly rising with medical inflation and prolonged
treatment cost for critical illness. In such a situation, an employee might
feel requirement of more Sum Insured for treatment
• Top up provides an additional coverage to employees over and above
the company sponsored limit
• The premium rates are lower as compared to employee purchasing an
additional retail insurance policy
ADVANTAGES
• Coverage is identical to main medical policy (Except capped ailments
like Maternity, OPD etc.)
• Employee can choose the said sum insured as per his/her needs
• The main medical plan and the top up plan can be claimed together
for the same hospitalization.
• Employee gets a tax benefit on the premium paid towards the top up
plan
Voluntary Top-Up Plan

• The sum insured options of INR 3 Lacs, 5 Lacs and 10 Lacs
• Nomination for top up policy is done once a year & not in between the policy period except for the new joiners
• Premium will be deducted in January payroll
• When the main medical plan sum insured is exhausted, only then the top up plan pays for the claim (amount over
and above it)
Annual Premium (Inclusive of GST) Annual Premium (Inclusive of GST)
Top up Sum Insured Employee, Spouse/ Partner, Children, Employee, Spouse/ Partner,
Parents (ESCP) Children (ESC)
INR 3 lacs 13,133 7,880
INR 5 lacs 19,700 11,820
INR 10 lacs 26,267 15,760
Note :
• The new joiners can declare their dependents for the voluntary program within 30 days from their date of joining.
They will have to send an email with Subject as “Top Up Enrollment – 2023 – (Employee Code)” to
Kirti.Rathi@nivabupa.com , cc: ankita.prasad@nivabupa.com with their employee code, employee name &
the Top up Sum Insured. The premium for new joiners would be charged on the pro rata basis
• The premium shall be refunded (if there is no claim reported from the family for both IPD and OPD) on pro-rata
basis to the employee, who decides to leave Expedia in mid of the policy year. The employee shall receive the
refund as a part of full & final
• Post the declaration window closes, no request for enrollment shall be entertained.
• All the coverages of the base Group Medical Policy would prevail except for maternity, OPD and capped ailments
coverage
• The Room rent limit of base policy will be applied irrespective of top up plan/Sum Insured opted.
Tele Medicine Service – Key Features
Complementary Tele-Medicine facility for Expedia Group by Niva Bupa
• Employees can consult General Physicians (GP) over the call within 30 minutes
• All kind of health-related issues can be consulted
• Extended to family members enrolled in the policy
• Please refer the next slide for the process flow

Tele Medicine Service – Process Flow
Phone consultation available with a General Physician to help

you and your family for primary health care queries
The doctor shall call you once you request for an appointment
and share prescription on e-mail in case you need medication
Step 1 : Click on :
https://nivabupaconsult.docsapp.in/#/consult
Step 2 : Enter the name as “First Name” space “Last Name”
of the patient
Step 3 : Enter the official email ID of the employee
(mandatory)
Step 4 : Select the Date of Birth of the patient from the
Calendar (mandatory)
Step 5 : Enter the mobile no. of the employee (mandatory)
Step 6 : Enter the policy no. (Optional)
Step 7 : Brief on the Symptoms (mandatory)
Step 8 : Give consent to access the medical information by
clicking on the box
Your Tele-medicine booking confirmation message will pop up

on your screen
Niva Bupa’s Doctor will initiate the call with in 30 minutes and
share prescription on email in case you need medication
Hospitalization claim process
Cashless process - Emergency
Cashless process - Planned
Reimbursement (non-cashless)
Cashless Process
Hospitals in the Cashless means the Insurer may authorize upon a claimant request
network (please refer for direct settlement of admissible hospitalization expenses between a
to the website for the
updated list) Network Hospital and the Insurer. In such case the Insurer will directly
settle eligible amount with the Network Hospital
The Insured Person may have to pay advance deposits at the

https://www.nivabupa.com
commencement of the treatment but same is adjustable or refundable
The list of the at the time of discharge
hospitals are dynamic
in nature, hence it is The amount deducted as not covered at the time of discharge will not
appropriate to check
the above mentioned be covered under OPD benefit
link
Note : Patients seeking treatment under cashless hospitalization are

eligible to make claims under pre and post hospitalization expenses.
For all such expenses the bills and other required documents needs to
submitted separately as part of the claims reimbursement.
Cashless Hospitalization- Emergency
Step 1: Get Admitted Pre-

Member gets admitted authorization Non cashless
In cases of emergency, the member in the hospital in case
should get admitted in the nearest given by the Hospitalization
of emergency by Insurer
network hospital by showing theirID showing his ID Card NO Process
card
YES
Step 2: Pre-Authorization by hospital
Relatives of admitted member should Member/Hospital Member gets treated
inform the call centre within 24 hours applies for pre- and discharged
PROCESS
about the hospitalization & seek preauthorization to the after paying all non
authorization. The preauthorization Insurer within 24 hrs of medical expenses like
letter would be directly given to the admission refreshments, etc..
hospital. In case of denial of the
request, member would be informed
directly
Step 3: Treatment & Discharge To access the

Insurer verifies Hospital sends
Network Hospital
After your hospitalization has been pre- applicability of the complete set of
authorized, the employee is not claim and issue pre- claims documents list please visit
required to pay the hospitalization bill authorization for processing to the https://www.nivabupa.
in case of a network hospital. The bill Insurer com
will be sent directly to, and settled by
the Insurer
Cashless Hospitalization- Planned
Step 1: Pre-Authorization Member intimates Claim Insurer authorizes

All non-emergency hospitalization Insurer of the planned Registered by the cashless as per
instances must be pre-authorized hospitalization in a Insurer on SLA for planned
with the Insurer, as per the specified pre- same day YES
hospitalization to the
procedure detailed below. This is authorization format
hospital
done to ensure that the best at- least 48 hours in
healthcare possible is obtained and advance
the patient/ employee NO
is not inconvenienced when
taking admission into a Follow non cashless Pre-Authorization
Network Hospital. process Completed
Member gets treated Hospital sends

Step 2: Admission, Member produces ID
and discharged after complete set of
Treatment & discharge card at the network
paying all non entitled claims documents for
After the hospitalization has hospital and gets
benefits like processing to Insurer
been pre-authorized, you need admitted
refreshments, etc..
to secure admission to the
hospital. A letter of credit will be
issued by Insurer to the Please Note: At the time of discharge when the Insurer
hospital. Kindly present your ID receives the final bill, they try to renegotiate with the Hospital
card at the Hospital admission for a better price. Hence it may take some time for
desk. The bill will be sent directly Insurer to revert back with final approval. This exercise checks
to, and settled by Insurer the hospital to overcharge you and helps keep your Claims
sum insured utilization optimized for any future Processing &
exigencies .. Please be patient Settlement by
Insurer & Insurer
Non-Cashless (Reimbursement model)
Admission procedure
• In case you choose a non-network hospital, you will have to liaise directly with the hospital for admission
• However, you are advised to check with Insurer to ensure eligibility for reimbursement of hospitalization expenses
Discharge procedure
• In case of non network hospital, you will be required to clear the bills and submit the claim for reimbursement from
the insurer. Please ensure that you collect all necessary documents such as – discharge summary, investigation
reports etc. for submitting your claim
Submission of hospitalization claim

• You must submit the final claim with all relevant documents of the pre-hospitalization and the hospitalization within
30 days from the date of discharge from the hospital
• For post-hospitalization expenses, the documents shall be submitted with in 7 days of exhaustion of post
hospitalization period of 60 days
• The soft copies of the claim documents can be shared via email, the details are mentioned in slide no. 15
• Claim form is attached
Niva Bupa-claim-form.pdf
Non-Cashless Claims Process
Member intimates Insurer Patient gets admitted as per the Employee emails the claim
Claim registered by Insurer
before or as soon as hospital norms. All payments documents max. within 30 days A
after receipt of claim intimation
hospitalization occurs made by the employee of discharge
Is document
received
Is claim Insurer performs medical scrutiny
within 30 days
payable? of the documents
Yes from
Yes discharge
•The email should contain
No No clearly the Employee ID &
patient name
Claim can be rejected
Is
Insurer checks document documentatio Claims processing done as per
Payment made to the employee
sufficiency n complete Yes SLA
as required
No
Receives mail about deficiency

A
and document requirement
Medical Benefit – General Exclusions

• Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations
• Circumcision unless necessary for treatment of disease
• HIV and AIDS
• Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.
• Venereal diseases
• Injury or disease caused directly or indirectly by nuclear weapons
• Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges,
telephone charges, etc..
• Cost of spectacles & hearing aids
• Any cosmetic or plastic surgery except for correction of injury
• Hospitalization for diagnostic tests only
• Vitamins and tonics unless used for treatment of injury or disease
• Voluntary termination of pregnancy during first 12 weeks (MTP)
• Claims (of high value) submitted without prescriptions/diagnosis
• Health foods
• Costs incurred as a part of membership/subscription to a clinic or health center
• Non-medical expenses like Hospital surcharge, telephone bills, cafeteria bills
Contact Details for claims/network hospitals/cards

Insurance Company : Niva Bupa Health Insurance Co. Ltd. (In House Insurer)
Insurance Broker : Marsh India Insurance Brokers Pvt. Ltd.
Email address for sharing the claim documents : B2Bclaimbcp@nivabupa.com, with a copy to
expediagroup@nivabupa.com, Kirti.Rathi@nivabupa.com; Aparna.Malhotra@marsh.com &
manish.pundhir@marsh.com
Please ensure your mail is within 8 MB, else you are likely to get a delivery failure message
Niva Bupa Health Insurance Co. Ltd.

Details Name Email ID Mobile No
Point of Contact - 1 Kirti Rathi Kirti.Rathi@nivabupa.com 9999760468
Escalation point - 1 Ankita Prasad Ankita.Prasad@nivabupa.com 8929901757
Escalation point - 2 Brajendra Kumar Pandey Brajendra.Pandey@nivabupa.com 8929489331
Marsh India Insurance Brokers Pvt. Ltd.

Point of Contact - 1 Aparna Malhotra Aparna.Malhotra@marsh.com 8588879047
Escalation point - 1 Manish Pundhir Manish.Pundhir@marsh.com 8377907994
Escalation point - 2 Rachit Baijal rachit.baijal@marsh.com 7290089449
Escalation point - 3 Dr. Kapil Dev Mehta Kapil.D.Mehta@marsh.com
Group Personal Accident Policy (GPA)
Coverage Details (Employee)
Benefits Extensions – Definitions
Claims Procedure
Document Checklist
General Exclusions
Contact Details
GPA Benefit Details
All employees will be provided with a Personal Accident insurance policy through Niva Bupa Health Insurance Co. Ltd.,
based on company’s benefits. This insurance provides compensation/payment up to a financial limit as assigned by the
company, to the insured person or his/her legal heirs, if the insured person suffers death or disablement due to an
accident. The cover is worldwide, but payment of claim can only be made in INR
Policy Parameter
Insurer Niva Bupa Health Insurance Co. Ltd.
Policy Start Date 1st January’2023
Policy End Date 31st December’2023
Coverage For Employees only and does not include family members
Sum Insured 3 times of annual CTC
Accidental Death Yes (100% of Sum Insured)
Permanent Total Disability Yes (100% of Sum Insured)
Permanent Partial Disability As per defined table of the policy
Temporary Total Disability Weekly Benefit - 1% of Sum Insured subject to a maximum of INR 5,000 per week for
104 weeks
Medical Extension Restricted to 10% of sum insured or 40% of claim amount or actual expenses,
whichever is less
Educational Benefits Payable up to INR 100,000 for a child or INR 200,000 maximum for 2 children below
the age of 19 or 10% of capital Sum Insured, whichever is less
Geographical Limit Worldwide
Repatriation of Remains Covered up to 1% of the Sum Insured up to INR 2,500
GPA Coverages
Permanent Total Disability
If such injury shall, as a direct consequence permanently and totally, disable the
Definition Insured person of being employed, then a lump sum equal to hundred percent
(100%) of the Capital Sum Insured is paid to such employee
Coverage in Expedia Yes (100% of Capital Sum Insured)
Permanent Partial Disability

Permanent partial disability is a disability in which the insured person is prevented
Definition permanently from working at full physical capability because of partial loss of use
of the body i.e., loss of one finger, eyesight loss of one eye etc.
Coverage in Expedia Yes, as per Table defined in the policy
Temporary Total Disability

Temporary Total Disability is an injury which leads to total disability but is
Definition temporary in nature. For eg. Fracture of a limb which prevents the insured person
to perform regular duties or activities for a defined period of time
Yes, Weekly Benefit- 1% of Sum Insured subject to a maximum of INR 5,000 per
Coverage in Expedia
week for 104 weeks
Coverages
Medical Extension
Any expenses incurred by the insured on OPD basis towards the medical
Definition
expenses following an accident
Restricted to 10% of sum insured or 40% of claim amount or actual expenses,
Covered
whichever is less
Education Benefits
In the event of death or permanent total disability of the employee due to an
Definition accident, the group personal accident insurer will provide an education
compensation fund for a maximum of two dependent children.
Covered Payable up to INR 100,000 for a child or INR 200,000 maximum for 2 children
below the age of 19 or 10% of capital Sum Insured, whichever is less
GPA Claims Process
Claimant / Nominee notifies HR, who in

turn would intimate Insurer and submit Yes
required claim documents within 30 The claim payment is done to the
Is claim
Days of the event employee or nominee (in case of
payable?
accidental death)
On obtaining all relevant documents,

Insurance Co. will begin processing No
of the claim
Insurer provides a valid reason for the

rejection to HR and/or Claimant
Claim Investigation and review of

submission of all the required
documents
Group Personal Accident – Claims Document Checklist
Weekly Benefit Claims Death Claims Dismemberment/ Disablement Claims
1. Completed Claim form 1. Completed claim form 1. Completed claim form

2. Doctor's Report 2. Attending Doctor's report 2. Doctor's Report
3. Disability Certificate from the 3. Death Certificate 3. Disability Certificate from the
Doctor, if any 4. Post-Mortem/ Coroner's report Doctor
4. Investigation/ Lab reports (x-ray 5. FIR ( First Information Report) 4. Investigation/ Lab reports (x-ray
etc.) 6. Police Inquest report, wherever etc.)
5. Original Admission/discharge applicable 5. Original Admission/ discharge
card, if hospitalized card, if hospitalized.
6. Employers Leave Certificate & 6. Police Inquest report, wherever
Details of salary applicable
GPA Claim Form

GPA General Exclusions
• Service on duty with any armed force

• Insanity
• Venereal disease
• AIDS
• Influence of intoxicating drink or drugs
• Aviation other than as a passenger (fare paying or otherwise) in any duly licensed standard type of
aircraft any where in the world
• Nuclear radiation or nuclear weapons material
• Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared or
not), civil war, rebellion, revolution, insurrection, mutiny, military, or usurped power, seizure,
capture, arrest, restraint, detainments of all kings, princes, and people of whatever nation,
conditions and qualities so ever
• Childbirth, pregnancy or other physical causes peculiar to the female sex
• While committing any breach of law with criminal intent
Contact Details for claims intimation under the GPA Policy
Insurance company : Niva Bupa Health Insurance Co. Ltd

Insurance Broker : Marsh India Insurance Brokers Pvt. Ltd.
Niva Bupa Health Insurance Co. Ltd.

Point of Contact - 1 Kirti Rathi Kirti.Rathi@nivabupa.com 9999760468
Escalation point - 1 Ankita Prasad Ankita.Prasad@nivabupa.com 8929901757
Escalation point - 2 Brajendra Kumar Pandey Brajendra.Pandey@nivabupa.com 8929489331
Marsh India Insurance Brokers Pvt. Ltd.

Point of Contact - 1 Aparna Malhotra Aparna.Malhotra@marsh.com 8588879047
Escalation point - 1 Manish Pundhir Manish.Pundhir@marsh.com 8377907994
Escalation point - 2 Rachit Baijal rachit.baijal@marsh.com 7290089449
Escalation point - 3 Dr. Kapil Dev Mehta Kapil.D.Mehta@marsh.com

Employee Insured Benefits Manual - 2023

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Employee Insured Benefits Manual - 2023

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Expedia Group - Employee Benefits Manual

Expedia Group – Insurance Benefits Manual - 2023

Brief introduction – Employee Benefits Insurance

Group Medical Benefits

Out Patient Department (OPD)

Voluntary Parental Cover

GMC Contact Details

Coverage Details For Group Medical Policy

Employee Eligible Siblings of the employee Not Eligible

Covers expenses related to :

B) Expenses would be • Intensive Care Unit

Coverages of time bound exclusions

30 days waiting period

1st/ 2nd /3rd and 4th years waiting period

Pre & Post Hospitalization Expenses

• These benefits are admissible in case of hospitalization in India.

Infertility and the procedures to catalyst conception

Eligibility Employee or Spouse

Ambulance / Advance treatments / Domiciliary cover

Other Salient Features

Internal congenital disorders are covered, these are disorders by birth

External congenital disorders are covered up to 6 years of age. These

Treatment of Autism is Covered under both hospitalization and OPD

Coverage continuation for dependents till the

Lasik Surgery Covered for eyesight =/-7.5 or worse

Consultation and Medicine pertaining to AYUSH services are covered

Terms WHAT THIS WOULD COVER

• The bills of previous

WHAT THIS WOULD COVER

Process Flow – Soft Copy Claim Processing

• The email is to be sent on B2Bclaimbcp@nivabupa.com, with a copy to expediagroup@nivabupa.com,

• The turn around time for claim processing is 15 working days

Voluntary Parental Cover

Family Sum Insured Annual Premium (Inclusive of GST)

Voluntary Top Up Plan

Voluntary Top-Up Plan

Tele Medicine Service – Key Features

Complementary Tele-Medicine facility for Expedia Group by Niva Bupa

• All kind of health-related issues can be consulted

• Extended to family members enrolled in the policy

• Please refer the next slide for the process flow

Tele Medicine Service – Process Flow

Phone consultation available with a General Physician to help

Your Tele-medicine booking confirmation message will pop up

Hospitalization claim process

Cashless process - Emergency

Cashless process - Planned

The Insured Person may have to pay advance deposits at the

Note : Patients seeking treatment under cashless hospitalization are

Cashless Hospitalization- Emergency

Step 1: Get Admitted Pre-

Step 3: Treatment & Discharge To access the

Cashless Hospitalization- Planned

Step 1: Pre-Authorization Member intimates Claim Insurer authorizes

Member gets treated Hospital sends

Non-Cashless (Reimbursement model)

Submission of hospitalization claim

Non-Cashless Claims Process

Claim can be rejected

Receives mail about deficiency

Medical Benefit – General Exclusions

Contact Details for claims/network hospitals/cards

Niva Bupa Health Insurance Co. Ltd.

Marsh India Insurance Brokers Pvt. Ltd.