ASL Employees Benefits Manual - 2022-23

Aurionpro
Employee Benefits Manual
EMPLOYEE BENEFITS MANUAL

Aurionpro
Disclaimer:
This manual is intended to be general summary of the benefits provided by Aurionpro solutions Ltd & 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.
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.
Aurionpro
Provides insurance coverage to employees for expenses related to hospitalization

Group Medical due to illness, disease or injury
Provides insurance coverage against the risk of death / injury during the policy
Group Personal Accident period sustained due to an accident caused by violent, visible and external means
FAQs & Common Definitions Frequently Asked Questions & Annexure

Aurionpro
Medical Benefits
Coverage Details (Employee)
Cashless Process
Non-Cashless
Claims Process
Claims Document List
Benefits Extensions – Definitions
General Exclusions
GMC Contact Details
Prudent Utilization of Benefit

Aurionpro
Coverage Details For Employee Policy

Policy Parameter
Insurer The New India Assurance Company Limited
TPA Health India TPA Services Pvt. Ltd.
Policy Start Date 31/3/2022
Policy End Date 30/3/2023
Coverage Type Group Mediclaim
Sum Insured INR 3,00,000
Maximum no of Members insured in a 1+3 Siblings No

family
Employee Yes Others No
Spouse Yes Mid Term enrollment of existing Dependents Disallowed

Children (up 25 year & Maximum of first Yes Mid Term enrollment of new joiners (New
2 children only employees +their Dependents) Allowed
Parents No
Mid term enrollment of new dependents
Parents-in-Law No (Spouse/Children) Allowed
*No Individual should be covered as dependent of more than one employee

Aurionpro

Benefits / Extensions Coverage Benefits / Extensions Coverage
Standard Hospitalization Yes

Domiciliary
Not Covered
Hospitalization
TPA services Yes Pre-Post
30 days and 60 days
Hospitalization Exp.
Pre-existing diseases Yes
Pre and Post Natal INR 5,000 within the maternity limit
Waiver on 1st year exclusion Yes
1% of Sum Insured for Normal
Waiver on 1st 30 days excl. Yes and 2% of Sum Insured for ICU room
changes respectively also Associate
Room Rent Capping
Normal- 40K & C-Sec cost linked to room rent , In case of
Maternity benefits
–50K Covid room rent for ICU on actual
basis
Baby cover day 1 Yes
Copay
INR 5000 (Emergency Not Applicable
Ambulance Services
only)
Policy Period
New Dependents (due to Marriage /
Existing Employees + Dependents New joiners + Dependents Birth)
Commencement Commencement Commencement
31st March ’2022 Date of joining Date of such event
Date Date Date
Termination Date 30th March ’2023 Last date of Within 15 days of

Termination Date Declaration
employment Event
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Benefits contd..
Benefits / Extensions Coverage
Internal Congenital Disease Covered
Day Care procedures Covered as per standard Insurance list
Terrorism Related Hospitalization Covered
Expenses Incurred for treatmnet of Disease/Illness/Accidental

Ayurvedic Treatment as in-patient in government Injuries by sysytemof medicines other than Allophatic shall be
recognized hospitals restricted to 25% of the sum insured subject to maximum of Rs.
25000/- for entire policy period.
Ailment wise Capping No capping
Oral Chemotherapy/Adjuvent
Chemotherapy/Hormonal Covered
Chemotherapy/Biological Theraphy
OPD OPD Covered - Only accidental Fracture cases
Domiciliary Hospitalization
Not Covered
Aurionpro
Benefits contd..
Benefits / Extensions Coverage
No Deduction in case of death of employee only up to Sum Insured
Covered, only in case death of employee to be continue till end
Continuous coverage for dependent
of policy period
1. Infertility Treatment
We will pay the Reasonable and Customary Charges for Medical
Expenses incurred in respect of the Insured person, towards
infertility related diagnostic services to determine the cause of
infertility, treatment and procedures for the primary pregnancy only.
This cover is over and above maternity limit under the policy. Incase
both maternity and Infertility claim fall under the same policy period,
both the claims will be paid as per limits specified.
We will be liable to pay for the Medical Expenses incurred in relation
to the following:
a. Fertility hormones,
b. Artificial insemination,
Infertility - INR 50,000 for infertility Treatment for
c. Surgery,
Employee & their spouse (including procedure &
d. Other therapeutic procedures,
procedure related OPD)
e. Any ovulation induction induced via certain oral or injectable
infertility medication
f. Assisted reproductive technology (ART) and In Vitro Fertilisation
(IVF)
We will not be liable to make any payment in respect of the
following:
i. Infertility services beyond 8 weeks of pregnancy;
ii. Infertility services for persons who have undergone voluntary
sterilisation procedures; and
iii. Infertility services for women with natural menopause at the Age
of 40 years and above.
Aurionpro
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 Expenses for up to 30 days prior
to his / her Hospitalization.
Covered • 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-hospitalisation Expenses for up to 60 day
period.
Covered • Yes
*Any One Illness: A claim is considered as a single illness if it has a continuous period of illness or results in a relapse
within 45 days of the earlier treatment.
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Maternity Benefits
Benefit Details
Benefit Amount • INR 40,000 For Normal & INR 50,000 C-
section
Restriction on no of children • Maximum of 2 children
9 Months waiting period • Waived off
Pre and Post Natal • INR 5,000 within maternity limit
• These benefits are admissible in case of hospitalization in India.

• Covers first two children 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 20 weeks from the date
of conception are not covered.
Aurionpro
Enrolment
Enrolment Mid-term inclusions
- Employee has to enrol their dependent’s for Mediclaim ▪ Family details of New joinee to be shared with Marsh Team via
policy on Benefitme Portal defined process in the portal
- You can download e-cards from BenefitMe portal ▪ Employee marriage – spouse should be enrolled within 30 day
- In case of any discrepancy or any missing family member of Marriage
please send an email to subhash.kale@marsh.com
▪ New born baby – New Born Baby should be enrolled within 30
days of the birth(E.g. Baby of (<<EmployeeName>>)
This e-card is not transferable. Each insured life will be issued ▪ Adoption of a child - Child should be enrolled within 30 days
an e-card. This card is a form of identification only. from date of adoption
Things to remember
▪ Please declare your family members within the
stipulated time frame to HR team.
▪ Failing to do so will lead to the family member being
uninsured until the next renewal i.e. in March 2023..
▪ Any claim towards the un-insured family member will not be
registered for the current policyperiod.
Aurionpro
Cashless Process
Hospitals in the Cashless means the Administrator may authorize upon a Policyholder’s request
network (please for direct settlement of eligible services and it’s according charges between a
refer to the Network Hospital and the Administrator. In such case the Administrator will
website for the directly settle all eligible amounts with the Network Hospital and the Insured
updated list) Person may not have to pay any deposits at the commencement of the treatment
or bills after the end of treatment to the extent as these services are covered
For Updated List visit to under the Policy.
TPA link as below:

Note : Patients seeking treatment under cashless hospitalization are eligible to
https://healthindiatpa.com make claims under pre and post hospitalization expenses. For all such expenses
/Hospital_Search.aspx the bills and other required documents needs to submitted separately as part of
the claims reimbursement.
Aurionpro
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 Administrator
network hospital by showing theirID showing his ID Card NO Process
card. Um vis. Opiorus ses, nocaet
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 pre authorization to the after paying all non
authorization. The preauthorization Administrator within 24 medical expenses like
letter would be directly given to the hrs of admission refreshments, etc..
hospital. In case of denial member
would be informed directly
Step 3: Treatment & Discharge Administrator verifies Hospital sends

To Access the
After your hospitalization has been pre- applicability of the complete set of
claim to be registered claims documents https://healthindiatpa.
authorized the employee is not required
to pay the hospitalization bill in case of and issue pre- for processing to the com/Hospital_Search.
a network hospital. The bill will be sent authorization Administrator aspx
directly to, and settled by Administrator
Aurionpro
Cashless Hospitalization- Planned
Step 1: Pre-Authorization Member intimates Claim Administrator

All non-emergency hospitalization Administrator of the Registered by the authorizes cashless
instances must be pre-authorized planned Administrator on as per SLA for
with the Administrator , as per the hospitalization in a same day YE
planned
procedure detailed below. This is authorization
specifiedpre-
format S
hospitalization to the
done to ensure that the best at- least 48 hours in
hospital
healthcare possible, is obtained, advance
and the patient/employee NO
is not inconvenienced when
taking admission into a Follow non cashless Pre-Authorization
Network Hospital. process Completed
Step 2: Admission, Member gets treated and Hospital sends

Treatment & discharge Member produces ID
discharged after paying complete set of
card at the network
After your hospitalization has all non entitled benefits claims documents for
hospital and gets
been pre-authorized, you need like refreshments, etc.. processing to
admitted
to secure Administrator
admission to a hospital. A letter of
credit will be issued by Administrator
Please Note: At the time of discharge when the
to the hospital. Kindly present your
Administrator receives the final bill, they try to renegotiate with
ID card
the Hospital for a better price. Hence it may take some
at the Hospital admission desk. The
time for Administrator to revert back with final approval. This
employee is not required to pay the
exercise checks the hospital to overcharge you and Claims
hospitalization bill in case of a
helps keep your sum insured utilization optimized for Processing &
network hospital. The bill will be
any future exigencies .. Please be patient Settlement by
sent directly to, and settled by
Administrator Administrator &
Insurer
Aurionpro
Non-Cashless
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 follow the pre-authorization procedure to ensure eligibility for reimbursement of
hospitalization expenses from the insurer.
Discharge procedure
• In case of non network hospital, you will be required to clear the bills and submit the claim to TPA 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 within 15 days from the date of discharge from
the hospital.
Aurionpro
Non-Cashless Claims Process
Member intimates TPA before Insured admitted as per hospital Insured Submits relevant
Claim registered by TPA after
or as soon as hospitalization norms. All payments made by documents the Help desk A
receipt of claim intimation
occurs member within 30 days of discharge
Is document
received
Is claim TPA performs medical scrutiny of •Insured will create the
within 30 days
payable? the documents summary of Bills (2 copies)
Yes from
Yes discharge and attach it with the
original bills
No No
•The envelope should
contain clearly the
Employee ID & Employee e-
Claim Rejected
mail
Is Payment to be Employee at the

TPA checks document documentatio Claims processing done as per help desk. The discharge
sufficiency n complete Yes SLA voucher and copy of payment
as required receipt to be sent to HR.
No
Receives mail about deficiency

A
and document requirement
Aurionpro

 Completed Claim form with Signature
 Hospital bills in original (with bill no; signed and stamped by the hospital)
with all charges itemized and the original receipts
Claims Form
 Discharge Report/Certificate/card (original)
 Attending doctors’ bills and receipts and certificate regarding diagnosis (if
separate from hospital bill)
 Original reports or attested copies of Bills and Receipts for Medicines,
Investigations along with Doctors prescription in Original and Laboratory
 Follow-up advice or letter for line of treatment after discharge from hospital,
from Doctor.
 Provide Break up details including Pharmacy items, Materials, Investigations
even though it is there in the main bill
 In case the hospital is not registered, please get a letter on the Hospital
letterhead mentioning the number of beds and availability of doctors and
nurses round the clock.
 In non- network hospital, you may have to get the hospital and doctor’s
registration number in Hospital letterhead and get the same signed and
stamped by the hospital, if required.
*Please retain photocopies of all documents submitted

FAQ.. Aurionpro
Is 24 hour Hospitalization mandatory for filing a claim in the Mediclaim Policy?
Yes, Only Expenses on Hospitalization for minimum period of 24 hours are admissible. However this time limit will not apply for
specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye surgery (Cataract only) Lithotripsy (kidney stone removal),
Tonsillectomy taken in the Hospital/Nursing home and the insured is discharged on the same day of the treatment will be
considered to be taken under HospitalizationBenefit.
What is Medical Insurance?

Medical Insurance is a purely hospitalization policy which provides coverage to you as an employee and also covers your family
(spouse, dependent children and parents) towards treatment in case of a medical emergency, as per policy terms and conditions
Are there any special criteria for seeking admission/ treatment in the hospitals/ nursing homes? HOSPITAL / NURSING
HOME means any institution in India established for indoor care and treatment of sickness and injuries and which (a) has been
registered as a Hospital or Nursing Home with the local authorities and is under the supervision of a registered and qualified
Medical PractitionerAND
(b) Should comply with following criteria's:-
i) It should have at least 15 inpatient beds.
ii) Fully equipped operation theatre of its own wherever surgical operations are carried out.
iii) Fully qualified Nursing Staff under its employment round the clock.
iv) Fully qualified Doctor (s) should be in-charge round the clock.
v) Maintains a daily records of each patients
N.B: In class 'C' towns condition of number of beds be reduced to 10.
Further, it necessarily should not be blacklisted with the insurance company

FAQ.. Aurionpro
What is family floater?
Under the family floater, the insurance cover will be available to all members of the family unit. The sum insured is available for
utilization by any member of the family. It is however subject to the overall family sum insured for all members put together.
Will my stay be covered under Mediclaim, if I have been admitted under doctors instructions but there has been no
proper line of treatment?
No. Hospitalization not accompanied with active line of treatment is not covered under Mediclaim Insurance
Does pre-existing disease cover mean that all diseases and medical procedures are covered?
Pre-existing disease benefit helps the member get a complete coverage for all medical emergencies, including ailments that
may have been there before the start of this policy.
Is there any limit for reimbursement of expenses incurred in a laboratory or a diagnostic center as part of hospitalization?
No. If the expenses form part of the hospitalization process and if the amount is approved and payable as per the terms and conditions
of the policy, then they are reimbursable up to the sum insured amount.
Are homeopathic, Unani expenses covered?
homeopathic, Unani expenses are not covered under this policy.
Are all pregnancy related expenses covered?
Voluntary medical termination of pregnancy is not covered under Mediclaim. Only cases of abortions where mother’s life is under
threat and doctor has advised an abortion during first 20 weeks from the date of conception is covered in the mediclaim policy.
What happens if my family status changes during the policy?

If the family status changes (by reason of marriage or birth), the employee needs to enroll the details of the
new dependent within 30 days from date of marriage or date of birth, as applicable.
Are congenital diseases covered under the policy

Only in case of life threatening.
FAQ.. Aurionpro
Will location of dependent family members matter?
No. Further, as the policy provides the coverage for treatment taken within India, employee and dependent family member can
avail benefit as per policy terms and conditions, at any approved/registered hospital in India.
What happens if me and my spouse are working in the same organization?

An individual can be covered in the policy only once. In such a case, you are advised not to declare each other under the
definition of family, and may cover your children, if any, only once under any of the two families.
Is the baby covered from Day 1?

On Delivery of a child, the child is prone to many health disorders like jaundice or expenses incurred for incubator for pre-
mature births or any other complication to the child. Please note that for such complications, the baby will be covered from
DAY 1 in the overall family floater Sum Insured (Vaccination charges, are not payable. Pediatric charges & observation
charges are not payable if there is no active line of treatment). If you Face any difficulty in enrolment of your spouse or
children you may write to (subhash.kale@marsh.com)
The information on my e card is incorrect. What should I do now?

Please write to HR Team. Your HR team will connect with Marsh team to get the necessary corrections done in the
insurance database and issue a new e-card for you.
Can I file more than one claim in a year?

You can claim as many times you are hospitalized during the period of Insurance but the insurance company's liability in
respect of all claims put together shall not exceed the Sum Insured.
What if I undergo major hospitalization in 2 different hospitals? Will the policy reimburse expenses incurred?
Yes. The expenses are reimbursed up to the limit of sum insured and if they satisfy the terms and conditions of the
policy and proper documents required for both the hospitalization (Discharge Summary from both the hospital is must)
Post my marriage, my surname has been changed; however, my e-card has my maiden name written on it. How do I
get the name changed on my e card?
Please write to (subhash.kale@marsh.com) marsh will check with HR and get necessary corrections done in the insurance
database and issue a new e-card for you.
Aurionpro
Contact Details
TPA :Health India TPA Services Pvt. Ltd .
Address :406-412, 4th Floor, Neelkanth corporate park, Kirol village road, Vidya Vihar Society,
Vidya Vihar West, Mumbai – 400086.
Level- 1 Level- 2
Mr. Vinod Padyar Ms. Prashant More
+91 - 9136903287 +91 – 9870366121
Vinod.padyar@healthindiatpa.com prashant.more@healthindiatpa.com
Insurance Broker : Marsh India Insurance Broker
Escalation- 1 Escalation- 2
Mr. Milind Gurav Name Mr. Shashikant Dingankar
+91- 9833806373 Contact No +91 - 9833806360
Milind.Gurav@marsh.com Shashikant.Dingankar@marsh.com
Aurionpro
Contact Details
Aurionpro Solutions Ltd
Level- 1 Level- 2
Mr. Manish Sawant / Ms. Deepti Londhe Mr. Rahul Kamble – Manager –HR
manish.sawant@aurionpro.com / rahul.kamble@aurionpro.com
deepti.londhe@aurionpro.com
Mobile: +91- 9594441623
Mobile: +91- 9594441610 / +91- 9221958896
Aurionpro
VOLUNTARY PARENTS EMPLOYEE

BENEFITS MANUAL
Aurionpro
Disclaimer:
This manual is intended to be general summary of the benefits provided by Aurionpro solutions Ltd & 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.
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.
Aurionpro
Provides insurance coverage to parents for expenses related to hospitalization

Voluntary Parental Policy due to illness, disease or injury
Aurionpro
Medical Benefits
Coverage Details
Cashless Process
Non-Cashless
Claims Process
General Exclusions
GMC Contact Details
Prudent Utilization of Benefit

Aurionpro

Policy Parameter
Insurer The New India Assurance Company Limited

TPA Health India TPA Services Pvt. Ltd.
Coverage Type Voluntary parents policy
Sum Insured INR 2,00,000 , INR 3,00,000 , INR 5,00,000
Sum Insured (In INR) 200,000 300,000 500,000
Premium (Excl. GST) 17,000/- 21,022/- 25,968/-

Maximum no of Members insured in a 2 Siblings No
family
Employee No Others No
Spouse No Mid Term enrollment of existing Dependents Disallowed

Children (up 25 year & Maximum of first No Mid Term enrollment of new joiners (New
2 children only employees +their Dependents) Allowed
Parents Yes
Mid term enrollment of new dependents
(Spouse/Children) NA
Parents-in-Law Yes
Note:
 Voluntary parent policy premium will be deducted within next 8 months from salary or within policy period, whichever is earlier.
 Voluntary Parental Policy has Lock-In and Lock-Out period for 2 years. (i.e. Once employee has opted in for V Parental policy they cannot opt out till next
two years of continuous policy, similarly, if employee has opt out they cannot opt in again for two years for re-enrolment of parents)
 Tax rebate for insurance premium paid towards dependent parents under section 80D of ITA
 No Individual should be covered as dependent of more than one employee
Aurionpro

Benefits / Extensions Coverage Benefits / Extensions Coverage
Standard Hospitalization Yes

Domiciliary
Not Covered
Hospitalization
TPA services Yes Pre-Post
30 days and 60 days
Hospitalization Exp.
Pre-existing diseases Yes
Pre and Post Natal NA
Waiver on 1st year exclusion Yes
1% of Sum Insured for Normal
Waiver on 1st 30 days excl. Yes and 2% of Sum Insured for ICU room
Room Rent Capping
changes respectively also Associate
Maternity benefits NA cost linked to room rent
Baby cover day 1 NA Copay

15% on each claim
Ambulance Services NA
Policy Period
New Dependents (due to Marriage /
Existing Employees + Dependents New joiners + Dependents Birth)
Commencement Commencement Commencement
04st June ’2022 Date of joining NA
Date Date Date
Termination Date 03rd June ’2023 Last date of

Termination Date Declaration NA
employment
Aurionpro
Ailment/Disease wise capping

Appendix 40,000
Eye related Per Eye 30,000
Gall Bladder 30,000
Hernia 40,000
Hydrocele 25,000
Hysterectomy 40,000
Piles 35,000
Kidney Stone 45,000
Liability for Nasal Sinus Surgeries 30,000

Aurionpro
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 Expenses for up to 30 days prior
to his / her Hospitalization.
Covered • Yes
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-hospitalisation Expenses for up to 60 day
period.
Covered • Yes
*Any One Illness: A claim is considered as a single illness if it has a continuous period of illness or results in a relapse
within 45 days of the earlier treatment.
Aurionpro
Cashless Process
Hospitals in the Cashless means the Administrator may authorize upon a Policyholder’s request
network (please for direct settlement of eligible services and it’s according charges between a
refer to the Network Hospital and the Administrator. In such case the Administrator will
website for the directly settle all eligible amounts with the Network Hospital and the Insured
updated list) Person may not have to pay any deposits at the commencement of the treatment
or bills after the end of treatment to the extent as these services are covered
For Updated List visit to under the Policy.
TPA link as below:

Note : Patients seeking treatment under cashless hospitalization are eligible to
https://healthindiatpa.com make claims under pre and post hospitalization expenses. For all such expenses
/Hospital_Search.aspx the bills and other required documents needs to submitted separately as part of
the claims reimbursement.
Aurionpro
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 Administrator
network hospital by showing theirID showing his ID Card NO Process
card. Um vis. Opiorus ses, nocaet
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 pre authorization to the after paying all non
authorization. The preauthorization Administrator within 24 medical expenses like
letter would be directly given to the hrs of admission refreshments, etc..
hospital. In case of denial member
would be informed directly
Step 3: Treatment & Discharge Administrator verifies Hospital sends

To Access the
After your hospitalization has been pre- applicability of the complete set of
claim to be registered claims documents https://healthindiatpa.
authorized the employee is not required
to pay the hospitalization bill in case of and issue pre- for processing to the com/Hospital_Search.
a network hospital. The bill will be sent authorization Administrator aspx
directly to, and settled by Administrator
Aurionpro
Cashless Hospitalization- Planned
Step 1: Pre-Authorization Member intimates Claim Administrator

All non-emergency hospitalization Administrator of the Registered by the authorizes cashless
instances must be pre-authorized planned Administrator on as per SLA for
with the Administrator , as per the hospitalization in a same day YE
planned
procedure detailed below. This is authorization
specifiedpre-
format S
hospitalization to the
done to ensure that the best at- least 48 hours in
hospital
healthcare possible, is obtained, advance
and the patient/employee NO
is not inconvenienced when
taking admission into a Follow non cashless Pre-Authorization
Network Hospital. process Completed
Step 2: Admission, Member gets treated and Hospital sends

Treatment & discharge Member produces ID
discharged after paying complete set of
card at the network
After your hospitalization has all non entitled benefits claims documents for
hospital and gets
been pre-authorized, you need like refreshments, etc.. processing to
admitted
to secure Administrator
admission to a hospital. A letter of
credit will be issued by Administrator
Please Note: At the time of discharge when the
to the hospital. Kindly present your
Administrator receives the final bill, they try to renegotiate with
ID card
the Hospital for a better price. Hence it may take some
at the Hospital admission desk. The
time for Administrator to revert back with final approval. This
employee is not required to pay the
exercise checks the hospital to overcharge you and Claims
hospitalization bill in case of a
helps keep your sum insured utilization optimized for Processing &
network hospital. The bill will be
any future exigencies .. Please be patient Settlement by
sent directly to, and settled by
Administrator Administrator &
Insurer
Aurionpro
Non-Cashless
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 follow the pre-authorization procedure to ensure eligibility for reimbursement of
hospitalization expenses from the insurer.
Discharge procedure
• In case of non network hospital, you will be required to clear the bills and submit the claim to TPA 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 within 15 days from the date of discharge from
the hospital.
Aurionpro
Non-Cashless Claims Process
Member intimates TPA before Insured admitted as per hospital Insured Submits relevant
Claim registered by TPA after
or as soon as hospitalization norms. All payments made by documents the Help desk A
receipt of claim intimation
occurs member within 30 days of discharge
Is document
received
Is claim TPA performs medical scrutiny of •Insured will create the
within 30 days
payable? the documents summary of Bills (2 copies)
Yes from
Yes discharge and attach it with the
original bills
No No
•The envelope should
contain clearly the
Employee ID & Employee e-
Claim Rejected
mail
Is Payment to be Employee at the

TPA checks document documentatio Claims processing done as per help desk. The discharge
sufficiency n complete Yes SLA voucher and copy of payment
as required receipt to be sent to HR.
No
Receives mail about deficiency

A
and document requirement
Aurionpro

 Completed Claim form with Signature
 Hospital bills in original (with bill no; signed and stamped by the hospital)
with all charges itemized and the original receipts
Claims Form
 Discharge Report/Certificate/card (original)
 Attending doctors’ bills and receipts and certificate regarding diagnosis (if
separate from hospital bill)
 Original reports or attested copies of Bills and Receipts for Medicines,
Investigations along with Doctors prescription in Original and Laboratory
 Follow-up advice or letter for line of treatment after discharge from hospital,
from Doctor.
 Provide Break up details including Pharmacy items, Materials, Investigations
even though it is there in the main bill
 In case the hospital is not registered, please get a letter on the Hospital
letterhead mentioning the number of beds and availability of doctors and
nurses round the clock.
 In non- network hospital, you may have to get the hospital and doctor’s
registration number in Hospital letterhead and get the same signed and
stamped by the hospital, if required.
*Please retain photocopies of all documents submitted

Aurionpro
Contact Details
TPA :Health India TPA Services Pvt. Ltd .
Address :406-412, 4th Floor, Neelkanth corporate park, Kirol village road, Vidya Vihar Society,
Vidya Vihar West, Mumbai – 400086.
Level- 1 Level- 2
Mr. Vinod Padyar Ms. Prashant More
+91 - 9136903287 +91 – 9870366121
Vinod.padyar@healthindiatpa.com prashant.more@healthindiatpa.com
Insurance Broker : Marsh India Insurance Broker
Escalation- 1 Escalation- 2
Mr. Milind Gurav Mr. Shashikant Dingankar
+91- 9833806373 Contact No +91 - 9833806360
Milind.Gurav@marsh.com Shashikant.Dingankar@marsh.com
Aurionpro
Contact Details
Aurionpro Solutions Ltd
Level- 1 Level- 2
Mr. Manish Sawant / Ms. Deepti Londhe Mr. Rahul Kamble – Manager –HR
manish.sawant@aurionpro.com / rahul.kamble@aurionpro.com
deepti.londhe@aurionpro.com
Mobile: +91- 9594441623
Mobile: +91- 9594441610 / +91- 9221958896
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FAQ’s & Common Definitions
Documents and links
FAQ’s
Annexure
IRDA (Insurance Regulatory

http://www.irdaindia.org/
and Development Authority)
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Group Personal Accident Policy
Coverage Details (Employee)
Claims Procedure
Document Checklist
General Exclusions
Contact Details
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GPA Benefit Details

All employees will be provided with a Personal Accident insurance policy through- New India Assurance Co. Ltd, based on company
rules (you may contact your HR for further details). This insurance provides compensation/payment up to a financial limit as
assigned by the company, to the insured person or his legal personal representative, 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 India and in Indian Rupees.
Policy Parameter
Insurer HDFC Ergo General Insurance Company
Coverage Group PERSONAL ACCIDENT
Sum Insured Grade Basis
Accidental Death Covered
Permanent Total Disability Covered
Permanent Partial Disability Covered
Temporary Total Disability Disability covered up to limit of 1% of Sum Insured subject or INR 5,000 whichever is lower, on
weekly basis for 104 weeks1% of the Accidental Death Sum Insured or Rs. 10,000 for
Employees in Grade II
Medical Extension covered up10% of the Accidental Death Sum Insured
Terrorism Covered
Geographical Limit World Wide
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Benefit Extensions
• This policy covers the following benefits-
• Accidental Death
• Permanent Total Disability (PTD)
• Permanent Partial Disability (PPD)
• Temporary Total Disability (TTD)- up to 104 weeks. 1% of Sum Insured subject to maximum of INR 5000
per week, which ever is lower in Grade I & 1% of the Accidental Death Sum Insured or Rs.10,000 for
Employees in Grade II
• Medical Extension- 10% of SI or 40% of admissible claim or actuals, whichever is less
• Coverage operates worldwide on 24 hours basis.
• Terrorism cover.
• Education benefit @ 10% of SI or INR 20,000 which ever is lower
• Last Rites Costs – Accident Only 2% of AD SI or Up to Rs.5000/- Whichever is less
• Mobility Extension 10% of the SI subject to maximum of Rs. 20,000/-
Aurionpro
GPA Claims Process
Claimant / Nominee notifies HR, who in

turn would intimate Insurer and submit
required claim documents within 30 Is claim Yes Cheque is sent to Employer (HR), from
Days of the event payable? where it is given to the Claimant/ Assignee
On obtaining all relevant documents,

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

rejection to HR (death) no death
(Claimant)
Claim Investigation and Review of

submission of all the required
documents
Aurionpro
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

Aurionpro
Contact Details - GPA Claims

ESCALATION 1
Name Mr. Milind Gurav

Contact No +91- 9833806373
Email ID Milind.Gurav@marsh.com
ESCALATION 2
Name Mr. Shashikant Dingankar

Contact No +91 - 9833806360
Email ID Shashikant.Dingankar@marsh.com
Aurionpro
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Employee Benefits Manual

EMPLOYEE BENEFITS MANUAL

Provides insurance coverage to employees for expenses related to hospitalization

FAQs & Common Definitions Frequently Asked Questions & Annexure

Claims Document List

Benefits Extensions – Definitions

GMC Contact Details

Prudent Utilization of Benefit

Coverage Details For Employee Policy

Coverage Type Group Mediclaim

Sum Insured INR 3,00,000

Maximum no of Members insured in a 1+3 Siblings No

Spouse Yes Mid Term enrollment of existing Dependents Disallowed

*No Individual should be covered as dependent of more than one employee

Coverage Details For Employee Policy

Standard Hospitalization Yes

Termination Date 30th March ’2023 Last date of Within 15 days of

Day Care procedures Covered as per standard Insurance list

Terrorism Related Hospitalization Covered

Expenses Incurred for treatmnet of Disease/Illness/Accidental

Ailment wise Capping No capping

OPD OPD Covered - Only accidental Fracture cases

Pre & Post Hospitalization Expenses

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

TPA link as below:

Cashless Hospitalization- Emergency

Step 1: Get Admitted Pre-

Step 3: Treatment & Discharge Administrator verifies Hospital sends

Cashless Hospitalization- Planned

Step 1: Pre-Authorization Member intimates Claim Administrator

Step 2: Admission, Member gets treated and Hospital sends

Submission of hospitalization claim

Non-Cashless Claims Process

Is Payment to be Employee at the

Receives mail about deficiency

Claims Document List

*Please retain photocopies of all documents submitted

What is Medical Insurance?

N.B: In class 'C' towns condition of number of beds be reduced to 10.

Further, it necessarily should not be blacklisted with the insurance company

What happens if my family status changes during the policy?

Are congenital diseases covered under the policy

What happens if me and my spouse are working in the same organization?

Is the baby covered from Day 1?

The information on my e card is incorrect. What should I do now?

Can I file more than one claim in a year?

Insurance Broker : Marsh India Insurance Broker

Aurionpro Solutions Ltd

VOLUNTARY PARENTS EMPLOYEE

Provides insurance coverage to parents for expenses related to hospitalization

Claims Document List

Benefits Extensions – Definitions

GMC Contact Details

Prudent Utilization of Benefit

Coverage Details For Employee Policy

Insurer The New India Assurance Company Limited

Sum Insured (In INR) 200,000 300,000 500,000