Tata Power



INTRODUCTION

This FAQ gives the salient features of the Health Insurance Scheme – Mediclaim Policy will reimburse reasonable expenses to the insured Tata Power, CGPL, MPL, TPJDL and TPCDT Employees, subject to certain maximum limits, which the employees have incurred on account of hospitalisation

Tata Power Employees and their families are covered under the Mediclaim Insurance Scheme for the Sum Insured as per their Grade for the Hospitalisation expenses. The Insurance policy is with New India Assurance Company (NIAC) and the claims are administered by Mediassist who are the Third Party Administrators (TPA).

The Insurance policy basically covers the Hospitalisation expenses whilst admitted as in-patient to the extent of reasonableness of the charges subject to the Individual family limit of the Sum Insured for each year of the policy.

In order to ensure that the Policy is better managed and is understood by the employees we are providing the following frequently asked questions which are covered under this write-up and will help employees to avail its facility.

For the benefit of better understanding to the Employees the FAQs are given below under 8 heads (A to H):

A) Who is covered / Limits of coverage / add and delete dependants and the I- Card / E – Card

Who all are eligible to get covered in Company‘s Group Floater Mediclaim Policy? 4

What are the limits for coverage? 4

How do we add names of new employees and dependents in the Policy? 5

How can I delete my dependents name from the Policy? 5

How can I get Mediclaim I.Card/E-Card? 5

B) What should I do in case of Hospitalisation of Myself OR my family members?

Basic information 5

C) What is CASH LESS Claim / Reimbursement Claim.? / Limit Under Cash Less claim / List of Hospitals

What is Cash Less claim and Reimbursement claim 6

Where can I Claim Cash Less Hospitalisation / what is GIPSA Hospitals 6

GIPSA hospital List 7

If my cashless approval is partial, what I should do? 7

D) What expenses are payable under the Scheme / Ailments Excluded / Expenses not payable / Non Mediclaim items disallowed

What expenses are payable under the Mediclaim policy? 8

What expenses are not payable exclusions? 8

What ailments are excluded under the policy? 8

Additional Coverage & Restrictions to Officers 8

What are Non-Medical items generally disallowed? Can I get a list of it? 9

E) Claim Process / Procedure during Discharge at Hospital / Documents to be submitted

What is the procedure/requirement for claim submission? 9

What is the time limit for reimbursement claim submission? 9

Why are original documents required for submitting a claim? How can I get my original reports and x-ray films back? 9

From where I can get Claim Form 9

What is the cycle time for claim settlement? 10

How can I track my claim status / settlement letter?

How can I track my claim status? 10

My claim is in query stage for IR (Information required). What should I do? 10

My claim status is marked as denied. What should I do if I do not agree with the denial reasons? 10

Certain portion of my claim has been disallowed in my settlement. If I do not agree with the same, how can I claim it? 10

Claim vigilance / claim investigation by TPA personnel. 10

F) Transferred Employees Between Subsidiaries – CGPL / MPL / TPCL

I am transferred/shifted to Group Companies in Tata Power with new employee number. What is the procedure followed to avail mediclaim facility? 11

G) Retired Employees:

If I am retiring in the current year, what should I do for continuing my mediclaim in the Company’s Group Floater Mediclaim Policy? 12

I am a retired employee, what is the premium I have to pay for my coverage to continue in Tata Power Company’s Group Floater Mediclaim Policy? 12

I am a retired employee, wants to enhance my existing sum insured. 12

I have resigned from Tata Power. Whether I can continue the coverage by paying premium in the Group Mediclaim Policy. Upto what period my Mediclaim coverage remain valid? 12

H) Problems faced in Claim

Frequently Asked Questions

A) Who is covered / Limits of coverage / add and delete dependants and the I- Card / E – Card

Who all are eligible to get covered in Company‘s Group Floater Mediclaim Policy?

i) Self, Spouse, Dependent Children upto age of 25 and Dependent Parents or in-law parents

* Dependents - (1) Legally married spouse, (2) legitimate or legally adopted son/daughter, (3) parents – father, mother or father-in-law, mother-in-law who is not gainfully employed for wage or profit or in service, business or profession and to be truly a ‘dependent’ of the employee and normally reside with him.

ii) Special category

|a) |In respect of dependent children who are 25 years of age  and above, upon their satisfying the following conditions: |

|                      i.        They are not working |

|                     ii.        They are not married |

|b) |In respect of dependent handicapped sibling, upon their satisfying the following conditions: |

|                      i.        They are not working |

|                     ii.        They are not married |

|                    iii.        Appropriate cert of handicapped status being produced |

|c) In respect of siblings of Unmarried employees,  upon their satisfying the following conditions: |

|                      i.        They are not working |

|                     ii.        The parents are deceased |

For regularizing the above coverage, the employee has to make an application to Head Corporate Insurance through their concerned divisional office in the prescribed format enclosing the necessary declaration duly verified by the Divisional Head.

Further, such declaration needs to be made annually to ensure that the special status continues.

( Click here for Special category addition form)

What are the limits for coverage?

|Grade |Sum Insured |

|MC2 and above |10 lakhs |

|MD2, MD1 |7 lakhs |

|ME-2, ME1 |5 lakhs |

|ME4, ME3,FDA |4 lakhs |

|Staff above Basic 400 |3.5 lakhs |

|Staff upto Basic 400 |2.5 lakhs |

Employees of Jojobera and Power House 5 & 6 are covered under Tata Steel medical facility. However employees are having an option to get covered under our existing Mediclaim policy for coverage of 2.5 lakhs.

How do we add names of new employees and dependents in the Policy?

New employees inducted through HR data get added to Mediclaim system through a process run from IT Dept.

The Employee himself has to add immediately, dependents name in Mediclaim System available in Sangam - employees portal – Mediclaim – add - dependent name.

The coverage will be regularised through monthly addition with Insurance Company effective from the date of addition in the Mediclaim system.

How can I delete my dependents name from the Policy?

Deletion of names also has to be done in Mediclaim system available in Sangam - employee’s portal.

Employee should delete the name of dependents for whom they do not want to continue the coverage due to specific reasons. i.e. marriage, employed, beyond 25 years of age, expired etc.

How can I get Mediclaim I.Card/E-Card?

| |E-card is available at employee Login id: @tatapower (Example: 123456@tatapoweer) Password : tatapower |

B) What should I do in case of Hospitalisation of Myself OR my family members?

Basic information

What I should do in the event of hospitalisation?

keep copy of:

i) Company ID Card,

ii) Mediassist Mediclaim E-Card/I-ICard,

iii) a list of nearby GIPSA hospitals where cashless hospitalisation facility can be availed.

iv) Contact details of few close colleagues from work place.

v) Contact details of TPA personnel and Company Insurance contact personnel.

Above basic information be kept at residence and other family members are kept informed on its utility.

Hospitalisation of Self OR Family – care that needs to be taken

When self is hospitalised ensure family members have the details of above basic informations.

C) What is CASH LESS Claim / Reimbursement Claim.? / Limit Under Cash Less claim / List of Hospitals

What is Cash Less claim and Reimbursement claim

What is Cash Less claim and Reimbursement claim

Cashless

i) Cashless facility is available only on GIPSA rates agreed hospitals.

ii) for cashless hospitalisation show copy of Mediassist E-Card/I-card to hospital cashless counter to facilitate them to send cashless request to TPA.

iii) in case or any problem contact TPA personnel/Corp Insurance Dept Personnel.

iv) at the time of Cashless Hospitalisation discharge it is essential to take final bill copy from Hospital.

< for more details on cashless procedure click here >

Reimbursement Mediclaim

Admitted in to a Non GIPSA hospital then settle the hospital bills and put up a reimbursement Mediclaim by filling Mediclaim form and attaching relevant original documents to Head - Corp. Insurance, B-Block, Corporate Centre, Carnac,

Care to be taken at the time of Discharge

Verify hospital for its correctness of charges, there should be detailed bills on consumables, medicines charges, diagnostic test etc. Collect original discharge card, all diagnostic test reports in original, original payment receipts for all payments made.

Where can I Claim Cash Less Hospitalisation / what is GIPSA Hospitals

Group of Public Sector Insurance Company has fixed certain surgical procedures cost based on hospital grades. These rates are known as GIPSA rates. Hospitals which have accepted these rates are called GIPSA Hospitals. TPC Mediclaim covered employees and dependents can avail cashless hospitalisation in GIPSA Hospitals.

Employee not availing Cashless facility and paid hospitalisation expenses, he has to put up a Reimbursement Mediclaim attaching all original documents for getting reimbursement.

GIPSA hospital List

i) GIPSA hospital list is available in our Mediclaim System front page – Cashless facility.

ii) Latest cashless hospital list available at

Cashless initial approval is partial.

In certain cases TPA gives an initial approval which is lesser than the estimated amount requested by the hospital. The remaining amount can get cleared at the time of discharge by sending final hospitalisation bill, discharge card copy and a fresh request form duly filled and signed by the hospital

In case of any problems TPA responsible persons on Tata Power Mediclaim Policy can be contacted on following numbers:

Ms Tejeshree Gujar : 7718813070

Ms Smita Khedekar : 8451050893

D) What expenses are payable under the Scheme / Ailments Excluded / Expenses not payable / Non Mediclaim items disallowed

What expenses are payable under the Mediclaim policy?

Expenses Payable:

I. Room Charges, RMO charges, Nursing Charges, ICU Charges.

II. Surgeon fee, Anaesthetist fee, Consultants fee, Medical Practitioner fee, Specialist fees, Anaesthesia., OT charges

III. Medicines & drugs,

IV. Cost of Implants, Devices like pacemaker

V. Relevant Diagnostic tests charges

VI. Expenses towards pre and post hospitalisation for a period of 30 and 60 days respectively

What expenses are not payable exclusions?

Expenses Not Payable:

I. Health Check up charges without effective Hospitalisation

II. Admission/Registration, Telephone charges, Attendants charges, Special Nurses.

III. Non Medical Expenses generally disallowed. < click here view non medical expenses list >

IV. Expenses beyond pre 30 and post 60 days.

V. Experimental & unproven treatment.

VI. Treatment taken outside India.

13. What ailments are excluded under the policy?

General Policy Exclusions:

Circumcision, Vaccination, Inoculation, Cosmetic treatment, Plastic surgery

Spectacles, Contact lenses, Hearing Aids

Dental Treatment Congenital disease, Sterility, Venereal disease, Alcohol use, Self injury.

Vitamins and Tonics not prescribed post hospitalisation & unrelated to treatment

Naturopathy treatment

Treatment for Infertility

Beauty Treatment of any description.

Plastic surgery (other than necessitated due to accident)

Sexually transmitted diseases, any condition directly or indirectly associated with Human T cell lymphotropic virus Type-III or condition of similar kind commonly referred to as AIDS.

14. Additional Coverage & Restrictions to Officers

|Maternity coverage |normal delivery procedure Rs 30,000 and caesarean delivery procedure Rs 50,000 |

|Room Rent (per day) |Shall not exceed 1% of sum insured subject to maximum of |

| |Rs 5,000 per day. |

|ICU (per day) |Shall not exceed 2.5% of sum insured subject to maximum of |

| |Rs 10,000 per day. |

|GIPSA rates |Applicable for cashless as well as reimbursement claims. |

|Cataract Operation |Limited to Rs 45,000 per eye. |

|Parents /In-law parents |Employees can include either parents or in-law parents |

< Click here to view Circular >

What are Non-Medical items generally disallowed? Can I get a list of it?

< Click here to view Non-Medical items generally disallowed >

E) Claim Process / Procedure during Discharge at Hospital / Documents to be submitted

What is the procedure/requirement for claim submission?

|i) | |Make an intimation entry in the mediclaim system available at Sangam-employee portal and get the claim number. |

|ii) | |Fill up the Mediclaim form and sign it. Mention the claim intimation number |

|iii) | |Attach following original documents: |

| |a) |Duly filled claim form |

| |b) |Discharge card |

| |c) |Detailed Final Hospital bills |

| |d) |Payment receipts |

| |e) |All diagnostic test reports with advice note. |

| |f) |Medicine cash memo with prescription. |

| |g) |X-ray reports and films. |

What is the time limit for reimbursement claim submission?

For Hospitalisation claim submission, initial claim should be submitted immediately after the discharge i.e. within 10 days from the date of discharge This will enable speedy recovery of major portion of the claim amount and any query on claim processing can be resolved by getting required documents from hospital without much trouble.

Follow-up claim can be submitted as subsequent claim once follow-up on hospitalised treatment gets over, subject to maximum 60 days post hospitalisation period.

Why are original documents required for submitting a claim? How can I get my original reports and x-ray films back?

|Original documents are required for Insurance company’s audit compliance. |

|Where the employee wants his original reports for future treatment, kindly submit a letter along with the original & duplicate |

|reports. TPA will verify the same & return the original reports. |

From where I can get Claim Form

< Click here to view Claim Form >

What is the cycle time for claim settlement?

15 working days from the date the claim is submitted to Insurance Company, subject to availability of complete documents and information required to settle the claim by TPA.

How I get my Mediclaim settlement payment?

Mediclaim settlement payment received from Insurance Company will get credited to employee’s bank account through NEFT from Tata Power. For subsidiaries / JVs NEFT transfer will be done to the concerned Company, who in turn will disburse the amount to its employees.

How can I track my claim status / settlement letter?

| |

| |

|Login id : employee number@tatapower |

| |

|Password : tatapower |

| |

|(here employee can get coverage details, e-card, claim status, settlement details) |

| |

| |

My claim is in query stage for IR (Information required). What should I do?

Employee has to submit the information/documents required by the TPA. Attach the documents with IR intimation mail received and send the documents to

|The Tata Power Company Limited |

|Corporate Centre B-Block, 5th floor, |

|34 Sant Tukaram Road, Carnac Bunder |

|Mumbai 400 009 |

|Tel. 67171536 Attn: Mr Abdul Razak L Khan |

My claim status is marked as denied. What should I do if I do not agree with the denial reasons?

Employee has to submit the reason with supporting documents to TPA directly or forward it to Corp. Insurance Dept., Carnac. Mumbai.

Certain portion of my claim has been disallowed in my settlement. If I do not agree with the same, how can I claim it?

Employee has to submit the supporting documents for the disallowed portion of the claim along with settlement copy to TPA directly or forward it to Corp. Insurance Dept.,34, Sant Tukaram Road, Carnac Bunder, Mumbai – 400 009

Claim vigilance / claim investigation by TPA personnel.

As a part of claim containment measures TPA investigator may visit the hospital to confirm the authenticity of the patient, check the employee’s entitlement and facility provided by the hospital, ailment and treatment plan, billing pattern matching with agreed GIPSA rates.  The TPA investigator may visit patient/relative in this regard.  Employees are requested to co-operate with this procedures to enable us to keep a proper control and claim containment in this regard.

F) Transferred Employees Between Subsidiaries – CGPL / MPL / TPCL

I am transferred/shifted to Group Companies in Tata Power with new employee number. What is the procedure followed to avail mediclaim facility?

i) Transfer to from Tata Power to CGPL / CGPL to Tata Power and Transfer to from Tata Power to MPL / MPL to Tata Power with new employee number:

Current coverage continues upto 31st March of the change year. Any claim during the year can be claimed under old employee number. On induction through new employee number employee name will get added in Mediclaim system directly from HR induction process. Employee has to add dependents name for regularising their coverage for renewal.

ii) Transfer from Jojobera to other locations, how Mediclaim coverage get regularised?

(a) If the employee is already covered in Contributory Jojobera Special Coverage for 2.5 lakhs Sum Insured, then he has to intimate Insurance Dept. to change the category of his insurance from JSP coverage to regular coverage as per his grade. Insurance Dept will change the coverage category as per his grade and regularise it. Employee has to verify and confirm his eligible coverage regularised by viewing his coverage data available and accessible to him in Sangam-Employees portal-mediclaim-view/edit family data.

(b) If the employee is not covered under Mediclaim then he has to intimate Insurance Dept. to add his name in Mediclaim System. Insurance Dept will add employee name in Mediclaim System. Employee has to add his dependents in Mediclaim system available in Sangam-Employees portal-Mediclaim-Add Dependents Name.

iii) Transferred to Jojobera

(a) Existing coverage will continue till expiry of the policy period. On renewal name get deleted. Employee can opt for Jojobera Contributory Special Coverage for 2.5 lakhs.

iv) Shifting from Tata Power to Overseas Assignment and employee wants to continue his and family coverage in Tata Powers Group Floater Mediclaim Policy.

Employees are permitted to continue their coverage by paying full premium. These category employees are kept in a separate group and premium will be collected during March month of every renewal

G) Retired Employees:

If I am retiring in the current year, what should I do for continuing my mediclaim in the Company’s Group Floater Mediclaim Policy?

|Mediclaim policy coverage period is 1st April to 31st March. Retiring employee does not have to pay the premium upto the end of the|

|Financial year in which he retires. Thereafter, for continuing the mediclaim coverage in Tata Power Group Mediclaim policy, retired|

|employee has to pay the premium on every renewal. i.e. during the month of March of every year. Renewal intimation will be sent to |

|the retired employee at the residential address available in mediclaim system. |

|Retiring employee has to update his post retirement residential address, Telephone No./Mobile No, e-mail id in the mediclaim system|

|available in Sangam-employees portal before retirement. |

I am a retired employee, what is the premium I have to pay for my coverage to continue in Tata Power Company’s Group Floater Mediclaim Policy?

There are three options available; employee can choose any one during retiring year.

(i) There is a special coverage for Retired employees for Sum insured Rs.2.00 lakhs.

Premium for this coverage is Rs 6000/- + service tax for self and 10% addition for dependent.

i.e for coverage of self and spouse Rs 6600/- + service tax.

(ii) There is a special coverage for Retired employees for Sum insured Rs.4.00 lakhs.

Premium for this coverage is Rs 10000/- + service tax for self and 10% addition for dependent.

i.e for coverage of self and spouse Rs 11000/- + service tax.

(iii) For employees opting for the existing coverage to continue, the premium will be calculated on prevailing rates and intimated to them during the month of February/March for making payment of the premium during the month of March

I am a retired employee, wants to enhance my existing sum insured.

Enhancement of sum insured is not permitted. Reduction from higher sum insured category to lower sum insured category is permitted

I have resigned from Tata Power. Whether I can continue the coverage by paying premium in the Group Mediclaim Policy. Upto what period my Mediclaim coverage remain valid?

Mediclaim claim insurance is renewed every year based on employees who are in service as on 1st April. Policy is valid upto 31st March of the financial year. Recovery of Mediclaim premium is done from resigned employee’s final settlement for unexpired period’s coverage i.e. Separation date to 31st March of the financial year

H) Problems faced in Claim

Clarification on Mediclaim related issues.

|Sr. |Areas of Frequent Disallowment in Mediclaim |Solution/Remarks |

|No | | |

|1 |Cashless hospitalisation request denied by TPA for want of |Employee can put up a reimbursement claim clarifying the information needed |

| |information on admissibility |by TPA |

| | |along with supporting documents. |

|2 |Surcharge/Service charges are payable in current years |Put up reimbursement mediclaim attaching payment receipt of surcharge amount.|

| |Mediclaim Policy. Hospital collected surcharge charges from| |

| |employee. | |

|3 |Diagnostic test expenses disallowed for want of original |Put up a Grievance Claim attaching original test report with settlement |

| |reports. |letter copy. |

|4 |Medicine charges disallowed for want of bifurcated/detailed |Get the detailed medicine charges from hospital and put up a Grievance Claim |

| |bills. |attaching it with settlement letter copy. |

|5 |Expenses beyond agreed GIPSA rates for cashless cataract |Expenses beyond cashless GIPSA rates approval on Cataract Operation cannot be|

| |operation |claimed through reimbursement Mediclaim. |

|6 |In emergency cashless request E-Card not available |Put Emp. No. on cashless request form and send the request to TPA from |

| | |Hospital. In case of any problem take the help of TPA contact |

| | |persons/Company Insurance contact persons. |

|7 |TPA will give immediate initial approval on cashless request|Ensure from the hospital, the final bill and |

| |and final approval on receipt of final bill and discharge |discharge summary has been send to TPA well in |

| |summary. |advance before discharge. |

|8 |Line of treatment is not clear on cashless request TPA may |All developments on cashless approval is marked to employee e-mail |

| |raise queries on information required. Upon satisfying the |id/mobile. Ensure queries if any have been replied by hospital in time. |

| |query by Hospital TPA clear the cashless request. | |

|9 |Cashless facility is only available in GIPSA hospitals. |Cashless facility is not available in NIA network hospitals who are not |

| | |agreed GIPSA rates. |

|10 |Cashless claims settlement payment to hospitals will be paid|Employee get copy of mail on cashless |

| |within 30 days and employee get mail from TPA in this |Settlement advice to hospital. Deposit refund |

| |regard. |can be collected accordingly. |

|11 |Cashless hospitals collect nominal deposit amount from |Employee get mail on cashless settlement |

| |employee to cover up non medical expenses on cashless |advise to hospital. Deposit refund can be |

| |hospitalisation. |collected accordingly. |

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