Employee Benefit Manual

Client FREYR SOFTWARE SERVICES PRIVATE LIMITED

Remark Benefit Manual-2024-2025
1.1 Benefit Details
Policy Parameter

Insurer Name Universal Sompo General Insurance

Company

Broker Name Policy Bazaar Insurance Broker

Insurance TPA MD India Health Insurance TPA Pvt

Policy Start Date 17-May-2024

Policy End Date 16-May-2025

Member Coverage Employee, spouse and 2 children upto

the age of 25 years & 2 Dependent
Parents & Parents In Law covered

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Poiicy benefit
Benefit Name Benefit type

Sum Insured Per Family INR 5,00,000

Room Rent Limits For 5 Lac SI , 1.5% of Sum Insured for Normal
(7,500/- Per Day room rent includes nursing and
RMO charges.)
ICU Limit & 2.5% of Sum Insured for ICU (12,500/- Per day
room rent includes nursing and RMO charges.).
Proportionate Deduction on If patinet pick a room with a rent that is more than what
Room is eligible for, insurers won't only deduct the
difference in room charge but will also proportionately
deduct all associated expenses.

Pre and post hospitalization Covered pre 30 days and post 60 days respectively
Expenses

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Poiicy benefit
Benefit Name Benefit type

New Born baby Covered Covered in policy upto sum insured incase of any
active line of treatmemt given -
Well Baby & Well Mother
Will be covered within maternity sub Limit
expences
Complicated Maternity Will be covered upto the family floter sum insured with
minimum hospitalization of 24 Hours.active treatment.
OPD expenses are not payable
Maternity Benefis Rs. 50000/- for Normal & 75,000/- Caesarean .

Pre & Post Natal expenses Covered up to maternity sub-limit in case of

hospitalization, OPD is not covered
Oral chemotherapy Covered up to full sum insured.

Lucentis Will be covered upto 50,000

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Poiicy benefit
Benefit Name Benefit type

Road Ambulance INR 3000 Per hospitalization

Internal Congenital disease Internal Congenital disease is covered and External congenital
and External congenital disease is covered in life threatning situation.
disease

Lasik Surgery for power above +/- 7.5

Lasik Surgery
Animal/ Serpent attack Covered upto INR 5,000 on each and every claim
Co-payment 10% Co-payment will be applicable on all admissible Parental
claims only.
Ayurveda/Ayush-covered Up to INR 25000 if treatment is for not less than 24 hrs, in an
govermernt recognized Ayurvedic Hospital
Nasal sinus surgeries
Nasal sinus surgeries upto 35000.

Psychiatric ailment Hospitalisation arising out of psychiatric ailment upto 30,000

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Poiicy benefit

Benefit Name Benefit type

Organ Donar Charges covered Upto sum insured

25% of sum insured

Modern Treatment Methods & List - Uterine Artery Embolization and HIFU, Ballon
Advancement Technologies
Sinuplasty, Deep Brain Stimulation, Immunotherapy -
Monoclonal Antibody as injection, Intra Vitreal injection,
Robotic surgeries,Bronchial thermoplasty, Vaporisation
of the prostrate, IONM, Stem cell for bone marrow
transplant for haematological. 50% Co-pay for Cyber-
Knife, Gamma Knife treatmentand cell transplatation,
Robotic surgery, Femto laser treatment for eyes.

Domiciliary Hospitilization Covered Upto family sum insured

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 Special Condition
Benefit Name Benefit type

Life threatening maternity cases Payable Upto sum insured

1 -No deduction in claim and fill amount will be paid as

per thehospital bill
Death Benefit 2 ,Dependent Coverage Post Employee Death - Till end
of the respective policy.

LGBT Employees
Covered and their legally wedded partner except for
Gender change treatment

No capping in cataract treatment but the lens payable

is unifocal/monofocal subject to reasonable &
Cataract coverage customary charges.In case of multifocal lens, claim will
be processed Considering ,unifocal/monofocal charges
and the difference needs to be paid by the employee

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Standard Hospitalization
• Room and boarding
• Doctors fees
• Intensive Care Unit
• Nursing expenses
• Surgical fees, operating theatre, anesthesia and oxygen and their administration
• Physical therapy
• Drugs and medicines consumed on the premises
• Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)
• Dressing, ordinary splints and plaster casts
• Costs of prosthetic devices if implanted during a surgical procedure

A) The expenses shall be reimbursed provided they are incurred in India and within the policy period.
Expenses will be reimbursed to the covered member depending on the level of cover that he/she is entitled to.

B) Expenses on Hospitalisation 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, Dental Surgery,
Lithotripsy (kidney stone removal), Tonsillectomy, D & C 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 Hospitalisation Benefit.

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General Exclusions
•Plastic Surgery, Dental Treatment/Surgery (Cosmetic Purpose)
•Use of intoxicating drugs/ alcohol
•Sterility/Infertility/Venereal Disease/Circumcision/AIDS
•Intentional Self Injury, Mental disorder
•Congenital Diseases (External) e.g. An operation to remove a 6th finger, Skin Grafting,
Convalescence / General Debility
•Admission for only Laboratory /Observation /Evaluation purpose. Less than 24 hours
treatment,OPD treatment. Admission for more than 24 hours with no active line of treatment,
Health Checks, Domiciliary Hospitalization
•Vitamins & Health Drinks like Horlicks, Complan etc.. and Tonic inconsistent with
treatment, Special diet and extra diet for patients (unless prescribed by the Doctor)
•Non Medical Expenses, Telephone, Fax, Barber, Photocopy, Vaccinations, Toiletries and TV
charges, Service Charges, Maintenance and Surcharges, Special Nursing, Duty Doctor
Charges, Attendant Pass.

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Cashless Hospitalization List

List of hospitals in the TPA’s network eligible for cashless hospitalization

Hospital List :-
https://mdindiaonline.com/ProviderList.aspx

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Cashless Process:-
Cashless means the Administrator may authorize upon a Policyholder’s request for
direct settlement of eligible services and it’s according charges between a Network
Hospital and the Administrator. In such case the Administrator will directly settle all
eligible amounts with the Network Hospital and the Insured 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 under the Policy.

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.

TAT for Cashless- 2 Hours form the time documets are sent to the
TPA by the Hospital

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Reimbursement Process
Admission procedure

● In case you choose a non-network hospital you will have to liaise directly with
the hospital for admission.

Discharge procedure

● In case of non network hospital, you will be required to clear the bills and
submit the claim to insurance co.for reimbursement . 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.

● TAT for Reimbursment:- Claim processing TAT is 7 working days &

paymemt will be made in 7 days form the approval date.

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 Claim Documents - List
● 1. · Completely filled & duly signed claim form with the claim amount.
● 2. · Original detailed discharge summary.
● 3. · Original final hospital bill with detailed cost-wise break up of all the
● components included.
● 4. · Original payment receipt against the final hospital bill
● 5. · Original investigation reports along with doctor's advice
● 6. · Original pharmacy bills along with doctor's advice
● 7. · Valid photo ID of the patient and the employee
● 8. · Hospital registration certificate/declaration from the hospital
● mentioning the number of beds with available facilities, duly signed &
● stamped on the hospital letterhead.
● 9. · Original invoice and sticker of implant, in case it is applicable.
● 10. · In case of an accident claim, a copy of MLC/FIR, if any. In case it is not
● applicable then treating doctor justification would be needed.
● 11. · In case of an accident claim, a treating doctor's justification to rule out
● the influence of intoxicating substances would be needed.
● 12. · Name printed cancel cheque(of insured)/self-attested bank statement
● with IFSC code/copy of the front page of passbook with beneficiary detail.
● 13. · Aadhar Card(Patient and Insured)
● 14. · Medical Card(Patient)

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 Reimbursment Claim process

For reimbursment is the claim amount is less then 2,00,000

the claim can be fined through email or Visit App, Beyond
2,00,000 the document need to sent to the below address

Address for claim Submition

MDIndia Health Insurance TPA Pvt. Ltd.
H. No. 6-3-883/A/1#:103, 1st Floor, Imperial Plaza,
Beside Topaz Building, Panjagutta, Hyderabad-500082.

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 Document List

List Of Non Claim Form Claim Form

Payable Items

DAY CARE LIST.pdf

Claim form.pdf
List-of-non-payabl
e-by-IRDA.pdf

Day Care List

DAY CARE LIST.pdf

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 Premium : Per Dependents Premium

Family Floater Sum Base Dependents Cost That

Insured will deduct from your Salary
5,00,000 7,458

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 Enrollment Link

Click on the below link to open the enrollment

https://corporate.policybazaar.com/enrolments/freyr-
software-services/register

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Enter the details in the below window to Enroll the dependent

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 Matrix for Cashless & Reimbursement Claims
Policy Bazaar contact Details

Cashless Shivani 818317239 [email protected]

Reimbursement Supriya 9355827182 [email protected]

1st Level Sankhadeep Deb 9311957125 [email protected]

2nd Level Himanshu Shama 9802014205 [email protected]

MD India TPA Contact Details

Contact Designation Email ID
Details Level Contact No.

Mr Vishal Executive [email protected] SPOC-1st Level 7058034460

Aarthi Sr. Executive [email protected] 2nd Level 7391042264

Mr.Nitin Asst Manager [email protected] 3rd Level 8530126205

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