The document outlines the group medical insurance benefits provided to employees of EPOWERX LEARNING TECHNOLOGIES PRIVATE LIMITED. It provides details of the policy holder, period of coverage, insurer, and TPA. The policy covers employees, spouses, 2 children, and dependent parents. Benefits include coverage for room rent up to INR 6,000/9,000 depending on sum insured, ICU coverage, maternity benefits, and pre/post-hospitalization. The policy also lists general exclusions like cosmetic treatment, HIV/AIDS, alcohol/drug abuse, and intentional self-injury. Contact details for Futurisk as the insurance broker and Medi Assist as the TPA are provided for

1. EMPLOYEE BENEFITS MANUAL

2. Group Medical Insurance
This insurance scheme enables Medical Insurance coverage to employees/dependents for expenses related to hospitalization due to
illness, disease or injury.
2023-2024 POLICY BENEFITS

3. Group Medical Insurance Policy

4. GROUP MEDICAL INSURANCE
Policy Benefits Group Medical Plan
Policy Holder EPOWERX LEARNING TECHNOLOGIES PRIVATE LIMITED
Period of the Cover Annual
Inception Date 21st
of March 2023 midnight
Expiry Date 20sth
of March 2024 midnight
Insurer Liberty General Insurance Ltd
TPA Medi Assist Healthcare Services Ltd
Geographical Limits Covered for expenses incurred in India only
New Joinees + Dependents on intimation by HR
Commencement Date Date of joining
Termination Date Date of leaving
New Dependents (due to Marriage / Birth) on intimation by HR
Commencement Date Date of such event
Termination Date Date of leaving of employee

5. GROUP
MEDICAL
INSURANCE
Policy Benefits
Members Covered
1+3 Self + Spouse + 2 children+ Either one set of dependent
parents/Parent inlaws
Age limit 0-80
Children covered 2 children
Sum Insured 3 Lakhs, 5 Lakhs & 15 Lakhs
Room Rent
For Sum Insured 3 Lakhs - INR 6,000 Normal
3 Lacs -INR 6k Normal.
B). 5 Lacs /15 Lacs Sum insured single standard AC room max up to
INR 9k Normal.
ICU
Covered on actuals-or Inr 25,000 whichever is lower for all Sum
insured and all other related charges in accordance with room rent
restriction or actual which ever is lower.
Pre-existing cover Covered
Proportionate clause
If the claimant opted for a higher room rent limit, then assigned
proportionate charges will be borne by the claimant only.
Deletion of 30 days waiting period Waived
1st, 2nd, 3rd &
4th Year Exclusion
Waived

6. GROUP
MEDICAL
INSURANCE
Policy Benefits
Pre-existing cover Covered
Maternity Benefits Opted Normal - INR 50,000 & Caesarean - INR 75,000
Maternity Day 1 Covered
9 months waiting period Waived off
Baby Day 1 Cover Covered
Pre and Post Natal 5,000 within Maternity limit
Pre & Post Hospitalization Cover Pre 30 days & post 60 days
Ambulance Charges Rs. 1000 in case of Emergency
Claim Submission Within 30 Days from Date of Discharge
Cataract 40k per eye.
CONGENITAL INTERNAL COVERED
CONGENITAL EXTERNAL Covered under life threatening conditions only.
Daycare procedures Covered

7. GROUP
MEDICAL
INSURANCE
Policy Benefits
DISEASE WISE CAPPING FOR PARENTS
Hysterectomy 50,000
Removal of gall bladder 40K
Surgery for piles 40K
Surgery for fissure, Fistula and sinus 35K
Surgery for nasal septum correction 30K
Angiography invasive 30K
PTCA 2,50,000
Appendectomy 50K
D & C 25K
) Hernia 50k
Deviated Nasal Septum 45k
Surgery for renal stone 60k
Prostate Surgery TURP 60k
CABG 3L
Total Knee / Hip Replacement INR 2.50K

8. GROUP
MEDICAL
INSURANCE
MODERN TREATMENT LIST AS PER SUM INSURED
Treatments 3L 5L 15L
Uterine Artery Embolization
and HIFU
37,500 1,00,000 2,00,000
Balloon Sinuplasty 15,000 40,000 1,00,000
Deep Brain stimulation 75,000 2,00,000 4,00,000
Oral chemotherapy 37,500 1,00,000 2,50,000
Immunotherapy- Monoclonal
Antibody - injection
75,000 2,00,000 4,00,000
Intravitreal injections 15,000 40,000 1,00,000
Robotic surgeries/Cyberknife
treatment
75,000 1,50,000 4,00,000
Stereotactic radio surgeries 75,000 1,50,000 2,50,000
Bronchial Thermo plasty,
Vaporization of the prostrate,
(Green laser treatment), IONM
- (Intra Operative Neuro
Monitoring)
Covered Upto 50% of SI subject to maximum 1,000,000/- for SI 3L, 5L & 15 L
Stem cell therapy 75000 1,50,000 4L

9. GENERAL EXCLUSIONS
• Circumcision unless necessary for a disease , illness or injury not excluded hereunder, or , as may be necessitated due to an accident
• Birth control procedures, hormone replacement therapy, treatment arising from or traceable to pregnancy, childbirth including caesarean
section and voluntary medical termination of pregnancy during the first 12 weeks from the date of conception. However, this exclusion will
not apply to Ectopic Pregnancy proved by diagnostic means and certified to be life threatening by the attending Medical Practitioner
• Routine medical, eye and ear examinations, cost of spectacles, contact lenses or hearing aids, issue of medical certificates and examinations
as to suitability for employment or travel
• Acquired Immune Deficiency Syndrome (AIDS), AIDS related complex syndrom (ARCS) and all diseases / illness / injury caused by and/or
related to HIV
• Vitamins and tonics unless forming part of treatment for disease, illness or injury as certified by the Medical Practitioner
• Treatment of obesity, general debility, convalescence, rundown condition or rest cure, congenital external diseases / illness or defects or
anomalies, sterility, venereal disease or intentional self-injury and use of intoxicating drugs/alcohol
• Any treatment received in convalescent homes, convalescent hospitals, health hydros, nature cure clinics or similar establishments
• Medical Treatment following use of intoxicating drugs and alcohol or drug abuse, solvent abuse or any addiction or medical condition
resulting from or relating to such abuse or addiction.
• Sex change or treatment, which results from, or is in any way related to, sex change.
• Vaccination and inoculation of any kind.
• Disease / illness / injury / critical illness directly or indirectly, caused by or arising from or attributable to foreign invasion, act of foreign
enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped power riot, strike,
lockout, military or popular uprising or civil commotion.
• Treatment by a family member and self-medication or any treatment that is not scientifically recognized.
• Prostheses, corrective devices and medical appliances, which are not, required intra-operatively or for the disease/ illness/ injury for which
the Insured / Insured Person was hospitalised which is not excluded hereunder.

10. GENERAL EXCLUSIONS
• Any stay in Hospital without undertaking any treatment or where there is no active regular treatment by the Medical Practitioner
• Treatment of mental disease / illness, stress, psychiatric or psychological disorders
• Aesthetic treatment, cosmetic surgery and plastic surgery unless necessitated due to accident or as a part of any disease/ illness / injury
not excluded hereunder
• Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel
• Disease, illness, injury, directly or indirectly, caused by or contributed to by nuclear weapons/materials or radioactive contamination.
• Experimental and unproven treatment
• Cost incurred for medicines which are not under the advice of the Medical Practitioner and which are not consistent with or incidental to
the diagnosis and treatment
• Any treatment which is undertaken as an out-patient without any admission as an in-patient at the Hospital
• Naturopathy treatment.
• Treatment taken from persons not registered as Medical Practitioners under respective medical councils.
• Medical Treatment in respect of the Insured/Insured Person whilst engaging in speed contest or racing of any kind (other than on foot),
bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the
use of guides or ropes, potholing, abseiling, deep sea diving using hard helmet and breathing apparatus, polo, snow and ice sports.
• Intravitreal Injection like Avastin/ Lucents/Macugen etc..
• Keratoconus
• Medical treatment required following any criminal act of the Insured / Insured Person

11. WHAT MUST YOU REMEMBER ?
1 Cashless for all network hospitals
2 Reimbursement Claims can be submitted within 45 days from the date of discharge.
3 Mid-term inclusion of dependents for existing employees not allowed (Exception: Newly married spouse & newborn baby)
4
Any charges under, Admission charges, Registration Charges, Administrative Charges, Surcharge, Service Charge and all
non-medical charges falling under the heading of Miscellaneous charges are not payable
5 Please retain a copy of all documents submitted to us for further reference
6 Please retain POD copy of the courier for tracking your consignment in case of any delay etc.
7
For implants used in Cataract, Heart Valve Surgeries, CABG, Abdominal Surgeries, Knee replacement surgeries. Please
submit the bill (in case purchased outside) from the vendors for the prosthetic devices used along with Sticker
8 Reimbursement claim from Network hospital will be admissible as per the agreed package with Insurance company.

12. GETTING ENROLLED
Midterm Dependent Inclusion
Please notify HR and Futurisk Team on below mentioned ID each time you enroll a new dependent i.e. when your family status changes because of
marriage, birth or adoption of a child :-
The inclusion of new spouse must be declared within 20 days of the marriage.
Similarly, information about new-born child has to be declared immediately or within 20 days of childbirth.
Name :- Ms. Priyanka
Email ID :- priyanka.ok@skill-lync.com
Mob:9345100966
Name :- Ms. CV Sireesha
Email ID :- sireesha@futurisk.in
Mob: 9900019976

13. CASHLESS PROCESS
Cashless hospitalization means the Administrator may authorizes 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.
List of hospitals in the TPA’s network eligible for cashless hospitalization
Hospital Network List
1. Click on Network Hospital Lists :
https://www.medibuddy.in/networkHospitals
*Please press Control+Click to follow the link
1. You may save this excel file on your
workstation, preferred to view online as
it is updated regularly
Contact Call center at 24 X 7
Customer Service Center Toll Free
1800 425 9449
Call Center No - 080 2206 9449
Medi Assist Insurance TPA
PrivateLimited
Address – Tower D, 4th Floor, IBC
Knowledge Park, 4/1, Bannerghatta Main
Rd, Bengaluru, Karnataka 560029
CLAIM FORM
TPA Contact Details
Name Contact Number Email ID
General Queries Toll free number Info@mediassist.in 1800 419 9449
SPOC-Medi Assist Anuradha.K anuradha.k@mediassist.in (91) 8123584018
1st level Escalation Prabavathi V prabhavathi.v@mediassist.in (91) 6366420418

14. DOCUMENT CHECKLIST
Sr. No. Documents Checklist
1 Original Claim Form fully filled up and duly signed by you ✓
2
Original Main Hospital bill with Bill No. & break-up (with detailed break-up of various heads like Room Rent / OT
Charges/ Nursing Charges etc.) ✓
3 Original Discharge Summary (Gives the summary of diagnosis and treatment in hospital) ✓
4 Original Death Summary (Only in case of death of patient during hospital stay) ✓
5 Original Hospital Payment Receipt with Receipt No. ✓
6 Hospital Registration No. (Registration No. & No. of beds on hospital letterhead with signature) ✓
7 Doctor’s Registration No. (On Doctor’s letterhead with signature) ✓
8 Original Pharmacy & Investigation bills ✓
9 Original Prescriptions ✓
10 Investigation Reports in Original / Attested from hospital (reports for all tests done along with images) ✓

15. PLANNED HOSPITALIZATION

16. EMERGENCY HOSPITALIZATION

17. REIMBURSEMENT PROCESS

18. FAQ’S
What is a Mediclaim policy?
A Mediclaim policy reimburses hospitalization expenses incurred as an inpatient for the treatment of sickness or accident occurring during the period of
insurance.
What is the duration of the policy?
One year effective from the date of inception of policy, i.e.
GMC - 21st of March 2023 to 20th of March 2024
Is there a minimum time limit for stay within the hospital under Mediclaim?
Under Mediclaim, the minimum stay within the hospital must be for a minimum of 24 hours. However for dialysis, chemotherapy, eye surgery, etc (as per the
defined list) – the stay can be for less than 24 hours.
Who is an Insurance Broker?
An Insurance broker is appointed to assist you in all your Insurance related requirements. Futurisk is your Insurance Broker.
What is the Role of Futurisk?
Futurisk is your SPOC for any & all insurance related matters.
What is a floater policy?
A Floater policy is a single policy that takes care of the hospitalization expenses of your entire family who has been declared at the time of taking the policy.
Any member of your family or all put together can claim up to the maximum sum insured.
What is Sum Insured?
Sum insured is the maximum amount that can be claimed under the policy. This is the limit for the policy period

19. CUSTOMER SUPPORT CONTACT DETAILS
Futurisk Contact Details
Name Contact Number Email ID
SPOC Ms. CV Sireesha (91) 9900019976 sireesha@futurisk.in
Final Level Mr. John Anthony (91) 9900013118 john@futurisk.in
You may reach out to following points of contact from ‘Futurisk Insurance broking Company Private Limited’ for further assistance or if there is a
mismatch in the information uploading.

20. DISCLAIMER
Disclaimer
This Benefits Manual will serve as a guide to the benefits provided by “EPOWERX LEARNING TECHNOLOGIES PRIVATE LIMITED ”.
The information contained herein is only a summary of the terms and conditions agreed with the insurer. If there is a conflict in
interpretation, then the terms and conditions of the policy will prevail.