This document provides information about a health insurance plan being offered to IEEE members by Medimanage and Bajaj Allianz General Insurance. The key details include Medimanage's role in administering the plan, available coverage options and premium amounts, enrollment process, benefits included, exclusions and limits. Some highlights are a choice of sum insured from Rs. 2-10 lakhs, coverage for pre-existing conditions, maternity benefits, cashless claims processing, and portability for existing members to enroll within 60 days to avoid waiting periods.

1. HEALTH PLAN

2. • Medimanage’s Role for IEEE
• Policy Snapshots
• Premium
• Retail vs Group
• Medimanage Profile

3. Medimanage’s Role
• Plan Administration
– Enrollment of Members & their dependents
– Member Communication management & Query Resolution
– Complete Policy Administration for coordination of Policy &
Endorsements, Additions & Premium Accounting
– Claims coordination with TPAs & Insurers and facilitating timely
payment of reimbursement claims
– Cashless Coordination Service
– Tracking of Premium & Claims, Analyzing the same & providing
quarterly MIS on the policy performance
– Escalation management with 3-Tier Escalation matrix within
Medimanage to ensure minimal involvement of IEEE
management.

4. Policy Snapshots - Benefits
Benefits Details
Cover For E, S, 2C, 2P
Sum Insured (Floater) 2L, 3 L, 5 L, 7 L &10 L
Minimum Initial Enrolment 1,000 families
PED Cover From Day 1*
Maternity Cover Covered after 3 mths – 30 K
Room Rent Limit 1% of SI
ICU Rent Limit 2% of SI
Waiting Period For persons above 55 years
Limits On Procedures 6 Ailments
Co-payment Parents- 15% of admissible claim
Sum Insure Upgrade Not allowed
New Member Addition Pro-rata basis
E-Self | S-Spouse | 2C- Two Children | 2P-Two Parents | * Conditions Apply | Refer Detailed Terms

5. Policy Snapshots - Benefits
Benefits Details
Deletion None
Cashless Available
80D Benefit Available
Enrollment Now or Never basis
E-Self | S-Spouse | 2C- Two Children | 2P-Two Parents | * Conditions Apply | Refer Detailed Terms

6. Enrolment Snapshot
• Policy admin through Medimanage portal – Mpower
• Member submits family data as per format to IEEE
• Member gives cheque in the name of IEEE
• IEEE member data embedded in the system
• Each member gets a “My Page”
• Member logs in to see details of family covered
• A master policy for all members
• TPA cards uploaded on member “My Page”
• 80D benefit to each payee

7. Retail Vs Group - Bajaj
Retail Group
Parents cannot part of E+S+2C Plan Parents can be part of E+S+2C plan
Pre-existing cover after 4 yrs Pre-existing cover from day 1*
30 day waiting applicable 30 day waiting waived
4 yr waiting applicable 4 yr waiting waived*
Pre policy medical required – 45 yrs No pre-policy medical
Congenital Internal Ailments not covered Congenital Internal Ailments covered
Co-pay 10% - Non network hosp
Co-pay 20% - 55 yrs and above
15% for parents
Maternity not covered Maternity covered
New born covered midterm Midterm cover of new born allowed
Max cover 5 Lakhs upto 55 yrs Max cover 10 Lakhs
Premium 2 L – 7378 (E+S+2C) Premium 2 L - 8251
Premium 3 L – 9955 (E+S+2C) Premium 3 L - 9736
With 12% more premium for 2 L Maternity & Pre-existing ailments covered.
Premium for 3 L is 2% lower than retail premium

8. The Cover
E-Self | S-Spouse | 2C- Two Children | 2P-Two Parents |
PLANS
Sum Insured E E+S+2C E+S+2C+2P E+2P
2,00,000 A 1 B1 C1 D1
3,00,000 A2 B2 C2 D2
5,00,000 A3 B3 C3 D3
7,00,000 A4 B4 C4 D4
10,00,000 A5 B5 C5 D5
•Each person shall select one of the options from A1 to D5 and from sum
insured 2 Lakhs to 10 Lakhs.
•The premium is paid for by the individual vide credit/debit card.
•E+2P is permitted for unmarried persons only. Married persons must cover
parents under E+S+2C+2P plan. Deviation will result in claim rejection.
•Sum insured once selected cannot be changed.

9. Premium
E-Self | S-Spouse | 2C- Two Children | 2P-Two Parents |
BAJAJ (excluding Taxes )
Sum Insured E E+S+2C E+S+2C+2P E+2P
2,00,000 3,173 8,251 18,151 10,154
3,00,000 3,744 9,736 21,419 11,982
5,00,000 4,718 12,267 26,988 15,098
7,00,000 5,898 15,333 33,734 18,872
10,00,000 7,254 18,861 41,493 23,213
BAJAJ (including Taxes ) @ 12.36%
Sum Insured E E+S+2C E+S+2C+2P E+2P
2,00,000 3,565 9,271 20,394 11,409
3,00,000 4,207 10,939 24,066 13,463
5,00,000 5,301 13,783 30,324 16,964
7,00,000 6,627 17,228 37,904 21,205
10,00,000 8,151 21,192 46,622 26,082

10. Terms
• This policy is available only for IEEE members.
• All existing members will qualify for the enrolment & will get 60 days to enrol
self, employees & family members. If a member fails to enrol during this
period the waiting period mentioned in Slide 17 shall be for a period of 2
years and maternity shall be covered after 9 months.
• Sum insured is on a floater basis.
• Self, Spouse, first 2 children and parents can enrol.
• Pre-existing ailments & Congenital internal ailments are covered.
• There will be no waiting periods except for persons who are 55 years and
above of age at the time of policy commencement.
• There are limits on 6 procedure – Slide 17.
• Day care procedures are covered.
• Room rent will be 1% of sum insured limited to INR 5 k / day.
• ICU rent will be 2% of sum insured limited to INR 10 k / day.

11. Terms
• All charges (Doctor fees, Surgeon fees etc) linked to class of occupancy.
• Maternity is covered after 3 months from enrolment for INR 30 K (subject to
point 2 in Slide 1)
• Baby cover from day 1 in the main policy.
• Pre & Post hospitalization covered (30 days & 60 days).
• Cashless facility available
• Co-pay of 15% on all admissible parent claims. No co-pay for Self, spouse and kids.
• 2 children upto 25 years can be covered.
• The max age at which a person (Primary, Secondary or Parent) can enter
this plan is upto 75 years. Persons above 75 years cannot enter this plan.
Persons (Primary, Secondary or Parents) who are 55 years and above will
have a 1 year waiting for the following ailments listed below. – Slide 17
• Cover will cease when a person reaches 85 years of age.

12. Terms
• A member can enter this policy only after 6 months from being inducted as a
member of IEEE. Proof of membership to be provided at the time of
enrolment.
• In case Self & Spouse are both members of IEEE they will be given a single
cover.
• New member enrolment drive will be opened from the 07th of every month
and closed on the 28th. The cover for these members will commence from
the 1st of the next month provided that day not a holiday.
• Failure to enroll within timeframe shall attract increased waiting periods as
mentioned in Slide 10 point 2.
• Parents will be covered on NOW Or Never basis. This means any member
who has not covered parents in this plan during the enrolment period for that
member will not be allowed to cover them at any point in future.

13. Terms
• Spouse & Kids of married members will be covered on NOW Or Never basis.
This means any married member who has not covered spouse & kids (if
there are kids) in this plan during the enrolment period for that member will
not be allowed to cover them at any point in future.
• A married member, who has covered himself/herself under the Self+S+2C or
Self+S+2C+2P plan, will be allowed to add the new born in course of the
policy period at no extra cost. This enrolment must happen in 30 days from
date of event.
• An unmarried member who is covered under the Self or Self+2P plan can, on
marriage, cover spouse in course of the policy period by paying the
differential premium. This enrolment has to be done within 30 days from the
date of event.
• Members who exit this plan at any point will not be allowed to enter the plan
again.

14. Terms
• There will be no deletion.
• Cashless hospitalization is available in all the network hospitals.
• Claims to be submitted within 30 days from the date of discharge.
• Claim intimation time of 7 Days or before discharge whichever is earlier.
Claims will be rejected on account of delay in submission.
• Domiciliary care is excluded & standard exclusions apply.
• Claims will be rejected if the age mentioned at the time of a claim is different
that the age calculated for the same period based on the age provided at the
time of enrolment and this difference is greater than 1 year.

15. Terms
• This program will commence only with a minimum of 1000 primary members.
This means the sum total of all the primary members (Self) excluding the
family members should be 1,000.
• 80D benefit under the income tax act of 1961 can be claimed through the
certificate of insurance issued by the insurer to each payee.
• Each member shall confirm participation by filling the enrolment form.
• Post your queries to ieeehealth@medimanage.com
• Point of contact – Sahana Shetty
• Tel - +912230770101

16. Procedure Limits
• Limits on 6 procedures per life per occurrence.
• Cataract : INR 30,000 per eye
• Hernia : INR 45,000
• Hysterectomy : INR 45,000
• Joint replacement : INR 1,75,000 per joint per year.
• TURP for BPH : INR 42,000
• Coronary angiogram: INR 25,000
• Co pay is not applicable for the above procedures.

17. 1 Yr Waiting Period

18. Medimanage Profile
• Only dedicated Health Insurance Broker in India
• Offices at Mumbai, Bangalore, Chennai, Delhi & Pune
• Team strength of 117 members (all key members are
either with Insurer and/or TPA background)
• Promoted by Engineers, Strong on Systems & Processes
• Niche player as HR BPO for Health Insurance
Administration
• Facilitated more than 10,000 cashless admissions
• Handled more than 40,000 reimbursement claims
• Managed more than 150,000 employee queries over
Phone, Email & Online Platform.

19. Medimanage Value Adds
Other Brokers Medimanage
Advisor & Placement Agent Consultant & Plan Administrator
Generalist Specialist
Coordination for Insurer
Interactions
Ownership of all Interactions
(Insurer, Cashless,
Reimbursement & MIS)
Manual Processes
End-to-End Online Insurance
Administration Portal
MIS Preparation from TPA
Customized MIS from
Medimanage

20. Few of our delighted clients

21. Medimanage Insurance Broking PL
101, Shivkrupa, Kirol, Vidyavihar (W), Mumbai – 400 086
Phone – 91 22 6728 2929 Fax – 91 22 6728 2930
Mumbai | Pune | Bangalore | Chennai | Delhi
www.medimanage.com