Tata Motors Insurance brokering and Advisory Services Ltd. Benefit Manual

1. Tata Motors Insurance
Broking And Advisory
Services Ltd.
Benefit Manual

2. TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD.
Tata Coffee Limited
Group MediClaim Insurance
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3. TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD.
Topics
• Policy Features & Terms
• Claim Procedure
• Contact Details and Escalation Matrix
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4. TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD.
Policy Features & Terms
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5. TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD.
Policy Features
Insurance Company Tata AIG General Insurance Co Ltd
Third Party Administrator Family Health Plan Insurance TPA Ltd (FHPL)
Broker Tata Motors Insurance Broking And Advisory Services Limited
Coverage Period 22-09-2018 to 21-09-2019
Sum Insured INR 50,000 per member
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Family Definition Employee, Spouse, 2 dependent children up to 25 years and parents
Room rent INR 2,000 per day including nursing charges. ICU no restriction
Maternity INR 25,000 for normal and INR 50,000 for C-Section
New Born Baby Covered subject to declaration within 30 days from the date of birth
Inpatient treatments Covered
Day-care treatment Covered
Pre and post
hospitalization
Covered
Pre-existing diseases Covered

6. TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD.
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Policy Terms
Hospitalization
 Minimum period of 24 hours of admission in a hospital for a medical /
surgical management
Day care procedures
 Covered wherein 24 hours hospitalisation not required. Enclosed the
list of day care procedures
Pre & Post Hospitalization
 30 days from Date of Admission & 60 days from Date of Discharge
respectively.
 These expenses should be towards the management of same illness
against which patient was hospitalized. This is admissible only when
the inpatient cost are paid by the insurance Company
Covers expenses related to -
 Room and boarding
 Intensive Care Unit
 Doctors fees
 Nursing expenses
 Surgical fees, operating theatre, anesthesia and oxygen and their administration
 Drugs and medicines consumed on the premises
 Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)
 Costs of prosthetic devices if implanted during a surgical procedure
 Radiotherapy and chemotherapy

7. TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD.
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Policy Terms
Exclusions
 War or any act of war, invasion, act of foreign enemy and war like operations
 Any insured person committing a breach of law with criminal intent
 Intentional self injury or attempted suicide while sane or insane.
 The abuse or the consequences of the abuse of intoxicants or drugs.
 Treatment of obesity and any weight control program
 Treatment for correction of eye due to refractive error,
 Aesthetic or change-of-life treatments of any description such as sex transformation operations
 Plastic surgery or cosmetic surgery unless necessary as a part of medically necessary treatment
 Treatment and associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including
elastic stockings, diabetic test strips, and similar products.
 The provision or fitting of spectacles or contact lenses including optometric therapy,
 Congenital external diseases
 Cosmetics, hygiene articles, body care products and bath additive, barber or beauty service and vitamins
and tonics unless vitamins and tonics are certified to be required by the attending Medical Practitioner as
a direct consequence of an otherwise covered claim.

8. TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD.
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Policy Terms
Exclusions
 Convalescence, cure, rest cure
 Experimental, investigational or unproven treatment
 All preventive care, vaccination including inoculation and immunizations
 Circumcisions unless necessitated by illness or injury and forming part of treatment
 Venereal disease, sexually transmitted disease or illness
 Treatment rendered by a Medical Practitioner which is outside his discipline or the discipline for which he
is licensed;.
 Any treatment or part of a treatment that is not of a reasonable charge, not medically necessary; drugs
or treatments which are not supported by a prescription.
 Artificial limbs, crutches or any other external Aids & Appliance and/or device used for diagnosis or
treatment (except when used intra-operatively
 Non-medical expenses and non-payable; you can access the list of same at
https://www.fhpl.net/Forms/NonPayableChanges.pdf
Note:- Please refer to policy wordings for detailed list of exclusions

9. TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD.
Claim Procedure
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10. TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD.
1. Arrange to send completely filled pre-authorization request from respective hospital insurance desk
to FHPL. You can access the list of network hospitals at https://www.fhpl.net/
2. Planned hospitalization should be intimated to FHPL at least 72 hours prior to admission.
3. Emergency admission to be intimated within 24 hours after hospitalization.
4. Pre-authorization request should be completely filled and duly signed & stamped with hospital
stamp by treating doctor & the Insured (along with undertaking).
5. Prior admission, consultation, medication papers & investigation reports should be provided along
with the pre-authorization request.
6. After review, FHPL will issue authorization letter to the respective network hospital.
7. All claim amounts (excluding non-medical expenses & non-payables) will be authorized as per
hospital tariff/ schedule of charges. List of non-medical expenses and non-payable are available at
https://www.fhpl.net/Forms/NonPayableChanges.pdf
Cashless Claim Procedure (Network Hospitals)
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11. TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD.
Reimbursement Claim Procedure
1. All original documents as per check list along with claim form should be submitted to FHPL at
the below mentioned address/ FHPL helpdesk at your office within 30 days from the date of
discharge and OPD claims to be submitted within 3 months from the date of treatment
Sandesh Rai
Family Health Plan Insurance TPA Limited
No.11 ,2nd Floor,C –Block NITON Palace Road Bangalore -560052
Phone: 080-22356256/57
Mobile: +91 7353082100
2. On receipt of your claim at FHPL, the documents will be scrutinized as per the terms and
conditions of Group Mediclaim Insurance Policy.
a) On scrutiny of your claim, if there are any further requirements/clarifications on
admissibility of the claim, FHPL may revert for such additional information, which will
have to be submitted from your end within the specified timelines.
b) Once the claim is approved, the Insurance company will directly credit the approved
claim to your bank account as provided in the cancelled cheque submitted during the
claim.
You can download the claim form and check list at -
 Claim form https://www.fhpl.net/Forms/TATAAIG_ClaimForm.pdf
 Check list https://www.fhpl.net/Forms/Checklist.pdf
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12. TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD.
Contact Details and Escalation Matrix
Contact Details
Toll Free Number 18004254033
Escalation 1
SPOC
Tamilselvi
Mobile : 9087282007
Email : tamilselvi.kr@fhpl.net
Escalation 2
Aji Thomas
Mobile : 9243468751
Email : AjiThomas@fhlp.net
Escalation 3
Tata Motors Insurance Broking And Advisory Services
Mr Arundas CK
Mobile : 9739459993
Email : arun.das1@tmibasl.com
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13. THANK YOU
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