Date: - 22nd March 2019

To,
Dear All ABMers,

Circular: ABM’s Group Mediclaim Insurance Policy – 2019-20

We are very happy to inform you all that ABM has successfully & on time renewed our Group
Mediclaim Insurance Policy for all employees on the payroll of ABM. As you are already aware, the
insurance coverage is given to Self + Spouse + 2 Children. (Parents are not covered). The insurance
company is New India Assurance Company Limited. The policy is valid from 18th March 2019 to 17th
March 2020.

The policy document will provide more guidance to each of you so that you will not face any difficulty
in understanding the various processes involved under the Mediclaim policy.

The sum insured for each employee under this policy is arrived at a pre-defined category of Rs.1.00
Lakh, Rs.1.50 Lakh, Rs.2.50 Lakh and Rs.4.00 Lakh based on the CTC of each employee.

Following is the table used for arriving at the sum insured as per the criterion fixed by company.

Sr. No. Annual CTC in Rs. as of 1st March'2019 Sum Insured in Rs.
1 Up to 2,00,000 1,00,000
2 2,00,001 to 5,00,000 1,50,000
3 5,00,001 to 10,00,000 2,50,000
4 Above 10,00,000 4,00,000

ABM has appointed an organization called NEW INDIA ASSURANCE CO LTD AND INVESTACC
ISNURANCE BROKERS PVT LTD. This means, Investacc will function as a mediator between ABM
employees and the Insurance Company in respect of claims from ABMers, right from claim
preparation/submission to till claim settlement. The Investacc can be contacted in case if you need any
claim-related guidance, help or clarification. As per the information given by Insurance Company, an
Authorized representative of the Investacc will be available at all Network Hospitals/Nursing Homes
across India as per the list provided along with the insurance kit.

Employees can bring to the notice of Administration Department about any non- response or
non-co- operation from Investacc, if any.
We will issue MediClaim Card for each employee along with the list of Network Hospitals in India. In
case of non- receipt of ID cards, discrepancies, if any then employee should mail the same to
Administration Department. For any claim related query, you will need to contact on the telephone
numbers and address mentioned below.

 ABM Representatives for

First Level Escalation
1. Mr. Ajay Matekar
Cell: +91 7498657450
Email: ajay.matekar@abmindia.com

Second Level Escalation

2. Mr. Dhiraj Patil
Cell: +91 9324561323
Email: head.admin@abmindia.com

 For Claim Settlement

Investacc Insurance Brokers Pvt Ltd.
918, Samarth Aishwarya,
“B” Wing, 9th Floor
Lokhandwala Complex
Andheri West,
Mumbai – 400053.

Contact Details of staffers:

1. Mr. Nilesh Chaubey, Manager-CRM
Cell: +91 9167615788
Email: crm@invetsacc.co.in

2. Mr. Mohd Arkam Ansari - AVP

Cell: +91 9833377608
Email: arkam@investacc.co.in

Best Regards,

Prasad Kelkar
Head HR & Admin
 ABM KNOWLEDGEWARE LIMITED
Group Mediclaim Insurance Policy (Policy Document)

The Company is pleased to inform all that we have renewed Group Mediclaim Insurance Policy for all
ABMers and their dependents with New India Assurance Company Limited which is valid from 18th
March 2018 to 17th March 2019.
Who all are covered under this policy?

This policy is known as Floater Group Mediclaim Cover which is a cashless policy and dependents
means, Self + Spouse + 2 Children (Parents are not covered under this policy).

Investacc Insurance Brokers Pvt Ltd to function as a dedicated Team. The Investacc will function as a
mediator between ABM employees and the Insurance Company in respect of all claims from ABMers,
right from claim preparation/submission to till settlement of the claim.

Every Insured will be provided with an Insurance Card from the Insurance Company which needs to be
produced to the Network Hospital where a representative of the Investacc will be available to take care
of all procedures and processes for hospitalization and other related activities. We have the facility of
making “E-card” and access your details for each and every individual. Those who are willing to have
this facility need to send an email to undersigned and we will provide you the website, user ID &
Password for accessing your details.

What is cashless hospitalization?

Cashless hospitalization does not mean that treatment is free of cost; Investacc will mediate between
the hospital and the insurance company and settle the hospital bills (claims) on behalf of the insured as
per the benefits named in the policy, coverage under the policy and exclusions under the policy. Any
expenses that are not payable under the insurance policy will not be authorized during hospitalization
and the same will have to be borne by the patient.

What are not reimbursable (claimable) under cashless hospitalization?

Generally, hospitalization and medical expenses like registration charges, telephone charges, diet
charges documentation charges and any other non -medical expenses included in the hospital bill are
not reimbursable under cashless hospitalization

Where is Cashless Hospitalization available?

Hospitalization and/or treatment is allowed anywhere in India where network hospitals and or Nursing
Homes i.e. only those hospitals/Nursing Homes with whom the insurance company have tie up for
cashless hospitalization exists.
These Hospital/Nursing Home are duly licensed registered with the appropriate authorities (Civic
Bodies) having more than 15 beds and a full time doctor and nursing staff in attendance. List of

Network hospitals across India will be forwarded separately Policy Coverage

• Pre-Existing Diseases
• Coverage is in effect from the date of policy
• Maternity cover without waiting period (Maternity cover restricted to Rs.30,000/-Normal delivery &
Rs.40,000/- Caesarean)
• Co-Pay: 15% Co-pay applicable on each claim for the employees & Dependent

Pre-Hospitalization

Relevant medical expenses incurred during a period up to 30 (thirty) days prior to hospitalization for
that illness or bodily injury sustained and considered a part of a claim admissible under the policy.

Post-Hospitalization

Relevant medical expenses incurred during a period up to 60 (sixty) days after hospitalization for an
illness or bodily injury sustained and considered a part of a claim admissible under the policy.

Inclusions (expenses reimbursable/claimable):

• Room, Boarding & Nursing Expenses- Not exceeding 1% of sum insured

• I.C unit expenses - Not exceeding 2% of Sum Insured(If Opted for Higher Room/ICU the
proportionate deduction applicable)
• Ambulance Services-1% of sum insured or Rs. 1500/-whichever is less
• Surgeon, Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines &
Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, cost of Prosthetic devices, implanted
during surgical procedures like pacemaker, relevant Laboratory/ Diagnostic test, X-Ray, and other
medical expenses related to the treatment.

Hospitalization & Day Care Procedure:

Admission in any Hospital in India upon the written advice of Medical Practitioner for a minimum
period of 24 consecutive hours except in case of “Specified Treatment”, where the admission in such
Hospital may be for a period of less than 24 hours. Specified Treatment means any treatment or cure for
any one or more of the following illnesses:
1. Cataract
2. Lithotripsy (Kidney Stone Removal)
3. Tonsillectomy
4. Dialysis
5. Dilation & Curettage
6. Chemotherapy
7. Radiotherapy
8. TURP (Prostate Surgery)
9. Coronary Angiography
10.Cardiac Catheterization
Exclusion:

 Injury /Disease- Arising from or attributable to war invasion, Act of foreign enemy, war like
operations or by nuclear weapons/ materials
 Circumcision, vaccination, aesthetic treatment, plastic surgery unless, cosmetic, inoculation
 Cost of braces, equipment or external prosthetic devices, non-durable implants, eye glasses, Cost of
spectacles lenses, hearing aids including cochlear implants and durable medical equipment,
correction of eye sight.
 Convalescence, general debility, “Run-down” condition or rest cure, obesity treaty and its
complications, congenital external disease/defects or anomalies, treatment relating to all
psychiatric and psychosomatic disorders, infertility, sterility, use of intoxicating drugs/alcohol, use
of tobacco leading to cancer.
 Any dental treatment which corrective, cosmetic, filling of cavity, root canal including wear and
tear etc. unless arising from disease or injury and which require hospitalization
 Self-injury, Bodily injury or sickness due to willful or deliberate exposure to danger (except in an
attempt to save a human life), intentional self-inflicted injury, attempted suicide and arising out of
non-adherence to any medical advice.
 Treatment of any Bodily injury sustained whilst or as a result of active participation in hazardous
sports or any kind./ any criminal act.
 Massages, Steam bathing, Shirodhara and alike treatment under Ayurvedic Treatment
 AIDS
 Diagnostic, X-Ray or Laboratory examination not consistent with or incidental to the diagnosis of
positive existence and treatment of any ailment,
 Vitamins and tonics unless forming part of treatment for injury or disease as certified by the
attending physician.
 Any Naturopathy Treatment. Experimental Treatment and Unproven treatment (not Recognized by
Indian Medical Council).
 Genetic disorders and stem cell implantation/surgery.
 Any Domiciliary Hospitalization. Treatment taken outside India
 Treatment of obesity and any other weight control programme
 Change of treatment from one system of medicine to another unless recommended by the
Consultant/Hospital under whom the treatment is taken.
 All non-medical expenses including convenience items for personal comfort such as telephone,
television, Ayah, Private Nursing / Barber or beauty services, diet charges, baby food, cosmetics,
tissue paper, diapers, sanitary pads, toiletry items and similar incidental expenses.
 Service charges or any other charges levied by hospital
 External and or durable Medical/ Non-medical equipment of any kind used for diagnosis and or
treatment including CPAP, CAPD, Infusion pump etc., Ambulatory devices i.e. walker, Crutches,
Belts, Collars, Caps, splints, slings, braces, Stockings, etc. of any kind Diabetic foot wear,
Glucometer/Thermometer and similar related items etc. and also any medical equipment Which is
subsequently used at home etc.
 Psychiatric and psychometric disorders, misuse of drugs /alcohol
 Expenses incurred primarily for evaluation/diagnostic purposes not followed by active treatment.
 Abortion unless recommended by Doctors
 Naturopathy treatment, acupressure, acupuncture, Magnetic and such other therapies Treatment
irrelevant to the diseases diagnosed, private nursing charges, referral fee to family doctors, out
station consultants/surgeon fees etc.
 Change of treatment from one party to other party unless being agreed/allowed and recommended
by the consultant under whom treatment is taken
 Any treatment required arising from insured participation in any hazardous activity
 Any stay in the hospital for any domestic reason or where no active regular treatment given by
hospital
 Non prescribed drugs and medical supplies, hormone replacement therapy,
 Doctors home visit charges.
 Treatment different from the one for which hospitalization was necessary

Documentation Required for Reimbursement:

 Dully filled Claim form (Part A & B)

 Original discharge card in proper format with diagnosis, admission and treatment details
 Original final hospital bill in proper taxable format with bill number and / or revenue stamp
 Original Hospital payment receipt
 Original medicine bills / cash memos supported by original prescriptions
 Investigation bills/ receipts supported by Original investigation reports and doctor’s advice
for same.
 Consultation bills supported by Consultation papers
 Diagnostic report for first time claim
 Implant (Invoices)/Stickers
 In Accident/Incident cases detail incidental report and MLC / FIR copy mandatory
 Photo ID proof, Address proof and Pan-card copy for both.
 A photocopy of Mediclaim policy in case of retail policy (Not applicable for corporate clients)
 Cancelled cheque of primary insured / proposer Keep photo copies of above documents with
you for further treatment (Insured Name should be printed on the cheque copy or Bank Pass
Book Copy or the Bank Statement copy).
Documents to be obtained before discharge from the hospital in case of cashless facility:

Do not collect
 Original discharge card
 Original reports
 Original bills
 Photocopy of Prescriptions

Collect

 Original X-ray plates

 Original prescription for treatment advised on discharge
 Ensure that you sign the original bill and a claim form before your discharge from the
hospital
Do’s:
1) Intimation needs to be sent to Investacc within 48 hours of hospitalization.
2) Intimation can be done through Investacc mail intimation
3) Claim documents needs to be submitted within 7(Seven) days from date of discharge in
case of reimbursement claim.
4) All claim documents to be submitted in Original.
5) The MLC/FIR copy in case of accident case.
6) In case of Deficiency, the additional required documents to be submitted within 7 days.
7) Obstetric history of patient in case of maternity claim.
8) Sticker / Bill for any prosthesis, stent, lens, etc implanted at the time of surgery, Invoices of
the Lens in the case of cataract operation.
9) Minimum hospitalization of 24 hours for admissibility of claim.
10) Photo id and Address Proof required during cashless process of Insured/Claimant.