Kindle Engineering &

Construction Private
Limited
Employee Benefits Policies Presentation

A business of Marsh McLennan

 Coverage Details
01

Claim Process
02

Claim Documents
03
Agenda
Definitions
04

Contact Details
05
Coverage Details
Medical Benefit – Coverage Details
Policy Parameter
 Insurer TATA AIG General Insurance Company Limited

 Policy Start Date 15th August 2023

 Policy End Date 14th August 2024

 Coverage Type Family Floater

Employee + Spouse + 3 Dependent Children Up To 25 Years + 2 Dependent Parents Up To 80

 Dependent Coverage
Years

 Sum Insured INR 5 Lakhs

Benefits / Extensions Coverage

Benefits / Extensions Coverage
 Standard Hospitalization • Yes
• Yes  Day Care Surgeries • Yes
 TPA Services
 Pre Existing Diseases • Yes  Pre-Post Hospitalization Expenses • Yes

 Waiver On 1/2/4 Years Exclusion • Yes  9 Months Waiting Period • Waived Off

 Waiver On 1st 30 Days Exclusion • Yes  Room Rent Capping • Yes

 Maternity Benefits • Yes Ambulance Charges • INR 2000

Terrorism Related Hospitalization •Covered

 Baby Cover Day 1 • Yes

4
Medical Benefit – Policy Period

Existing Employees + Dependents

Commencement Date 15th August 2023

14th August 2024

Termination Date
Or Last Working Date Whichever Is Earlier

New Joinees + Dependents

Commencement Date Date Of Joining

14th August 2024

Termination Date
Or Last Working Date Whichever Is Earlier

New Dependents (due to Marriage / Birth)

Commencement Date Date Of Such Event

14th August 2024

Termination Date
Or Last Working Date Whichever Is Earlier

5
Medical Benefit – Dependant Coverage
Maximum Number Of Members Insured In A Family 1+6
Employee Yes
Spouse Yes
Children 3 Dependent Children

Parents 2 Dependent Parents (Either Set)

Mid Term Enrollment Of Existing Dependents Disallowed

Mid Term Enrollment Of New Joinees (New Employees +

Dependents) Allowed Within 30 Days Of Joining

Mid Term Enrollment Of New Dependents (Spouse/Children)

Allowed Within 30 Days Of Marriage Or Birth

Age Band
1 Day To 80 Years

No Individual Should Be Covered As Dependant Of More Than One Employee

6
Medical Benefit – Standard Coverage
Covers Expenses Related to
• Room and Boarding
• Doctors Fees
• Intensive Care Unit
• Nursing expenses / RMO Charges within room rent limit (Should Be A Part Of Room Rent Charges).
• 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)
• Dressing, ordinary splints and plaster casts
• Costs of prosthetic devices if implanted during a surgical procedure
• Radiotherapy and chemotherapy
• Organ transplantation including the treatment costs of the donor but excluding the costs of the organ

A) The expenses are payable provided they are incurred in India and within the policy period. Expenses will be Non Payable List
reimbursed to the covered member depending on the level of cover that he/she is entitled to.
B) Expenses on Hospitalization for minimum period of 24 hours with active line of treatment 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 Hospitalization Benefit.
C) A security deposit can be collected by the empanelled hospitals to adjust the non admissible expenses
Room Rent Caps

• 1% Of Sum Insured For Normal Room and 2% Of Sum Insured For ICU Room Per Day

• The Above Limit Applies On Total Of Room Rent, Nursing Expenses and RMO Charges Which Means Room Rent + Nursing
Expenses + RMO Charges are Restricted To 1% Of Sum Insured For Normal Room and 2% Of Sum Insured For ICU Room.

• (In the Event Of Insured Being Admitted In Room Category Higher Than Capping’s Mentioned Above Per Day, Then the
Insured Will Bear the Difference Of All the Medical Expenses As In the Final Hospital Bill In the Same Proportion)
Other Conditions
• Congenital Internal Diseases Covered.
• Congenital External Diseases Covered In Life Threatening Conditions.
• Cyber Knife Treatment / Stem Cell Transplantation Covered With 50% Co Pay
• Cochlear Implant Treatment Restricted To 50% Of SI
• Organ Donor Expenses Covered
• Family Transportation Benefit Covered Up To INR 5000
• Nursing Allowance Covered up To INR 1500
• No Ailment Wise Capping
• AYUSH Treatment Covered Up To 25% Of Sum Insured
• Lasik/Refractive Error Treatment – If Power Of Eye Is Above +/-6.5 D Then Claim Is Payable
• Psychiatric Treatments Covered Up To INR 50,000
• Emergency Air Ambulance With Per Event Limit Of INR 100000
• Hospitalization Arising Out Of Functional Endoscopic Sinus Surgery Within A Limit Of 35000
Per Family Within the Family Floater Sum Insured
Capping On Parental Claims

• Coronary Angiogram Capped At INR 20000

• Angioplasty Capped At INR 100000 and By Pass Surgery Capped At INR 150000

• Limit On Treatment/Illness/Surgery:

• Hernia 50000

• Hysterectomy 50000

• Joint Replacement Including Vertebral Joints 125000

Pre and Post Hospitalisation
Pre-hospitalization Expenses

Medical Expenses incurred immediately before the Insured Person

is Hospitalised,
provided that:
i. Such Medical Expenses are incurred for the same condition for
Definition which the Insured Person’s Hospitalisation was required, and
ii. The In-patient Hospitalization claim for such Hospitalization is
admissible by the Insurance Company.

Covered • Yes

Duration • Up to Maximum 30 Days prior from the date of Hospitalization

Post-hospitalization Expenses

Medical Expenses incurred immediately after the Insured Person is

Hospitalised,
provided that:
i. Such Medical Expenses are incurred for the same condition for
Definition which the Insured Person’s Hospitalisation was required, and
ii. The In-patient Hospitalization claim for such Hospitalization is
admissible by the Insurance Company.

Covered • Yes

Duration • Up to Maximum 60 Days post the date of discharge

11
Maternity Benefits
Benefit Details
Benefit Amount • Up To INR 35,000 For Normal and INR 50,000 For C Section
Delivery Available For Employee and Spouse Up To First Two
Deliveries.
Restriction On No Of Children • Maximum Of 3 Living Children

Pre and Post Natal Expenses •Covered Up To INR 5000 Within Maternity Limit

9 Months Waiting Period • Waived Off

• These Benefits are Admissible In Case Of Hospitalization In India.

• Claim in respect of delivery for only first two children and/or operations associated therewith will be considered in respect of
any one Insured Person covered under the Policy or any renewal thereof. Those Insured Persons who already have two or
more living children will not be eligible for this benefit.
• Expenses incurred in connection with voluntary medical termination of pregnancy during the first 12 weeks from the date of
conception are not covered.

12
Additional Coverage For Modern Treatments
Covered With 50% Co-Pay As Below:

• Uterine Artery Embolization and HIFU (High Intensity Focused Ultrasound)

• Balloon Sinuplasty
• Deep Brain Stimulation
• Oral Chemotherapy
• Immunotherapy Monoclonal Antibody To Be Given As Injection
• Intravitreal Injections (Except Lucentis)
• Robotic Surgeries Covered With 50% Co Pay
• Vaporization Of the Prostrate (Green Laser Treatment Or Holmium Laser Treatment)
• Bronchial Thermoplasty
• Stereotactic Radio Surgeries
• Intra Operative Neuro Monitoring
• Stem Cell Therapy Covered with 50% Co Pay
 Claim Process
Claim Documents
Medical Benefit – Enrollment

 Existing employees are covered under the policy from 15th August, 2023. However, you must enroll
your dependents within 30 days of start date. If you fail to enroll, the next enrolment can be done only
at next year.

 All New joiner must enroll their dependents within 30 days of joining the company.

 In case of change of status due to marriage or birth of child , information of the new addition has to be
shared with the HR within 30 days of such event.
Medical Benefit – 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.

List Of Network Hospitals - Eligible For Cashless Hospitalization

Complete Hospital Network List For Cashless

https://tips.vidalhealthtpa.com/vidalhealth/HospNetwork.htm

Kindly Refer the Above Website Links For the Updated Hospital List

Planned Hospitalization

Emergency Hospitalization
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.
 Planned Hospitalization (Cashless)
Step 1 Member intimates TPA of the TPA authorizes cashless as
Pre-Authorization planned hospitalization in a specified Claim Registered Yes per SLA for planned
pre-authorization format at-least 48 by the TPA on hospitalization to the
hours in advance same day hospital
All non-emergency hospitalization
No
instances must be pre-authorized
with the TPA, as per the procedure
detailed below. This is done to
ensure that the best healthcare Follow non cashless Pre-Authorization
possible, is obtained, and the process Completed
patient/employee is not
inconvenienced when taking
admission into a Network Hospital.

Step 2 Member produces ID card Member gets treated and

Admission, Treatment & Hospital sends complete
at the network hospital discharged after paying
discharge set of claims documents
and gets admitted all non entitled benefits
for processing to TPA
like refreshments, etc.
After your hospitalization has been
pre-authorized, you need to secure
admission to a hospital. A letter of
credit will be issued by TPA to the
hospital. Kindly present your ID Claims Processing &
card at the Hospital admission Settlement by TPA &
desk. The employee is not required Insurer
to pay the hospitalization bill in case
of a network hospital. The bill will be
sent directly to, and settled by TPA

Next
Procedure For Cashless In a Network Hospital
• Send the Admission request note to Insurance Company.(Request note available
on admission counter of network hospital)

• Planned Admissions : Intimation to TPA & Marsh India 24 Hours Prior to the Date
of Admission.

• On receipt of the above form, on duty doctor will verify your coverage vis-à-vis
your insurance policy and if covered, a Authorisation Letter (AL) will be sent to
your hospital and copy to you if you so desire.

• In case of incomplete information on the request note, additional information

might be called for.

• TAT for the First Response is 3-4 Hours from the Receipt of the Documents.
• The denial of authorisation for cashless access does not mean denial of
treatment and does not in any way prevent you from seeking necessary medical
attention or hospitalization.
 Emergency Hospitalization & Process
Step 1
Get Admitted
In cases of emergency, the member
should get admitted in the nearest P
network hospital by showing their ID R
card.
O Pre-
C Member gets admitted in authorization No Non cashless
E the hospital in case of given by the
Hospitalization
S emergency by showing his TPA within
Step 2 ID Card maximum of 4 Process
S
Pre-Authorization by hospital hours
Relatives of admitted member Yes
should inform the call centre within
24 hours about the hospitalization &
Seek pre authorization. The
Member/Hospital applies Member gets treated and
preauthorization letter would be
for pre-authorization to the discharged after paying all
directly given to the hospital. In
TPA within 24 hrs of non medical expenses like
case of denial member would be
admission refreshments, etc.
informed directly

Step 3 TPA verifies applicability of Hospital sends complete set

Treatment & Discharge the claim to be registered of claims documents for
After your hospitalization has been and issue pre-authorization processing to the TPA
pre-authorized the employee is not
required to pay the hospitalization
bill in case of a network hospital.
The bill will be sent directly to, and
settled by TPA
 Non-Cashless (Reimbursement)
Admission procedure
• In case you choose a non-network hospital you will have to liaise directly with the hospital for admission &
send intimation to TPA within 24 Hours.
• However you are advised to follow the pre authorization procedure to ensure eligibility for reimbursement
of hospitalization expenses from the insurer.

Discharge procedure
• In case of non network hospital, you will be required to clear the bills and submit the claim to TPA for
reimbursement from the insurer. Please ensure that you collect all necessary documents such as –
discharge summary, investigation reports etc. for submitting your claim.

Intimation and Submission of Hospitalization Claim

• You must intimate the hospitalization to TPA/HR/Marsh India within 24 hours from date of admission.
• You must submit the final claim with all relevant documents within 30 days from the date of discharge from
the hospital.
Please note that noncompliance of timeline mentioned above will lead to rejection of
claim.
 Non-Cashless Claims Process

Member intimates TPA before or Insured admitted as per hospital Insured sends relevant
Claim registered by TPA after
as soon as hospitalization norms. All payments made by documents to TPA office within A
receipt of claim intimation
occurs member 15 days of discharge

Is document
Is claim TPA performs medical scrutiny of received within 15
payable? the documents days from •Insured will create the
Yes discharge summary of Bills (2 copies)
Yes
and attach it with the bills
No No •The envelope should
contain clearly the
Employee ID & Employee e-
Claim Rejected mail

Is
Payment to be made to HR.
documentatio
TPA checks document Claims processing done as per The discharge voucher and
n complete
sufficiency Yes SLA copy of payment receipt to be
as
sent to HR.
required
No

Send mail about deficiency and

A
document requirement
Important Points For Claims Process

 Intimation Is To Be Given 24 Hours Prior To Admission In Case Of Planned Admissions

and Within 24 Hours In Case Of Emergency Admissions.

 TPA Will Coordinate With the Hospitals and Will Process the Claims

 Pre Authorization Request In Case Of Admission In Network Hospital and Intimation In

Case Of Non Network Hospital Is Mandatory.
Reimbursement Claim Intimation Format
• Emp. Name:

• Patient Name :

• Health ID No/ Mediclaim Card No:

• Emp. Code:

• Date Of Admission:

• Hospital Name:

• Hospital Address:

• Contact No :

• Diagnosis/ Disease:

• Employee Contact Number:

Reimbursement Claims Intimation To Be Sent To:

Email ID For Claim Intimation:

TO: -
[email protected]

CC – HR Team
CC- [email protected]
Claims Document List – Reimbursement Claim
Completed Claim form with Signature Claims Form & Documents
Hospital bills in original (with bill no; signed and stamped by
the hospital) with all charges itemized and the original receipts

Discharge Report (original)

Reimbursement Reimbursement Documents Check Bank Details
Attending doctors’ bills and receipts and certificate regarding Claim Form Part A Claim Form Part B List
diagnosis (if separate from hospital bill)

Original reports or attested copies of Bills and Receipts for The Reimbursement Claim File With All Complete Documents Should Be
Medicines, Investigations along with Doctors prescription in Submitted In HARD COPY To Below Address Within 30 Days From the
Original and Laboratory
Date Of Discharge From the Hospital:
Follow-up advice or letter for line of treatment after discharge
from hospital, from Doctor. Ms Kinjal Patel
Provide Break up details including Pharmacy items, Materials, Marsh India Insurance Brokers Pvt. Ltd. 1001, 10th Floor, Sun Avenue One, Near
Investigations even though it is there in the main bill Shreyash Foundation Back Gate, Manekbaug – Shyamal Road, Satellite,
Ahmedabad – 380015
In case the hospital is not registered, please get a letter on
the Hospital letterhead mentioning the number of beds and
availability of doctors and nurses round the clock. Please Note That Noncompliance Of Process and Timeline Mentioned
Above Will Lead To Rejection Of Claim.
In non- network hospital, you may have to get the hospital
and doctor’s registration number in Hospital letterhead and
get the same signed and stamped by the hospital, if required.

If you are required to buy medicine or investigation done *Please Retain Photocopies Of All Documents Submitted
outside the hospital, kindly obtain proper Cash Memo /
Receipt for payment made by you in original.
Certain charges such as (Telephone / Fax, Food & Beverages
for relatives, Barber, etc.) are not covered in your insurance
policy, if you have obtained such services from the hospital
please pay for the same directly to the hospital.
Claim Settlement

• When you submit your claim along with all relevant documents to TPA, the same
will be scrutinized by a team of medical doctors and claim processors and if
found in order – TPA will issue a reimbursement for the amount paid by you .

• In case of discrepancies or deficiencies in the documents, TPA will issue a letter

listing the deficiencies and deficient documents need to be submitted within 15
days.

• If the claim file is complete in all respects TPA will normally settle the claim within
15 working days from the date of receipt of complete documents.

• Insurer/TPA will settle the claim, deducting the amount pertaining to deficient
documents/Non Payable Items.

• When the deficient documents are submitted, TPA will reopen the file and pay for
the same if admissible.
Definitions
Benefit – Definitions
Day Care List
Benefits Definition

Any Pre-Existing ailments such as diabetes, hypertension, etc or related ailments for which care, treatment

√
Pre existing
or advice was recommended by or received from a Doctor or which was first manifested prior to the
diseases
commencement date of the Insured Person’s first Health Insurance policy with the Insurer

Any Illness diagnosed or diagnosable within 30 days of the effective date of the Policy Period if this is the Covered

√
First 30 day waiting first Health Policy taken by the Policyholder with the Insurer. If the Policyholder renews the Health Policy
period with the Insurer and increases the Limit of Indemnity, then this exclusion shall apply in relation to the
amount by which the Limit of Indemnity has been increased

During the first year of the operation of the policy the expenses on treatment of diseases such as Cataract,
Covered

√
First Year Waiting Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele,
period Congenital Internal, Sinusitis and related disorders are not payable. If these diseases are pre- existing at
the time of proposal they will not be covered even during subsequent period or renewal too
Covered
In consideration of additional premium, this policy is extended to cover the new born child of an employee

√
covered under the Policy from the time of birth till 90 days. Not withstanding this extension, the Insured
Baby Cover Day 1 shall be required to cover the newly born children after 90 days as additional member as mentioned
elsewhere under this Policy. However it is mandatory for the employee to enroll his/her child within 30 days
from the date of child birth. Covered

√
The Insurer will pay for Emergency ambulance and other road transportation by a licensed ambulance
Ambulance service to the nearest Hospital where Emergency Health Services can be rendered. Coverage is only
provided in the event of an Emergency.
Covered
Any dental treatment or surgery of a corrective, aesthetic nature unless it requires Hospitalization; is
Dental & Vision carried out under general anesthesia and is necessitated by Illness or Accidental Bodily Injury. X
Treatment
Excludes cosmetic treatment, frames, contact lenses & hearing aid cost.
Restricted
Day Care Procedure means the course of medical treatment or a surgical procedure listed in the Schedule

Day Care
which is undertaken under general or local anesthesia in a Hospital by a Doctor in not less than 2 hours
and not more than 24 hours. Generally 8 aliments (i.e. Dialysis, Chemotherapy, Radiotherapy, Eye
surgery, Dental Surgery, Lithotripsy (kidney stone removal), Tonsillectomy, D & C), do refer day care as
attached.
√Covered
 Benefit – Definitions
X Not Covered

Diagnostics Expenses

Definition Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-Ray or laboratory examinations or
other diagnostic studies not consistent with or incidental to the diagnosis and treatment of the positive existence
of presence of any ailment, sickness or injury for which confinement is required at a Hospital/Nursing Home or at
home under Domiciliary Hospitalization as defined

Note: When treatment such as Dialysis, Chemotherapy, Radiotherapy is taken in the Hospital/Nursing Home/Clinic and the insured is discharged the same day the
treatment will be considered to be taken under Hospitalisation Benefit section and thus covered.
Medical Benefit – General Exclusions

•Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations
•Circumcision unless necessary for treatment of disease
•Congenital external diseases or defects/anomalies
•HIV and AIDS
•Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.
•Venereal diseases
•Injury or disease caused directly or indirectly by nuclear weapons
•Naturopathy
•Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone
charges, etc.
•Cost of spectacles, contact lenses, hearing aids. Multifocal lens in Cataract is not payable
•Dental treatment of any kind unless requiring hospitalization due to sickness or injury
•Any cosmetic or plastic surgery except for correction of injury
•Hospitalization for diagnostic tests only
•Vitamins and tonics unless used for treatment of injury or disease
•Infertility treatment
•Voluntary termination of pregnancy during first 12 weeks (MTP) Exclusions
•Detailed list of exclusions and FAQ attached
Medical Benefits – Contact Details

Providers

1st Level Contact Escalation Point:-

Escalation 1:-
Ms Kinjal Patel Mr. Salil Ojha
[email protected]
Marsh India 8980016256
Marsh India
9825166869 Escalation 2:-
Mr. Jwal B Chokshi
[email protected]
[email protected] 7045940829

30
Group Personal
Accident
Coverage Details

Enrollment in the program

Claims Process

Claims Document List

Contact Details
 Benefit Details – GPA
 Sum Insured 3 Times Of Annual CTC
Insurance Company TATA AIG General Insurance Company Limited
Policy Period 15th August 2023 To 14th August 2024

Cover Details
Accidental Death Yes
Permanent Total Disablement Yes
Permanent Partial Disability Yes (As Per the Table)
Temporary Total Disability (1 % Of SI Or Rs.10,000/- Or Actual Salary Per Week For 100 Weeks Whichever Is Less)
Worldwide Cover and Terrorism Covered
Children Education Benefit For Dependent Children In Case Of Employee’s Death Up To Rs 10,000 Per Child For 2
Children

Repatriation Of Mortal Remains / Carriage Of Covered Up to Rs 10,000

Body
Medical Expenses Reimbursement Up To 40 % Of the Death/Disability Claimed Amount Or Actual Medical Bills
Or 10% Of SI Whichever Is Less .
Animal Bite/Snake Bite/Insect Bite Covered Except Mosquito Bite.
Modification Of Residence/Vehicle House and Vehicle Modification Allowance In Case Of PTD Maximum Up To Rs.20,000 Or
Actual Whichever Is Less.

Cremation Or Funeral Expenses In Case Of Accident Maximum Up To Rs.10,000 Or Actual Whichever Is Less.
Family Transportation Benefit Covered up To INR 3000
Ambulance Charges Covered Up To INR 5000
 Enrolment

• All existing employees are covered under the policy from 15 th August 2023.

• For new employees, your enrollment data must reach the Insurer within 30 days of your joining Company. Please contact your HR
and provide enrollment data (viz. name, date of birth, gender).
Claims Procedure for GPA

Employee / Beneficiary notifies HR, On obtaining all relevant Claim Investigation and Review
who in turn would intimate Insurer documents, Insurer begins within 3 days of submission of
and submit required claims processing the claims all the required documents
documents within 14 days of the
event

Yes No
Is claim
approved
within 7
days

On approval, the cheque is sent On rejection of the claim,

to HR within 3 working days, Insurer would provide a valid
from where it is given to the reason for the rejection to HR /
Employee / Beneficiary Employee / Beneficiary

BACK
Document Checklist

Death Claims Dismemberment/ Disablement

Claims
• Completed claim form
• Attending Doctor's report • Completed claim form
• Death Certificate • Doctor's Report
• Last 3 months of salary slip • Disability Certificate from the
• Post Mortem/ Coroner's report Doctor
• FIR ( First Information Report) • Last 3 months of salary slip
• Police Inquest report, wherever • Investigation/ Lab reports (x-
applicable ray etc.)
• Original Admission/ discharge
card, if hospitalized.
• Police Inquest report, wherever
applicable

GPA Claim Form Detailed Document Requirements

GPA Claim Form Documents

required

BACK
Policy Period

Existing Employees
15th August 2023
Commencement Date

Termination Date 14th August 2024

(Or Date Of Leaving the Organization Whichever Is Earlier)

New Joinees

Commencement Date Date Of Joining

Termination Date 14th August 2024

(Or Date Of Leaving the Organization Whichever Is Earlier)

Back
Details for PPD

BACK
Exclusions

1. Service on duty with any armed force

2. Intentional self injury, suicide or attempted suicide
3. Insanity
4. Venereal disease
5. AIDS
6. Influence of intoxicating drink or drugs
7. Aviation other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft
any where in the world
8. Nuclear radiation or nuclear weapons material
9. Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil
war, rebellion, revolution, insurrection, mutiny, military, or usurped power, seizure, capture, arrest,,
restraint, detainment’s of all kings, princes, and people of whatever nation, conditions and qualities so ever
10. Childbirth, pregnancy or other physical causes peculiar to the female sex
11. While committing any breach of law with criminal intent

BACK
Group Term Life Cover

Coverage Details

Enrollment in the program

Claims Process

Claims Document List

Contact Details
Benefit Details
Policy Parameter
 Insurer TATA AIA Life Insurance Company
 Policy Start Date 31st August, 2023
 Policy End Date 30th August, 2024

 Sum Insured Eligibility 3 Times Of Annual CTC

Coverage Details

Death

• A Life Cover Will Provide Financial Security To Family Members In Case An Employee Loses His/Her Life Owing To Death Due To
Any Reason.

• In the Event Of Death Of A Member Due To Any Cause (Natural/Accidental/Disease), A Compensation In the Tune Of 5 Times Of
Annual CTC Will Be Paid To Family Members Of the Deceased Employee.
Policy Period

Existing Employees

Commencement Date 31st August, 2023

30th August, 2024

Termination Date (Or Date Of Leaving the Organization Whichever Is
Earlier)

New Joinees

Commencement Date Date Of Joining

30th August, 2024

Termination Date (Or Date Of Leaving the Organization Whichever Is
Earlier)
 Enrolment

• All existing employees are covered under the policy from 31st August, 2023

• For new employees, enrollment data must reach the Insurer by 7 th of subsequent month of joining. Please contact your HR and provide
enrollment data (viz. name, date of birth, gender) immediately on joining.

• The policy ends on 30th August, 2024.

Claims Procedure for GTL

Beneficiary notifies HR, On obtaining all relevant Claim Investigation and Review
who in turn would intimate Insurer documents, Insurer begins within 3 days of submission of
and submit required claims processing the claims all the required documents
documents within 90
days of the event

Yes No
Is claim
approved
within 7
days

On approval, the cheque is sent On rejection of the claim,

to HR within 3 working days, Insurer would provide a valid
from where it is given to the reason for the rejection to HR /
Employee / Beneficiary Employee / Beneficiary

BACK
 GTL – Document Checklist

• Claim form with authorized signature & stamp of client

• Original Death Certificate
• Nomination declaration in the attached format (incase the nomination declaration is not in the attached
format, then the leave records will have to supplied)
• Nominees bank details GTL Claim Form
• Proof of age of the life insured
• Membership proof and Member id proof
• Last attending doctor's death certificate
GTL Claim Form
• Guardian details for minor beneficiary
• Driving license (Accidental claim)
• First information report (Accidental & dismemberment claim or any police case in natural death)
• Post mortem report (Accidental or any police case in natural death)
• Police case closure report (Accidental or any police case in natural death)
• Viscera Report (Accidental or any police case in natural death, if applicable)
• Cause of death certificate
45
Marsh India Insurance Brokers Pvt. Ltd. having corporate and the registered office at 1201-02, Tower 2, One World Center, Plot-841, Jupiter Textile Compound Mills, Senapati Bapat Marg, Elphinstone Road (W), Mumbai 400 013 is registered as a
composite broker with Insurance and Regulatory Development Authority of India (IRDAI). Its license no. is 120 and is valid from 03/03/2021 to 02/03/2024. CIN: U66010MH2002PTC138276

A business of Marsh McLennan Copyright © 2022 Marsh India Insurance Brokers Pvt. Ltd. All rights reserved.