Medibuddy-EnrolPolicyConditions 22

Welcome to the Medi Assist Family
Medi Assist India TPA Pvt. Ltd. (Medi Assist) has been appointed as the Third Party Administrator (TPA) for health
insurance benefits management by your organization. As a privileged member of the Medi Assist family, you are now
eligible for hassle-free health insurance claims administration.
What this really means for you is that should you or any of your family members who are covered under your
insurance policy require hospitalization, we become the interface between you and your insurer. We handle all the
paperwork related to your claim; wherever possible, we give you the benefit of cashless hospitalization; and we
ensure that your claim is settled at the earliest.
Apart from hospitalization, Medi Assist also enables access to a range of wellness services at our network hospitals
and service providers – and we make these available to you online with our Medi Assist Online Portal, and over your
smartphone, with our mobile app, MediBuddy.
Please retain this booklet for quick help and future reference.
Here’s to healthy living!

India Medical Insurance - Policy Terms & Conditions
Insurance Company United India Insurance Company Ltd.
Third Party Administrator(TPA) Medi Assist India TPA (P) Ltd.
Policy Period Start Date 00:00 Hours of March 30, 2022
Policy Period End Date 00:00 Hours of March 29, 2023
Age Limit 1 day to 90 years
Base Plans
Plan A
A 100% company sponsored plan in which you are provided default coverage (associates who are in the India
location) whereas your Spouse and up to two living children are provided coverage subject to enrolment
within the window period. Sum insured will be as per band.
A maximum of first two living children below 21 years, which can be extended up to 25 years only if they are
unmarried and unemployed girls, and are children pursuing higher studies (subject to submission of Bonafide
Certificate from the institution). Differently abled children will be provided coverage without age restriction
subject to child being dependent on parents and subject to the limit of children in plan (subject to
declaration from Associate and HR confirmation).
Plan B
This plan provides cover for your dependent for any one set of Parents / Parents-in-law in addition to Spouse
and up to two children subject to enrolment within the window period. Plan A & Plan B is a floater Insurance
coverage and the premium of Plan B will be borne by the associate. Please refer to the premium table below
for the same. Maximum Age limit is 90 years of Parents / Parents-in-law.
Plan C
This plan is designed for onsite employees only who wish to opt for health insurance coverage for any one
set of their parents / parents-in-law residing in India. The plan is opened only once in a year during the
annual enrolment period for associates located onsite. The premium of this plan will be entirely borne by the
associate, please refer to the premium table below for the same. Maximum Age limit is 90 years of Parents /
Parents-in-law.
If an Onsite associate opting for Plan A/Plan B and upon return to India no new enrolment window will be
available. Enrolment of dependents to be completed (spouse/ children/ parent/ parent-in-laws) within this
online enrolment window.
If an Onsite associate opting for Plan C and on their return to India, only Plan A will be given as a part of
enrolment and the sum insured of Plan A and Plan C taken earlier cannot be considered as a single sum
insured and no new enrolment window/coverage will be available for any associate and dependents
returning to India on temporary basis or only dependents on permanent basis.
Premium Table:
Premium Grid (Payable by Associate)
U1 to U3 U4 & P1 P2 & above
Plan Type
Sum Premium Sum Premium Sum Premium
Insured Amount Insured Amount Insured Amount
Plan A 2 lakhs - 3 lakhs - 4 lakhs -
Plan B 1 lakhs 16,364 1 lakhs 25,898 2 lakhs 33,168
Plan A+B
3 lakhs 16,364 4 lakhs 25,898 6 lakhs 33,168
(Floater Coverage)
1 lakh 12,289 1 lakh 12,289 1 lakh 12,289
Plan C 2 lakhs 22,768 2 lakhs 22,768 2 lakhs 22,768
3 lakhs 33,893 3 lakhs 33,893 3 lakhs 33,893
| https://www.mediassist.in | https://Portal.mediassist.in |Email ID: [email protected] | Toll No: 8152860999 | Tech M Policy T&C 22-23
Key Points on Premium:
Plan B Premium is applicable on floater basis & shall remain the same whether you add one or both parents.
Premiums and sum insured amounts mentioned in policy are per annum.
The applicable Premium would be deducted in 3 equal instalments from your salary in subsequent pay cycle,
only if you opt for any voluntary plan i.e. Plan B, Plan C and Top Up.
On account of separation from the organization, the coverage for all plans under Group Medi Claim Policy
will end on the last working day at Tech Mahindra and the related premium amount will be refunded with
F&F Settlement in case there was no claim reported against any of the enrolled beneficiaries.
Associates joining post policy commencement will be charged premium from their DOJ as per the below grid
and Premium changes would commensurate with market behavior every year for all Plans.
Quarter % of Annual premium payable for Associates joining between Premium Charged
1st quarter 30.03.2022 - 29.06.2022 100%
2nd quarter 30.06.2022 - 29.09.2022 75%
3rd quarter 30.09.2022 - 29.12.2022 50%
4th quarter 30.12.2022 - 29.03.2023 25%
Top-Up Cover:
An optional top-up cover of additional sum insured is also available in addition to the above mentioned base plans.
Coverage for you & your family members will be as per the beneficiaries enrolled in the base plan opted during
inception. Associates can opt for Top up coverage between 2 to 20 Lakhs. Top-Up is an optional plan which can be
opted by paying an additional premium. TOP UP PREMIUM Table - Premiums are inclusive of 18% GST.
Top Up Premium Grid
Sum Insured (INR) Premium (per annum / inclusive of 18% GST)
200000 6,662
300000 7,564
400000 8,077
500000 9,578
1000000 12,349
1500000 18,127
2000000 27,730
Key Points of the Top-Up Cover:

Top up plan opted for the first time will have waiting period of 3 months for the claims related to Pre Existing
Disease (PED) ailments.
The terms and conditions are identical to those of the base policy comprising of co-pay, disease/ailment wise
capping, pre and post hospitalization benefits, etc.
Top-up cover will get activated when sum insured/disease sub-limit is exhausted in the base policy. Once the
sub-limit is exhausted in the base policy, the same sub-limit clause becomes applicable again in the top-up.
Items deducted for a claim processed under family floater (of the base plan) like excess room rent / ICU rent
/ non-payable items / co-payment amount cannot be claimed from top-up cover.
Expenses related to all maternity benefits, related complications, and surrogacy is excluded from the scope
of the top-up coverage.
Onsite associate opting Top-up Plan along with Plan C during inception, then on return to India Top up Plan
will be applicable only for dependents enrolled under Plan C and Top up plan can be opted only during policy
inception & not during mid-term of policy for existing associates.
Maternity Expenses:
Maternity is covered without any waiting period up to INR 40,000 for normal delivery and INR 50,000 for C-
section. A co-payment of 10% will be applicable on the maternity limit.
Pre-Post Hospitalization expenses are not covered for Maternity related claims i.e. Pre-Post natal expenses.
Day one coverage for the new-born baby subject to enrolment within 45 days of Date of Birth.
Expenses incurred towards Well Baby Care hospitalization are not covered under the policy.
New born coverage related to Jaundice to be restricted with capping of INR 15,000 with 10% co-payment.
All Maternity related complications related hospitalization expenses traceable to pregnancy, childbirth
including normal Caesarean Section will be included within Maternity Limit.
Maternity benefit is extended up to two living children only. Those insured persons who are already having
two or more living children regardless of child enrolment in the policy will not be eligible for maternity claim.
Surrogacy-Covered for 1st child only & within maternity limit. Pre-Post expenses aren’t covered in surrogacy.
Tubectomy and Vasectomy is not covered under the policy.
Third and fourth Child Coverage:

The third and fourth child may be covered in the policy. However, associate will need to pay an additional
premium per child from the mentioned Grid. The coverage amount will be as per existing Base Plan Type.
The premium mentioned is per child, if associate is adding 3rd Child & 4th Child under the coverage.
U1 to U3 U4&P1 P2 & Above

Plan Type
Premium Amount Premium Amount Premium Amount
Third Child (Plan A) 1,200 1,800 2,400
Third Child (Plan B) 3,912 6,134 7,930
Key Points on Base Plan and Policy:

No mid-term inclusion for dependents enrolment. However, the same is excluded for newly married Spouse
within 45 days from date of marriage and New born child (first two living children) within 45 days from the
date of birth. Therefore, the Reimbursement claim payment will be delayed due to the member addition
endorsement occurring during mid-term of the policy period. Hence, request to opt for Cashless facility.
Newly married Spouse and New Born baby to be added / declared on Medi Buddy Portal for coverage within
45 days of event. If Date of Marriage of associate and Date of Birth of baby is beyond 45, system will not
provide option to select date beyond 45 days of DOM/DOB. If in case, Spouse and Baby are added with
incorrect date i.e. DOM/DOB, then added dependent wouldn’t be eligible for coverage for the policy year.
No mid-term inclusion of Parents/Parents-In Law in the policy. Even if associate getting married in between
of policy period and will have option to enroll Parents/Parents-In Law during next renewal window only.
Only one set of Parents/Parents-in-law will be allowed for enrolment under Plan B, adverse selection
(Parents & Parents-in-law) will not be allowed.
Plan B - Dependents enrolled under Plan B for insurance coverage will be locked for 3 Plan years. If there are
no amendments made during the year of unlock post 3 years completion, Plan B lock in will continue for
another 3 plan years.
Associate who resign / separated from Tech Mahindra, need to submit member claims (if any) before the
last working date else it will not be possible to accept / process as member details will be removed on
associate last working date. If any claim benefit is taken (by associate / dependent member) after the last
working day, Medi Assist will ask for refund of the paid amount from associate.
On account of demise of any dependent enrolled under Plan B, associate can write to us at
[email protected] along with Death certificate for removal of name during policy renewal period only.
The benefit for pay out of claim for - Main Hospitalization and Pre-Post Hospitalization claim expenses will
be payable under the policy in which the Date of Admission is falling. For example, if the DOA is 28th
March’22 and DOD is 5th April’22, which is a policy transition period, all the expenses related to this claim
(main and pre-post) will be considered in the policy year 2021-22.
Change in the associate Plan / Coverage amount due to mid-term change in band / salary / designation
during policy year is not applicable.
This insurance coverage is for treatment taken within Geographical limits of India only.
Portability option is available. Associate has to approach Mahindra Insurance Brokers -

[email protected] before 30 days or prior of last working day in the organization to avail
portability benefit.
Hospital Criteria for Claim/Coverage:
A Hospital established for in-patient care and day care treatment of illness and/or injuries and which has
been registered as a Hospital with the local authorities under the Clinical establishments (Registration and
Regulation) Act, 2010 or under the enactments specified under the Schedule of Section 56(1) of the said Act
OR complies with all minimum criteria as under:
Has qualified medical practitioner(s) in charge round the clock.

Has qualified nursing staff under its employment round the clock.
Has a fully equipped Operation Theatre of its own where surgical procedures are carried out.
Maintains daily records of patients & makes these accessible to the insurance company's authorized
personnel. Have at least 10 in-patient beds in towns having a population of less than 10 lacs and at
least 15 in-patient beds in all other places.
Please refer to the Network Hospitals information in the home page of our MediBuddy Web Portal (via TWINGO
Portal login https://twingo.techmahindra.com) - https://www.medibuddy.in/networkHospitals
In the event of any claim admissible under this scheme, the insurance company will pay to the hospital, nursing
home or the insured person, the amount of such expenses as would fall under different heads mentioned below:
Pre-existing disease is covered in the Base Policy from Day One, waiver of first 30 days waiting period, 1st
Year, 2nd Year, 3rd Year& 4th Year exclusions – waived for all
Room, boarding & nursing expenses as provided by the hospital or nursing home not exceeding 1.5% of the
base plan sum insured per day or the actual amount, whichever is less. This also includes nursing care, RMO
charges, IV fluid charges, blood transfusion charges, injection administration charges and similar expenses.
Intensive Care Unit (ICU) expenses not exceeding 3% of the base plan sum insured per day or actual amount,
whichever is less. This also Includes Monitor charges, which are not payable separately
Room / ICU Charges are calculated only on Base Sum Insured and Proportionate expenses are not applicable
except for difference of Room / ICU Charges.
Surgeon, anesthetist, medical practitioner, consultants, specialists’ fees. Anesthetic, blood, oxygen,
operation theatre charges, surgical appliances, medicines & drugs, dialysis, chemotherapy, radiotherapy,
cost of artificial limbs, cost of prosthetic devices implanted during surgical procedures like pacemaker,
orthopedic implants, infra-cardiac valve replacements, vascular stents, relevant laboratory/diagnostic tests,
X-rays and such similar expenses that are medically necessary, subject to Policy T&C.
Hospitalization expenses (cost of organs excluded from the coverage) incurred on the donor with respect to
organ transplant to the insured will be covered within the major surgery ailment capping limit per
hospitalization.
INR 2,500 is payable for ambulance services per hospitalization (AMBULANCE Payable-Ambulance from
home to hospital or inter-hospital shifts is payable/ RTA as specific requirement is payable).
Each and every claim is subject to 10% co-pay on the total approved claim amount unless specifically
exempted.
Co-pay and Non-payable expenses are not applicable in case of associate’s Death during the period of
hospitalization.
Medical Insurance benefits for Same Gender Partners included in the policy, subject to policy terms and
conditions. Insured / Primary member should confirm the Partner’s details with a Self-attested declaration
form to [email protected] with GID and Mobile number to connect if any further information required
The partner shall be covered from inception of the policy date only. No mid-term inclusion or change of
partner is permitted during the policy period.
Gender change operation for only associate will be covered up to the limit of 5 Lacs during a policy year.
For AYUSH Treatment, hospitalization expenses are admissible only when the treatment has been
undergone in a government hospital or in any institute recognized by the government and/or accredited by
the Quality Council of India / National Accreditation Board of Health.
Expenses in respect of the following specified illnesses/surgeries will be restricted as detailed below:
Cataract: 10% of the sum insured or INR 25,000, whichever is less and 10% co-pay for all dependents
Hernia and hysterectomy: 20% of the sum insured or INR 60,000, whichever is less and 10% co-pay
for parents/In-laws only
Major surgeries:75% of the sum insured or INR 3,00,000, whichever is less and 10% co-pay for
parents/In-laws only
Major surgeries include cardiac surgeries; brain tumor surgeries; pacemaker implantation; cancer
surgeries; hip, knee, joint replacement surgeries; and organ transplant. The above limits specified
are applicable per hospitalization
The above mentioned Sublimit capping will be inclusive of Pre/Post Hospitalization Expenses
The below mentioned non-medical payments are covered under the current policy:
HIV investigation charges, IV cannula charges, IV injection charges, additional doctor charges,
bandage, plaster, cotton pads, gloves, electrolytes, cotton bandage, surgical tape, oxygen
consumption charges, nebulizer charges, oxygen mask charges.
Home Quarantine Benefit – COVID 19:
Coverage for treatment at home / other places / facilities / isolation centres which are notified by competent
Government Authority for treatment of Covid 19 patients will be covered and agree subject to:
Coverage restricted to Covid 19 positive patients only and for treatment of Covid 19 only.
The home / other treatment continues for at least 3 consecutive days in which case we will make payment
under this Benefit in respect of Medical Expenses incurred from the first day of such treatment.
The treating Medical Practitioner confirms in writing that home / other isolation was medically required and
the Insured Person satisfies us that a Hospital bed was unavailable
If a claim is accepted under this Benefit then we shall not pay any Post-hospitalization Medical Expenses, but
we will accept a claim for Pre-hospitalization Medical Expenses
No payment will be made towards accommodation / room rent under this clause.
All expenses payable against valid GST invoices raised by a registered hospital
Sublimit of up to Rs.15, 000 per patient under Family Sum Insured with 10% copay applicable.
Self-medication, Self-Quarantine for suspected COVID 19, Diagnosed with COVID 19 prior to commencement
of Policy and Cost of PPE Kit is excluded from the benefit.
Infection control / Disinfection / Sanitation charges and COVID Precaution charges not payable
Mandatory Documents required for Home Quarantine Benefit:
Duly filled Claim Form.
Covid Positive Report.
Doctor consultation paper advising Home Quarantine.
Doctor Prescription for pharmacy and lab investigations.
Supporting pharmacy bills and all lab investigation bills.
All lab investigations reports.
Health Card of Patient, ID proof and Employee Co. ID proof.
Original Cancel Cheque of Self i.e. Employee (Name, IFSC Code & A/C number should be present).
The above mentioned documents are not exhaustive, but may differ on a case to case basis; additional documents
can be called for after the medical scrutiny.
Home Quarantine Benefit for Covid Positive cases can be availed only in Reimbursement. The claim process for
submission of documents is shared under Reimbursement claim process Header below.
Benefits the Policy:
Modern Treatment
Sr.
Methods & Advancement Sublimit Co-pay applicable
No.
in Technology
No Co-pay for claims of
Uterine Artery Embolization &
Up to 20% of Sum Insured subject to a maximum of Employee, spouse &
1 High Intensity Focused
Rs.2 Lacs, per policy period and whichever is less. children and 10% only for
Ultrasound (HIFU)
Parental Plan
2 Balloon Sinuplasty
Rs.1 Lac, per policy period and whichever is less. children and 10% only for
Parental Plan
Employee, spouse &
3 Deep Brain Stimulation Up to 70% of Sum Insured
children and 10% only for
Parental Plan
10% Co-pay for all
4 Oral Chemotherapy As per policy T&C
dependents
Immunotherapy-Monoclonal Up to 20% of Sum Insured subject to a maximum of Employee, spouse &
5
Antibody to be given as injection Rs.2 Lacs, per policy period and whichever is less. children and 10% only for
Parental Plan
10% Co-pay for all
6 Intra vitreal Injections As per policy T&C
dependents
Up to 75% of Sum Insured per policy period for claims No Co-pay for claims of
involving Robotic Surgeries for (i) the treatment of Employee, spouse &
any disease involving Central Nervous System children and 10% only for
Robotic Surgeries (Including irrespective of aetiology; (ii) Malignancies Parental Plan
7
Robotic Assisted Surgeries) No Co-pay for claims of
Up to 50% of Sum Insured per policy period for claims Employee, spouse &
involving Robotic Surgeries for other diseases children and 10% only for
Parental Plan
Up to 50% of Sum Insured per policy period for claims Employee, spouse &
8 Stereotactic Radio Surgeries
involving Stereotactic Radio Surgeries. children and 10% only for
Parental Plan
9 Bronchial Thermoplasty
Parental Plan
Vaporization of the Prostate
10 (Green laser treatment for
holmium laser treatment)
Parental Plan
Intra Operative Neuro Monitoring Up to 15% of Sum Insured subject to a maximum of Employee, spouse &
11
(IONM) Rs. 1 Lac, per policy period and whichever is less. children and 10% only for
Parental Plan
Stem Cell Therapy:
Hematopoietic Stem Cells for
10% Co-pay for all
12 bone marrow transplant for As per policy T&C.
dependents
haematological conditions to be
covered only
In regards to further clarification for above mentioned ailments, you may drop us an email at [email protected] along with
all relevant medical documents for us to review and confirm you on any clarification needed.
Pre-Post hospitalization Medical Expenses:
Pre and post hospitalization expenses payable with respect to each hospitalization shall be the actual
expenses incurred
Pre-hospitalization Medical Expenses:

Relevant Medical expenses incurred for up to 30 days prior to the admission date will be
considered.
Provided that, such medical expenses are incurred for the same condition for which the insured
person’s hospitalization was required and the inpatient hospitalization is admissible by the
insurance company.
Post-hospitalization Medical Expenses:

Relevant medical expenses incurred for up to 60 days from the date of discharge will be
considered.
Provided that, such medical expenses are incurred for the same condition for which the insured
person’s hospitalization was required and the inpatient hospitalization is admissible by the
insurance company.
Exclusions:
The company shall not be liable to make any payment under this policy for any expenses whatsoever incurred by any
insured person in connection with or in respect of:
Injury / disease directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign
enemy, war-like operations (whether war has been declared or not).
Circumcision unless necessary for treatment of a disease not excluded here under or as may be necessitated
due to an accident.
Vaccination or inoculation of any kind unless it is post animal bite.
Change of life or cosmetic or aesthetic treatment of any description such as correction of eyesight, etc.
Plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
Cost of braces, equipment or external prosthetic devices, non-durable implants, eyeglasses, Cost of
spectacles and contact lenses, hearing aids including cochlear implants, durable medical equipment.
Dental treatment or surgery of any kind unless necessitated by accident and requiring hospitalization.
Convalescence, general debility, run-down condition or rest cure, obesity treatment and its complications
including morbid obesity; congenital external disease / defects or anomalies, treatment relating to all
psychiatric and psychosomatic disorders, infertility, sterility, venereal disease, intentional self-injury and
Use of intoxication drugs / alcohol
All expenses arising out of any condition directly or indirectly caused by or associated with Human T-Cell
Lymphotropic Virus Type III (HTLB - III) or Lymphadenopathy Associated Virus (LAV) or the Mutants
Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind, commonly
referred to as AIDS.
Charges incurred at a hospital or nursing home primarily for diagnosis, x-ray or laboratory examinations or
other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive
existence of presence of any ailment, sickness or injury for which confinement is required at a hospital or
nursing home. (Admission for diagnosis, evaluation, investigation, observation etc. is not admissible).
Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the
attending physician.
Injury or disease directly or indirectly caused by or contributed to by nuclear weapon / materials.
Naturopathy treatment, acupressure, acupuncture, magnetic therapies, experimental and unproven

treatments/ therapies. Treatments including experimental drug therapy not based on established medical
practice in India, experimental or unproven treatments / therapies.
External and/or durable medical / non-medical equipment of any kind used for diagnosis and/or treatment
and/ or monitoring and/or maintenance and/or support including CPAP, CAPD, C-arm, infusion pump, and
syringe pump Oxygen concentrator etc. Ambulatory devices, i.e., walker, crutches, belts, collars, caps,
splints, slings, braces, stockings, Elastic-crepe bandages, external orthopedic pads, subcutaneous insulin
pump, diabetic footwear, glucometer / thermometer, alpha / water bed and similar related items, etc., and
also any medical equipment, is non-payable and which is subsequently used at home etc.
Genetic disorders related treatment / Investigations/expenses not payable
Change of treatment from one system of medicine to another unless recommended by the
consultant/hospital under which the treatment is taken.
All non-medical expenses including convenience items for personal comfort such as charges for 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.
Any kind of service charges, surcharges, admission fees/registration charges, luxury tax and similar charges
levied by the hospital.
Treatment for Sleep Apnea Syndrome, treatments such as Rotational Field Quantum Magnetic Resonance
(RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen
Therapy and CPAD (Continuous Peritoneal Ambulatory Dialysis)
Laser assisted Hemorrhoidectomy / Fistula / Prostatectomy / Coblation assisted Tonsillectomy and any other
surgeries – Claim liability is restricted to cost of conventional surgery.
Attendant charges including food, bed, travel charges for any ailments are not admissible.
Femto Second Laser Cataract Surgery and Multi Focal Lens - Claim liability is restricted to cost of MICS.
Balloon Kyphoplasty - Claim liability is restricted to cost of conventional surgery (Stabilization of spine).
Video Assisted Fistula Treatment (VAFT) - Claim liability is restricted to cost of conventional Fistulectomy.
Bio Absorbable Stent – Liability to be restricted to the cost of Drug Eluting Stent (DES).
Bariatric Surgery – Claim not payable as it’s excluded under policy (Obesity and its complications).
Radio Frequency Ablation (RFA) for Varicose Veins – Claim liability to be restricted to the cost of Laser
treatment.
Ozone / Hyperbaric Oxygen therapy – Claim not admissible as it is not a proven treatment.
Artificial Pancreas System – claim not payable as it is not a customary procedure.
Replacement of Battery and/or Leads of Pacemaker - Only cost of Prosthetic devices implanted during
surgical procedure is payable.
Diagnostics test sent abroad - Not payable as our geographical limits is only India.
AYUSH / Ayurveda doctor’s prescribing allopathic treatment - Claim is not payable.
Monitor charges to be Inclusive of ICU charges, this is not payable separately in ICU.
Domiciliary treatment is not covered.
Holter Monitoring is not payable.
Epidural Injection is not payable.
Infection control / Disinfection / Sanitation charges not payable.
Covid Precaution charges for Doctor, Nursing and Housekeeping, etc not payable.
PPE KIT charges are excluded from policy coverage.
Biopsy and FNAC is not payable on standalone basis, as it’s a Diagnostic Procedure.
CT Angiogram is not payable, as it’s a Diagnostic Procedure.
Admission for any Diagnostic Procedures is not covered under the policy.
Any Injection not listed in a day care procedure and doesn’t require Inpatient hospitalization is not payable.
Claim Procedure: Cashless and Reimbursement
Cashless Hospitalization Process:
Cashless hospitalization is a facility provided by the insurance company where the policyholder can get admitted
and undergo necessary treatment without paying the hospital directly for the medical expenses. The eligible medical
expenditure which is incurred is settled by the insurance company directly with the hospital. You can avail cashless
hospitalization only in the hospitals that are part of your TPA’s network.
Medi Assist enables you to avail cashless hospitalization at a hospital that falls within your insurer’s network and also
entitles you to discounts and reduced package tariffs at these hospitals. Hospitalization and related expenses can be
made cashless upon approval of pre-authorization based on your policy cover. It allows you the relief of no upfront
payments from your pocket.
At Medi Assist, you can avail cashless and eCashless hospitalization at our network of hospitals.
Cashless hospitalization can be availed only at a Medi Assist network hospital upon approval of your
preauthorization application. In the event of hospitalization at a network hospital for a procedure covered under
your health insurance policy:
The hospital may ask you to pay the following expenses at the time of discharge as they are not covered under the
policy:
Non-medical expenses.
Applicable co-pay amount.
Any expenses not payable as per insurance policy or above the limit (e.g. excess room rent, admission
charges, service charges, etc.)
Emergency hospitalization:
Emergency Hospitalization: This typically happens in case of emergencies such as road traffic accident. The
hospital that the Associate/dependent was hospitalized happens to be one of our network hospitals
Search for a network hospital

Visit network.medibuddy.in to find a hospital that falls within your insurer network or click the
‘Hospital’ tile on your MediBuddy (via TWINGO Portal login).
The Hospital tile on MediBuddy also gives you full details for the list of hospitals including location,
specialties, packages and more
During admission, present your Medi Assist E-card along with any other valid Government ID. You can click
the ‘E-card’ tile on MediBuddy to view your MA ID card
Ensure that the hospital sends your preauthorization form to Medi Assist, your TPA.
MediBuddy+ hospital portal: Log the request online (or)
Email: [email protected]
You will receive updates on the status of your claim throughout the lifecycle of the claim.
Medi Assist sends the approval to the hospital. Further enhancement approvals may be issued on request,
subject to the terms and conditions of the policy.
Track your claim in real-time:

Click the Claims tile on the MediBuddy app (OR)
Log into me.medibuddy.in and click the Claims tab (OR)
Visit track.medibuddy.in to search claims by Claim ID, MA ID, or Employee ID (OR)
SMS ‘Claims (Claim Number)’ to +91 966 314 9992
In case the request cannot be approved or if the expenses are not covered by your policy, you will have to
settle the hospital bill in full and subsequently raise a reimbursement claim after discharge. Do remember
that denial of a preauthorization request must not be construed as a denial of treatment or denial of
coverage. The claim will be processed subject to Policy T&C in Reimbursement.
After discharge, the hospital will send all the documents related to your claim to Medi Assist for settlement.
Kindly retain the copy of the claim documents for your reference.
At the time of discharge, check and sign the original bills and the discharge summary. Do carry home a copy
of the signed bill, discharge summary and all your investigation reports for future reference.
The list of network hospitals is subject to change, with hospitals being empaneled on a regular basis. To
access the latest list of hospitals in your insurer network, visit network.medibuddy.in or use the GPS-enabled
Hospital search option on your MediBuddy portal and app.
Note: In case of suppression of material facts or misrepresentation of facts by the hospital or the insured, the pre-
authorization issued for the cashless facility will stand cancelled. The insured will be liable to settle the hospital bill in
full.
Circumstances under which cashless hospitalization may be rejected:
If the information contained in the request is insufficient for Medi Assist to arrive at a decision and further
information is not available for whatever reasons.
The ailment for which hospitalization is sought is not covered under the particular insurance policy for
reason like pre-existing conditions, specific exclusions, etc.
The insured has already exhausted the insurance coverage for the year.
Planned Hospitalization:
ECASHLESS Process:
Planned Hospitalization: Where the Associate/dependent plans the admission at our network hospital in
advance. Ex: Surgery scheduled after 7 days.
Planned hospitalization at your convenience, your choice, and your fingertips. eCashless is an offering by Medi Assist
which helps you avoid wait time at the hospital’s insurance desk on the day of admission to obtain pre-authorization.
With eCashless, you obtain a provisional pre-authorization at the comfort of your home or office well ahead of your
admission. This helps you plan your hospitalization better.
eCashless is an offering available for planned surgeries/procedures, where you are aware of the day of admission in
advance. Hence, you should initiate the eCashless request at least 48hrs prior to the day of admission
eCashless gives you the power to get a provisional preauthorization even before you walk into the hospital.
You can initiate an eCashless request using the following ways:
You can download the MediBuddy app. Go to the app and click the eCashless tile to initiate a request
You can go to www.medibuddy.in and click the eCashless tile to initiate the request
You can also open MediBuddy on your mobile browser and select the eCashless option.
You can logon to the Medi Assist portal www.mediassistindia.com and opt for the eCashless option
While initiating eCashless, you are requested to upload certain documents such as diagnosis of the health problem,
so that your operating surgeon/hospital can provide you an estimated cost of treatment. The documents you can
consider up loading while initiating the eCashless request include:
The last consultation papers and details

Investigation Reports
Photo ID Proof of Patient.
Associate can use their Mobile app/Portal to raise a preauthorization request at least 48 hours before hospitalization
and also indicate their preferred room type.
Hospitals receive this request from Medi Assist online, confirm availability of room and provide an estimate for the
treatment.
Based on the confirmation from the hospital, Medi Assist sends a passcode protected provisional preauthorization
request to the hospital. Simultaneously, the member receives a secure passcode on the mobile app.
The hospital can open and confirm the provisional preauthorization letter from Medi Assist only after the member
walks into the hospital and presents the secure passcode along with a valid photo ID proof.
On the day of admission, you must carry the following documents/Information:
Secure passcode/OTP
Medi Assist e-Card
Photo copy of ID card
Medical advice for hospitalization or previous consultation documents
All investigation reports
Any other document, relevant to the treatment of the insured
The use of secure passcode ensures full security of the transaction. The hospital “unlocks” the provisional
preauthorization only upon receipt of the passcode and after due validation of the patient at the time of walk-in.
Note: The eCashless facility must not be used for emergency hospitalizations. Cashless approval is subject to your
policy terms and conditions and availability of sum insured.
Reimbursement Claim Process:

You can raise a reimbursement claim for treatment from a non-network hospital or for a procedure that is not
eligible for cashless hospitalization or in the event of denial of pre-authorization. You will have to settle the hospital
bill in full and subsequently raise a reimbursement claim after discharge
Claim documents should be submitted to the Medi Assist within 30 days from date of discharge (DOD) to Medi Assist
help desk SPOC who will be available at your work location
In case of non-availability of the Helpdesk at your location, claim documents can be sent to the nearest location
Helpdesk (Please refer to the Helpdesk Scheduler for address).
Please submit duly signed clarification letter, if any delay in submission of claim, from DOD is above 30 days.
Basis the documents you submit, we will review and process the claim subject to policy T&C. The medical team at
Medi Assist processes the claim:
Once the claim is approved, the amount is reimbursed via NEFT by insurance company.
In case of additional information, query letter is sent to you by email with details required.
In case your claim is denied, the denial letter is sent to you by e-mail quoting the reason for
denial of your claim by insurance company.
The following are the mandatory documents required for availing reimbursement claims in Original:
Duly filled claim form with complete details along with Claim amount and account details.
Original Detailed Discharge Summary
Original Final hospital bill with detail cost wise break-up of each component
Original Cash paid receipt pre-numbered towards final hospital bill paid
All Original Investigation / tests reports
Consultation Papers with Treatment details
Pharmacy bills with supporting prescription from the treating doctor
Indoor Case Sheet (wherever applicable) – Xerox copy
MLC Certificate/FIR Copy in case of road traffic accident
Obstetric history / antenatal scan report in case of maternity claims
A-Scan report in case of cataract claim
Health Card of Patient, ID proof and Employee Co. ID proof
Original Cancel Cheque of Self i.e. Employee (Name, IFSC Code & A/C number should be present)
The above mentioned documents are not exhaustive, but may differ on a case to case basis;
additional documents can be called for after the medical scrutiny.
*Hospital Criteria for Reimbursement claims: The hospital should be registered with the local authority and must have a
registration certificate to that effect. The medical practitioner should hold a certificate of a recognized institution
and must be registered by the medical council of the respective state.
Pre- Post Hospitalization Claim Process:
Pre-Post Hospitalization expenses can be claimed in reimbursement only, you need to fill claim form and submit all
documents in Original to Help Desk SPOC within 30 days of completion of Post Hospitalization coverage period.
Duly filled claim form with complete details along with Claim amount and account details.
All Original Investigation / tests reports
Consultation Papers with Treatment details
Pharmacy bills with supporting prescription from the treating Doctor
Original Cancel Cheque of Self i.e. Employee (Name, IFSC Code & A/C number should be present)
Health Card of Patient & ID proof and Employee Co. ID proof
Self-Help Tools
Medi Assist Online Portal: MediBuddy
The Medi Assist MediBuddy is more than just a corporate portal that allows you to manage your corporate health
insurance policy. MediBuddy is your personalized gateway to managing your health and reducing cost of healthcare
for your family.
Log into https://twingo.techmahindra.com with your Tech M username and password to begin.
You can alternatively login via portal.medibuddy.in (Use Google Chrome / Firefox browser).
Username will be <Associate ID@techm> & password will be Date of Birth in DDMMYYYY format.
Please click on “India Medical Insurance” on TWINGO Portal as per below path:
TWINGO > HUMAN RESOURCE > INDIA MEDICAL INSURANCE & WELLNESS
Please use Google Chrome or Firefox or IE version 10.0 & above
• Log into MediBuddy Online and click the links in the Medical Insurance tab to understand the details of your
policy before proceeding with the enrolment.
• Go to Medical Insurance > Online Enrolment to view the details of all your beneficiaries once the enrolment
process is complete.
• Go to Medical Insurance > Download E-Card tab to generate and print out a Medi Assist ID card on the fly.
• Go to Hospitalization > Network Hospitals to browse through our extensive list of network hospitals across
the country.
MEDIBUDDY APP
ANNEXURE I: LIST OF DAY CARE PROCEDURES:
Claim admissibility for below list of Dare Care Procedure will be concluded only after reviewing Medical documents.
The mentioned of Day Care Procedure mentioned here under is not to be taken as confirmation for coverage or
claim coverage. As, this is only a list of Dare Care Procedures. You may write to [email protected] for any
coverage related query along with Doctor Prescription and relevant reports.
SNO DAY CARE PROCEDURE SNO DAY CARE PROCEDURE

1 Stapedotomy 2 Excision And Destruction Of A Lingual Tonsil
Other Operations On The Tonsils And
3 Stapedectomy 4
Adenoids
5 Revision Of A Stapedectomy 6 Incision On Bone, Septic And Aseptic
Closed Reduction On Fracture, Luxation Or
7 Other Operations On The Auditory Ossicles 8
Epiphyseolysis With Osteosynthesis
Suture And Other Operations On Tendons
9 Myringoplasty (Type -I Tympanoplasty) 10
And Tendon Sheath
Tympanoplasty (Closure Of An Eardrum
11 Perforation/Reconstruction Of The 12 Reduction Of Dislocation Under Ga
Auditory Ossicles)
13 Revision Of A Tympanoplasty 14 Arthroscopic Knee Aspiration
Other Microsurgical Operations On The
15 16 Incision Of The Breast
Middle Ear
17 Myringotomy 18 Operations On The Nipple
Incision And Excision Of Tissue In The
19 Removal Of A Tympanic Drain 20
Perianal Region
Incision Of The Mastoid Process And
21 22 Surgical Treatment Of Anal Fistulas
Middle Ear
23 Mastoidectomy 24 Surgical Treatment Of Haemorrhoids
Division Of The Anal Sphincter
25 Reconstruction Of The Middle Ear 26
(Sphincterotomy)
Other Excisions Of The Middle And Inner
27 28 Other Operations On The Anus
Ear
29 Fenestration Of The Inner Ear 30 Ultrasound Guided Aspirations
31 Revision Of A Fenestration Of The Inner Ear 32 SclerotherapyEtc
Incision (Opening) And Destruction

33 34 Incision Of The Ovary
(Elimination) Of The Inner Ear
Other Operations On The Middle And Inner
35 36 Insufflation Of The Fallopian Tubes
Ear
Excision And Destruction Of Diseased
37 38 Other Operations On The Fallopian Tube
Tissue Of The Nose
Operations On The Turbinates (Nasal
39 40 Dilatation Of The Cervical Canal
Concha)
41 Other Operations On The Nose 42 Conisation Of The Uterine Cervix
43 Nasal Sinus Aspiration 44 Other Operations On The Uterine Cervix
45 Incision Of Tear Glands 46 Incision Of The Uterus (Hysterotomy)
47 Other Operations On The Tear Ducts 48 Therapeutic Curettage
49 Incision Of Diseased Eyelids 50 Culdotomy
Excision And Destruction Of Diseased
51 52 Incision Of The Vagina
Tissue Of The Eyelid
Local Excision And Destruction Of Diseased
53 Operations On The Canthus And Epicanthus 54 Tissue Of The Vagina And The Pouch Of
Douglas
Corrective Surgery For Entropion And
55 56 Incision Of The Vulva
Ectropion
57 Corrective Surgery For Blepharoptosis 58 Operations On Bartholin’S Glands (Cyst)
Removal Of A Foreign Body From The
59 60 Incision Of The Prostate
Conjunctiva
Removal Of A Foreign Body From The Transurethral Excision And Destruction Of
61 62
Cornea Prostate Tissue
Transurethral And Percutaneous Destruction
63 Incision Of The Cornea 64
Of Prostate Tissue
Open Surgical Excision And Destruction Of
65 Operations For Pterygium 66
Prostate Tissue
67 Other Operations On The Cornea 68 Radical Prostatovesiculectomy
Removal Of A Foreign Body From The Lens Other Excision And Destruction Of Prostate
69 70
Of The Eye Tissue
Removal Of A Foreign Body From The
71 72 Operations On The Seminal Vesicles
Posterior Chamber Of The Eye
Removal Of A Foreign Body From The Orbit
73 74 Incision And Excision Of Periprostatic Tissue
And Eyeball
75 Operation Of Cataract 76 Other Operations On The Prostate
Incision Of The Scrotum And Tunica Vaginalis
77 Incision Of A Pilonidal Sinus 78
Testis
Other Incisions Of The Skin And
79 80 Operation On A Testicular Hydrocele
Subcutaneous Tissues
Local Excision Of Diseased Tissue Of The Excision And Destruction Of Diseased Scrotal
81 82
Skin And Subcutaneous Tissues Tissue
Other Excisions Of The Skin And Plastic Reconstruction Of The Scrotum And
83 84
Subcutaneous Tissues Tunica Vaginalis Testis
Simple Restoration Of Surface Continuity Other Operations On The Scrotum And
85 86
Of The Skin And Subcutaneous Tissues Tunica Vaginalis Testis
87 Free Skin Transplantation, Donor Site 88 Incision Of The Testes
Excision And Destruction Of Diseased Tissue
89 Free Skin Transplantation, Recipient Site 90
Of The Testes
91 Revision Of Skin Plasty 92 Unilateral Orchidectomy
Other Restoration And Reconstruction Of
93 94 Bilateral Orchidectomy
The Skin And Subcutaneous Tissues
95 Chemosurgery To The Skin 96 Orchidopexy
Destruction Of Diseased Tissue In The Skin
97 98 Abdominal Exploration In Cryptorchidism
And Subcutaneous Tissues
Incision, Excision And Destruction Of Surgical Repositioning Of An Abdominal
99 100
Diseased Tissue Of The Tongue Testis
101 Partial Glossectomy 102 Reconstruction Of The Testis
Implantation, Exchange And Removal Of A
103 Glossectomy 104
Testicular Prosthesis
105 Reconstruction Of The Tongue 106 Other Operations On The Testis
Surgical Treatment Of A Varicocele And A
107 Other Operations On The Tongue 108
Hydrocele Of The Spermatic Cord
Incision And Lancing Of A Salivary Gland
109 110 Excision In The Area Of The Epididymis
And A Salivary Duct
Excision Of Diseased Tissue Of A Salivary
111 112 Epididymectomy
Gland And A Salivary Duct
113 Resection Of A Salivary Gland 114 Reconstruction Of The Spermatic Cord
Reconstruction Of A Salivary Gland And A Reconstruction Of The Ductus Deferens And
115 116
Salivary Duct Epididymis
Other Operations On The Salivary Glands Other Operations On The Spermatic Cord,
117 118
And Salivary Ducts Epididymis And Ductus Deferens
External Incision And Drainage In The
119 120 Operations On The Foreskin
Region Of The Mouth, Jaw And Face
Local Excision And Destruction Of Diseased
121 Incision Of The Hard And Soft Palate 122
Tissue Of The Penis
Excision And Destruction Of Diseased Hard
123 124 Amputation Of The Penis
And Soft Palate
Incision, Excision And Destruction In The
125 126 Plastic Reconstruction Of The Penis
Mouth
127 Plastic Surgery To The Floor Of The Mouth 128 Other Operations On The Penis
129 Palatoplasty 130 Cystoscopical Removal Of Stones
131 Other Operations In The Mouth 132 Lithotripsy
Transoral Incision And Drainage Of A
133 134 Coronary Angiography
Pharyngeal Abscess
135 Tonsillectomy Without Adenoidectomy 136 Haemodialysis
137 Tonsillectomy With Adenoidectomy 138 Radiotherapy For Cancer
139 Cancer Chemotherapy 140 ARMD & Oral Chemotherapy
LIST OF EXPENSES EXCLUDED:
Below list is indicative and not exhaustive. The exact deductions on account of the non-payables can be ascertained
once the documents are scrutinized by our medical team.
SNO LIST OF EXPENSES EXCLUDED ("NON-MEDICAL") SUGGESTIONS

TOILETRIES/COSMETICS/ PERSONAL COMFORT OR CONVENIENCE ITEMS
1 HAIR REMOVAL CREAM Not Payable
2 BABY CHARGES (UNLESS SPECIFIED/INDICATED) Not Payable
3 BABY FOOD Not Payable
4 BABY UTILITES CHARGES Not Payable
5 BABY SET Not Payable
6 BABY BOTTLES Not Payable
7 BRUSH Not Payable
8 COSY TOWEL Not Payable
9 HAND WASH Not Payable
10 M01STUR1SER PASTE BRUSH Not Payable
11 POWDER Not Payable
12 RAZOR Payable
13 SHOE COVER Not Payable
14 BEAUTY SERVICES Not Payable
Essential and may be paid specifically for cases who have undergone
15 BELTS/ BRACES
surgery of thoracic or lumbar spine.
16 BUDS Not Payable

17 BARBER CHARGES Not Payable
18 CAPS Not Payable
19 COLD PACK/HOT PACK Not Payable
20 CARRY BAGS Not Payable
21 CRADLE CHARGES Not Payable
22 COMB Not Payable
23 DISPOSABLES RAZORS CHARGES ( for site preparations) Payable
24 EAU-DE-COLOGNE / ROOM FRESHNERS Not Payable

25 EYE PAD Not Payable
26 EYE SHEILD Not Payable
27 EMAIL / INTERNET CHARGES Not Payable
FOOD CHARGES (OTHER THAN PATIENT'S DIET
28 Not Payable
PROVIDED BY HOSPITAL)
29 FOOT COVER Not Payable
30 GOWN Not Payable
Essential in bariatric and varicose vein surgery and should be considered

31 LEGGINGS
for these conditions where surgery itself is payable.
32 LAUNDRY CHARGES Not Payable

33 MINERAL WATER Not Payable
34 OIL CHARGES Not Payable
35 SANITARY PAD Not Payable
36 SLIPPERS Not Payable
37 TELEPHONE CHARGES Not Payable
38 TISSUE PAPER Not Payable
39 TOOTH PASTE Not Payable
40 TOOTH BRUSH Not Payable
41 GUEST SERVICES Not Payable
42 BED PAN Not Payable
43 BED UNDER PAD CHARGES Not Payable
44 CAMERA COVER Not Payable
45 CLINIPLAST Not Payable
46 CURAPORE Not Payable
47 DIAPER OF ANY TYPE Not Payable
Not Payable ( However if CD is specifically sought by In surer/TPA then
48 DVD, CD CHARGES
payable)
49 EYELET COLLAR Not Payable
50 FACE MASK Not Payable
51 FLEXI MASK Not Payable

52 GAUSE SOFT Not Payable
53 GAUZE Not Payable
54 HAND HOLDER Not Payable
55 INFANT FOOD Not Payable
Reasonable costs for one sling in case of upper arm fractures should be
56 SLINGS
considered
ITEMS SPECIFICALLY EXCLUDED IN THE POLICIES
57 WEIGHT CONTROL PROGRAMS/ SUPPLIES/ SERVICES Not Payable
COST OF SPECTACLES/ CONTACT LENSES/ HEARING

58 Not Payable
AIDS ETC.,
DENTAL TREATMENT EXPENSES THAT DO NOT REQUIRE
59 Not Payable
HOSPITALISATION
60 HORMONE REPLACEMENT THERAPY Not Payable
61 HOME VISIT CHARGES Not Payable
INFERTILITY/ SUBFERTILITY/ ASSISTED CONCEPTION
62 Not Payable
PROCEDURE
OBESITY (INCLUDING MORBID OBESITY) TREATMENT IF
63 Not Payable
EXCLUDED IN POLICY
64 PSYCHIATRIC & PSYCHOSOMATIC DISORDERS Not Payable
65 CORRECTIVE SURGERY FOR REFRACTIVE ERROR Not Payable
66 TREATMENT OF SEXUALLY TRANSMITTED DISEASES Not Payable
67 DONOR SCREENING CHARGES Not Payable
68 ADMISSION/REGISTRATION CHARGES Not Payable
HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC
69 Not Payable
PURPOSE
EXPENSES FOR INVESTIGATION/ TREATMENT
70 IRRELEVANT TO THE DISEASE FOR WHICH ADMITTED Not Payable
OR DIAGNOSED
71 STEM CELL IMPLANTATION/ SURGERY and storage Not Payable
ITEMS WHICH FORM PART OF HOSPITAL SERVICES WHERE SEPARATE CONSUMABLES ARE NOT PAYABLE BUT THE SERVICE IS
72 WARD AND THEATRE BOOKING CHARGES Payable under OT Charges, not separately
Rental charged by the Hospital
73 ARTHROSCOPY & ENDOSCOPY INSTRUMENTS
Payable. Purchase of Instruments Not Payable.
74 MICROSCOPE COVER Payable under OT Charges, not separately
75 SURGICAL BLADES, HARMONIC SCALPEL, SHAVER Payable under OT Charges, not separately
76 SURGICAL DRILL Payable under OT Charges, not separately
77 EYE KIT Payable under OT Charges, not separately
78 EYE DRAPE Payable under OT Charges, not separately
79 X-RAY FILM Payable under Radiology Charges, not as consumable
80 SPUTUM CUP Payable under Investigation Charges, not as consumable

81 BOYLES APPARATUS CHARGES Part of OT Charges, not separately
BLOOD GROUPING AND CROSS MATCHING OF DONORS
Part of Cost of Blood, not payable
82 SAMPLES
83 Antiseptic or disinfectant lotions Not Payable - Part of Dressing Charges
BAND AIDS, BANDAGES, STERLILE INJECTIONS,
Not Payable - Part of Dressing charges
84 NEEDLES, SYRINGES
85 BLADE Not Payable
86 APRON Not Payable
87 TORNIQUET Not Payable
88 ORTHOBUNDLE, GYNAEC BUNDLE Not Payable, Part of Dressing Charges
89 URINE CONTAINER Not Payable
ELEMENTS OF ROOM CHARGE
Actual tax levied by government is payable. Part of room charge for sub
LUXURY TAX
90 limits
91 HVAC Part of room charge, Not Payable separately
92 HOUSE KEEPING CHARGES Part of room charge, Not Payable separately
SERVICE CHARGES WHERE NURSING CHARGE ALSO
Part of room charge, Not Payable separately
93 CHARGED
94 TELEVISION & AIR CONDITIONER CHARGES Part of room charge, Not Payable separately
95 SURCHARGES Part of room charge, Not Payable separately
96 ATTENDANT CHARGES Part of room charge, Not Payable separately
97 CLEAN SHEET Part of Laundry / Housekeeping, Not Payable separately
EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH
Patient Diet provided by Hospital is payable
98 FORMS PART OF BED CHARGE)
99 BLANKET/WARMER BLANKET Part of room charge, Not Payable separately
ADMINISTRATIVE OR NON - MEDICAL CHARGES
100 ADMISSION KIT Not Payable
101 BIRTH CERTIFICATE Not Payable
BLOOD RESERVATION CHARGES AND ANTE NATAL
102 Not Payable
BOOKING CHARGES
103 CERTIFICATE CHARGES Not Payable
104 COURIER CHARGES Not Payable
105 CONVENYANCE CHARGES Not Payable
106 DIABETIC CHART CHARGES Not Payable
DOCUMENTATION CHARGES / ADMINISTRATIVE
107 Not Payable
EXPENSES
108 DISCHARGE PROCEDURE CHARGES Not Payable
109 DAILY CHART CHARGES Not Payable
110 ENTRANCE PASS / VISITORS PASS CHARGES Not Payable
111 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE Payable under Post-Hospitalisation where admissible
112 FILE OPENING CHARGES Not Payable

INCIDENTAL EXPENSES / MISC. CHARGES (NOT
113 Not Payable
EXPLAINED)
114 MEDICAL CERTIFICATE Not Payable
115 MAINTENANCE CHARGES Not Payable
116 MEDICAL RECORDS Not Payable
117 PREPARATION CHARGES Not Payable
118 PHOTOCOPIES CHARGES Not Payable
119 PATIENT IDENTIFICATION BAND / NAME TAG Not Payable
120 WASHING CHARGES Not Payable
121 MEDICINE BOX Not Payable
122 MORTUARY CHARGES Payable up to 24 hrs, shifting charges not payable
123 MEDICO LEGAL CASE CHARGES (MLC CHARGES) Not Payable
EXTERNAL DURABLE DEVICES
124 WALKING AIDS CHARGES Not Payable
125 BIPAP MACHINE Not Payable
126 COMMODE Not Payable
127 CPAP/ CAPD EQUIPMENTS Device not payable
128 INFUSION PUMP – COST Device not payable
129 PULSEOXYMETER CHARGES Device not payable
130 SPACER Not Payable
131 Spirometer / Respirometer Device not payable
132 SP02 PROBE Not Payable
133 STEAM INHALER Not Payable
134 ARMSLING Not Payable
135 THERMOMETER Not Payable
136 CERVICAL COLLAR Not Payable
137 SPLINT Not Payable
138 DIABETIC FOOT WEAR Not Payable
139 KNEE BRACES ( LONG/ SHORT/ HINGED) Not Payable
140 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER Not Payable
141 LUMBOSACRAL BELT Payable for surgery of lumbar spine.
Payable for any ICU patient requiring more than 3 days in ICU, all patients
142 NIMBUS BED OR WATER OR AIR BED CHARGES with paraplegia /quadriplegia for any reason and at reasonable cost of
approximately Rs 200/day
143 AMBULANCE COLLAR Not Payable
144 AMBULANCE EQUIPMENT Not Payable
145 MICROSHEILD Not Payable
Essential and should be paid in post-surgery patients of major abdominal
146 ABDOMINAL BINDER surgery including TAH, LSCS, incisional hernia repair, exploratory
laparotomy for intestinal obstruction, liver transplant etc.
ITEMS PAYABLE IF SUPPORTED BY A PRESCRIPTION

BETADINE / HYDROGEN PEROXIDE / SPIRIT /
147 Not Payable
DISINFECTANTS ETC
PRIVATE NURSES CHARGES - SPECIAL NURSING
148 Not Payable
CHARGES Post hospitalization nursing charges
NUTRITION PLANNING CHARGES - DIETICIAN
149 Patient Diet provided by hospital is payable
CHARGESDIET CHARGES
150 SUGAR FREE Tablets Payable -Sugar free variants of admissible medicines are not excluded
Payable when prescribed (Toiletries are not payable, only prescribed
151 CREAMS POWDERS LOTIONS
medical pharmaceuticals payable)
152 Digestion gels Payable when prescribed
153 ECG ELECTRODES One set every second day is Payable.
154 LISTERINE/ ANTISEPTIC MOUTHWASH Payable when prescribed
155 LOZENGES Payable when prescribed
156 MOUTH PAINT Payable when prescribed
157 NEBULISATION KIT If used during Hospitalisation is Payable reasonably
158 NOVARAPID Payable when prescribed
159 VOLINI GEL/ ANALGESIC GEL Payable when prescribed
160 ZYTEE GEL Payable when prescribed
161 VACCINATION CHARGES Routine Vaccination not Payable / Post Bite Vaccination Payable
PART OF HOSPITAL'S OWN COSTS AND NOT PAYABLE

162 AHD Not Payable - Part of Hospital's internal Cost
163 ALCOHOL SWABES Not Payable - Part of Hospital's internal Cost
164 SCRUB SOLUTION/STERILLIUM Not Payable - Part of Hospital's internal Cost
OTHERS
165 VACCINE CHARGES FOR BABY Not Payable
166 AESTHETIC TREATMENT / SURGERY Not Payable
167 TPA CHARGES Not Payable
168 VISCO BELT CHARGES Not Payable
ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT,
169 Not Payable
ORTHOKIT, RECOVERY KIT, ETC]
170 KIDNEY TRAY Not Payable
171 MASK Not Payable
172 OUNCE GLASS Not Payable
173 OUTSTATION CONSULTANT'S/ SURGEON'S FEES Not payable
174 PELVIC TRACTION BELT Payable in case of PIVD requiring traction
175 REFERAL DOCTOR'S FEES Not Payable
Not payable pre Hospitalisation or post Hospitalisation / Reports and
176 ACCU CHECK (Glucometery/ Strips)
Charts required / Device not payable
177 PAN CAN Not Payable
178 SOFNET Not Payable
179 TROLLY COVER Not Payable
180 UROMETER, URINE JUG Not Payable
181 AMBULANCE Payable
182 TEGADERM / VASOFIX SAFETY Payable - maximum of 3 in 48 hrs and then 1 in 24 hrs
183 URINE BAG Payable where Medically Necessary - maximum 1 per 24 hrs
184 SOFTOVAC Not Payable
l185 STOCKINGS Payable for case like CABG etc.
Note: The above list is indicative and not exhaustive. The exact deductions on account of the non-payables can be
ascertained once the documents are scrutinized by our medical team.
Tech M Location Wise Matrix:

Location SPOC Name – Medi Assist Email IDs Mobile No
Hyderabad, Warangal Vizag and Vijayawada Aditya Mishra [email protected] 9100955626
Manish Sharma [email protected] 7042796747
Noida and Gurugram
Mukesh Thakur [email protected] 9205132575
Prashant Deshmane [email protected] 7028946079
Pune, Nasik and Nagpur
Dhanashri Muley [email protected] 9606073650
VijayaLakshmi [email protected] 8754447965
Chennai, Trivandrum, and Coimbatore
Suresh Pandian [email protected] 9742288553
Vemu Moshe [email protected] 8296894345
Bengaluru and Mysuru
Chandan [email protected] 7337821296
Mumbai Mayur Gavali [email protected] 7710069276
Chandigarh, Jaipur, Indore and Gandhinagar Shashikant [email protected] 7087033824
Kolkata and Bhuvaneshwar Mohammad Qazzafi [email protected] 8585044781
Contact us - Customer Service

India associates: 815-286-0999
Onsite associates: 080-6761-7555
Business Email ID : [email protected]
Claims document should be couriered to
Medi Assist Insurance TPA Pvt Ltd

2nd Floor, White House, 6-3-1192/1/1, 3rd Block, Kundanbagh Colony, Begumpet, Hyderabad, Telangana 500016
Corporate Name : Tech Mahindra & EMP ID :
Disclaimer: The policy conditions for Tech Mahindra incorporated in the website and web portal are extracts of the Group Mediclaim Policy wordings of United
India Insurance Company Limited. These are only for reference and clarity in understanding. For any further clarifications, please write to us on
[email protected]. Please contact our dedicated Toll number 815-286-0999 (24/7 Helpline number) or the Local Helpdesk SPOC for further clarifications. An
Onsite Associate can reach on our Toll Number +91 80-6761 7555. The terms and conditions mentioned are exhaustive. However, the policy doesn’t describe the
ailment / case study of the treatments. If you find any doubt / require clarification don’t hesitate to connect with TPA before hospitalization / treatment for the
claim admissibility. The document has been prepared for associate / employee better understanding and it is not for external circulation. If you have any query
related to Claim admissibility /not happy with the TPA reply, you can raise the grievance on insurance company (United India Insurance) website
https://uiic.co.in/customercare/grievance for their review.
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Welcome to the Medi Assist Family

Here’s to healthy living!

Key Points of the Top-Up Cover:

Tubectomy and Vasectomy is not covered under the policy.

Third and fourth Child Coverage:

U1 to U3 U4&P1 P2 & Above

Key Points on Base Plan and Policy:

Portability option is available. Associate has to approach Mahindra Insurance Brokers -

Hospital Criteria for Claim/Coverage:

Has qualified medical practitioner(s) in charge round the clock.

Mandatory Documents required for Home Quarantine Benefit:

Duly filled Claim Form.

Covid Positive Report.

Doctor consultation paper advising Home Quarantine.

Doctor Prescription for pharmacy and lab investigations.

Supporting pharmacy bills and all lab investigation bills.

All lab investigations reports.

Health Card of Patient, ID proof and Employee Co. ID proof.

Pre-hospitalization Medical Expenses:

Post-hospitalization Medical Expenses:

Vaccination or inoculation of any kind unless it is post animal bite.

Injury or disease directly or indirectly caused by or contributed to by nuclear weapon / materials.

Naturopathy treatment, acupressure, acupuncture, magnetic therapies, experimental and unproven

Genetic disorders related treatment / Investigations/expenses not payable

AYUSH / Ayurveda doctor’s prescribing allopathic treatment - Claim is not payable.

Domiciliary treatment is not covered.

Holter Monitoring is not payable.

Epidural Injection is not payable.

Infection control / Disinfection / Sanitation charges not payable.

PPE KIT charges are excluded from policy coverage.

CT Angiogram is not payable, as it’s a Diagnostic Procedure.

Claim Procedure: Cashless and Reimbursement

Cashless Hospitalization Process:

Applicable co-pay amount.

Search for a network hospital

Track your claim in real-time:

You can initiate an eCashless request using the following ways:

The last consultation papers and details

Reimbursement Claim Process:

Please use Google Chrome or Firefox or IE version 10.0 & above

SNO DAY CARE PROCEDURE SNO DAY CARE PROCEDURE

31 Revision Of A Fenestration Of The Inner Ear 32 SclerotherapyEtc

Incision (Opening) And Destruction

SNO LIST OF EXPENSES EXCLUDED ("NON-MEDICAL") SUGGESTIONS

16 BUDS Not Payable

23 DISPOSABLES RAZORS CHARGES ( for site preparations) Payable

24 EAU-DE-COLOGNE / ROOM FRESHNERS Not Payable

Essential in bariatric and varicose vein surgery and should be considered

32 LAUNDRY CHARGES Not Payable

50 FACE MASK Not Payable

51 FLEXI MASK Not Payable

55 INFANT FOOD Not Payable

ITEMS SPECIFICALLY EXCLUDED IN THE POLICIES

57 WEIGHT CONTROL PROGRAMS/ SUPPLIES/ SERVICES Not Payable

COST OF SPECTACLES/ CONTACT LENSES/ HEARING

80 SPUTUM CUP Payable under Investigation Charges, not as consumable

112 FILE OPENING CHARGES Not Payable

122 MORTUARY CHARGES Payable up to 24 hrs, shifting charges not payable

ITEMS PAYABLE IF SUPPORTED BY A PRESCRIPTION

PART OF HOSPITAL'S OWN COSTS AND NOT PAYABLE

Tech M Location Wise Matrix:

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