FEATURES & BENEFITS

• Start Ups / SMEs want to attract the same quality of talent thatlarger companies do.

• Start Ups / SMEs either can’t get desired coverage or arepriced out completely

• Healthcare costs are rising by the minute at every level of care

• Access to knowledgeable, effective intermediaries is verydifficult for Start Ups / SMEs

• Support for claims and dispute settlement is nearly non-existent for smaller employee groups

• Increasing premia for smaller companies

The Problem

• To provide a comprehensive, flexible and affordable healthinsurance covers for companies owned by TiE members.

• Bring technology into the domain of health insurancemanagement empowering the customer to make informedchoices and to enable efficient delivery of health insuranceadministration services.

• Provide a “single window” approach such that all theoperations are seamlessly & empathetically taken care of.

Program Objectives

• E=Self / Employee, S=Spouse, C=Child, P=Parent

• Each person shall select one of the options from A to D and fromsum insured 2 Lakhs to 10 Lakhs.

• The premium can either be paid for by the company or the individual.• E+2Pis permitted for unmarried individuals only. Married persons must cover

parents under E+S+2C+2P plan. Deviation will result in claim rejection.• Sum insured once selected cannot be changed.

The Cover

Plan 2,00,000 3,00,000 5,00,000 7,00,000 10,00,000 A E E E E EB E+S+2C E+S+2C E+S+2C E+S+2C E+S+2CC E+S+2C+2P E+S+2C+2P E+S+2C+2P E+S+2C+2P E+S+2C+2PD E+2P E+2P E+2P E+2P E+2P

• This policy will be a common policy – TiE Health Plan.• This policy is available only for companies (as defined by companies

act 1956) owned by TiE members.• Owner members, their employees & family can be added into this plan.• All existing members (till 31/10/12) will qualify for the enrolment & will

get 60 days – 31/01/13 – to enrol self, employees & family members• Sum insured is on a floater basis.• Self / Employee, spouse, first 2 children and parents can enrol.• Pre-existing ailments & Congenital internal ailments are covered.• There will be no waiting periods except for persons who are 55

years and above of age.• There are limits on 6 procedure – Slide 10• Day care procedures are covered.• Room rent will be 1% of sum insured limited to INR 5 k / day.• ICU rent will be 2% of sum insured limited to INR 10 k / day.• All charges (Doctor fees, Surgeon fees etc.) linked to class of occupancy.

The Deal - Terms

• Maternity is covered after 3 months from enrolment for INR 30 K.• Baby cover from day 1 in the main policy.• Pre & Post hospitalization covered (30 days & 60 days).• Cashless facility available (TPA – Mediassist)• Co-pay of 15% on all admissible parent claims.• No co-pay for Self / employee, spouse and kids• 2 children upto 25 years can be covered.• Persons can be covered up to 85 years. The max age at which a

person (Primary, Secondary or Parent) can enter this plan is upto 75years. Persons above 75 years cannot enter this plan. Cover willcease when the person completes 85 years.

• Persons (Primary, Secondary or Parents) who are 55 years andabove will have a 1 year waiting for the following ailments listedbelow. – Slide 11 & 12

• A new member and therefore his/her company can enter this policyonly after 6 months from being inducted as a member of TiE. Proof ofmembership to be provided at the time of enrolment.

The Deal – Terms

• In case Self & Spouse are both members of TiE / working the sameorganization / working in different organizations where bothorganizations are enrolled into the TiE Health Plan, they will be givena single cover

• A new member / company has 15 days from date of enrolmenteligibility to enrol self / family.

• Enrolment drive will be opened from the 1st of every month andclosed on the 15th. The cover for these members will commenceafter 2 working days from that day.

• Parents will be covered on NOW Or Never basis. This means anymember who has not covered parents in this plan during theenrolment period (for that member) will not be allowed to cover themat any point in future.

• Spouse & Kids of married members will be covered on NOW Or Neverbasis. This means any married member who has not covered spouse &kids (if there are kids) in this plan during the enrolment period for thatmember will not be allowed to cover them at any point in future.

The Deal – Terms

• A married member, who has covered himself/herself under theSelf+S+2C or Self+S+2C+2P plan, will be allowed to add the newborn in course of the policy period at no extra cost. This enrolmentmust happen in 30 days from date of event.

• An unmarried member who is covered under the Self or Self+2P plancan cover spouse in course of the policy period by paying thedifferential premium; in the event of marriage. This enrolment has tobe done within 30 days from the date of occurrence.

• The companies can add employees as and when they join and thispremium will be computed on a pro-rata basis. No addition will bepermitted if the enrolment of a new joiner is done 15 days afterhis/her date of joining.

• There will be no deletion and hence no refund of premium.• Members who exit this plan at any point will not be allowed to enter

the plan again.• Sum insured upgrade is not permitted.

The Deal – Terms

• Cashless hospitalization is available in all the network hospitals.• Claims to be submitted within 30 days from the date of discharge.• Claim intimation time of 7 Days or before discharge whichever is

earlier. Claims will be rejected on account of delay in submission.• Domiciliary care is excluded & standard exclusions apply. Please

read the policy conditions for exclusions on the Medimanage websiteon the same link.

• Maternity benefit is available for the first 2 living children only.• Claims will be rejected if the age mentioned at the time of a claim is

different that the age calculated for the same period based on theage provided at the time of enrolment and this difference is greaterthan 1 year.

The Deal – Terms

• Limits on 6 procedures per life per occurrence.• Cataract : INR 30,000 per eye• Hernia : INR 45,000• Hysterectomy : INR 45,000• Joint replacement : INR 1,75,000 per joint per year.• TURP for BPH : INR 42,000• Coronary angiogram: INR 25,000

• Co pay is not applicable for the above procedures.

The Deal – Limits

1 Yr. Waiting – 55 Yrs. & Above

i Benign ENT disorders and surgeries

ii Polycystic ovarian diseases.iii Surgery of hernia.iv Surgery of hydrocele.v Non infective Arthritis.vi Undescendent Testes.vii Cataract.viii Surgery of benign prostatic hypertrophy.

ixHysterectomy for menorrhagia or fibromyoma or myomectomyor prolapse of uterus

x Fissure / Fistula in anus.xi Piles.xii Sinusitis and related disorders.

1 Yr. Waiting – 55 Yrs. & Above

xiii Surgery of gallbladder and bile duct excluding malignancy.xiv Surgery of genito urinary system excluding malignancy.xv Pilonidal Sinus.xvi Gout and Rheumatism.xvii Hypertension.xviii Diabetes.xix Calculus diseases.

xxSurgery for prolapsed inter vertebral disk unless arising fromaccident.

xxi Surgery of varicose veins and varicose ulcers.xxii Joint Replacement due to Degenerative condition.xxiii Age related osteoarthritis and Osteoporosis.

The Deal – Premium, Policy, Enrolment

• This program will commence only with a minimum of 1000 primarymembers. This means the sum total of all the primary members(Self/Employee) excluding the family members should be 1,000.

• Each bonafide enrollee has to pay the premium on line throughCredit / Debit card. No other payment mechanism is permitted.

• The premium will be credited directly to the insurer account.• Each transaction will have a unique transaction ID and the payments

will be tracked on this basis for reconciliation with the banker.• The policy with the 1st set of 1000 primary members will begin on the

– 1st January 2013. In case the critical mass is reached earlier, thepolicy will commence earlier.

• Eligible Companies / Employees enrolling after this critical mass willbe added on a pro-rata basis.

• 80D benefit under the income tax act of 1961 can be claimedthrough the Form16 on the basis of the premium payee list issued bythe insurer.

• Team Medimanage will provide each company with the enrolmentconfirmation link to be circulated among the employees.

• This way you need not spend time monitoring this activity and alsothis will help in monitoring the critical mass count before the paymentgateway is opened.

• Once the critical mass is reached:-• Medimanage will send a to each primary member the portal

enrollment and payment gateway link.• This will happen by 20th December 2012 or earlier as the case may be.• The payment gateway will closed on the midnight of 28/12.

• For monthly enrollments, each company will send the above link toits new joiners for enrollment confirmation.

• On receipt of the enrollment confirmation, Team Medimanage willsend the portal enrolment & payment gateway link.

The Deal – Premium, Policy, Enrolment

Premium DetailsHow Do I Calculate My Premium

Sum Insured E E+S+2C E+S+2C+2P E+2P2,00,000 2,987 4,655 15,185 13,516 3,00,000 4,167 6,494 19,367 17,041 5,00,000 6,231 9,712 27,289 23,808 7,00,000 8,785 13,649 40,138 35,273

10,00,000 10,594 16,512 46,391 40,473 1 Select whom you want to cover.2 Select your sum insured.3 Check the premium in that grid.

4

5 Premium mentioned are inclusive of service charges & service tax. ST @ 12.36%5 Send in your confirmation through the below link

http://teammedimanage.wufoo.eu/forms/tie-health-plan-enrollment-confirmation/

The premiums mentioned are as per the band and based on an average number of family members being covered in applicable categories. The premium therefore does not change if the number of people in a band are lesser than that mentioned here. For eg - E+S+2C allows cover for spouse and 2 kids. If any member has 1 child the premium for that band would remain unchanged.

• Policy will be issued in 15 working days from the date of completionof enrolment.

• Endorsements to be issued in 15 working days from the date ofcompletion of enrolment..

• TPA cards will be uploaded in 10 days from the date of policy / endoissuance.

• Reimbursement claims to be settled in 20 working days from thedate of submitting all valid documents.

Service Timelines

Retail v/s TiE Health PlanRetail TiE Health Plan

Pre-existing cover Not Covered Covered30 day waiting period Applicable Not Applicable4 year waiting period Applicable Not ApplicableHealth checkup 60 years Not ApplicableRoom rent 1% 1%ICU room rent 2% 2%Congenital Internal Ailments

Not Covered Covered

Ailment limits None 6 LimitsCo-pay 10% on all claims 15% for parentsMaternity Not Covered Covered

New Born CoverAt the time of renewal. Midterm inclusion of new born not permitted

From Day 1

Group benefits of Large CorporatesPre-existing ailments cover from day 1 (parents included).Congenital internal ailments covered.Maternity cover up to 30,000.Parents cover from day 1.No health checkups.

Greater flexibilitySelection of sum insured. Selection of dependents.

Lower premiumsPremiums lower by up to 30%.

Better predictabilityAllows costs to be spread over large numbers keeping premiums in reasonable limits.

End to end support“One stop shop” for all claims, queries & facilitation. Self Help Web interface for Enrollment, Support and Claims.

5 Reasons Why TiE Health Plan

Medimanage.comFront End Service ProviderTiE appointed representative for the Policy. Single pointcontact and service provider for all services under the planfrom enrolments, to cashless authorizations, to re-imbursement claims settlements, to query management.

Oriental Insurance Company Ltd.Insurance Company

MediassistThird Party Administrator (TPA)Hospital network owner. Cashless provider. Claims settler

Service Platform

•Post your queries totiehealth@medimanage.com

•Point of contactRahila Sarang

•Contact number+91-22-67282904

Medimanage Contact Points

TiE India is only a facilitator of thisprogram and is not liable for anyissues arising out of this contract.Such issues if any have to bedirectly settled by the concernedparties with the agencies involved.

Disclaimer