Australia - 17-18

CIGNA TTK GLOBAL
HEALTH GROUP POLICY

WIPRO TECHNOLOGIES
Jul 2017
Diamond Plan ( Australia)

Agenda
Overview
Plan benefits
Member Enrollment
Member portal access
Claim Assistance
Escalation Matrix
Key Clarification
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna 2
OVERVIEW
CIGNA TTK HEALTH INSURANCE
Cigna TTK Health Insurance Company Limited is a joint venture between the U.S.
based global health services leader, Cigna Corporation and Indian conglomerate,
TTK Group.
Making good health the focus of health insurance:

• We excel in providing differentiated health insurance solutions
• Health and wellness programs that support our customers in making lifestyle changes
and managing chronic medical conditions.
• Cigna TTK Health Insurance aims to cover millions of Indians by providing for their
health and supporting them in illness.
• Global expertise that’s Indian at heart.
CIGNA: GLOBAL LEADER IN HEALTH INSURANCE WITH OVER 200 YEARS OF EXPERIENCE
Present in 31 countries around the

globe
Global revenue of Rs. 2.2 lac

Crore*
86 million+ global customer

relationships
Ranked 90 on Fortune 500 list**

 Formed in 1982 through the merger of
Insurance Company of North America (1792)
More than 37,000 dedicated and Connecticut General (1867)
employees worldwide  Headquartered in Bloomfield, Connecticut, USA
“A global health services company that stands apart in the industry by

keeping the customer at the center of everything it does.”
*Source : Cigna global annual report 2014 - 2015 (conversion rate 1USD = INR 64)
**Source: Fortune 500 list 2015
CIGNA has vast experience in health globally, and has serviced
more than 7.5 Crore customers and multiple partners
Unrivalled global network of over 900,000

quality hospitals,
physicians, clinics and health specialists
Everyday Cigna helps 100,000 customers with various services

transactions around the globe
Best-in-class customer experience: 90%+ customer

retention
We have experience in managing successful

partnerships globally
Plan is assisted by Mayfair Consultancy Services Ltd.
8
PLAN BENEFITS
Plan Structure
Health Benefits Coverage
Maximum Benefits Click Here
Section A
Travel Exigency coverage
Deductible applicable for IPD/OPD Yes - Click Here
Hospitalization & Inpatient Admission Expenses Yes - Click Here Personal Accident Yes - Click Here
Ambulance Services and Outpatient Expenses Yes - Click Here Loss of personal effects - ONLY as a
Yes - Click Here
result of Mugging
Pre-existing & Chronic Illnesses Yes - Click Here
Surgically Implanted Prostheses Yes - Click Here Loss of passport Yes - Click Here
Gynaecological Check-up Yes - Click Here Personal liability Yes - Click Here
Health check-ups /Wellness Care Yes - Click Here
Loss of baggage Yes - Click Here
Dental Care and Vision care Yes - Click Here
Baggage Delay Yes - Click Here
Prescription drugs/medicines Yes - Click Here
Mental Disorders Yes - Click Here Trip delay Yes - Click Here
Vaccinations Yes - Click Here Hijacking Yes - Click Here

Physical Therapies Yes - Click Here
Replacement & Rearrangement of Staff Yes - Click Here
Section B
Yes - Click Here
Maternity Expenses Yes - Click Here Emergency Hotel Accommodation
Section C
Emergency Repatriation & Evacuation including other Medical Yes - Click Here
Expenses:
CLAIMS PROCESS MEMBER PORTAL ACCESS TOP FAQs
GET IN TOUCH
10
AUD 1,000,000 maximum for claims in respect of all benefits listed under
Section A, B & C put together, per person, per annum unless otherwise
specified in respect of a particular benefit.
Back
(Deductible applicable for IPD/OPD)
Inpatient Admissions: Nil

Outpatient and Other treatments: AUD 10 per claim on medical as well as maternity claims,
unless otherwise stated separately under the benefit.
Per claim means any expenses incurred towards the same ailment up to 14 days.
Back Next
Benefits
Hospitalization & Inpatient Admission Expenses:
Fully Covered: All reasonable and customary costs covered in line with the
relevant Government gazette rates or the Medicare Benefits Schedule,
which-ever is the higher
Ambulance Services:
Fully Covered: Government Approved Ambulance medically required for

inpatient admission or transfer for emergency treatment.
Outpatient Expenses:
Fully Covered: All reasonable and customary costs covered, with Medicare
Benefits Schedule referred to as a minimum.
Deductible: AUD 10 per claim
Back
Benefits
Pre-existing Illnesses/Chronic Illnesses
Inpatient Admissions: Fully Covered

Outpatient and other treatments: AUD 1,000 per person per year.
Surgically Implanted Prostheses
Fully Covered – All reasonable and customary costs covered in line with the relevant Government gazette rates.
Gynaecological Check-up
Up to 200 AUD
One check-up per person per year for females over 30 Years Only
Back
14
Benefits
Dental Care
For all dental care except for any preventive treatment (such as
cleaning, scaling, polishing) and any orthodontic or restorative work.
Dental Limit: AUD 1500
Co-payment: 10% for all claims per person per year.
Routine Vision Care *Reimbursement basis
One routine check-up plus one pair of prescription spectacles/lenses per

year up to the above limit.
* Reimbursement only
Deductible: AUD 15 per claim and only one visit per person per 12
months up to AUD 200
Back
Benefits
Prescription drugs/medicines:
All PBS (Pharmaceutical Benefits Scheme) listed & Prescription

Drugs are covered, excludes OTC.
(Over the Counter – available without a Physician’s prescription)

medicine unless listed by the PBS.
Mental Disorders:
Emergency treatment for psychiatric conditions or mental

disorders.
Max cover limit (per annum): AUD 1,000

Deductible: AUD 5 per claim.
Back
Benefits
Vaccinations for Children 0- 4 years:
Max Covered up to: AUD 200 per child per annum.
Physical Therapies:
(Chiropractic, Physiotherapy and Acupressure only)
*Reimbursement basis
Max Covered up to: AUD 500
Co-Payment: 10% for each and every session. All Claims must have a
GP referral.
Back
Maternity Expenses: All Insured Members must be covered for a minimum of 3 months (90 days) before
they become eligible for coverage under this section
If the Coverage start date before 01st June 2017

The Insured must be covered for a minimum of 3 months (90 days) to become eligible for cover under this
section. Fully covered after 3 months eligibility
If the Coverage start date after 01st June 2017 (New members)
The Insured must be covered for a minimum of 6 months before being eligible for the full coverage under this
section
(*New Members will be defined as Insured or dependant travelling from 1st June 2017 onwards as the case
may be)
Up to 3 months – No Coverage
From 91st Day to 180th Day – AUD 2000
After 6 months eligibility period - Fully covered
10% co-pay for IPD treatment in PRIVATE hospitals

Deductible – AUD 10 per claim for OPD Claims
Back
Emergency Repatriation & Evacuation including other Medical Expenses: *All Repatriations & Evacuations must
be intimated and pre- authorized.
Up to AUD 1,000,000. Less any amount paid under Section A medical expenses.
- Additional up to AUD 2000 to cover expenses for close business associates, relatives or friends to remain with
Insured. (maximum AUD 200 per night)
- Cover costs of transporting one member of the family necessarily having to accompany the Insured person
returning to the Home Country.
- On-going treatment in home country for up to 12 months from the date of incident/loss or when the Section C
max limit is reached, whichever is earlier.
- The decision to approve or require Repatriation is made by the Insurer or their authorised representatives, so
long as the Insured is certified fit to fly.
- Repatriation of mortal remains is covered under this section up to the full Sum Insured.
Back
Travel & Other Medical Benefits
Section D and E
Travel Plan is assisted by COMPATRIOT INSURANCE PCC LIMITED MAYFAIR CELL

Mayfair Cell Re-Insured at Lloyds of London Back
20
Personal Accident:
If, during the Period of Insurance, the Insured Person sustains Bodily injury as a direct result of an
accident the Insurers will compensate the Insured up to the amount stated in the Schedule of Benefits.
*This limit will not apply to Accident during natural calamities.
• Accidental Death : AUD 25,000

(Under 16 years AUD 1,000)
• Loss of one or more eyes/or limbs : AUD 10,000
• Permanent Total Disablement : AUD 25,000
Travel Plan is assisted by COMPATRIOT INSURANCE PCC LIMITED MAYFAIR CELL Back
Mayfair Cell Re-Insured at Lloyds of London
21
LOSS OF PERSONAL EFFECTS COVERAGE
Loss of personal effects - ONLY as a result of Maximum Limit AUD 1,500 per claim
Mugging Loss of Cash - Max cash limit of AUD 250 per claim
Deductible: AUD 50 each claim.
Loss of passport AUD 250 per passport lost.
Deductible: NIL

Back
22
TRAVEL RELATED BENEFITS : COVERAGE
Loss of baggage : Max claim limit: AUD 1000 per claim
Deductible: AUD 100 per claim
Baggage Delay: Max claim limit: AUD 200 Per claim
Deductible: first 12 hrs
Maximum per hour : AUD 10
Trip delay: Max claim limit: AUD 300 Per claim
Maximum per hour : AUD 10
Deductible: first 10 hrs
Hijacking: Max claim limit: AUD 300 Per claim
We will pay you a distress allowance of USD 10 for every 6 hr period during which AUD 10 per 6 hrs
any common carrier in which you are traveling has been Hijacked, where as a
direct consequence, your trip has been disrupted up to a max of USD 300. Deductible : (number of hours): 12 Hours
Replacement & Rearrangement of Staff: AUD 5,000
In conjunction with Emergency Repatriation

Back
23
MEMBER
ENROLLMENT
Back
MEMBER PORTAL
ACCESS
Next
Member Login Steps
Step 1: Log on to
https://cigna.mayfairwecare.com/
Step 2: Click on the link “New User. Please

click here” in the "Insured Login"
Back Next
Member Login Steps (Contd.)
Step 3: The system will prompt for Member

ID and your registered e-mail ID. Click on
“Reset”.
Step 4: Employee receives an

activation e-mail from Mayfair.
Click on the link and follow the online
instructions
Step 5: Please enter the details to

activate account.
Back Next
Member can access dependent’s details by clicking on the tab as shown below.
Policy details can be accessed by clicking on the Policies tab and then on the Open Policy
icon as shown below.
Back Next
Details can be accessed by clicking on the tab available in left side of the page
Membership Card and Coverage document can also be downloaded from the respective TABs.
Back Next
On the Documents tab, member can download various documents such as Claim form, Membership Guide and
FAQ
Back
CLAIMS
ASSISTANCE
Cashless Claims Process – Health Benefit
Initial scrutiny
and GOP issued
Hospitalization Send an email to the provider
Emergency Or call in case 4 hours
required with copy to
emergency member
Do call us to identify emergency claims TOLL FREE NUMBER from most

Planned
landlines (Rest of the world):

+800 6293 2470
TOLL FREE NUMBER Australia:
1800 170 879
TOLL FREE NUMBER Singapore:
8004481532
Member selects Member Sends Initial scrutiny TOLL FREE NUMBER USA:
provider from Intimation via 18007493214
and GOP issued
member’s login email at to Direct Number:
48 hours to the provider
and fix an mayfairassist@
with copy to +91 8030147200
appointment mayfairwecare.com
member
Provider list can be extracted with below web links

• For Rest of the world: https://www.sevencorners.com/ppo/international/mayfair/
• For USA: http://www.multiplan.com/search/search-2.cfm?originator=84453
Back Next
Pay and claim (Reimbursement) process – Health Benefit
E-Mail Intimation can be sent at

mayfair.claims@mayfairwecare.com with the scan copy of all the
documents.
Claims forms can be downloaded by login at
https://cigna.mayfairworldwide.net
Intimation will be sent to member for additional

Scrutiny of Additional info document / information (within 2 working days) and post
document required receipt of required information claim will be processed
by Claims
team Follow up would be done three times at 7 days interval
Sufficient to proceed
You can also reach by calling TOLL FREE

Employee will receive the claim acknowledgment along with from most landlines: +800 6293 2470
Claim no.
(2 working Days) Direct Line: +91 80 30147200
IST (GMT +5.5) 08.00 to 20.00
Claims will be processed and request will be sent to bank for

payment
(within 10 working Days)
Feedback will be
sought from members
Payment credited to Members account as per the details
provided and settlement advice sent through email
(within 3 - 5 working Days Approx.)
Back Next
Travel Claims Process
Acknowledgment Claim
Employee sends the 2 Days
email is sent to assessment &
intimation and claim
member along scrutiny done by
form at
with claim MayFair
mayfair.claims@
reference no.
mayfairwecare.com
10 Days
Inform about additional information /
document required from member
Follow up would be done three times at

7 days interval.
Payment Payment Advise

credited to 5 Days sent to Bank and
member’s settlement
account letter issued
For Escalations - email can be sent at info@mayfairwecare.com

Contact details + 800 6293 2470 (toll free no.) & +91 80 3014 7200
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Back 34
PRIMARY CONTACT POINT
Contact Point
General queries, claim mayfair.claims@mayfairwecare.com

submission and benefit
assistance
Guarantee of payment related mayfairassist@mayfairwecare.com
service
Any Complain & Grievance For any escalation you can send an email at
info@mayfairwecare.com and
Mahendran.MC@Cignattk.in with copy to
Wiprosupport@cignattk.in
To access your complete benefits, policy inclusion, exclusion and claims form, kindly refer to your member booklet or
log on to https://cigna.mayfairwecare.com/
Back
TOP FAQS
Q1. Eligibility under Maternity Coverage. (For New Travelers)
A1. Fully covered after 6 months eligibility period upto maximum limit of Sum Insured. No coverage
available up to 90 days from the start date of coverage. USD 2000 payable from 91 st day till 180th
day i.e. between 3 to 6 months.
Note: Eligibility period is defined basis date of travel.
Q2. Why the waiting period has increased from 3 to 6 months for availing the full Maternity
Coverage?
A2. The decision is taken by Wipro C&B team based on previous claims experience.
Q3. How to get the Medical claim form?

A3 Medical claim form is available in member login page under Documents TAB. This is also a part
of member booklet which is sent with e-pack. If requested we can also send the soft copy.
Q4. Introduction of Deductible this year.

A4. The member has to pay AUD 10 per claim on OPD - Medical as well Maternity Claims.
Per claim means any expenses incurred towards the same ailment upto 14 days.
Back Next
Q5. How to get the Medical claim form?
A5. Medical claim form is available in member login page under Documents TAB. This is also a
part of member booklet which is sent with e-pack. If requested we can also send the soft copy.
Q6. List of Service Providers in Australia.

A6. Service provider list can be extracted from web url
https://www.sevencorners.com/ppo/international/mayfair/
Q7. What is the co-pay under copay for Psychiatric counseling ?

A7. There is no Co-pay for this benefit, cover is given for AUD 1000 per person with Deductible:
AUD 5.
Q8. Who is the medical coordinator to be notified about pregnancy?

A8. Notification can be sent at mayfair.claims@mayfairwecare.com for re-imbursement claim
and at to mayfairassist@mayfairwecare.com for cashless claims
Back Next
Q9. Claim query under Vision care
A9. Reimbursement for one visit per person per 12 months up to AUD 200
One routine check up plus one pair of prescription spectacles/lenses per year up to the above limit
is covered with Deductible: AUD 15 per claim only
In this scenario if the claim is already paid up till AUD200 in previous policy same can not be
claimed up till one year of last claim.
Q10. Claim query under Dental coverage

A10. Emergency Dental Care limit is AUD 1500, Co-payment : 10% for all claims per person per
year.
For all dental care except for any preventive treatment (such as cleaning, scaling, polishing) and
any orthodontic or restorative work.
Back Next
THANK YOU!
Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company.
“Cigna,” the “Tree of Life” logo and “GO YOU” are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating
subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut
General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental
Health, Inc. All models are used for illustrative purposes only.
000000 00/13 © 2013 Cigna. Some content provided under license.

Australia - 17-18

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Australia - 17-18

Загружено:

Авторское право:

Доступные форматы

CIGNA TTK GLOBAL

HEALTH GROUP POLICY

Diamond Plan ( Australia)

Member portal access

Making good health the focus of health insurance:

Present in 31 countries around the

Global revenue of Rs. 2.2 lac

86 million+ global customer

Ranked 90 on Fortune 500 list**

“A global health services company that stands apart in the industry by

Unrivalled global network of over 900,000

Everyday Cigna helps 100,000 customers with various services

Best-in-class customer experience: 90%+ customer

We have experience in managing successful

Vaccinations Yes - Click Here Hijacking Yes - Click Here

CLAIMS PROCESS MEMBER PORTAL ACCESS TOP FAQs

Inpatient Admissions: Nil

Hospitalization & Inpatient Admission Expenses:

Fully Covered: Government Approved Ambulance medically required for

Deductible: AUD 10 per claim

Pre-existing Illnesses/Chronic Illnesses

Inpatient Admissions: Fully Covered

Surgically Implanted Prostheses

Dental Limit: AUD 1500

Co-payment: 10% for all claims per person per year.

Routine Vision Care *Reimbursement basis

One routine check-up plus one pair of prescription spectacles/lenses per

All PBS (Pharmaceutical Benefits Scheme) listed & Prescription

(Over the Counter – available without a Physician’s prescription)

Emergency treatment for psychiatric conditions or mental

Max cover limit (per annum): AUD 1,000

Vaccinations for Children 0- 4 years:

Max Covered up to: AUD 200 per child per annum.

Max Covered up to: AUD 500

If the Coverage start date before 01st June 2017

10% co-pay for IPD treatment in PRIVATE hospitals

Travel Plan is assisted by COMPATRIOT INSURANCE PCC LIMITED MAYFAIR CELL

• Accidental Death : AUD 25,000

Travel Plan is assisted by COMPATRIOT INSURANCE PCC LIMITED MAYFAIR CELL

Travel Plan is assisted by COMPATRIOT INSURANCE PCC LIMITED MAYFAIR CELL

Step 2: Click on the link “New User. Please

Step 3: The system will prompt for Member

Step 4: Employee receives an

Step 5: Please enter the details to

Do call us to identify emergency claims TOLL FREE NUMBER from most

landlines (Rest of the world):

Provider list can be extracted with below web links

E-Mail Intimation can be sent at

Intimation will be sent to member for additional

You can also reach by calling TOLL FREE

Claims will be processed and request will be sent to bank for

Follow up would be done three times at

Payment Payment Advise

For Escalations - email can be sent at info@mayfairwecare.com

General queries, claim mayfair.claims@mayfairwecare.com

Q3. How to get the Medical claim form?

Q4. Introduction of Deductible this year.

Q6. List of Service Providers in Australia.

Q7. What is the co-pay under copay for Psychiatric counseling ?

Q8. Who is the medical coordinator to be notified about pregnancy?

Q10. Claim query under Dental coverage

000000 00/13 © 2013 Cigna. Some content provided under license.

Вам также может понравиться